c-section safer? - Page 3

[kltroy]

She's right that a CS is safer THAN IT USED to be. Also safer than vag birth in some select situations (like previa, and even breech if nobody has a clue how to do a vag. breech). And the salary thing for docs is true too, BUT docs feel a lot of pressure to "bill for procedures". Ultimately a practice gets most money through insurance billing, so if you go in for an ultrasound, for example, your doctor's office will bill for an office visit + 1 u/s (2 procedures). Docs who bill a lot bring lots of $ to the practice. This can manifest as a raise, bonus, or offer for partnership in the future. Ethically, I know no doctors who would perform major surgery for this reason, but billing is frequently at the back of their minds, at a subconscious level.

[barefootpoetry]

Originally Posted by kltroy

She's right that a CS is safer THAN IT USED to be.

Well, in that case, vag birth is a lot safer than it used to be, too. So is pretty much everything else, as science and knowledge continue to progress.

[majormajor]

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.


well if i could have any wish, they'd both be 100% safe!

i think vaginal birth should always be the default, with a c/s when necessary. i have no idea what the c/s rate "should" be, but i'm pretty sure it should be a whole lot lower than it is. 10 or 15%?? i doubt c/s will ever be safer, because i don't see how you can eliminate the risk to moms. it's not like they can be done laporscopically!

i am not anti-c/s though. i don't like the way it's kind of demonized as a second-rate birth. i know it is for some people, but everyone's different.

it's a strange topic, because while it's kind of theoretical for me, there are women like stormbride for whom it's absolutley not theoretical. my heart breaks for them. i just want to be able to do one small part, and that's have an honest discussion about risks, even if 100% of the discussion doesn't jive with the rest of my beliefs. i think that we all owe that to women like stormbride.

and stormbride, i'm so sorry to hear that you never got any answers about your baby. that must be so hard. i was just reading an article on yahoo that said in more than 25,000 babies in the US are stillborn each year, and more than 30% of the time no one can figure out what happened. i didn't realize the numbers were so high.

[Storm Bride]

Originally Posted by majormajor

i am not anti-c/s though. i don't like the way it's kind of demonized as a second-rate birth. i know it is for some people, but everyone's different.

I know there are women who don't see it as second-rate birth. I'm truly happy for them. I have to admit that I don't exactly see it as second-rate birth, either. I don't see it as birth at all. Whenever I hear the phrase "cesarean birth", I kind of want to throw up.

it's a strange topic, because while it's kind of theoretical for me, there are women like stormbride for whom it's absolutley not theoretical. my heart breaks for them. i just want to be able to do one small part, and that's have an honest discussion about risks, even if 100% of the discussion doesn't jive with the rest of my beliefs. i think that we all owe that to women like stormbride.

and stormbride, i'm so sorry to hear that you never got any answers about your baby. that must be so hard. i was just reading an article on yahoo that said in more than 25,000 babies in the US are stillborn each year, and more than 30% of the time no one can figure out what happened. i didn't realize the numbers were so high.

I actually have a pretty good idea what happened (maternal infection), and it's possible that the autopsy report will tell me. Unfortunately, when I asked for it, I didn't get it...apparently, they don't release the results to parents, unless you go see your doctor so he/she can "interpret" it for you. I'm not up to that yet. However, it wasn't anything really clear cut, as nobody at the hospital had any idea what had happened.


Honestly...I've reached a point where I'm just looking forward to getting this baby out (even thought the "how" of that gives me insomnia and nightmares) and getting my tubes tied. Except for my wonderful kids, my reproductive life has been one long nightmare, and waking up is sounding really, really good. (Kind of a funny sentiment from somebody who regularly got "I hate you" in jest from other moms when pregnant with my first, because pregnancy is a walk in the park on a lovely spring day.)

[Ldavis24]

Originally Posted by majormajor

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!

agreed my mother had my younger brother via c-section this is in 1987 and now she has had 3 resulting surgeries to repair the damage done by that c-section. The last being they had sew her bladder to her stomach wall to keep it from collapsing, that after having her uterus removed in the second surgery...While this is not typical of the post c-section mother, I just wanted to highlight that unless you educate yourself there is a good chance your doctor won't.

[Storm Bride]

Originally Posted by Ldavis24

agreed my mother had my younger brother via c-section this is in 1987 and now she has had 3 resulting surgeries to repair the damage done by that c-section. The last being they had sew her bladder to her stomach wall to keep it from collapsing, that after having her uterus removed in the second surgery...While this is not typical of the post c-section mother, I just wanted to highlight that unless you educate yourself there is a good chance your doctor won't.

...or can't. I have no faith that doctors are even aware of the risks, in many cases. They see surgery as a perfect tool that solves all the problems inherent in the flawed way a woman's body works...and they don't see what doesn't fit the picture.

[jeliphish]

Did she mean that c/s are safer in general than they used to be??? She would be right then....I mean any surgical technique has become safer over the years. That still doesn't mean that they are safer than an uncomplicated vaginal birth though. But C/S themselves have of course gotten safer over the year....so has gall bladder surgery, and open heart surgery.

[Ldavis24]

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.


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.

