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c-section safer?

post #1 of 105
Thread Starter 
Please forgive me if this is not in the correct place. I just talked to my sil the other day who is pregnant and due in about a month. She and I are due just a few days apart. Anyway, she is having a hospital birth and I am having a homebirth. Let me say, that I am very encouraging with whatever decision she has made. Anyway, we talked about c-sections and how they are done so much more now in America than before and she said it's because it's safer. First of all, I know that is not true, but she also said she doesn't get why people think a dr. would do a c-section just for the money because the dr. doesn't make any more money on a c-section than the dr. makes on a vaginal birth. She said it is her understanding the dr. makes a salary. Is she right about that? Also how can I find info for myself that c-sections are not safer and that we are losing more babies in America than other countries where the norm is vaginal birth? Again, this is for me and not for her. She and I agreed to disagree, but I just want to make sure I'm right about the info I gave her. It makes sense to me that a vaginal birth is safer since that is how God created it to be, but I have been known to be wrong before. Thanks ladies.
post #2 of 105
Of course a c-section is not safer than an uncomplicated vaginal birth (that does not use instruments). A c-section is a major surgery and with it comes the complications of major surgery. There is also increased respiratory distress that comes from a baby being born prior to it's own chosen birth date and not going through the birth canal.

However, I personally believe (yet don't have research to back it up... : ) that a non-emergency c-section might be safer than today's hospitalized vaginal births (meaning births with the combination of pitocin, epidurals, and vacuum extractions). At least safer for the baby...I can't imagine having your head yanked by vacuum suction that can pop off and have to be redone several times, after being squeezed by unnaturally strong contractions is good for the baby. And of course, for some people, a c-section is safer than a vaginal birth (but that's rare of course).

I am coming at this from the angle of someone that had 2 vaginal births that resulted in the pit/epi/vacuum combo, the second of which lead to the death of the baby. My third baby was born via c-section due to another medical issue, plus CPD (confirmed after the first two births--my baby's heads are always bigger than my pelvic opening, and they only come out via vacuum). My little girl had respiratory distress syndrome, but besides a UTI in me a week later, there were no other complications and we both came home a couple days after the birth. However, my abdomen was open, my uterus removed, sewn, and put back in, and the baby was born before she would have otherwise chose to. I can not imagine that is safer than a medication/intervention free birth for a person without pre-existing (or newly existing I guess) reasons for it...

There will always be bad outcomes no matter what you choose to do, but unnecessary interventions are typically more dangerous than letting nature take it's course (and of course, I do believe that sometimes the interventions can be safer than not taking the interventions of course...but I also think that should not be the norm)
post #3 of 105
Quote:
Originally Posted by justice'smom View Post
she doesn't get why people think a dr. would do a c-section just for the money because the dr. doesn't make any more money on a c-section than the dr. makes on a vaginal birth. She said it is her understanding the dr. makes a salary. Is she right about that?
I'm honestly not sure if she's right or not about the salary & same money for CS vs. vaginal. However, the CS takes less of the doc's time! No waiting around. Nurses & anaesthiologist come in to prep mom, doc does the surgery & it's all said & done. Less time investment. Also, if they're scheduled in advance, no need to wait around during nights & weekends!

She needs to see the movie "The Business of Being Born" if she doesn't believe many CS are done today for reasons other than medical necessity.

There have been some great studies. Unfortunately, I don't have them off hand, but I'm sure you'll get some replies here with good links.
post #4 of 105
At the hospitals I've worked at, the doctors are salaried, so I don't necessarily buy the "more money" argument (although I guess if sections generate more revenue for the hospital, more sections would mean they would have more revenue to offer higher salaries to doctors)......but I do entirely buy the less time and being able to schedule it, not having to wait around. Sigh.
post #5 of 105
A really big reason that the docs do more c-sections (and in a sense, save money) is b/c of liability concerns. Doing a c-section equates in a court of law to having done "everything" possible to save the mother and/or baby. So if you're looking at this from the sue-happy standpoint of the American way, a doctor will save more money by erring on the side of caution (so to speak) and doing a c-section. That way if the outcome is bad, the doc will not be held liable and will therefore save a bundle on malpractice insurance and payouts. Does that make sense? I'd recommend reading the book Pushed - I don't know how to word these things very well myself but that book really spells it all out for you. Everyone giving birth should read that book first.

Vaginal birth *is* safer than surgical birth for most women and babies. That is indeed true.
post #6 of 105
Def not safer. No intervention is without risks. We have a 10 fold increase in accreta because of the sky rocketing c/s rates. With the "once a section, always a section." comes complications that increase with each surgery.

