It's not news that the U.S. ends each calendar year with a new all-time high cesarean rate, but it may be news that Kentucky's rate is even higher than the national average--7th in the nation for surgical birth.  While the national rate jumped from 31.8% in 2007, to an alarming 32.3% for 2008, Kentucky babies born in 2007 were born surgically 34.6% of the time.

Louisville women have few options to ensure a c-section will be performed only for a true emergency.  While cesarean can undoubtably be a life-saving procedure, many are often the result of unnecessary interventions--including the very common mix of Pitocin and epidural anesthesia--mothers who don't fully understand their rights and options, and doctors who prefer schedules.

Former Louisville resident, Rachel Wintringham Isbell, gave birth surgically 4 1/2 years ago, and believes she was pressured into her cesarean for the convenience of her medical team.

"We made it to 7 [cm] unmedicated," but as she began transition, the most difficult part of labor, just before the staff's shift change at 4 am, she began to feel pressured into cesarean because staff suddenly claimed her baby was too large to deliver vaginally.

"My physical recovery was and still is horrible!  I couldn't carry my own baby to change his diaper for over a month.  I had a difficult time with nursing.  I was in a total pain-med fog during the first very precious bonding moments.  I missed a lot."

Women who want a natural experience for their own safety, quick recovery, and intense bonding with baby are forced to move away from Obstetricians (doctors who are surgeons by trade), to midwives, who prefer to treat problems in labor only if they occur.

Unlike 24 U.S. states, and most of the developed world, Kentucky has banned midwifery, even for hospital births, which has also negated the option of safe birthing centers for uncomplicated pregnancies. Our legal options include hospital birth with a doctor, or home birth, dangerously unattended. Midwifery for legal home births does exist in Louisville; however, your (very knowledgeable and skilled) midwife would be practicing illegally.  

Two resources exist in Louisville to empower local moms-to-be who are either looking for VBAC (vaginal birth after cesarean), or who are first-time moms who want to avoid the greater than 1 in 3 chance of undergoing surgical birth--the Birth Care Network, "dedicated to providing options for positive, informed childbirth", and the Louisville chapter of the International Cesarean Awareness Network (ICAN) "to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting VBAC."

The message of a woman controlling her birth experience is often countered with strict criticism, which can lead to guilt and distrust in one's own body, further increasing the risk of unnecessary cesarean by simply stalling natural labor.  

Isbell trusted her own instincts, but had little control over the fear instilled by her birthing team.  Her baby weighed 8.5 pounds at birth, large but still average, and is now empowered with the knowledge that ultrasound weight estimates can be off by as much as 1-2 pounds.

Isbell's emotional recovery from her unexpected surgical birth has been the most difficult for her to cope with.

"I feel like I was raped. I still have nightmares of being wheeled away for surgery. I was screaming for someone to help me focus, and I couldn't hold a conversation with anyone due to the intensity of the contractions.  I couldn't communicate to anyone that I could do this--just help me focus!  My baby and I were fine, but my screams to not cut me were not heard."

For mothers-to-be searching for a more drastic solution to the misadventures of birthing in Louisville, one can do what Isbell did. She moved to Southern Indiana, and is carefully assembling her birth team to include people who will support her during labor as she attempts a VBAC with a doctor/midwife who boasts a 90 percent VBAC success rate--but, Isbell isn't even pregnant yet.

"Your birth will affect you for your entire life.  It's one of the single most important moments in your life, physically, emotionally and spiritually.  Your birth will forever stay with you.  Your choices will forever follow you.  Take birth into your own hands.  Educate yourself so that you are knowledgeable in all aspects and all choices along the beautiful journey leading up to the miracle of your baby's birth."

As Kentucky's cesarean rate continues to climb above the national average, Louisville mothers will continue to be at risk of unnecessary cesareans, and their consequences, which include maternal and fetal death. A c-section can save a life, but a cesarean done unnecessarily is often a medical convenience for which the benefits will never outweigh the risks.

For more information on how to navigate Louisville's birthing culture and get support to avoid an unnecessary cesarean, visit ICAN of Louisville.  Also, be sure to visit Louisville's Birth Care Network to learn about birthing options, find local doulas, midwives, and doctors who will support your family's preferred birth experience.

Photo: Kelly Brandon Epps just minutes after her own necessary cesarean.