If this was true, that a first time mother having a c-section is safer for the baby than vaginal birth then why do women such as Ina May Gaskin routinely have C-section rates below 4% in first time mothers and have far lower infant mortality rates than most anyone?
Clearly she is doing something right here with her work on the farm and you have no logic to back up your statement other than your feeling which is factually incorrect.

[Storm Bride]

Originally Posted by Ldavis24

If this was true, that a first time mother having a c-section is safer for the baby than vaginal birth then why do women such as Ina May Gaskin routinely have C-section rates below 4% in first time mothers and have far lower infant mortality rates than most anyone?
Clearly she is doing something right here with her work on the farm and you have no logic to back up your statement other than your feeling which is factually incorrect.

I'd have to look at the stats again. I don't recall finding anything that suggested primary c/s is safer than a first vaginal birth...but maybe it is, if we're talking about a typical intervention-laden hospital birth...

[majormajor]

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?

absolutely. i mean, my opinion again, but the future sections are SO much risker for mom and the future babies. also, there are so many consequences for moms i'll bet we're not even seeing yet. i wonder what kind of complications we're going to see when our generation with the 30-40% c/s rate hits old age.

i've also been thinking about my use of the term "safer." i haven't spent much time thinking about what a subjective word that really is in this case. i think in the future i'll stay away from the subjective terms. i mean, what if 1 in 10,000 fewer babies die because of c/s, but 1 in 50 have TTTS, 1 in 10 have asthma, 1 in 25 have diabetes... i'm not sure "safer" is appropriate in comparing the two, just "different."

hm, i'll think about this more.


oh, and i'm not going to be able to even justify my "safer" claim, because i didn't do anything like keep a spreadsheet of results. that'd be like doing my own cochrane review! the thought, at the bottom of it, is based on the idea that we know vaginal birth can go wrong, so we know about the mortality associated with vaginal birth. and we know if we c/s'ed every baby at 39 weeks, we'd save all of the unexplained stillbirth from happening. so when i used the #s from the VBAC studies, i was trying to figure out why babies die after a c/s. it would have been helpful for me if they discussed all of the c/s deaths, but they didn't.

anyway, i'm most certainly NOT advocating c/s for everyone at 39 weeks!

my friends IRL would be most entertained by this thread. i'm the one who's trying to make a VBA2C happen in maine (i think i have some good leads too).

[Ldavis24]

Originally Posted by Storm Bride

...or can't. I have no faith that doctors are even aware of the risks, in many cases. They see surgery as a perfect tool that solves all the problems inherent in the flawed way a woman's body works...and they don't see what doesn't fit the picture.

true I found with my OB before I switched to a midwife I felt like I had to justify that my body is capable of birthing. That in fact my body was designed for this and in fact on a physical level if my dog can give birth to 10 puppies because that is what her body was made for then my body can do it to. Well not the 10 puppies but you know what I mean.
Pregnancy is not a disease and I don't appreciate being made to feel like it is by any doctor. I just wish my mother had been able to know that she had options which she says she felt like she didn't have at the time.

[Storm Bride]

Originally Posted by majormajor

absolutely. i mean, my opinion again, but the future sections are SO much risker for mom and the future babies. also, there are so many consequences for moms i'll bet we're not even seeing yet. i wonder what kind of complications we're going to see when our generation with the 30-40% c/s rate hits old age.

I wonder about that, too. My mom had three c/s (in '63, '68 and '69 - then was told she couldn't have any more kids - she'd wanted six). As far as we can tell, she hasn't had any long-term effects (aside from a truly ugly scar), but she knows she has adhesions, and her abdomen has never been "right" since then. However, "my abdomen isn't right" isn't a medically accepted condition, yk?

I strongly suspect I'll have incontinence problems, at the very least. It's very difficult to maintain abdominal and pelvic floor strength when so much sensation has been lost.

[majormajor]

i didn't realize you were preggers storm bride, congrats! i'm also really sorry you've had such terrible experiences. i keep having this fantasy that i'll go into labor and give birth so quickly with #3 (i'm not pg yet, not even sure we're going to try for a third) that i can just have the baby at home by myself. i don't have the guts to plan an unassisted birth, but it's definitely my fantasy. maybe that's just my brain's way of dealing with those feelings.

[majormajor]

Originally Posted by Storm Bride

I'd have to look at the stats again. I don't recall finding anything that suggested primary c/s is safer than a first vaginal birth...but maybe it is, if we're talking about a typical intervention-laden hospital birth...

yes, this. wow i'm posting today more than i ever have! DD is sound asleep on my lap, so you'll be dealing with me for another half hour.

this was the problem when i was trying to research epidural safety too. they kept comparing epidurals to things like stadol and demerol, and then saying epidural was no different. so i'd say, ok, what are the effects of stadol or whetever, where are the studies from way back when when they first started using these drugs. nowhere to be found! i read somewhere that they tried a RCT trial with epidural too but couldn't get enough women to sign up. i don't know if i believe that though, i know TONS of women that have had NCBs.