While a dr might not get more money for each c/s the insurance he or the hospital carries is going to look at how many c/s he is doing. If hes not doing enough, they can drop him or increase his rates. They are also done from convenience more than out of necessity. Which is why most c/s happen during the day during the week. Money and time is always a consideration. If not directly, indirectly.
post #7 of 105
a c/s (after 39-40 weeks) is probably the safest way for a baby to be born, but the risks to mom and the risks to subsequent pregnancies make it overall the less safe choice. the risks to mom are very serious and IMO, tend to be glossed over.

also, while infant mortality is bad in this country, that measures deaths in the first year. our perinatal and neonatal mortality are good. the US has a lot of premature births, so i don't think c/s are a problem there.

unfortunately, i can't point you to any good resources discussing the problem. most web sites i find terribly biased, most of the data is inaccessible, and the issues are so varied... perhaps one day i'll write my own book on the subject! (i'm a science writer, as qualified as henci goer, but birth is an interest, not a specialty, so i doubt i ever will.... still, who knows).
post #8 of 105
Having your abdomen and colon surgically opened to manually extract your feces and then sewn shut again is not safer than pooping.

There are VERY few RARE cases where it would be safer to have a C-section. Transverse baby, placenta previa, IUGR, to think of a few. But in general, for the vast majority of women, a normal natural bodily function is safer than major surgery.
post #9 of 105
For a lot of women, that first cesarean IS somewhat safe (I won't say "safer" because it's not). It's that that first cesarean sets her up for a LONG path of fighting for a VBAC or having a ERCS. With each ERCS and subsequent pregnancy, it becomes dramatically more dangerous. It becomes a question of what you want your reproductive future to be.
post #10 of 105
12+ hours of labor with an uncertain birth time and possibly having to go to the hospital at 3 am, or 20 minutes in surgery at 3 in the afternoon. Even if they get paid the same amount, it's for a lot less work. It's not just that OBs are cold and evil and don't care about safety; they're brainwashed in medical school. They probably mostly believe that a c-section is as safe as a vaginal birth, even though it most definitely is *not*. An OB in the Business of Being Born talked about how one study showed times for c-sections peaked at 4 pm and 10 pm - time to go home, time to go to bed. And there are far fewer c-sections on the weekend. Convenience is a huge factor.

Doctors do not always do what's best for patients. Look at how they experiment on people, using drugs they don't know are safe, for example. They're just people like anyone else. They're not benevolent gods who only do what's right.
post #11 of 105
also, there are consequences of sections that woudn't even occur to most people. one of my closest friends had 2 sections in the 70s and 80s (and a VBAC in the 90s. she had classical incisions, too. and her VBAC baby was almost 9 lbs, face up. just had to throw that in there!). anyway, she needs some abdominal surgery now, that most people have laproscopically, but she might not be able to because of the scar tissue. who would have thought about that? not me! so now, she's going to have ANOTHER major abdominal surgery in her 50s. so yeah, there are consequences for mom for the rest of your life. definitely NOT something anyone should take lightly!
post #12 of 105
Just to answer on the money issue - most insurers have gone to global payments. Single payment for pregnancy and delivery, regardless of how it happens. Insurers don't want to give doctors an incentive to perform extra procedures (which they then have to pay for). This doesn't mean your OB is on salary, though. Private-practice OBs do usually get paid according to the number of deliveries they do, but it doesn't matter which way the baby comes out. In some HMOs doctors are salaried (I believe Kaiser works this way) and some hospitals employ laborists.

While CS are sometimes performed for convenience it is worth noting that an "elective" section (which might be medically necessary) will always be scheduled for a convenient time so we would always expect CS rates to be lower on the weekends.

The real reason is more liability than anything else. Since we have made CS pretty darned safe (we're only seeing problems now from so many repeated sections--they accumulate, and if the mother doesn't have more than 2 children we're unlikely to see them at all) it's much easier for patients to claim that CS was the safer call and a doc should have done it. So they would rather just do the section and not get sued.

In some cases they do really believe it's safer, like routine CS for frank breech, even though the trial might have had problems.

A CS is not safer than an uncomplicated vaginal delivery. The problem is that we don't know which deliveries will be uncomplicated--so CS is like taking off most of the risk from the baby and putting it onto the mother, plus adding some as well. Sometimes this is the right call. But if you do it all the time, you're just making women undergo major surgery for no reason.
post #13 of 105
Quote:
Originally Posted by AlexisT View Post

A CS is not safer than an uncomplicated vaginal delivery.
ok i have to be nit-picky here, then i'll stop. i hate this line of thinking, because you could just as easily say an uncomplicated c/s is just as safe as a v-birth. you can always pick out the group that come through just fine in retrospect, but that's pointless. i know you know that, you just happened on a pet peeve of mine!
post #14 of 105
As a definition-- uncomplicated major surgery is still not safer than a bodily function in the presence of normalcy.

