c-section safer? - Page 2

[Storm Bride]

Originally Posted by majormajor

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).

That's one of my biggest problems with this whole issue. Doctors get to define what parameters define "safe", then they get to decide which procedure is "safer". (Incidentally, why does paralysis count for a baby, but not for a mother?)

I had an "uncomplicated" c-section the first time. A close friend had an uncomplicated vaginal delivery about a year before that. The day after her baby was born, she was walking around the house. A week after my baby arrived, I got stuck on my couch, unable to even stand up to pick up my baby, who needed to eat. Fortunately, it was "only" about half an hour, before I managed to stand up, and fortunately, there was no emergency (only urgency). That surgery was not safer than, or even as safe as, an uncomplicated vaginal birth.

Frankly, until doctors actually document all the consequences of c-sections (they don't), and accept that it's up to the patient to decide if those consequences have a negative impact on their lives, I don't care what they say, or what their studies say.

My records don't show the permanent numbness in my abdomen and pelvis (and I don't care if you or the medical profession consider that a safety issue or not - I'm the one living with it, and all the ramifications of it). My records didn't show the, admittedly minor, infection in my incision in 2005...the one that kept the incision from closing for almost two months. My records don't show when one my kids hurts themselves, because I'm physically incapable of moving quickly enough to prevent an accident that I can see is about to happen. My records don't show the emotional and psychological impact of being unable to have a baby for ten years and wondering that whole time if it was because of my primary c-section. In other words...my records (aside from the errors and lies) are worthless.

The only recovery I've had that would be considered at all complicated by the medical profession was my last one, and a large part of that was because my son was stillborn. Yes - it was a HBAmC attempt, but my uterus didn't rupture, and nobody has any idea why he died. The c-section didn't stop his death...and I'll never know if the previous three contributed to it.

[Storm Bride]

I also wanted to add that I don't believe the increase in respiratory problems is solely because of prematurity or low birthweight. DD was my only (so far) scheduled, labour-free section. She's also the only one of my children who had breathing issues at birth. However, she wasn't premature. She was taken at 39w, 2d, and my dates are firm. She also weighed 10lb. 2oz. She simply wasn't ready to be born. That's all.

[L&K'smommie]

I don't know statistics of the other things but when I worked at an OB/GYN office a few years ago c/s did indeed cost more than a normal vaginal delivery(by at least $5000) and that was just the office charges. Now did each particular doctor see that extra money probably not but the doctor who owned the practice did. Plus, a c/s pays a lot more to the hospital than does a vaginal delivery so I can see how money could be an incentive but probably not as big of an incentive as convenience.

[barefootpoetry]

Originally Posted by majormajor

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).

The risk of death, both to mother AND baby according to every study I've found, is roughly three times greater with a C-section than a vaginal birth. There is the hole you asked for.

Also, what about all the other risks SHORT of death? If you don't die, does that mean everything else doesn't matter? What about placenta problems in future pregnancies? What about long-term lack of sensation at the scar site? What about incision infections? What about internal infections? What about PTSD and other birth-related trauma? What about the emotional affects of "giving birth" without the proper cocktail of hormones, a great recipe for PPD? What about the negative affect on the BFing relationship? What about baby developing asthma or allergies later in life, which some people suggest could be tied to Cesareans? What about the negligible, but worth mentioning, risk of baby being cut during the surgery? What about one of momy's organs accidentally being nicked? What about negative reactions to the anesthesia? What about hemorrage? I came a breath away from dying during a catastrophic hemorrage that would NOT have happened if I hadn't had an unnecessary Cesarean. The world went black, I couldn't speak or move, and my body was ice cold. But I guess since I didn't actually die and my baby isn't brain-damaged, it's all good.

[Storm Bride]

Originally Posted by L&K'smommie

I don't know statistics of the other things but when I worked at an OB/GYN office a few years ago c/s did indeed cost more than a normal vaginal delivery(by at least $5000) and that was just the office charges. Now did each particular doctor see that extra money probably not but the doctor who owned the practice did. Plus, a c/s pays a lot more to the hospital than does a vaginal delivery so I can see how money could be an incentive but probably not as big of an incentive as convenience.

I used to haunt the OB forums (had to stop because it was bad for my blood pressure, yk?), and I recall a time when they were discussing how great it would be to work at a 100% c-section hospital. Several of them treated the idea as a "died and gone to heaven" kind of scenario. They definitely like the convenience.

