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ICAN E-News Line International Cesarean Awareness Network Volume 23 September 2, 2004 Focus: Secondary Infertility **~**~**~**~** In This Issue: 1. Essay: Secondary Infertility 2. Relevant News 3. Editor’s Note 4. Studies **~**~**~**~** ICAN E-News invites you to your thoughts, comments, favorite quotes, birth stories, questions, websites and studies. Future topics include: **Canadian Issues **Seeds of Doubt** Banning Doulas** **~**~**~**~** 1. Essay: Secondary Infertility Sometimes dreams get shattered, and it takes many years to find out why. My personal philosophy since childhood has been “There’s a reason for everything, and for everything there is a reason.” I married young (21), and my husband and I wanted a big family, as we were both only children. We also made the conscious decision to wait to have children. Shortly before my 30th birthday, my beautiful daughter Georgia was born via cesarean section. I had taken the typical route of a first time pregnant mother. I obeyed my OB when at 40 weeks he wanted to induce me because he had to leave for the weekend to move his daughter to college. After too much pitocin; excruciating, unmanageable labor pain; an epidural; and 33 hours of labor; it was Friday at 5:00pm and I was cut open. I had a very healthy pregnancy, and my baby girl weighed 9 pounds at birth. At the time, I didn’t know how much the cesarean would impact my life. When we decided we were ready to have that first child, we conceived on my second cycle. I remember thinking “That was too easy!” Baby number two was much more difficult. After a year of trying to conceive, I saw the OB again. We ran a lot of tests and could find nothing wrong with myself or my husband. I had a hysterosalpingogram (HSG). This is an x-ray examination performed in the radiology department of the hospital in which dye is injected through the cervix to the uterine cavity and viewed by an x-ray. They found nothing abnormal. The next week I was pregnant. My guess is that my system was “flushed out” and maybe the pH balance was correct enough to conceive. I feared the baby would come out blue, and she almost did. I had another healthy pregnancy, and this time my labor started naturally, but upon arrival to the hospital, they insisted, against my objections, to give me more pitocin to speed up the labor. Once again, I could not manage the pain, and I had an epidural. I did have a vaginal birth after 15 hours, but, in a word, it was botched. My 9 ½ pound baby girl, Emily, came out slightly sideways, and I suffered 2nd degree vaginal tearing and started to hemorrhage. Emily had tried to breathe during labor, and inhaled meconium-contaminated fluid into her lungs. She was not breathing and was turning blue. Upon resuscitation, her right lung collapsed. After she was stabilized she was taken 4 blocks away to the NICU, where she stayed for 12 days. I got to see her for one minute before they took her and didn’t see her again for three days. I joked to my husband that I was going to have the next baby by “Option C”… adoption! Little did I know how true those words would become. After another year had passed, we tried for Baby #3. I wanted to have this baby naturally at the local birth center. This time I took Clomid and had hormone shots every month, but after 6 months I just couldn’t take it anymore. My family was worried about me having another bad delivery, and I was frustrated because this was just supposed to happen naturally. We didn’t hesitate to make a decision… we would adopt. Since we had two biological children, adopting babies and toddlers in the U.S. was very difficult. So we decided to adopt from Russia. We requested 2 sibling boys under age 4. Seven months and three trips to Russia later, we brought home 3 year old Jonathan, and 11 month old Alexander. (Ironically, they were both cesarean-born, too.) My family is complete, but not by the dream I had as a 21-year old to birth these babies on my own. Although I have never been given an official diagnosis, I am convinced that my primary cesarean caused my secondary infertility. A woman’s chances of having secondary infertility after a cesarean are increased. Studies show that women with secondary infertility and even one previous cesarean section, may have significant pelvic abnormalities. Women who do not birth a baby vaginally do not go through a certain hormone process and that inhibits fertility later. Another cause of secondary infertility is the absence of a “perfect environment” in the uterus because it is scarred from the cesarean. And part may be psychosomatic – your body is too scared to go through that horrible cesarean ordeal again. After my cesarean, I suffered post-partum depression, and it was then that I found ICAN and became a member. After my second daughter almost died, I became a Board member serving as Membership Director for 4 years. The first year into my “boardship” I started ICAN’s current website, and remain a member of the Board to this day as their Webmaster. My personal mission is two-fold: 1) I do not want women to suffer that unnecessary first cesarean, and 2) I do not want any other woman who dreams of having babies to lose her fertility as a result of a cesarean. I have to believe that my personal philosophy about “reasons for everything” is true… my inability to birth more children and my activism with ICAN will spare someone else the ordeal of secondary infertility. ~Jane Fruendt, ICAN Webmaster Become an ICAN Professional Subscriber!! ICAN's Professional Referral Network" is a resource not only for consumers, but for birth professionals such as yourself. The ICAN website gets between 4,000 - 5,000 hits per month. We rank high in browser searches for "cesarean" as well as "VBAC." Many of our initial contacts from women are when women seek "VBAC friendly" birth professionals. We hope to use our professional subscriber program as a way to connect women to birth