Elective csection...ugh

[trippingbillies]

I am so annoyed right now and I really dont know why but here goes. A friend's sister due with her first in a few weeks. I saw her today and she showed how the baby lay-head down. Hmm, sounds like the optimal position for a vaginal birth, right?

Well I come to find out she is having a scheduled csection because of the baby's position..which is normal as can be. Bull. She is having a csection because she does not want to go through the trauma of labor and delivery. I guess I am pissed because I gave birth vaginally and suffered greatly after dd's birth. I am also mad because, having worked in the insurance industry, I know that her unnecessary section will cost the insurance company money(The doctor of course will code the section as medically necessary but we all know the truth) which means that the premiums go up for everyone. I understand if you labor and the baby is in distress and/or you have pushed for hours and nothing is happening..by all means, section away! But to just say, "I give up" as a FTM from the get go seems wrong and unfair to the mothers who actually understand the motherhood isn't about convenience but about sacrifice

[MegBoz]

Education is key.

Honestly, if forced to chose between a fully, highly-medicalized vaginal birth and CS, I too would be tempted by CS!!! I find the idea of high-tech birth to really be traumatic. I mean, think about it! You go through all that laboring & pain & chances are good you'll end up with a CS anyway! (For FTP, fetal distress, failed induction, etc.) Might as well go straight there & skip the extra stress.

Also, high-tech birth increases the risk of worse perineal tears (epidural, purple pushing, and insturmental deliveries all increase tears), so I'd be tempted to chose the abdominal incision over the perineal laceration.

Point being - If you think 'That is all there is' then I can understand the choice for CS.

I don't blame the mama too much (ok, ok, I do blame her a little - but just a little!)

As someone here once posted, "I DID read books! I thought I WAS educated!" But when reading "What to expect when you're expecting" and taking the hospital-based birth class, you never truly get educated. & how are you supposed to know that? How are you supposed to know that one of the most popular birth books omits such vital info? How are you supposed to know about what you don't know?

From my own personal perspective, I knew the US CS rate was high - and much higher than other industrialized nations - only because I had a friend who's a PhD reproductive epidemiologist. She was talking about it once with a nurse friend & said things like, "We don't even know what normal labor curves are! Don't ever let them section you for FTP." So I thought, "OK, if our CS rate is higher than other industrialized nations, it's probably higher than it needs to be - and I want to be sure I'm not a victim of an unnecessary one."

So I sought to learn the truth about why we have more CS than necessary, which led me to the book "Thinking Woman's Guide" which got me on board for a natural birth. Before that little chain of events, I actually said the words, "Of course I'll get an epi! Why would I go through all that pain?! I've got nothing to prove." Yup, I did. Everyone gets an epi, it's just what you do, right? & without "Thinking Woman's Guide) I certainly never would have known how insane the NPO & cEFM rules are.

So even now, even as an eventual HBer, hopefully soon a Bradley teacher, & extremist NCB-advocate, I can STILL understand that view because I used to be there myself!

It's infuriating, and there is a lot of blame to go around. I place most of the blame on OBs and ACOG - if they didn't have ridiculous policies, things would be a lot better.

[GoestoShow]

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Edited by GoestoShow - 1/6/11 at 8:25am

[kltroy]

As a friend, you basically have ONE opportunity to say your peace, and then you need to drop it, IMHO. I would try and organize your thoughts before you do so. Your friend's sister needs to know the relative risks associated with each type of birth. There is good conclusive evidence that a c-birth:
- results in higher rates of complication for the baby, especially in terms of breathing difficulties
- higher risk of hysterectomy, more blood loss, more difficulty breastfeeding, longer recovery time (*MAJOR ABDOMINAL SURGERY*) for mom, not to mention subsequent births have increased risk of complications because of the surgery

I would also show her the current ACOG guidelines, which recommend that c-section is NOT indicated for suspected fetal macrosomia and certainly not for suspected malpositioning, unless it is breech (and even then, they leave it up to mom).

Get the numbers and do this right if you want to make an impact. Also convincing might be to show her the data that shows that a c-section does NOT protect against pelvic floor injuries and future urinary incontinence.

After you've said your peace, just sit on your hands and bit your tongue to her face. But if your friend seems open to the discussion, you can always speak with her at greater length, since she may pass some of it on to her sister.

