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Humanized Caesarean Birth: How do we help the 5-15% who will need a c-section? - Page 4

post #61 of 111
Quote:
Originally Posted by JTA Mom View Post
Yes, especially to the bolded. Birth is UNPREDICTABLE. There's so much 'hokey' stuff around it, it's insane. So many people will believe that writing a c/s part for their birthplan is just 'asking' for it to occur. Ummm, no, it's not. No more than writing a will is asking to die.

For me, I find control soothing. My last c/s, I asked to not have my arms strapped down. Made a HUGE psychological difference. Why? Because not being strapped down meant I wasn't completely helpless. No one likes feeling out of control. Not even tiny babies.

Even though I was going for a VBAC, I made sure to put down several specific c/s requests, such as double suturing, stitches instead of staples, free hands, and my issues with certain anesthesias and pain meds used. All led to a MUCH better experience. I still have psychological issues linked to having to have another c/s, 'failing' in my VBAC, etc. However, the actual surgery itself wasn't so bad because I took back some of my power during it. I was NOT at the mercy of the doctors. I was a participant.
Bolding is mine and YES and YES to all of that. I'm pursuing my MA in bioethics and we are always discussing the issue of "humanizing" end of life (EOL) care. IMO, the same issues are exist with the process of birth in the US.

With EOL - the ethicists while differ, many believe the goal-based approach, helps resolve or answer the technique or procedure issues. For instance if someone refuses to be on a vent overall and has that in their advance directives or HCPOA, but the problem is a short-term vent because of pneumonia how does a MD resolve the conflict or understand the directive without a goal-based statement. I think the same could help with birth and the creation of resources for moms to receive support if needed.

I think in a previous thread... the conversation continually pounded what the moms who had a CS could do in getting acceptance in the NCB and I think it was pointed out that targeting the moms was not the answer, but to target the MDs, CNMs, LMs, Doulas, and CBEs in changing their message to not monday-morning QB, or to immediately feel pity for that woman and into a message of listening and acceptance.
post #62 of 111
I did not have a CS, and havent had time to read this whole thread, but I wanted to add my 'experience', for what its worth.

DS was breech almost up till his birth, and hosp was not wanting to let me attempt a vaginal breech birth. I was mourning the 'loss' of my birth before it even happened, and was very distrought.

My midwives were amazing though. One in particular helped me to make peace with the thought of a caesarean. On one of my last appointments before DS was born, we went through a pretend run-through of the CS. Its a baby friendly hospital, so she explained how my husband and her would be with me the whole time, the Dr would immediately hand me the baby, she would help me get DS positioned for BFing while they would be sewing me up, etc. One important thing that helped me feel better was her telling me that it would still be 'a sacred and special event' even though it was not what I initially envisioned. That made me feel SO MUCH better.

VERY lucky for me, DS did end up turning, so I didnt have one, but I had made peace with it already in case I needed it, thanks to my caring and supportive midwives.

nak
post #63 of 111
I actually feel very peaceful about my birth, though it was far from ideal. I ended up with an emergency c-section due to out of control pre eclampsia and hellp.

Though it was very scary and an emergency situation, someone always explained every step (even if it happened while rolling quickly down the hallway). The anesthesiologist fought to give me a spinal instead of general anesthesia. He was very comforting and reassuring, staying by my head the whole time and giving me a play by play of what was happening.

The nurses stopped by me on the way to the nicu to let me give my babies a kiss.

The recovery nurses had someone in the nicu take a picture of each of my babies for me to hold while in recovery.

When I had to go back in the OR (hemorrhage), they again took a minuite while rolling me in to explain what was happening.

After everything was over and I was back in a regular room, the OBstopped by and talked to me for a long time, explaining what happened, why, and answering any questions I had about how it all went down.

All in all, I had a true emergency that was made much easier by the hospital person ell treating me like a scared first time mom and treating me accordingly.
post #64 of 111
Quote:
Originally Posted by lach View Post
A study just came out this week saying that "too posh to push" is a myth.