professionals in their area that support ICAN's mission. ICAN's Professional Referral Network page features a clickable map of the United States and Canada where web surfers can click to find birth professionals in their area. It also links to our searchable chapter page as well. If someone is looking for a chapter, her results page will link to the birth professionals in her area that are signed up as ICAN Professional Subscribers also receive ICAN's quarterly newsletter, The Clarion, and discounts at conferences! Don't delay! **~**~**~**~** 2) Relevant News: A study in Scotland has confirmed that women who have Caesareans may have problems getting pregnant again. **~**~**~**~** ICAN has a toll-free number: (800) 686-ICAN **~**~**~**~** 3) Editor’s Note My extended family gathered together for a barbeque last weekend. We admired all the babies. One of my brothers had his first baby eight months ago. My sister-in-law had wanted a baby for several years before my brother agreed. They did not attend any childbirth classes nor did they read any of the books I loaned them. She had a cesarean after 25 hours of labor. Their little girl is so cute. I asked if they were going to have another (I’ll admit I was being nosy). My brother surprised me, though, when he said he wanted another (when I announced I was expecting my fifth, he asked me “How many kids are too many?”). My sister-in-law spoke up and said if she got pregnant again, she would ‘have to’ have another cesarean. I (of course) asked why she had to have another cesarean. “Well, if I can’t push out a baby in 25 hours, it is never going to happen. I can’t go through that again. I can’t give birth to my babies. So I’m not having any more.” The medical model of care first takes away a woman’s birth, replacing it with an abusive and intrusive instrumental or surgical birth. It sometimes then takes away the woman’s future babies, due to either physical or emotional issues. Some women are physically unable to get pregnant again, some miscarry, and others choose not to become pregnant again. These women and their families are left to cope with the harm done to them with no acknowledgement of their struggles from the medical community or even, sometimes, from their family and friends. In preparing for this issue of the E-news, I was surprised to find so little information on secondary infertility. There was a small footnote that it happens, but no support or information on its causes or options for working through it. There are many causes of secondary infertility and many levels of healing when it strikes. ICAN can offer a safe place to heal from their last birth. Hopefully we can help prevent some cases of physical secondary infertility by preventing cesareans. We can help make birth safe and dispel our cultural fear of birth. In the future, maybe women will be able to choose how many children they want without the deciding factor being whether she can face the birth experience again. **~**~**~**~** 4) Studies This study did find a link between cesareans and secondary infertility. The relationship between Caesarean section and subfertility in a population-based sample of 14 541 pregnancies. Hum Reprod 2002 Jul; 17(7):1914-7 Murphy DJ, Stirrat GM, Heron J; ALSPAC Study Team. Division of Obstetrics and Gynaecology, University of Bristol, St. Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK. BACKGROUND: There has been a threefold increase in the rate of Caesarean section over the past 25 years. The long-term consequences of Caesarean section may include subsequent subfertility. METHODS: We investigated the relationship between Caesarean section and subfertility within a cohort of 14 541 pregnant women. RESULTS: A history of previous Caesarean section was associated with an increased risk of taking >1 year to conceive from the time of planning a pregnancy, adjusted odds ratio (OR) 1.53 [95% confidence interval (CI) 1.09, 2.14]. This association was stronger for women of parity > or =2, adjusted OR 2.97 (95% CI 1.72, 5.10). Nulliparous women with a history of subfertility were at increased risk of delivery by Caesarean section, adjusted OR 1.56 (1.22, 2.00) and OR 2.33 (1.64, 3.30) for durations of >1 and >3 years respectively. CONCLUSIONS: These findings suggest a complex relationship between Caesarean section and subfertility where subfertility may both precede and be a consequence of Caesarean section. PMID: 12093860 [PubMed - indexed for MEDLINE] This study did not find a link between cesareans and secondary infertility: Prior cesarean delivery in women with secondary tubal infertility. Wolf ME, Daling JR, Voigt LF. Am J Public Health 1990 Nov;80(11):1382-3 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle. The history of cesarean delivery was evaluated in a population-based case-control study of secondary infertility in King County, Washington. Sixty-one married women diagnosed with secondary infertility due to tubal problems who had a previous viable pregnancy were compared to 343 married women who had a previous viable pregnancy and then had a live birth that was conceived at the same time the infertile women began trying to conceive. The risk of tubal infertility was not substantially elevated in women who had a previous cesarean delivery in the most recent viable pregnancy compared to women with vaginal delivery (odds ratio = 1.2; 95% confidence interval = 0.4, 3.7). PMID: 2240313 [PubMed - indexed for MEDLINE] **~**~**~**~** This newsletter is for informational purposes only and does not replace the advice of a qualified birth professional. You are receiving this newsletter because you are either an ICAN subscriber or have recently contacted our organization. To unsubscribe frompreferences visit . ICAN respects the Internet and the privacy of those who use it. We do not rent or sell our e-mail list to anyone. Copyright 2004 International Cesarean Awareness Network, Inc.

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