70% c-section rate...mom's are happy and pain free! - Page 3

[minkajane]

Originally Posted by Storm Bride

I've never felt less in control of my life or my body or everything else, than when I'm lying on an OR table, unable to feel most of my body...

This. It was scary as hell, not knowing if my baby was out or not. I was refused a mirror or a lowered screen. The doc didn't describe the surgery as she did it and she didn't hold DS over the screen to show me like they usually do. Since he didn't cry right off, XH had to tell me he was out. Then after they stitched me up, when they were moving me to the gurney, it was so bizarre, watching them roll me back and forth and move my legs around and not being able to feel a thing. Then not being able to walk to be near my baby in the nursery till the next day. I would never have chosen to go through that and I will do everything I safely can to keep from going through it again.

[Storm Bride]

Originally Posted by Amylcd

That's the point, some hospitals can not handle these things, and try to minimize the risk (for themselves, of course) of something like this happening at their hospital.

Our local hospital is not equipped to deal with these things, which is why they only take "low risk" births. If they think your baby will need anything other than a warmer after birth you are flown to a different hospital.

The point is that they don't know. I was as low-risk as it gets with my first baby...and I ended up being rushed into OR for an "emergency" c-section. Personally, I don't believe it was warranted, but the staff thought so. What would they have done if they weren't equipped to handle obstetric emergencies??

I'll also mention that, when I lost Aaron, I was pressured several times to have a c-section because "you'll probably need one" (this was not based on fetal distress - he seemed fine, right up until his heart stopped), and they didn't have the OR staff on-site. And, you know...when his heart stopped, they managed to get the staff scrambled and had me in OR in minutes...not sure how many, but I'd say I was under less than five minutes after she called for the section.

Anyway, if a hospital isn't equipped to deal with the 0.4% chance of a UR in a scarred uterus, then they're not equipped to deal with the risk (lesser, admittedly) or rupture in an unscarred uterus, or the baby who drops sideways and blue into the birth canal (happened to my sister), or a sudden cord prolapse or anything else. The OB community finds it necessary to perform emergency sections on a lot more than just the women who are trying to VBAC....and many of those women are low-risk. The hospital is equipped to deal with an emergency, or they aren't.

My question is, if they're not equipped to deal with an emergency, why are we being told it's safer to birth there in the first place?? The whole basis of selling hospitals as "the safe place" to have a baby is that they can deal with emergencies that can't be dealt with at home. The VBAC ban is based on hospitals saying, "no, we can't".

[AlexisT]

Originally Posted by Ldavis24

Someone feel free to correct me if I am wrong, but I think I read that Brazil has the highest C-section rate in the world...Elective C-section and just C-section period...80% elective or something like that.

It's not. I can't get the stats now, but it's only the private hospitals that have this issue. The public hospitals have very low CS rates. It averages out to less than the US rate--something like 25%. This is one of the reasons Brazil has poor outcomes. Women who don't need CS get them (because they give birth in private hospitals) while some women who do need them don't get them, because they are poor. It's the worst of both worlds.

[Ceinwen]

First birth: extensive fourth degree tear, three hour repair in the OR, year long recovery, incontinence issues. Mentally - weary, but good.

Second birth: scheduled c-section. Super quick physical recovery, no complications, up and moving about very quick, scar invisible, no adhesions, etc. Mentally - not so hot.

While I found my physical recovery from my c-section to be quick & pain free, the mental aspect and emotional loss hit me about four months post partum.

[wombatclay]

Anyway, if a hospital isn't equipped to deal with the 0.4% chance of a UR in a scarred uterus, then they're not equipped to deal with the risk (lesser, admittedly) or rupture in an unscarred uterus, or the baby who drops sideways and blue into the birth canal (happened to my sister), or a sudden cord prolapse or anything else.

I think the missing portion of the equation is legal liability (which of course varies by country... I'm not sure how the Canadian system handles this so this is just the US version). In the case of a rupture in an unscarred uterus, or a cord prolapse, or a true birth emergency unless there is something verifiable that the staff "missed" they are not liable for the outcome. There is no way they could have "known" that mom X was about to have a cord prolpase or an abruption or that baby Y was about to turn breech or have a cardiac event.