[Hannah32]

Honestly, I think people need to respect others' decisions. It's not really up to you if she has an elective c-section. It's her call. I don't agree with it either, but it's not my body.

[annekh23]

I guess if someone said to me they were having a c-section because of baby's position, but I knew it was head down, I'd act dumb and say, oh, I didn't know there were any head down positions that need a c-section and then see what the response was and possibly ask more "dumb" questions which might turn out to be thought provoking.

I'm not a fan of maternal choice c-sections, but equally they are safe enough that the scope of medical reasons to have them are changing, 50 years ago, or less things would have looked very different.

[wbg]

As hard as it is I do, believe that we need to be respectful of every women's birthing choices, even though they might be very different to our own. Women need to give birth in a place and manner that they feel safe and empowered. When I chose to home birth, many people disagreed with my choice and felt obligated to "educate" me and try to change my mind. Their actions were not acceptable. I try to offer the same amount of courtesy and respect to women who make alternate choices to my own,as I wish I had been shown.

For what it is worth, elective C-secs make me crazy. But that is my personal opinion and I only share it if I am directly asked.

[KristyDi]

One of my best friends has had 2 completely elective c-sections. She didn't even try to justify them medically. She was scared of labor and scared something bad could happen to the baby. She is totally happy with her birth experiences, though she has been subtly belittled by a few natural birthing mamas we are acquainted with. That hurt her feelings quite a bit and made me pretty angry.

I think we have to respect women's right to make their own choices, even when they make what we think are crazy misinformed choices.

The thing that bothers me is that her OB didn't even try to talk to her about the risks of a section. He just happily scheduled her for major surgery w/ no real informed consent. I think if she had had a good, natural minded, supportive OB then she might have made a different choice

[TCMoulton]

Originally Posted by KristyDi

The thing that bothers me is that her OB didn't even try to talk to her about the risks of a section. He just happily scheduled her for major surgery w/ no real informed consent. I think if she had had a good, natural minded, supportive OB then she might have made a different choice

Unless you were at her OB appointment listening to the conversation she had with her OB you really have no way to know this. There is always the chance that there were concerns with her pregnancy that made a C/S the best choice for her.

I feel that if I want others to respect my birthing choices then I need to do the same for others regardless if I would make the same choices or not.

[S.Elise]

delete

[MegBoz]

Originally Posted by stella.rose

Personally, I think elective c-section is a crazy decision borne out of a deep hatred of one's own body and a deep distrust of the female body in general, which ultimately comes from sexism and misogyny in medicine and society in general.

Well put!!

Honestly, I personally DON'T support purely elective CS for no reason other then, "I just don't want to labor & birth." I don't.

It's PROVEN to be damaging to the baby: "CDC Says Cesarean Triples Neonatal Death Risk"

Now, I realize things like being a sexual abuse survivor can cause a woman to opt for a CS & I would support that. I don't recommend we have the law involved here - it's between a woman & her doc.

BUT, if a friend or family member of mine were to chose it, I can't say that I would sit there and say, " Well, your body, your choice." No. I wouldn't be anymore supportive of that than I would be of CIO or spanking. It is NOT a matter of pure personal preference. It's a choice that's proven to be damaging to the baby (as well as her own body.) I just can't sit there & say, "I'm OK with that, I support her choices."

So call me judgmental, but as a wise MDCer has in her sig file, "Judgment is not always wrong."

But again, as I posted earlier, I understand how people can make that choice given our culture - that doesn't mean I think it is acceptable and A-OK!

[DocsNemesis]

Thats the biggest thing for me-informed choice, INFORMED. I have met at least a few women who were not told of potential complications to themselves or their baby. Yes, those complications are written on that consent form but 99% of the population doesn't read them. Yeah, thats technically their bad, but still...a responsible doctor should be telling these women straight out what to expect and what complications can arise. I know the women should take responsibility as well-I mean, its not like the info is hard to find anymore-but the doctors are the ones performing the surgery.

For instance, I was there when my ex friends OB came in and told her that he was just going to section her because it was safer for her and the babies (she was having twins, but both were vertex-they were wanting them born because one baby wasn't growing fast enough for the OB's likes.) Oh and this same OB told her she had TTTTS with FRATERNAL twins. Anyway, there was absolutely no mention of potential complications and he basically went the opposite direction, telling her how dangerous vaginal birth is. THAT is NOT informed consent!

