My letter to the Surgeon General

This is not the final draft and I will be making it into a letter to senators and others as well as making a "form letter" for others to send to their political representatives and others who can DO something. Thanks Dr. Archelle!!! And Cathy for editing for me.

Dr. Benjamin,

Congratulations on your appointment. Your long experience helping those without access to medical care at personal cost and your focus on preventative medicine are hopeful signs in a country struggling to find ways to provide quality care for all citizens.

One major turning point in preventative health care for women is at pregnancy and birth. The choices made during that time shape the path the entire family takes for the foreseeable future. In the last century, however, while many obstetric developments have had huge benefits for women, our medical system now seems focused on treating pregnancy and birth as diseases to be fixed instead of natural processes to be nurtured with holistic care.

Our cesarean section rate (well over 30% and increasing every year) in the United States is well over the World Health Organization recommendations of 5-15%, and our nation rates a deplorable 42nd in maternal mortality rates as well as having higher infant mortality rates than other developed nations. These things are not unrelated.

We are not somehow a genetically flawed society of women. In my experience as a friend, confidante, and sometime educator to hundreds of mothers and mothers-to-be, women simply do not understand the increased risks of c-sections to themselves and their babies. They aren't informed that each following section increases their health risks which is almost inevitable after the first, because insurance companies allow so few hospitals and doctors to offer Vaginal Birth after Cesarean (VBAC) now, or the effect it has on future fertility and other problems. It doesn't help that certain medical professionals are actively encouraging "convenience" sections and flat-out lying about the relative risks when compared to vaginal birth.

Women who make a considered choice to birth vaginally (even if they end up with a medically necessary cesarean) are more likely to breastfeed, which leads to better health and nutrition for the child later in life as well, reducing the chances of childhood obesity. Those early informed choices empower mothers to educate themselves about health care choices for their entire families, raising children more likely to make informed choices as well.

There are many reasons for the problem, but the cure is widespread evidence-based education about birth choices that encourage women to take an active role in their care. We should be helping them research the hospital, doctor, or midwife who will help them safely achieve the kind of birth they want by requiring accurate reporting on individual practitioner and hospital rates of cesareans, VBACs, inductions, and clear communications of the benefits and risks of those and other options. Existing programs like WIC that have contact with pregnant women can be quickly utilized to disseminate correct, accessible information to the targeted population.

I loved discovering your emphasis on dignity for the patients in your Alabama clinic. It is a lack of dignity and respect for women's bodies and choices, as well as fear exaggerated by the media and our disconnect from family that is leading to an unsafe reliance on surgery over prevention of complications in a natural process. We should remind women that we as a species would not exist if most women were not able to birth without surgery or any intervention.

Please take on the cause of reducing the maternal and infant death rates by advocating a lower cesarean section rate and increasing breastfeeding rates. By starting here we can empower a citizenry more involved in their health choices and thereby more likely to make the healthier choices.