Oo! Link please?? Thanks!
post #65 of 111
Quote:
Originally Posted by Turquesa View Post
Oo! Link please?? Thanks!
http://www.nhs.uk/news/2010/10Octobe...ce-a-myth.aspx
post #66 of 111
I'm on my way out, and just skimmed the replies.

Can I ask what support those of you who are okay with having had c-sections need? You're okay with it. I'm not getting what the need for support is all about. I'm not saying you don't need it. I'm just not getting what it is. If I were okay with any of my so-called "births", I wouldn't need or want support, so I'm confused.

And, to whoever suggested therapy. I've thought of it, thanks. But, if there's one thing I've learned over the last 17 years, it's that people who are paid to "help" me have their own agendas, and my wellbeing isn't a high priority item. The absolute best thing I can do for myself is stay the hell away from well meaning "experts".
post #67 of 111
That's in the UK though, and my experience is that the NHS isn't as hot on maternal request CS.

there is one private hospital with a rate of 47% and my understanding is that they will, though.

There was a past US study showing that CDMR (Caesarean delivery by maternal request) wasn't as common as people thought. And it's probably not, given how CDMR is defined--basically, a woman asking her OB for a CS just because she wants one. ERCS is considered a medical indication. Not many women request a primary elective CS without any reason whatsoever. Women may be more eager to jump on an excuse for CS, but that's not counted.
post #68 of 111
Quote:
Originally Posted by Storm Bride View Post

Can I ask what support those of you who are okay with having had c-sections need? You're okay with it. I'm not getting what the need for support is all about. I'm not saying you don't need it. I'm just not getting what it is. If I were okay with any of my so-called "births", I wouldn't need or want support, so I'm confused.
I never needed support except from my DH and my family.

The only thing for me was the judgment from others who didn't know the circumstances, nor did they even want to hear them. There were those individuals who were very flippant about the whole thing and have zero idea what happened, but I live in a super homebirth obsessed, doula-ville of a crunchy area, so when any of those women in that circle(and my area is small, so it's many I know) hear that they just make assumptions.

I just don't like the holier than thou attitude I've ran into, IRL and on here honestly at times, and that somehow my child's birth was less because it wasn't the natural way. I think that is up to me to decide, not have people make assumptions about something they don't know.

That's just my take on it.
post #69 of 111
Lisa, I was pretty much kidding about a support thread for those who had ok c-sections. It just seems like it's always assumed that we are all traumatized and had bad experiences. It's nice, I guess, to acknowledge that for some, it's still the most wonderful thing they went through - despite not having the birth of their dreams. The baby was born... that baby we longed for and love more than anything. I realize the people who need the most support are those who had a hard time during and/or after the c-section. *I* did need support, in many ways, b/c I did (and still do) mourn the fact that I didn't have vaginal births. So, sorry for the misunderstanding, from me. I'm just at a point where I've healed, and am at peace with my babies births. I wish that for every mother.
post #70 of 111
Quote:
Originally Posted by AlexisT View Post
That's in the UK though, and my experience is that the NHS isn't as hot on maternal request CS.

there is one private hospital with a rate of 47% and my understanding is that they will, though.

There was a past US study showing that CDMR (Caesarean delivery by maternal request) wasn't as common as people thought. And it's probably not, given how CDMR is defined--basically, a woman asking her OB for a CS just because she wants one. ERCS is considered a medical indication. Not many women request a primary elective CS without any reason whatsoever. Women may be more eager to jump on an excuse for CS, but that's not counted.
In my experience, "too posh to push" was always a British claim. Americans don't really use the word posh. I don't think that I've ever heard anyone in the US say "too posh to push," though it's a phrase very commonly trotted out in the UK. So I'm not really sure how the fact that it's a UK study makes it irrelevant.
post #71 of 111
The particular phrase may be British, but the concept isn't. My point wasn't that it's irrelevant. It was that because the NHS discourages maternal request CS, a British study may find lower rates than a comparable US study (if one could be done) would.
post #72 of 111
Quote:
Originally Posted by MeepyCat View Post
Overuse of c-sections is one symptom of an extremely large problem. This problem did not originate with any individual pregnant woman, and it cannot be solved in the delivery room.