[murphysaangel]

"The Home Birth Advantage" by Mayer Einstein is great for statistics in this country. You could also send her info from ICAN and I am sure that Mothering.com has it's own list of great articles. I'm a firm believer in the fact that major abdominal surgery is ALWAYS going to be far complicated and pose more real and long-term risks for baby and mom. I'll try to find it but I know there's a study done by chiropractors that showed the baby's cranium is not properly shaped during c-sec's and will be more likely to have immune system problems due to the increase in pressure on the atlas and occiput (that would otherwise have been released during vag. birth). Not to mention increased risk for mom and baby of infection, major bloos loss, baby being nicked by scalpel, etc. I can attest to infection - after my son was born via unplanned cesarean I had 3 infections in as many weeks - with a high fever of over 104, the last one landing me back in the hospital and unable to breastfeed for 3 days. Luckily we were all fine after that and my ds took back to the breast no problem. But it's just one more non-immediate risk to the baby: less chance for bonding to mom and increase in the likelyhood of problems breastfeeding.

[phrogger]

C-sections are safer, then they were 50 years ago, but that is probably the extent of them being "safer". In general, they are not safer then a vaginal birth. There is something extremely important with the baby going through labor and then being squeezed through the birth canal.

C-sections CAN and DO save lives, I wont discount that at all. I have had one medically nessicary c-section that I have no doubt without there could have been some major complications (premature high order multiples) but really, how often does that happen? Not often at all.

My OB also makes the same no matter how the baby gets here, but it does make it easier on him. He is the only Dr. in the practice so unless he plans to have someone on call for him, he is usually the on call guy.

[leila1213]

Also, even if the doc is paid the same for a C/S vs. v-birth, scheduling the C/S (or induction) will guarantee they are credited with the revenue. Whereas, if labor is allowed to start on its own, they may not be on call at the time and therefore revenue goes to another dr.

[majormajor]

Originally Posted by barefootpoetry

The risk of death, both to mother AND baby according to every study I've found, is roughly three times greater with a C-section than a vaginal birth. There is the hole you asked for.

Also, what about all the other risks SHORT of death? If you don't die, does that mean everything else doesn't matter? What about placenta problems in future pregnancies? What about long-term lack of sensation at the scar site? What about incision infections? What about internal infections? What about PTSD and other birth-related trauma? What about the emotional affects of "giving birth" without the proper cocktail of hormones, a great recipe for PPD? What about the negative affect on the BFing relationship? What about baby developing asthma or allergies later in life, which some people suggest could be tied to Cesareans? What about the negligible, but worth mentioning, risk of baby being cut during the surgery? What about one of momy's organs accidentally being nicked? What about negative reactions to the anesthesia? What about hemorrage? I came a breath away from dying during a catastrophic hemorrage that would NOT have happened if I hadn't had an unnecessary Cesarean. The world went black, I couldn't speak or move, and my body was ice cold. But I guess since I didn't actually die and my baby isn't brain-damaged, it's all good.

perhaps i'm not being clear enough: c/s is, as far as the research has shown to this point, certainly more dangerous for the mother. that's, IMO, the number one reason we need to try to lower the c/s rate.

also, your absolutely right that there are quite a few more minor and major morbidities associated with c/s. when i was trying to make a choice between VBAC and ERCS, i decided to ignore those. like i said, personal preferences... but how do you weigh the odds a baby will be nicked by a scapel against the odds that it could die? to me, you can't have enough nicks to make a preventable death worth it.

so no, i'm absolutely not saying i think elective c/s is a great idea. however, i am saying that a first c/s is safer for a baby than a vaginal deliery, in terms of major morbidity and death. i know that's not a popular opinion on this website, which is probably why i usually stay out of these discussions!

and like i said before, i know what the research shows. there's only very scant, very flawed research that pits c/s against v-birth. like that worthless macdorman study. so, like i said, i have used VBAC as a proxy for vaginal birth vs. c/s. when you subtract the morbidity and mortality due to the c/s, i think you get a pretty good comparison of the two. and actually, there is a flaw with this method. i'd like to see how c/s affects mortality in the first year. more SIDS? more infections?

i also didn't mean to imply that experiences like your hemmorhage don't matter. i was trying to say that when i was looking at the data for myself, i decided that maternal mortality was the only parameter that i really cared about for myself. of course i would never want that for me or anyone, i didn't factor but the odds of it happening into my decision making, just because i didn't want to make myself crazy. i know c/s is more dangerous for mom.

baby, got to go!

[MegBoz]

Originally Posted by majormajor

sorry, i should be more specific! when i say safe, i'm thinking only of major morbidity or mortality.

Um, ok. I find that confusing, considering you first wrote:

Originally Posted by majormajor

a c/s (after 39-40 weeks) is probably the safest way for a baby to be born,

So "safest" means "safer than vaginal birth," correct?