There are a million articles out there that talk about this issue. I really like the mothering article about childbirth in a culture of fear. Perhaps search this and give it to her.

The OB may not make more $$ on a c-section (I don't know) but it is a quicker thing than waiting around for a natural birth to happen and if time = money... then maybe it is cheaper. Also there are many others that get paid in the case of a c-section plus all the additional meds. C-sections are a BIG source of income for hospitals if not OBs.
post #15 of 105
Quote:
Originally Posted by majormajor View Post
a c/s (after 39-40 weeks) is probably the safest way for a baby to be born, but the risks to mom and the risks to subsequent pregnancies make it overall the less safe choice.
No, I read of a large study that compared elective CS to vaginal birth & the CS babies had much higher rates of breathing problems.

Found the article:
Quote:
This study suggests that elective Caesarean section compared with intended vaginal delivery leads to a twofold to fourfold increased risk of overall neonatal respiratory morbidity and even higher relative risks of serious respiratory morbidity in term newborns.
post #16 of 105
Quote:
Originally Posted by MegBoz View Post
No, I read of a large study that compared elective CS to vaginal birth & the CS babies had much higher rates of breathing problems.

Found the article:
Those results are likely because of a tendency to take the babies out too early, rather than letting them go term.
post #17 of 105
[QUOTE=majormajor;13294818]a c/s (after 39-40 weeks) is probably the safest way for a baby to be born, QUOTE]

Why do you believe this to be true when the vast majority of the research out there shows otherwise?

Please let me know what brings you to this conclusion. I find this to be a VERY alarming statement.
post #18 of 105
Quote:
Originally Posted by majormajor View Post
a c/s (after 39-40 weeks) is probably the safest way for a baby to be born, but the risks to mom and the risks to subsequent pregnancies make it overall the less safe choice. the risks to mom are very serious and IMO, tend to be glossed over.
where did you find that info?

:
post #19 of 105
Quote:
Originally Posted by Kelly1101 View Post
Those results are likely because of a tendency to take the babies out too early, rather than letting them go term.
Nope. They evaluated that:

Quote:
It was found that 2.8 per cent of infants delivered normally at 37 weeks had respiratory problems compared with 10 per cent of those delivered by elective Caesarean. At 38 weeks the proportion was 1.7 per cent compared with 5.1 per cent, and at 39 weeks 1.1 per cent compared with 2.1 per cent.
post #20 of 105
Quote:
Originally Posted by MegBoz View Post
No, I read of a large study that compared elective CS to vaginal birth & the CS babies had much higher rates of breathing problems.

Found the article:
sorry, i should be more specific! when i say safe, i'm thinking only of major morbidity or mortality. so, for babies, that's permanent brain damage, paralysis, and death. for mothers, pretty much only death (just personal parameters).

re: that elective c/s study, the morbidity they discuss there are transient breathing problems, not death. i don't recall whether that study looked at mortality. but certainly, yes, transient breathing problems are higher in c/s babies. interestingly, i recall that that study showed that babies who were c/s'ed after labor had the same rates of breathing problems as vaginally born babies. would be quite interesting if it's labor, not the squeeze through the birth canal, that does whatever it does to the lungs!

finally, i will have to get back to you on why i believe what i do. a quick answer is that i'm not a big believer in much of the published research... i think there are so many flaws, and a lot of the research just doesn't do a good job of answering the question it's trying to answer. it's not that i think science doesn't work, it's just that i'm not sure how i feel about epidemiology. i think it might truly suck, but i'm still working out my feelings on that. but you can't do a randomized, double-blind, controlled trial on c/s vs. vaginal birth, so you have to do what you can with what you have. and anyway, there are few studies looking at just c/s mortality. anyway, my ideas come from reading the VBAC scientific literature. when i was preparing to VBAC, i read every paper i could get my hands on. IMO, VBAC vs. ERCS is a pretty good proxy for vaginal vs. c/s, cuz you can just subtract the mortality attributable to the previous c/s. and i didn't want to acknowledge it at first because it didn't go along with what i believed, but the studies showed a really small neonatal mortality in c/s babies.

however, i'd love for someone to bust through with a flaw in that logic! my opinions are never set in stone.
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