But if mom/babe has a known risk factor (a scarred uterus, a footling breech babe with ruptured membranes, a known previa, etc) that could, possibly, have been a factor in the emergency situation then the staff may be held liable with all the legal/financial fall out of that scenario.

When ACOG changed their vbac wording to say that a facility should have a surgical team immediately available instead of just on call they changed the liability playing field. Suddenly the standard of care required a surgical team to be sitting on their hands waiting while the vbac mama had her birth in order to avoid a lawsuit... if something went wrong, well, the facility was meeting the standard of care and "did their best". If the facility didn't have that team sitting there waiting though and something went wrong then *whammo*... they're not offering the required standard of care and the lawyers would have a field day. So smaller facilities that can't afford to pay a surgical team to do nothing for an unknown number of hours (or larger facilities that just didn't want to deal with vbac) have a perfect "get out of vbac free" card.

It's not that a facility can't handle one emergency better than another, it's that the standard of care for a vbac defines what resources they have to be able to offer in the case of an emergency... and those resources are different from a "true emergency".

I know it's off topic for this thread, and it certainly doesn't explain why facilities in Canada or the UK use the same excuses, but I wanted to toss this out there since the "if they can't do a vbac they can't do a birth" comment comes up a lot in threads like this...

[Storm Bride]

I know all that - but it doesn't change the fact that the reason people are told it's "safe" to birth in the hospital and "unsafe" to birth at home is that hospitals are equipped to deal with emergencies. Every single hospital that has banned VBAC because they don't have the ability to handle a potential UR is telling us all that they are not safer than birthing at home, because their much touted advantage (emergency care) doesn't exist.

[purplemoon]

Originally Posted by Storm Bride

I know all that - but it doesn't change the fact that the reason people are told it's "safe" to birth in the hospital and "unsafe" to birth at home is that hospitals are equipped to deal with emergencies. Every single hospital that has banned VBAC because they don't have the ability to handle a potential UR is telling us all that they are not safer than birthing at home, because their much touted advantage (emergency care) doesn't exist.

Can I get that on a t-shirt?

[wombatclay]

While I agree that the arguement is bogus when applied to the general hospital vs home question, I think (to play devil's advocate) they are saying that a properly equiped hospital is safer than home or a non-equipped hospital for a birth with a known risk factor. So a hospital with a VBAC ban (or no-breech, or no-twin, or whatever it is they're banning) will say they have that ban in place because they are not properly equiped to deal with a birth that has that specific known risk factor. Although I'm sure many care providers and facilities either believe, or are happy to have clients believe, that their arguement really is "all hospitals are safer than the alternatives"... that's not what the press releases actually say.

ETA- which is extra horrible since the implication is that VBAC (or whatever it is) is sooooo risky "even" a hospital isn't safe unless they're specially prepared. So they set up an unrelated equation (hospital is safer than home on one page, vbac is too risky for many hospitals on another) and leave the bogus but "obvious" conclusion drawing of "vbac is dangerous" up to the woman.

I think it would be more honest of them to say "this hospital is not prepared to handle the legal liability attached to this sort of birth" instead of just offering an "it's not safe" excuse since those two statements are very different and would prevent a lot of misunderstanding (though not to the benefit of the facility or hospitals in general). Personally, I feel the same way about midwives and alternative birth sites that refuse to attend vbac mamas with single layer sutures by saying "it's not safe" instead of being up front with the whole debate and their personal (or legal) concerns regarding suturing.

[cottonwood]

That is sooo ridiculous!!! Do you know what the Merck manual says about the actuale chance you have to rupture your uterous with a VBAC??

1% !!!!!!! that's it!!!!:

It's .5% for non-induced labors. Also, from http://www.mothering.com/articles/pr...fighting.html: "the risk of fetal death among the 13,115 women attempting VBAC was 0.038 percent (5/13,115). Thus the risk of a baby dying in association with VBAC was 12 times lower than the risk of a baby dying from non-rupture-related causes."