Talking about what to do about c-sections reminds me somewhat of similar discussions about obesity or poverty. It is tempting (perhaps more comfortable) to see the problem solely in terms of personal responsibility and to miss the complexity of an entire system within which individuals are acting, with varying degrees of privilege & power.
post #73 of 111
I haven't read through the entire thread, yet, but I have read most. I want for mothers what most women want, safe births empowered by informed choices. I have never judged a woman for having a c-section. I have never had a c-section. I have however wondered if a c-section was necessary or not many times. The reason why is because the risks involved are higher, the outcomes poorer, and breastfeeding and recovery can be more challenging with a c-section. If the c-section was unnecessary, then these are unnecessary risks and challenges for mother and baby. Why do I wonder this when I hear c-section stories? Not out of judgment of the women. The most common birth story I hear for the past five years is induced labor, induction didn't go well or couldn't find babies heart beat, and then a c-section. It is actually much more common for me to hear birth stories with this common thread than any other. I have to wonder was the mother fully informed? Was the induction a choice or was it pushed upon her by a medical professional? If there wasn't an induction would there have been a c-section?

If a woman chooses a c-section and is fully informed that is her choice. If a woman is in labor and a c-section is presented as safer because of complications and she is informed fully of all possible known risks and outcomes and she chooses a c-section that is her choice. I knew a woman who choose a c-section with her second birth because she ripped terribly (and I mean terribly) with her first vaginal birth. That was her choice. I assure you I did not judge her. I did however wonder if her first birth had been managed differently if she might not have ripped so terribly.

I choose natural birth because I have every reason to believe that, barring emergent circumstances, it is safer and has better outcomes for mother and baby.

My nephew is currently is NICU. His birth is one of the stories that have the same common thread I hear all too often. His mother was told that because she had elevated blood sugar during her pregnancy that her baby would be too big to birth vaginally. They told her they needed him to be born early. They induced her before her due date. The induction didn't go well. At one point they couldn't find the baby's heart beat. She was told a c-section was needed. 30 minutes later (if this was truly an emergency the baby could have very well died waiting 30 minutes imo) they performed a c-section and he was born weighing 4 lbs and 11 oz. The difficulties and complications they are now experiencing are why I wonder, was this necessary? Not because I am judging the mother, but because I want safe births empowered by informed choices for women. I want the best possible outcome for mother and baby within those choices made by the woman giving birth. Not a coerced choice, or a false choice, but informed choice. Meanwhile I will be praying for mother and baby and setting aside any other thoughts other than the best possible outcome within their situation. Because that is what I want for them.
post #74 of 111
I haven't had a csection, but our birth plan covers it for the case that it might become necessary. What is most important to me is that baby won't have any procedures done or be fed anything and be with DH right away while I recover and nurse as soon as possible. I really mostly care about how soon baby is with me and how soon baby gets to bond with DH in the meantime, and that delayed cord clamping is done, which can be done with csections.
I wouldn't care what other people say quite frankly. What I am super afraid of is having a section pushed on me for no reason, and I think that is a very valid fear these days.

As for reasons to why the rates are so high, it cannot be litigation and health insurance policies only. That may be the roots, but I'm German and in Germany we are approaching rates of 30% and higher. We do not have lawsuits that award high amounts at all. We have a social security/welfare network that ensures everyone has health care, that disabled children are taken care of, that everyone has a roof over their heads and plenty of food and even a TV and internet access. Still, rates are raising every year. There is more to it than the whole lawsuit thinking.
post #75 of 111
As a Mom who had a wonderful birth, even with a c-section, the best thing anyone can do to support me is to not act like I lost or gave up by having a c-section delivery. I had an elective c-section with my second child and the "oh" then quiet when I told people I was having one was really disconcerting. I wanted to say, "but wait this is why. . ." every time I got that reaction, but honestly I would have been saying that all day long.