If you say that CS is "safest way" (i.e. meaning "SAFER than vaginal birth") then why would you not include all risks? Even if the CS has only slightly higher risks, or risks that aren't life-threatening, such as transient breathing problems?

I don't understand why anyone would even bother to say, "IF you compare only death rates, CS is safest. (Yes, there are other risks to CS, but let us disregard those.)" Why? Why would you disregard all the other factors? What is the point of such a comparison?

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.

You are absolutely correct that there are many lousy studies. Fortunately, there are some scientists out there who do know how to conduct good studies. If you read "Born in the USA" by Dr. Marsden Wagner, he talks extensively about bad research & why it is bad.

But finally, I think quantity is important. With large enough sample sizes and enough studies, the truth will emerge... like it or not.

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.

Yes, the randomized double-blind study is the absolute ideal format for conducting research. Yes, one can't be done on CS vs. vaginal. (Actually... I'm fairly certain some docs have tried!! I'm pretty sure I read that in either the book "Pushed" or "Born in the USA" but they didn't get women interesting in participating.

Anyway, there are many things you can't do a randomized, double-blind study on. That doesn't mean the scientific community collectively throws their hands up in the air and says, "Humph, we just don't know." Yes, you're right you do the best with what you have. When you get large enough sample sizes so that you can match similar cases, you CAN get good data without the randomized double-blind.

and anyway, there are few studies looking at just c/s mortality.....
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.

Again, I have to wonder why you'd even consider this. Frankly, I'm shocked. Can you imagine if you went to your dentist and he said, "You have gum disease. I want to give you a treatment that may have nasty side-effects. BUT, it won't kill you - your rate of dying from this medical treatment procedure is not any higher than if we didn't do the procedure. Sure, there are other harmful, negative, and painful side effects. But the mortality rate is not higher. So you are fine with that, Right?

[barefootpoetry]

Originally Posted by majormajor

so no, i'm absolutely not saying i think elective c/s is a great idea. however, i am saying that a first c/s is safer for a baby than a vaginal deliery, in terms of major morbidity and death.

I am still as to how you came to this conclusion. Your method of reasoning on this topic is making absolutely no sense to me.

Even IF - and that's a really big IF - C-section is safer for babies, and I don't believe it is, how is that completely exclusive from the harm it does to the mother? Do babies not deserve a happy, healthy mom? Not one who is struggling to recover from major surgery? Don't they deserve a good breastfeeding relationship? Not one that is hampered by anesthesia that affects both parties and pain-killing drugs taken afterwards? Don't they deserve a mom who isn't much more likely to suffer from PPD and PPP and possibly harm her baby? A healthy baby and a healthy mom have to go hand in hand. Or wait, don't tell me, risk to the mother doesn't matter, since A) she didn't die, and B) her baby is okay. Gee, I wonder why this is such an unpopular thing for you to say, especially here.

A quick Google search shows me that infants have a three times higher death rate after/during C-section. If those studies may be "flawed" or "scant" then show me something else to go on. Show me what makes you believe that babies are honest-to-God safer being surgically extracted than born. I'm not talking about comparing scalpel nicks to death, and I'm not talking about the one-in-whatever-thousand chance a baby is incompatible with vaginal birth, like transverse lie or placenta previa, etc. Show me why C-section is a "safe" rule of thumb in general, and show me why vaginal birth is more dangerous. Because I am honestly not following yuo here. I would also like to see you explain your VBAC vs. ERCS thing a little more because that is confusing to me also.

[majormajor]

Originally Posted by MegBoz

So "safest" means "safer than vaginal birth," correct?

If you say that CS is "safest way" (i.e. meaning "SAFER than vaginal birth") then why would you not include all risks? Even if the CS has only slightly higher risks, or risks that aren't life-threatening, such as transient breathing problems?

I don't understand why anyone would even bother to say, "IF you compare only death rates, CS is safest. (Yes, there are other risks to CS, but let us disregard those.)" Why? Why would you disregard all the other factors? What is the point of such a comparison?

this is a good question. to me, it's because death and permanent brain damage are so much bigger than transient breathing problems that transient breathing problems are almost disappear from the equation. think about if you were to really try to quantify the risks of birth. imagine a point system, if you will. were one to tally the risks of each method of birth, one would have to assign beforehand that death is worth x points, HIE y points, TTTS z points. in my worldview, x = 1,000,000, HIE = 500,000, and TTTS = 1,000.

i would never for a second suggest that ANYONE ELSE adopt my point system. however, i have assumed that most people find death and HIE to be so much worse than any transient problem that they totally dwarf the transitory problems.

you're right, though. i should have written that a baby is less likely to die or suffer permanent brain damage or paralysis after a first c/s. my post continued to make that point that this is not the be all and end all of the decision regarding how to deliver, but it is one key factor.