Also as an example, when I had my cesarean, I wasn't told of many of the risks I read about later. Granted, mine WAS medically necessary, but the point is the same. I never knew I might have major nerve damage and never be able to feel my lower belly again, nor that the scar would cause major pain during this pregnancy due to adhesions.

So, if a woman wants a cesarean knowing all the risks-more power to her. Its not my body and its not my birth. No way would I chose that though!

[KristyDi]

Originally Posted by TCMoulton

Unless you were at her OB appointment listening to the conversation she had with her OB you really have no way to know this. There is always the chance that there were concerns with her pregnancy that made a C/S the best choice for her.

I feel that if I want others to respect my birthing choices then I need to do the same for others regardless if I would make the same choices or not.

I acknowledge that I wasn't at any of her OB appointments and I guess there is the possibility that she's lying to me, but I don't believe that to be the case since we are close friends and there is no reason for her to lie. But according to several very open and detailed conversations we've had about our birth experiences the things I posted were accurate. I'm not doing much interpreting either, I used many of the words she herself used.

I don't exactly agree with the bolded. I strongly believe I need to respect other women and respect their right to make choices about their births even when those choices are, IMO, the wrong ones. I don't feel it's necessary to give up my right to an opinion about others choices in order to respect other women. I just need to be aware and accept that my opinion about how they choose to birth is irrelevant to their lives. I also need to accept others as they are with caring and compassion, not condemnation no matter what their birth choices are. I also need to be aware that sharing my opinion about others choices with them is often completely unnecessary and in many case would be hurtful.

[GoBecGo]

Perhaps there is something that a person might NOT discuss with her friends here too. I knew a woman who "elected" a csection with her #1. A woman at the toddler group brow beat her about this for a long time. She never really stood up for herself, just sat there getting redder and redder and eventually one day she waled out and never came back. The next time i met her was at a sexual health clinic. I was having an IUD fitted, she was having yet another consult for the incredibly painful herpes lesions she suffers from, which, she told me (since we were already both sitting there at the STD clinic!) flared up so badly during her pregnancy that by the 35th week she had only 20% unaffected external genital skin. Hence the c-section.

Honestly, we might never know the full situations of those who make different choices to our own. Unless you ARE that person, you cannot know why they decided what they did. I'm a sexual abuse survivor and for ME having an elective c-section to avoid flashbacks would be just handing one more thing over to my abuser that should be mine - but i know other women who don't feel that way. I have come to terms with what happened to me enough that i can face up to genital pain and embrace it as MINE for MY birth. Should women who aren't in that place put off having a baby forever until they get to it? No.

As an aside i was born by elective c-section and i'm fabulous

[momz3]

Originally Posted by Hannah32

Honestly, I think people need to respect others' decisions. It's not really up to you if she has an elective c-section. It's her call. I don't agree with it either, but it's not my body.

This.

[soso-lynn]

While I do think that, ultimately, we have to respect other people's decisions, I do think it is absolutely appropriate to provide information and discuss the implications. I would much rather temporarily upset a close friend than see her dealing with unecessary complications after a c-section or having to help her find a VBAC friendly hospital for her second child. As long as the discussion is done within a respectful conversation, it is ok to share information and even debate those things. I would never feel personnally attacked or otherwise be upset if someone questionned my birth choices because I am confident that I am making informed decisions.

One thing I remember most of my prenatal classes with my first (they were held in a birthing center) was how many people there were having their second child and chose a midwife that time because of a bad, uninformed experience the first time. perhaps if everyone did not think it was politically incorrect to discuss birth then those things would not be as common.

[claddaghmom]

I don't see how remaining silent is respect for someone's choice, most especially if you have any inkling that it's not an informed choice, or that it's not a choice at all.

A coworker of mine was told she had to schedule a c-section b/c her baby was breech and wouldn't turn b/c she was past 36 weeks. I tried the 'dumb question' strategy mentioned by a pp. She 100% honestly believed that her dr. was right and that nothing could be done, that her baby wouldn't move for the rest of the pregnancy and that a breech birth was deadly.