I think we all need to realize that sometimes a c-section is the best option for a birth and that it can be a smart, empowering choice. Additionally, that sometimes an elective c-section is not a "unnecessarian" and the person electing that c-section is not lazy, afraid, or giving up. I, along with my doctor and my husband, decided that a c-section was the best choice because of my previous delivery. I had a really difficult natural vaginal delivery (30+ hours of labor, 4th degree tearing, and my daughter suffered a broken collarbone) with my first child who was over 9 lbs. and born on her due date. I got pregnant right away (my happy oops baby) and when the doctor realized that this next child was shaping up to be even larger, he spoke to me about maybe making the choice to deliver via c-section. In no way was I coerced, bullied, or made to feel like that was the only option, but rather that for me that might be the best option. I know that I certainly could have declined the c-section, but for me it was the right choice.

I have to say I am really happy that I did elect to have the c-section. My son ended up being over 10 lbs. and that was with him being delivered a week early. I honestly don't think I could have safely delivered him naturally. We hear a lot about our best birth and for some of us, this is the best birth.

As far as what made my c-section a good experience, I will echo what most posters who have had a positive c-section birth have said and that is communication. The hospital I delivered in (while not the fanciest) had a great staff that really cared about the patients. Both my husband and I were able to feel involved in every step and it was never a problem to have our new baby in our room for the entirety of the stay. Honestly my recovery was a heck of a lot easier, also. I would not wish the 4th degree tearing I had with my first natural delivery upon my worst enemy.
post #76 of 111
Quote:
Originally Posted by GuildJenn View Post
I can tell you from personal experience that the NCB is pretty quick to walk away from women who have neonatal losses due to birth complications too, even when the delivery was vaginal.
My heart goes out to you. No woman with a conscience would wish neonatal loss on another woman. And few women will not empathize; I'm convinced that deep down inside, we're all terrified of that prospect.

I do have to say that although your personal experience with a handful of NCB advocates is unfortunate, it is NOT fair to generalize these impressions to absolutely every woman who chooses natural childbirth. I can guarantee you that we're not some monolithic population that hangs out at the same country club, greets each other with a secret handshake, and scoffs at women who get epidurals and c-sections.

It is unfortunate that there are select, shan't-be-named bloggers who delight in turning it all into a Mommy War--NCB v. Intervention Moms. But we're each unique, and it is not fair to broadbrush every NCBer as self-righteous and judgmental...or every cesarean mom as some uneducated victim who didn't know better.

The point of this thread, as I interpret it, is to explore how to reach out to each other, as childbearing mothers, in a spirit of compassion and understanding. That effort works both ways. Those of us who choose NCB face an uphill battle of ridicule, judgment, derision, invalidation, and even bullying by medical staff that can't wait to placate us with "pain relief." We struggle to find support from our friends, family, and providers. No woman, regardless of her birth choices, deserves to be treated this way. But I don't think that sweeping generalizations will help us make any progress on this all-important conversation.

Again, I'm sorry for your loss.
post #77 of 111
Quote:
Originally Posted by Turquesa View Post
I do have to say that although your personal experience with a handful of NCB advocates is unfortunate, it is NOT fair to generalize these impressions to absolutely every woman who chooses natural childbirth. I can guarantee you that we're not some monolithic population that hangs out at the same country club, greets each other with a secret handshake, and scoffs at women who get epidurals and c-sections.
That's true, but this is after 6 years of talking about my loss and experience in various places, and speaking with other women about theirs.

I realize it's a generalization, but I feel pretty comfortable saying that as a group the natural childbirth community treats complications at birth which require hospital intervention and their aftermath pretty poorly.

This starts from the very beginning when women are encouraged with phrases like "manifest outcomes" and "birth is not an emergency" without acknowledging that sometimes, it is.

The truth is that the NBC is a very political movement and c-sections (and complications that require them) is one of the epicentres of those politics.

Quote:
Originally Posted by Turquesa View Post
The point of this thread, as I interpret it, is to explore how to reach out to each other, as childbearing mothers, in a spirit of compassion and understanding. That effort works both ways. Those of us who choose NCB face an uphill battle of ridicule, judgment, derision, invalidation, and even bullying by medical staff that can't wait to placate us with "pain relief." We struggle to find support from our friends, family, and providers. No woman, regardless of her birth choices, deserves to be treated this way. But I don't think that sweeping generalizations will help us make any progress on this all-important conversation.

