it always bothers me - Page 4

[MegBoz]

Originally Posted by GoBecGo

Elective c-sections without medical cause baffle me. How come if i go to the doc and demand insulin (i'm not diabetic, but hey, maybe i just want some!) they will say no, but a c-section "ok sure, let's get the diaries out and make a date!"...ermmm what?

As I think has already been posted earlier in this thread, maternal elective CS with truly no medical cause is actually very rare. (The "Listening to Mothers" survey found, literally, ONE person out of, I think 1,500 who opted for no-medical-cause elective CS.)

I suspect, and others have voiced this as well, that some docs would like us to BELIEVE it's more common than it is - that they are just giving women what we really want with the insane CS rate over over 32%. But the truth is that it is NOT the case.

(Remember though, as far as medical records are concerned, all non-emergency CS are classified "elective" even for really, truly good reasons like complete placenta previa.)

OBs think it's OK to do a CS without cause because it eliminates the dangerous risk of other negative outcomes of attempting vaginal birth. (Since vaginal birth is always an "attempt" since it so often ends up in CS anyway.)

Think of it from an OB's perspective - they see so many bad outcomes. They see birth as risky & dangerous (not to mention a painful, horrific, miserable experience.) at least in the US, that is all they see! They don't even REALIZE how their actions cause so much of it. Or, as Dr. Marsden Wagner so eloquently states, "Fish don't see the water they swim in."

Gary Haskins, former President of ACOG, actually said, a CS is safer for BOTH Mom & baby in almost every case. Absolutely sickening & horrifying. I can somewhat understand how some might think CS is safer for baby (even though it's not true), but to say it is always safest for the mother too is INSANE! And this guy was HEADING UP the organization that sets practice standards for obstetrics in the US. Clearly, there is a lot of distorted thinking going on & an appalling lack of knowledge.

From the perspective of the average American OB, your analogy of giving a non-diabetic insulin is totally inapplicable. Because vaginal birth is risky anyway. (Whereas not taking insulin, for a person with a well-functioning pancreas, is not a risky action.)

Obviously *I* don't believe vaginal birth is so risky & purely-elective CS is a reasonable option, I'm just saying, intellectually, I understand where OBs are coming from in granting elective CS. It's awful, but I can understand why it's happening.

Oh, and this is all to say nothing of other advantages to CS like getting to schedule it so:
-no need to be at the hospital on weekends
-no need to be at the hospital in the middle of the night
-no need to wait around for hours just to be paid the same amount anyway

-I believe many OBs are actually paid MORE for doing a CS

-protection against malpractice (Many have admitted, "You're sued for the CS you did not to, but not sued for the CS you DID perform. Since a damaged baby is the worst possible outcome - doing a CS is doing 'everything you can' to ensure a healthy baby.")
etc.

[GoBecGo]

From the perspective of the average American OB, your analogy of giving a non-diabetic insulin is totally inapplicable. Because vaginal birth is risky anyway. (Whereas not taking insulin, for a person with a well-functioning pancreas, is not a risky action.)

I understand but i don't sympathise. Their job is NOT to give women care based on their own anecdotal experience or opinion, their job is to give best-practice, evidence-based care to all women. They should not be permitted to ADD risk. Their oath:

I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.
TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.
I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.
WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.
WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.
WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse be my lot.

Bolding mine. This is what is promised, and it is NOT what is delivered.

As for "no medical reason" that's debatable - the friend i mentioned before was considering a section anyway, after her first birth, but when she went for the initial ob consult, before she even spoke, he began counting her blood transfusions aloud, flipping dramatically through her notes, and then told her how many litres she actually lost (more than they replaced of course). THEN he asked if she wanted to "risk another try". There is nothing to say a second vaginal birth would end like her first one did, and he admitted this when she actually asked him, but quickly followed up with a grim "but we can offer no assurances that it WON'T end up the same way...." and then a long heavy silence. I actually think rather a lot of women having a section for a non-medical reason have been convinced that there IS a medical reason by a scaremongering and unscrupulous ob. That was my point with the insulin - no doctor would get away with convincing non-diabetics it would be safer for them to take the insulin, whether they asked for it or not!

[MegBoz]

Originally Posted by GoBecGo

I understand but i don't sympathise.

Yeah, I'm with you there.

Out of curiosity, what is that "oath" from?

[Turquesa]

Originally Posted by MegBoz

Yeah, I'm with you there.

Out of curiosity, what is that "oath" from?

It's the Hippocratic Oath dating back to ancient Greece. Most but not all doctors take it to express a commitment to ethical practice. Obviously, not all follow it.

ETA: Thanks to the PP for posting this. We need it as a continual reminder of what to expect as health care clients/consumer.

[MegBoz]

Originally Posted by Turquesa

It's the Hippocratic Oath dating back to ancient Greece.

Right after I asked, I realized that is probably what it was, but I was surprised by how religious it was, & the statement not to perform abortion. I was thinking it must not be the oath docs take in the US today, since abortion is legal & we are a secular nation.
Sure enough, there is a modern version (the Wikipedia page) had a link to it that is different.