Exactly what am I supposed to 'respect' there? I respect her as a human, as a mama with fears about her wellbeing and dreams for her child. And so I remained charitable and in fact it turned out that she went into spontaneous labor and delivered about 10hrs before the c-section, so quickly they couldn't poke or drug, induce or cut anything on her.

[momz3]

Originally Posted by claddaghmom

I don't see how remaining silent is respect for someone's choice, most especially if you have any inkling that it's not an informed choice, or that it's not a choice at all.

A coworker of mine was told she had to schedule a c-section b/c her baby was breech and wouldn't turn b/c she was past 36 weeks. I tried the 'dumb question' strategy mentioned by a pp. She 100% honestly believed that her dr. was right and that nothing could be done, that her baby wouldn't move for the rest of the pregnancy and that a breech birth was deadly.

Exactly what am I supposed to 'respect' there? I respect her as a human, as a mama with fears about her wellbeing and dreams for her child. And so I remained charitable and in fact it turned out that she went into spontaneous labor and delivered about 10hrs before the c-section, so quickly they couldn't poke or drug, induce or cut anything on her.

I have to agree with you. The op never mentioned having a discussion WITH this lady. Instead of bitching about it on a forum, maybe she can offer some helpful information. Complaining about it to strangers will most likely do nothing.

kltroy had some good advice.Thank you, have a nice day!

[momz3]

Also, respecting her decision: It means that, sure, now she may not be informed. I think it is fair to say that based on the information provided. But, once she is informed, for instance, if the OP decides to actually speak with her and offer advice,and she decides to move on with the cesarean birth, then, whether you agree or disagree with it is irrelevant. It is possible to make in informed decision that may not be the BEST decision. She could have every cesarean horror story in front of her, all the best research regarding cesareans, believe it, and still go through with it, maybe for other reasons.

GobecGo makes a good point, too. We only know the little information the op has given. More than likely, there are big missing pieces here and she probably does not know every little detail like she think she does.

[GoBecGo]

Do people have the right to make UNinformed decisions?

I mean i'm all for information, and i got as informed as i could before i had DD, but honestly i was going to have a homebirth. I have a friend who had a surprise breech homebirth which resulted in fetal demise. I am still having a homebirth. Sure the stats support my view, but even if they didn't i would be having a homebirth. It's very handy for me that homebirth is as safe as hospital birth, but if it wasn't...i would still be terrified in hospital. So i would still give birth at home. And no amount of information on how i would be safer in hospital would inspire or help me in any way.

Sometimes it's good to realise people are on their own individual paths in life, and have their own specific lessons to learn. I really think with most people they learn as much as they feel they want to know. I have informed people of facts and unless they asked first i almost never get a positive response. Sometimes people aren't ready for the information until they're ready to ask the questions for themselves. I tend to lend out my Ina May Gaskin and Kitzinger books and keep schtum unless actually questioned these days.

When i was planning my HB with DD a LOT of genuinely concerned loving people tried to educate me on the error of my decisions. I hated it. Even when what they said was true (if you have a big bleed your chance of dying is increased at home - of course i knew my chance of having a big bleed was much lower at home) i just didn't want it. I had sought and found what i wanted. I know a lot of women who regret how their first birth went (i am one of them) and have changed things in subsequent pregnancies (i'm one of them too!) to potentially change their outcomes, but how many of them would have actually been ready to hear before the first birth what could happen? I have told about 5 women not to go for the induction purely based on dates, that it is more painful, that it increases the chance of c-section. None of them listened to me, all but one ended up with a cs and all but one (who liked her cs experience fine) deeply regret it and are going to do it all different next time.

Terrible births come in all shapes and sizes. I know women who were very content after their c-sections and women with PTSD after their precipitous vaginal births. On paper it might be a hellish induction followed by surgery, or a fast drug-free labour and vaginal birth, but really only the individual woman herself can tell us how it was, as a birth.

Imagine we were afforded this much scrutiny and comment to the conception of babies. Would this thread be called "missionary position with no candles YUK!"? What if we had access to info which indicated miscarriage was more likely if a particular position was used at conception? Would we deride those women who through ignorance or choice made love in that position when TTC anyway? It's so so personal, all of this. I think that seeing birth in this contentious way is divisive and harms women, when we could be supporting one another which would better serve the aim of getting ALL women a labour and birth experience which is empowering and satisfying.