Again, I'm sorry for your loss.
Thanks.

I personally believe that the way c-sections are treated by the NBC is a systemic, entrenched issue. There are good reasons for that - the rates are statistically available; there are definitely problems; it can be extremely violating; the medical community often fails to take the cascade of interventions into account - all of which is true and important.

But the NBC does politicize ITS information in return.

For example, the goal of 3% c-sections that's been bandied around a lot due to The Farm (where, as it turns out, you can risk out) is politically motivated. These kinds of statistics are often quoted without taking into account some of the consequences of those decisions. And yes, that's not necessarily the midwife down the street...but it does impact on women's senses of failure and of blame and impacts on their capacity to tell stories or seek support.
post #78 of 111
Dualistic thinking, rigidity & dogma at both ends of the spectrum contribute to the polarization around c-section, and I feel this does a disservice to all birthing moms, whether we have c-sections or not.

At this point, I personally am convinced that a safe, uncomplicated, unmedicated vaginal birth is way more possible for way more women than the medical "establishment" would acknowledge or allow for, and way less guaranteed than the most earthy-birthy NCBs advocates would have us believe. It can be tricky to navigate a middle way between those extremes.

As someone who's had a c-section, I feel pretty exhausted by what I see as two polarizing narratives about c-section, neither of which resonates with me. The mainstream medical "story" emphasizes the risky sides of birth, positions c-section as a life-saving procedure in all instances, and completely discounts the emotional and long-term impacts on mother & baby. And in the NCB community, c-section seems to be the scapegoat for everything that's wrong with the whole birthing system. I feel like because c-section is assumed to be an instrument of shame, trauma, and suffering there is an unquestioned emphasis on reducing c-sections rates by whatever means necessary, whether or not that goal makes sense for individual women. You say "c-section" and a million assumptions suddenly spring up, which makes it really hard to stop and listen to each woman's individual story and find some nuance in the conversation.

Let's separate the concept of "traumatic birth" from the concept of "c-section." I'm afraid these have become interchangeable within the NCB dogma. Not all c-sections are the same, and not all vaginal births are either. If a woman says she's traumatized, let's believe her and find a way to support her experience. If she says she's not, let's believe that too and offer just as much support. After all, having a baby is a ton of work, and labor/delivery is just the beginning! We all need all the support we can get.

And one more thing, let's assume that women who aim for natural births and end up with c-sections and/or trauma are a valued part of the natural birth community who have important information and perspective to share.

Just my 2 cents.
post #79 of 111
Wow, really interesting thread--thanks OP.

My own two cents on some of the issues raised:

1. I interpreted the OP's question as what can be changed about the actual act of c/s to make it more humane experience. Things I would like to have changed about my c/s:
a. I would like to have seen the baby being pulled out (but not the incision site itself--that would not have been good).
b. I would like to have seen and handled my placenta if so desired.
c. I would like to have received my baby first, still goopy.
d. I would like DH to have been able to videotape OR had a 2nd person in the room to take more pics. DH was a bit preoccupied with his son being born (imagine!), so we have very few pics of the baby and none of the operation (per hospital).
e. No talking about among staff about random stuff. A birth is a special, even sacred occasion, and I would have preferred not to listen to the staff and doctors chitchat.
f. I want the option of delayed cord clamping.
g. I would like additional support people (like my doula) to accompany me to op.
h. I would like to initiate breastfeeding (and logistical help doing this) in the OR if physically and emotionally able.

My c/s was emergent, but was not the horror that I have heard about (in the operation itself). However, there were obviously a lot of things (above) that I would like to have been different about it, that would have made it closer to the NCB I desperately worked for. And I also got some concessions with my c/s that I think should be standard: never being alone (on going into OR) and getting to keep both DH and my doula for the epidural placement because I was in an absolutely terrible emotional/physical state and all the staff knew it and weren't going to make it worse (and lower the baby's oxygen-levels even further by upsetting me more).

