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A BRIEF HISTORY OF THEUNNECESAREAN.COM

Who: Jill Arnold, many contributors and a slew of regular commenters spread across various social media platforms.

What: A patient advocacy community with a cheeky name that snowballed.

Where: At a kitchen table in San Diego, California, and via millions of bytes throughout the interwebs.

When: While our babies and young children were sleeping between 2008-2012.

Why: Read on...

Hi, I’m Jill. This website began as an anonymous blog under the pseudonym “Unnecesarean,” because that was something that people did back in 2008 instead of using their personal MySpace account to share their scathing commentary of [insert perceived societal malady here].

Motherhood gave me a lot of time to think because there’s only so long that you can gaze lovingly into your newborn’s eyes before waxing neurotically on what just happened to your life. I sat in coffee shops during the very occasional break from my babies and put all of my thoughts down as quickly as possible. The following was the first iteration of what became a very unique career and quixotic quest.

 

The original pages

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I refer to this as the original manifesto of the site. Had I not been just an anonymous blogger trying to work some things out at the time, this would have most likely been crafted into a mission statement. Read this page

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The “Avoid an Unnecesarean” got right to the point with a list of things I had learned that I thought would help a mom being pressured into scheduling a C-section that she thought seemed a little medically unjustifiable. Read this page

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Things got way more interesting when I passed the mic and added brilliant contributors to the scene. Read this page

I'd still stand by a lot of what was on these original pages. I’d tweak a few ideas and update the literature, but overall, it’s the best medical advice available online from a person with a BA from San Diego State that you’re going to find. [Read: Please don’t take medical advice from anonymous bloggers on the internet, okay?]

The Unnecesarean began as an obstetric safety web site and a community commentary on overutilization of the cesarean section. The response to the blog was swift and voracious, which tells me that there was an unmet need for exactly what I had started. It veered for a couple of years into the natural birth-crafted narrative of evil doctors and hospitals, with midwives as saviors per the philosophy du jour, and I did what I could over time to steer everything back to a data-driven, rational place. I eventually circled back around to the original mission of OB safety in a professional capacity after learning to navigate landmines in consumer engagement on the way here.

My friend Amy Romano did me a huge solid by encapsulating my motivation for starting all of this early on in Our Bodies, Ourselves. I truly would have been content to help just one mom who was struggling with feeling that something was amiss in the whole estimated-fetal-weight-too-big-baby situation in late pregnancy. 

Though I shared birth stories from others on the site, I never shared my own birth story, per se. Over time, I told it piecemeal in comments and indirectly in blog posts. While the process of writing this blog and curating content was healing for me, it wasn’t about me.

I told my story in the aggregate with numbers and I’m still telling it today.

My co-bloggers and I gave women a platform to be heard and to grieve something that can be very hard to explain, because you and your baby are fine... right? At that point in time, there wasn't yet widespread awareness of exactly how overused the cesarean birth was at the population-level, nor were there adequate data or transparency in reporting to tell the story. Once I got my own anger in check, which is visible in the progression of blog posts, I took a permanent step back from a culture that perpetuates a narrative with which I don't agree. 

The overarching philosophy when starting The Unnecesarean was that we all need to make decisions for ourselves based on the best available data and evidence, in health care and in life. Fortunately, I had created a viable data product that was actually marketable separate from the blog, so I was able to continue working toward safe optimization of cesarean and VBAC rates offline. IRL, if you will. I feel pretty grateful on a daily basis to be able to co-exist and work in a primarily academic space without an expensive advanced degree or a university affiliation and I've found that there are strategic benefits to being a free agent. 

By August 2012, I mocked myself in a final post the way I had angrily mocked others early on and exited stage left to continue researching the cesarean rate reporting landscape in the United States. It was the one of the best things I’ve ever done and, five years later, I’m actively employed in building strategies and solutions along with other leading experts in the field.

If I could persuade you to read one thing here before you start looking at cesarean and VBAC rates, it would be the Defending Ourselves Against Defensive Medicine series which ran in early 2011. I am proud of having curated this collection of articles and hosted the discussion that followed.


Defending Ourselves Against Defensive Medicine

In this introduction to the DOADM series, Jill Arnold, founder of The Unnecesarean, asks whether it’s ethical to brush off defensive medicine in obstetrics as merely an unfortunate and costly dilemma.

Myths of Malpractice in American Obstetrics 

Sociologist Louise Marie Roth shares her research, which challenges the claim that the number of obstetric malpractice lawsuits has caused the rise in the cesarean rate in the United States.

Malpractice 101 (and other scary stories surgeons tell in the dark) 

Courtroom Mama, a contributor to The Unnecesarean, offers an introduction to medical malpractice for the non-attorney.

Hanging Up My Gloves 

An anonymous OB-GYN describes the lawsuit that changed everything.

The Necesarean: The Perspective of a Plaintiff’s Birth Trauma Attorney 

Lee Tilson, who has litigated medical malpractice cases for decades and was drafted into the patient safety movement by medical errors that adversely affected two family members, shares his views on cesarean sections.

Who is defending whom from what? 

Sociologist Barbara Katz-Rothman looks critically at malpractice insurance, pregnancy, risk and the U.S. health care system.

The Separate “Fetal Patient”: Does Defensive Medicine Justify Medical Coercion?

National Advocates for Pregnant Women ask whether recent debates about so-called “personhood” measures—ones that would legally separate eggs, embryos and fetuses from the pregnant women who carry, nurture, and sustain them—raise the question of whether “defensive medicine” provides a reasonable justification for forcing pregnant women to undergo cesarean surgery or for locking them up if they refuse.

The Trap of Overselling and Underdelivering

OB-GYN Henry Dorn examines the role of technology and public opinion of modern obstetrics. 

Collateral Damage: A Patient’s Experience of Defensive Medicine

Emjaybee, a contributor to The Unnecesarean, gets real about her experience with defensive medicine in maternity care from the perspective of a patient.

Texas-Style Tort Reform: The Real Impact of Proposition 12

Non-partisan, consumer advocacy organization Texas Watch analyzes the effects of Proposition 12. 

No One Truly Benefits from Defensive Medicine 

President of the International Cesarean Awareness Network (ICAN) Desirre Andrews reflects on the organization’s concern for the effects of a defensive practice style.

Going on the Offensive

ANaturalAdvocate, a contributor to The Unnecesarean and almost-lawyer, tells how her son’s iatrogenic prematurity stemming from an induction at 37 weeks for suspected macrosomia affected her and her choices for future births.

Defensive Medicine is a Symptom of a “Risk Society”

Amy Tuteur, MD, proposes that while defensive medicine appears to be about protecting doctors from liability, it’s really about protecting patients from any and all risk.

Patient Advocates on How to Defend Oneself from Defensive Medicine

Two well-known patient advocates, Trisha Torrey and Dave deBronkart, share their thoughts on how to defend oneself from defensive medicine.

Building Trust in a Defensive Environment

Jill Arnold and Henry Dorn, MD, explore how to build trust in the patient-provider relationship in the final post of the Defending Ourselves against Defensive Medicine series.

A 2012 follow-up article:

Did Tort Reform in Texas Lower the State's Total Cesarean Rate?

 


 

In August 2011, Ricki Lake stopped by.

 

The site's original masthead ended up on the screen at the NIH VBAC Consensus Development Conference in 2010.

 

 

 

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