[Storm Bride]

Originally Posted by fourlittlebirds

It's .5% for non-induced labors. Also, from http://www.mothering.com/articles/pr...fighting.html: "the risk of fetal death among the 13,115 women attempting VBAC was 0.038 percent (5/13,115). Thus the risk of a baby dying in association with VBAC was 12 times lower than the risk of a baby dying from non-rupture-related causes."

Much of the discussion about VBACs also ignores that an infant death during a VBAC doesn't necessarily mean a rupture. Whatever killed Aaron, it wasn't a rupture. I seem to have picked up an infection, and I think that was probably what did it...but there's no evidence that it was actually VBAC related (except that he might have lived if I hadn't been so terrified of transferring). I have no idea where I'd fit into stats...or what my case could be used to "prove".

[langdonslady]

Originally Posted by felix23

My first c-section was pretty pain free and easy. I really didn't need hardly any pain medication, and I could button up pants (and they were low rise), in 2 days.

My second was a whole different story, though, and I'm kind of dreading a third.

You don't have to have a third necessarily. To talk to women who have had vaginal births after more than one section, you can take a look at the ican-online.org website.

[felix23]

Originally Posted by langdonslady

You don't have to have a third necessarily. To talk to women who have had vaginal births after more than one section, you can take a look at the ican-online.org website.

I'm not going to go into my medical history here, but I don't feel like it is safe for me to attempt a VBA2C. I not really upset about it, all I want is to make it to my scheduled c-section with nothing bad happening. Right now I'm not even sure if I'm going to attempt a third pregnancy anyway.

[Ceinwen]

Originally Posted by felix23

I'm not going to go into my medical history here, but I don't feel like it is safe for me to attempt a VBA2C. I not really upset about it, all I want is to make it to my scheduled c-section with nothing bad happening. Right now I'm not even sure if I'm going to attempt a third pregnancy anyway.

That was me - I kicked and screamed my way through three consultations with OB/GYNs AND my uber super duper crunchy midwives - who are advocates of UC to boot!

When my midwife told me that she could NOT in good concience attend a vaginal birth that I was having, I knew I had to focus on having the best (?) possible c-section I could have.

She still did all my prenatal care, attended the c-section and assumed care of the newborn... so it wasn't like I was completely abandoned to the system.

[RomanGoddess]

To be honest, given the way some vaginal births take place in hospital, I don't blame women for preferring the C-section route. If I had to choose between a routine episiotomy and a cut in my abdomen, I would take the cut in the abdomen, thank you very much.

[MOMYS]

I originally come from South Africa and the c-section rate in private hospitals is between 60 and 80%. Many of those are elective, many are planned (after an internal at 36 weeks a dr will say something like: You pelvis is too small to have a natural birth; your baby is too big to have a natural birth; etc. etc. etc.); and many are "emergency"" c-section (inductions that fail etc). Very, very few are true emergency c-section.
In state hospitals the c-section rate is MUCH lower - it probably falls within the WHO recommendation.

Medical aids (insurance) don't pay for elective c-sections, but the dr writes a note to say that he feels the blood pressure is too high or there is pelvic disproportion or whatever, and that takes care of it.

I've actually been speaking out LOUDLY against this for the last 2 weeks on one of the SA parenting boards I'm on. These are not big, busy boards like MDC, but I reckon about 70% of the moms have had their drs tell them something like: Baby to big; pelvis too small; induction etc. etc. etc.

These mamas truely trust their drs. They honestly BELIEVE that these drs have their (and their babies') best interest at heart. They cannot imagine changing care halfway (nevermind closer to the end) of their pregnancies. They cannot fathom someone seriously questioning their dr. These are not simple women.... they are generally well informed, intelligent women, but when it comes to their pregnancies and deliveries they honestly believe that they NEED specialized high care! That it isn't a natural thing, but a medical issue.

[MOMYS]

I don't think there is a correlation. The fact is that those who have access to private health care are the rich and although we all know that diseases don't see class/race/finances etc. a lot of diseases affecting the African continent are due to impoverishment and a lack of medical care....

Personally in South Africa, I think that just as in the States, a lot has to do with the money hence the push for c-sections in the private hospitals where the medical insurance will cover the costs. It also has to do with drs convenience and then of course with the drs insurance. I also think that drs see c-sections as so totally normal that that is just the way they do things.