2. As for the discussion of c/s and the politics of NCB community--I have never felt really "judged" for my c/s in the NCB community, probably due in large part to the fact that I have been over and over my birth and really do believe my c/s was the last resort in my case (but then, maybe most women who are happy with their c/s do too?). No one has ever said to me, "Well, you just didn't do x, y, and z." And I have the confidence of KNOWING that I did try everything I and my support team knew to have me do, so I feel confident that my c/s was necessary. The only negative experience I had with the NCB community was that I was part of the Hypnobabies Yahoo discussion group, and when I posted my traumatic birth story to the group, I got all of two responses (which were both VERY supportive), and the moderator didn't say anything. It could have been a simple oversight or a technical glitch, but I couldn't help but feel slighted and that the mod/teacher didn't have anything to say since I didn't end up with a vaginal delivery.

One thing that does bother me is that although I am a huge NCB believer and supporter, I also fear that I am in that 5-15% who simply cannot birth naturally (my MW and the OB who oped on me claim so, anyway). It leaves me in an awkward place wanting so badly to really belong to NCB but never being able to fully partake. I feel strongly enough about this that I am seeking a consult with a HB midwife to go over my birth record and get a non-medical model opinion.

In all, I think it's laudable to work on making c/s more humane, and I don't feel at all patronized or pitied by the NCBers on the thread who haven't had c/s!
post #80 of 111
Quote:
Originally Posted by CI Mama View Post
At this point, I personally am convinced that a safe, uncomplicated, unmedicated vaginal birth is way more possible for way more women than the medical "establishment" would acknowledge or allow for, and way less guaranteed than the most earthy-birthy NCBs advocates would have us believe. It can be tricky to navigate a middle way between those extremes.
Very true.

Quote:
As someone who's had a c-section, I feel pretty exhausted by what I see as two polarizing narratives about c-section, neither of which resonates with me. The mainstream medical "story" emphasizes the risky sides of birth, positions c-section as a life-saving procedure in all instances, and completely discounts the emotional and long-term impacts on mother & baby. And in the NCB community, c-section seems to be the scapegoat for everything that's wrong with the whole birthing system. I feel like because c-section is assumed to be an instrument of shame, trauma, and suffering there is an unquestioned emphasis on reducing c-sections rates by whatever means necessary, whether or not that goal makes sense for individual women. You say "c-section" and a million assumptions suddenly spring up, which makes it really hard to stop and listen to each woman's individual story and find some nuance in the conversation.
I have to confess to conflating c-sections and traumatic experiences. I think, for me, they are so completely intertwined that it took me a long, long time to grasp that it was even possible to have a c-section without being traumatized by it. I still have trouble understanding that, on an emotional level, but I've learned to grasp it on another level. I guess the same is true in reverse - the women who aren't traumatized by it have just as much trouble understanding how hellish it was for me, and women like me.

Quote:
Let's separate the concept of "traumatic birth" from the concept of "c-section." I'm afraid these have become interchangeable within the NCB dogma. Not all c-sections are the same, and not all vaginal births are either. If a woman says she's traumatized, let's believe her and find a way to support her experience. If she says she's not, let's believe that too and offer just as much support. After all, having a baby is a ton of work, and labor/delivery is just the beginning! We all need all the support we can get.
I absolutely agree that having a baby is a ton of work. But, I'm once again a little puzzled by the emphasis on support for those who aren't traumatized. Those of us who are emotionally devastated, depressed, traumatized, etc. still have all that work...and we're also struggling with an emotional load that can negatively impact every aspect of our lives with our new babies. I can guarantee that if that load weren't there, I wouldn't have needed anywhere near as much support as I did.

Maybe we're just using the terms differently, I don't know. But, honestly, to me saying that women who aren't traumatized need "just as much" support as women who are traumatized is inherently dismissive of the trauma. "Sure - you need support, because you were traumatized, but women who weren't traumatized need just as much" doesn't quite...gel...for me.

Quote:
And one more thing, let's assume that women who aim for natural births and end up with c-sections and/or trauma are a valued part of the natural birth community who have important information and perspective to share.
I definitely agree with this part.
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