Anyway, there are many things you can't do a randomized, double-blind study on. That doesn't mean the scientific community collectively throws their hands up in the air and says, "Humph, we just don't know." Yes, you're right you do the best with what you have. When you get large enough sample sizes so that you can match similar cases, you CAN get good data without the randomized double-blind.

i absolutely agree.

Again, I have to wonder why you'd even consider this. Frankly, I'm shocked. Can you imagine if you went to your dentist and he said, "You have gum disease. I want to give you a treatment that may have nasty side-effects. BUT, it won't kill you - your rate of dying from this medical treatment procedure is not any higher than if we didn't do the procedure. Sure, there are other harmful, negative, and painful side effects. But the mortality rate is not higher. So you are fine with that, Right?

but that's not a proper analogy. the way i see the data is that:
1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.

until that equation changes, i will advocate vaginal birth. however, i am not going to deny that one part of the puzzle comes out in favor of c/s. it doesn't change the fact that the picture that emerges when you consider all of the pieces favors vaginal birth.


the only thing we're disagreeing about is point number 1. it's a really tough question to answer because the increase in risk is so slight and so confounded by other variables that it's extraordinarily hard to measure. honestly, i don't think anyone knows yet. i said "probably" safer, but if you were to ask me my confidence in that.... maybe 65%? there's so much missing data that i think it's impossible to be sure.

[Drummer's Wife]

I am still lost on the first c-section being safer for baby. I've honestly never, in all my research, came to that conclusion.

Of course there are situations where a c-section is the safest method of getting baby out for both mother and baby, but your average laboring mom? That is a really odd statement to me.

eta: I was posting at the same time you were responding, major. Reading it now

[MegBoz]

Originally Posted by barefootpoetry

Even IF - and that's a really big IF - C-section is safer for babies, and I don't believe it is, how is that completely exclusive from the harm it does to the mother? Do babies not deserve a happy, healthy mom?

Excellent post. I second all of that.

Scientific studies aside... I don't think our process of human evolution is so flawed that CS is better for the baby than vaginal birth - across the board. That just seems nuts to me.

[barefootpoetry]

Originally Posted by majormajor

but that's not a proper analogy. the way i see the data is that:
1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.

until that equation changes, i will advocate vaginal birth. however, i am not going to deny that one part of the puzzle comes out in favor of c/s. it doesn't change the fact that the picture that emerges when you consider all of the pieces favors vaginal birth.

OK. I can kinda sorta agree with this, although I would still like to see evidence that vaginal birth is more dangerous for baby.

HOWEVER, if this is true, don't 2 and 3 therefore negate 1? I am being sincere here. If there is a slightly lowered risk, whatever it may be, of the first C-section, don't the subsequent risks of future C-sections, as well as the risk to mom, cancel out that lower risk to baby?

[jennyfah]

Originally Posted by majormajor

but that's not a proper analogy. the way i see the data is that:
1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.

until that equation changes, i will advocate vaginal birth.

So are you hoping that the equation *will* change, and that C-birth will someday be 'safer' than normal physiological birth? I don't think that I am alone in confusion here. I do want to understand what you are saying, and I hope that you can expand/clarify this. I think it is a valuable and interesting conversation, but I am not completely tracking with what you are saying.

Thanks,
Jen

[Lisa1970]

The doctor does not make a salary. Who would pay his salary? He is a private business and he gets paid by the business he has. This is not socialized medicine in this country.

The extra money for a csect is not small. Basically, I know a couple years ago it was $2500 for all prenatal care and birth and postnatal care. It was an extra $2500 for making it a csect. Plus, they do not have to be on call for csects, they just schedule them.

Csects come with far more danger than a regular delivery. Women die all the time from csects.

[Lisa1970]

[QUOTE=majormajor;13301713]but that's not a proper analogy. the way i see the data is that:
1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.

QUOTE]

This is completely wrong. Major surgery has a much higher risk than vaginal birth.

[Kelly1101]

Originally Posted by barefootpoetry

OK. I can kinda sorta agree with this, although I would still like to see evidence that vaginal birth is more dangerous for baby.

HOWEVER, if this is true, don't 2 and 3 therefore negate 1? I am being sincere here. If there is a slightly lowered risk, whatever it may be, of the first C-section, don't the subsequent risks of future C-sections, as well as the risk to mom, cancel out that lower risk to baby?

I think that's where the family plan comes into it-- if you're planning on having more children in the future, you DEFINITELY want to avoid the c/s. It's not quite so bad if it's going to be your only child, I think.

[Lisa1970]

http://www.associatedcontent.com/art...ny.html?cat=52