[GoBecGo]

whoops, i think that IS the modern version...? Doctors are still able to refuse abortion or euthanasia on moral grounds, and i have seen them quoted (in news articles) as citing their oath as their reasoning. I have also read that not all doctors are REQUIRED to take the hippocratic oath anymore. I did NOT know that!

[Lauren31]

Originally Posted by MegBoz

**WE, here on MDC know there is value in laboring for a while before CS, but the average mama doesn't & I'd bet the average OB doesn't tell her about this little benefit.

What is the value in it? Personally, I think I would be pretty sad and upset if heaven forbid I have to have an emergency C-section.

[MamaMelis]

I might have written something like this several years ago, before experiencing my own birth gone awry. Now I have a much more open mind.

These days, my feelings on the subject are pushing me to get recertified as a doula and get back into the world of birth (both on the breastfeeding side and the PP doula side). I WANT fervently to volunteer as a doula at a "mainstream" hospital. So many women don't have the luxury, the knowledge or the support systems (let alone the $4000 or even the luck of having a homebirth midwife in their area) and are laboring alone in hospitals. Rather that judge and lament them and their choices, I have decided that I have a responsibility to actually DO something to help them. I find that positive action is so much better received that passive judgement/anger.

[Bluegoat]

Originally Posted by Lauren31

What is the value in it? Personally, I think I would be pretty sad and upset if heaven forbid I have to have an emergency C-section.

You can still have "planned" section, and just wait for labour to begin to have it, if required. THe reason hospitals and doctors don't want to do this is it is inconvienient for them. The vast majority of unplanned sections are not emergencies anyway, it can take them an hour (or more) to get the patienmt into the ER, which means that it isn't actually an emergency.

As for the benefits of this: For one thing, it means the baby is ready to appear. Doctors often mess up due dates, and late premature babies are a lot more common than they used to be. U/S and measurements, or even the last date of menstruation, are NOT accurate as doctors will have people believe, they still are estimates. The only really accurate way to give a good due date (which is still going to vary) is to know the actual date of ovulation. Not to mention the way doctors count the days of pregnancy is pretty much wrong.

And then if you go into labour, your body has begun the chemical and hormonal processes of birth, which are actually important to you and your baby. Just as an example, they process of the mom's body making milk depends on those chemical interactions. When you don't even begin them, there is a much greater likelihood of problems, with breastfeeding, some people think with ppd, etc. On the non-human side, animals given c-sections without labour will not take care of their babies - all of which suggests we underestimate the importance of these interactions. We know we don't totally understand them.

[GoBecGo]

Labour brings about multiple hormonal and physiological events in the baby which make it far better prepared for life outside the womb. For starters labour usually doesn't begin until the lungs are mature, so you can be much surer of that if you wait for labour than if you wait for an arbitrary number of weeks to have passed from supposed conception. In addition labour brings about oxytocin and stress hormone production in the baby, the first help it to begin immediate bonding and the latter makes it more primed to breathe, switch to pulmonary circulation and be awake and alert enough to suckle immediately. The squeezing action of labour also stimulates the baby's general reflexive responses and pushes some of the fluid from its lungs (not as much as vaginal birth can but certainly more than surgery will) which means those that don't have terribly distressing births or receive drugs through the placenta arrive alert and awake and stay that way for an hour or two after the birth, incredibly important learning and bonding time for the motherbabe.

SOME babies born by c-section before labour are able to adjust very well. Many others struggle with their breathing and need suctioning and sometimes time in SCBU. Many of those who are physically ok suffer with excessive sleepiness, lack of interest in feeding, and bonding issues (due to sleeping all the time and not feeding). Mothers are often made to feel guilty for not bonding with their baby, whatever the mode of birth, but it is actually much harder to bond with a sleepy unresponsive baby who isn't interested in feeding and doesn't seem to "connect" than to a normal vigorous newborn which arrives primed for breathing, feeding and bonding. Most women are not warned of this before their csection - they are told about the physical risks of surgery. There is much to be said for the baby and the mother for waiting for labour, but for the Ob it means he might be in the OR at 3am, which is why many don't want to go for it.

[MegBoz]

Originally Posted by Bluegoat

You can still have "planned" section, and just wait for labour to begin to have it, if required.

Yes, that is what I was referring to in terms of "value" in laboring first.

Originally Posted by Bluegoat

As for the benefits of this: For one thing, it means the baby is ready to appear. ...The only really accurate way to give a good due date (which is still going to vary) is to know the actual date of ovulation.

Even still, even if you know the exact date of conception, 40W gestation may honestly not be enough for some babies! Whereas it may actually be TOO MUCH for another baby! (Friend of mine had her baby in a great, fast HB last month. She was 37W1D & the MW said the placenta was already starting to calcify & age! He was ready then, 40W would probably have been too long for him.)

Originally Posted by Bluegoat

And then if you go into labour, your body has begun the chemical and hormonal processes of birth, which are actually important to you and your baby. ... all of which suggests we underestimate the importance of these interactions. We know we don't totally understand them.