[Storm Bride]

Originally Posted by majormajor

i didn't realize you were preggers storm bride, congrats! i'm also really sorry you've had such terrible experiences. i keep having this fantasy that i'll go into labor and give birth so quickly with #3 (i'm not pg yet, not even sure we're going to try for a third) that i can just have the baby at home by myself. i don't have the guts to plan an unassisted birth, but it's definitely my fantasy. maybe that's just my brain's way of dealing with those feelings.

Yup. Baby-under-construction's EDD is June 28th...probably scheduling my 5th (and last!! YAYYY!) c-section for June 29th. I, at least, have a decent OB this time...it helps. I alternate between trying not to think about it, procrastinating on ordering "Birth from Within" (many people have recommended it to me), and staying up all night tossing and turning. Oh, yeah - and trying to focus on gestating in peace and enjoying my last pregnancy. That's the hardest one, but the most worthwhile, imo.

[barefootpoetry]

Originally Posted by majormajor

absolutely. i mean, my opinion again, but the future sections are SO much risker for mom and the future babies. also, there are so many consequences for moms i'll bet we're not even seeing yet. i wonder what kind of complications we're going to see when our generation with the 30-40% c/s rate hits old age.

Exactly. So the idea of the primary C-section being "safe" is null and void, because 9.9 times out of 10 in this country, you are automatically signed up for a ERCS for all future births. Which would never happen if you hadn't had that "safe" first C-section to begin with.

I have been screaming this at the top of my lungs for years now. Everywhere you see docs fa-REAKING out over the idea of doing VBAC, and going on and on about how dangerous it is, etc. etc. Well, the solution is so friggin' simple: STOP DOING THOSE FIRST C-SECTIONS. Oh, but the C-sections are "safe." :

So you see where my frustration comes from. You will rarely hear an OB lecture a patient and try to talk her down from a C-section, whether it is her first or fourth. But try to do a VBAC and the poop really hits the fan. It is so backwards. If there are all these risks from VBAC then OBVIOUSLY the C-section is the PROBLEM here.

[Drummer's Wife]

Originally Posted by barefootpoetry

Exactly. So the idea of the primary C-section being "safe" is null and void, because 9.9 times out of 10 in this country, you are automatically signed up for a ERCS for all future births. Which would never happen if you hadn't had that "safe" first C-section to begin with.

I have been screaming this at the top of my lungs for years now. Everywhere you see docs fa-REAKING out over the idea of doing VBAC, and going on and on about how dangerous it is, etc. etc. Well, the solution is so friggin' simple: STOP DOING THOSE FIRST C-SECTIONS. Oh, but the C-sections are "safe." :

So you see where my frustration comes from. You will rarely hear an OB lecture a patient and try to talk her down from a C-section, whether it is her first or fourth. But try to do a VBAC and the poop really hits the fan. It is so backwards. If there are all these risks from VBAC then OBVIOUSLY the C-section is the PROBLEM here.

Right. and to me, this is obviously a huge issue. I'd guess that most women end up having or at least wanting more than one child. SO, even if that initial c-section is 'relatively' safe, the risks go up for each subsequent cesarean.

Cause then you have people like Stormbride and myself who will likely end up with five c-sections. I have a hard time trying to understand how yet another surgery is safer than a vaginal birth, even when we are talking about a vba4c. I felt the same with #3 and #4 as well, yet finding a provider to take you on for a vbamc can be near impossible.

[phrogger]

Originally Posted by Drummer's Wife

Right. and to me, this is obviously a huge issue. I'd guess that most women end up having or at least wanting more than one child. SO, even if that initial c-section is 'relatively' safe, the risks go up for each subsequent cesarean.

Cause then you have people like Stormbride and myself who will likely end up with five c-sections. I have a hard time trying to understand how yet another surgery is safer than a vaginal birth, even when we are talking about a vba4c. I felt the same with #3 and #4 as well, yet finding a provider to take you on for a vbamc can be near impossible.

I ask the same question too. Honestly if my body worked I would just stay home because in my head at least, a vaginal delivery seems safer then my 5th c-section. And I have had good surgical births.

[barefootpoetry]

Originally Posted by Drummer's Wife

Cause then you have people like Stormbride and myself who will likely end up with five c-sections. I have a hard time trying to understand how yet another surgery is safer than a vaginal birth, even when we are talking about a vba4c. I felt the same with #3 and #4 as well, yet finding a provider to take you on for a vbamc can be near impossible.

Ugh. Big hugs to you guys. I can't imagine having that many C-sections. DH and I decided when I was pregnant with #2 that if I had to have another C-section, we were calling it quits in the babymaking department, because I just couldn't face being forced to do that a third or fourth time.

[Drummer's Wife]

Originally Posted by phrogger

I ask the same question too. Honestly if my body worked I would just stay home because in my head at least, a vaginal delivery seems safer then my 5th c-section. And I have had good surgical births.

my surgeries went really well, too. But I am still afraid of another c-section.

I feel the same way and yet it's almost impossible to assess the risks involved with a hba4c or uba4c vs a 5th cesarean. Mostly because there are not too many women who end up having 4-5 c-sections, and there are even less women who end up having vba4c --in the hospital, at home with a midwife, or at home unassisted. It's just a really rare occurrence.