My introduction to Elizabeth Cooper-Schultz comes by way of a text message in which she refers to Mary Birch as “that hospital that claims to be mother and baby friendly.”
When I arrive at the apartment she shares with her husband and two children in the UTC area, Cooper-Schultz welcomes me into her home with a hug, a cup of coffee, and a plate of strawberries and coffee cake. Once we’re seated, Cooper-Schultz begins. She’s eager to tell the story of her son’s birth.
“Usually I start off by telling people my C-section started even before I got to the hospital. I had a C-section because my doctor didn’t care if I had a C-section.”
According to statistics compiled by the Office of Statewide Health Planning and Development, Sharp Mary Birch Hospital for Women and Newborns had the highest rate of cesarean section deliveries in San Diego County in 2009. The California average was 29.8 per 100 births; at Sharp Mary Birch, the rate was 37.7. The World Health Organization suggests that C-section rates should be between 10 and 15 per 100 births.
At 40 weeks, two days prior to her due date, Cooper-Schultz’s water broke, though she was not in labor. In a birthing class she’d taken at Mary Birch, she’d been told that this happens to 25 percent of women. She says she’d never recommend the class “because it’s focused on the assumption that your birth will be intervened on in some way.” If your water breaks, they told her, we have to get the baby out within 24 hours. So she and her husband went to the hospital right away.
“They pretty much wanted to put me on Pitocin the minute I walked in the door because I wasn’t having regular contractions,” she says.
Pitocin is a synthetic form of a natural hormone called oxytocin that stimulates uterine contractions. The drug is controversial not for what it can do — help induce labor — but for its overuse as a tool of convenience, for managing or controlling labor, despite the risks it presents, including, in rare cases, uterine rupture and fetal distress.
Dawn Thompson, a private doula, or birth coach, based in Encinitas, calls Pitocin the first in the “snowball effect” of interventions that ultimately lead to a C-section. The contractions induced by Pitocin come strong and fast, unaccompanied by the endorphins present with natural contractions, and the use of Pitocin requires constant fetal monitoring, which limits mobility for the mother. Most women find the pain intolerable and end up needing an epidural. An epidural is an injection into the bony spinal canal of a local anesthetic that blocks nerve impulses in the lower half of the body. While epidurals eliminate pain, they come with their own set of risks, potentially slowing down the process of labor, causing a drop in blood pressure for the mother, and causing a lower heart rate for the baby. Ultimately, these interventions set the stage for the C-section.
Mary Birch administrators do not deny that their C-section rate is high. John Cihomsky, Sharp’s vice president of communications, wrote to me in an email, “Sharp Mary Birch Hospital for Women & Newborns is the busiest high-risk, Level III delivery center in the state. Sharp Mary Birch not only delivers the most babies in the state, but we also deliver the most babies weighing less than 1500 grams. These very low birth weight babies are almost always delivered by cesarean section. In addition, we also care for many mothers with high-risk perinatal conditions, such as placenta accreta, and medical conditions that often require delivery via cesarean.”
Hospital administration declined to give me a tour of the hospital or a face-to-face interview.
To be fair, Mary Birch is but one hospital among thousands across the country whose C-section rates are two to four times higher than they should be. And it’s likely that the “too posh to push” crowd and the “I want my kid born on Valentine’s Day” moms do their fair share to raise these rates with their elective C-sections.
But a significant number of women believe their C-section deliveries at Mary Birch were the result of convenience for the doctors, fear of litigation, and/or lack of staff training in nonmedicated childbirth options.
A study done in Portland, Oregon, in the late 1990s found a correlation between the use of Pitocin and C-section rates. The January 1, 2003, issue of Ob.Gyn.News outlines the study, in which 4635 women who went into labor spontaneously had an 11.5 percent C-section rate, while 2647 who were induced had a rate of 23.7 percent.
On the Drugs.com website, an “Important Notice” accompanies the indications and usage information about Pitocin.
“Elective induction of labor is defined as the initiation of labor in a pregnant individual who has no medical indications for induction,” the notice reads. “Since the available data are inadequate to evaluate the benefits-to-risks considerations, Pitocin is not indicated for elective induction of labor.”
It is common for hospitals to use Pitocin if a woman has not gone into active labor within 24 hours after her water has broken to avoid the risk of infection. But the staff at Mary Birch wanted to give Cooper-Schultz Pitocin within the first two hours.
Cooper-Schultz refused the Pitocin at first. She wanted to get things going naturally, and for the next several hours, she and her doula walked and used the birth ball, a large physiotherapy ball on which the mom can sit to relieve pain during labor and which is believed to assist in positioning the baby. At the 12-hour mark, her cervix had dilated to four centimeters. She says she now understands that this “is a good natural labor progression for a first-time mom.”
But it wasn’t fast enough for the staff at Mary Birch. Cooper-Schultz, who describes herself as the kind of person who will “try not to be a problem because you might be mean to me if I am,” allowed them to give her the Pitocin that she says they’d been pushing since she’d arrived.