Originally Posted by Poogles0213
I think you are really trying to be very open-minded about this, and that's awesome :-)
I'm glad you realize that the type of birth where a mother feels safest is often the best (as long as it is actually a safe option - not all birth choices are safe, regardless if the mother feels it is the safest or not); may I point out, though, that you're still basically saying that women "should" choose natural, unmedicated birth, while also paying lip-service to actual choice? I think that seems disingenuous, though I don't think you neccesarily mean it to be.
I fully admit this probably rubs me the wrong way partially because I hope to have a Maternal Request CS (I would be a first time mom); I have looked at the risks and benefits of both modes of delivery (vaginal v. cs) and feel much, much more comfortable with the controlled environment of a CS than taking my chances that I'll have an uncomplicated vaginal delivery. To hear over and over that this is somehow "less than" a vaginal delivery and a poor choice....well, it irritates after awhile ;-)
Not all women "should" choose natural birth, of course not. But yes, most low-risk women really should--that is, of course, in a better world, where all women are confident and well-read. (I am NOT saying you're not these things, to be clear, just that if all women were, more of us would choose natural birth as "Plan A.") In a better world, safe birth options would also be available to all women, and they are not. In the world we live in, however, I realize that medical birth for many women seems a more rational choice than it really is. It's more complicated than just choosing the most rational thing based on facts, because 1) facts can be twisted and even fabricated, and you have to be very motivated to find the closest thing to actual truth and 2) emotions are involved, for many women emotions around birth trump knowledge about birth, and emotions actually do have a profound effect on birth outcome. It becomes further complicated when you look at each individual person, as people are SO widely varied in what options are available to them, everything they know to be true, in their physical limitations, and in their own personal fears, etc. That is why I can't say for certain what would ever be the best choice for anyone else, and why I concede that medical birth in the absence of medical need is definitely the best choice for SOME people. I respect women's right to choose that, but in most cases, I really do think the choice would be a different one if women just had a teensy bit more education and support. **Again, not a personal judgement on you.
You say you have looked at the risks and benefits of elective c-section vs. vaginal birth. I believe you. But just for the benefit of others reading this, here is a bit of info, again from Thinking Woman's Guide, not because it's the only source of this info but just because it happens to be on my desk:
Benefits & risks of cesarean section:
Benefits: A c-section delivers the baby when vaginal birth would put mother or baby at risk or when the mother cannot deliver the baby vaginally (**might I say, a seriously huge benefit, IF the c-sec is legitimately NEEDED**)
Intrinsic to cesareans are pain, debility, and a longer recovery period, all of which interfere with bonding with the baby and breastfeeding. In one study, 1/4 of the women reported pain when interviewed 2 weeks after their c-sections, and 15% still reported pain at 8 weeks. More than 15% reported difficulties with normal activities such as getting out of bed, walking, bending, lifting, and tending the baby at 2 weeks. 1 in 10 still reported problems at 8 weeks.
Some cesarean complications relate strictly to the surgery and never occur with vaginal birth. Of those associated with both, all occur much more commonly with cesarean delivery.
During the operation, women with an epidural or spinal anesthetic may experience breathing difficulties if the anesthetic goes high enough to affect the breathing muscles. In some cases, women may have areas where there is no anesthesia. Hemorrhage and anesthesia complications may occur. According to one medical literature review, 1-6% of women lose enough blood to require a transfusion. Hemorrhage may sometimes require a hysterectomy. Accidental surgical injury to the bowel, bladder, uterus, or uterine blood vessels occurs in 2% of cases, although a 10-year review at one hospital reported that uterine injury occurred 10% of the time.
Postsurgical complications are also a problem. According to the same medical literature review, infection occurs 8-27% of the time after cesareans, 1% of women experience a paralyzed bowel (ileus), 6-18 women per 1,000 experience blood clots in their legs, and 1-2 per 1,000 experience clots that lodge in the lung (pulmonary embolism). The 10-year hospital review reported a 4.5% incidence of major complications--that is, severe hemorrhage, need for repeat surgery (generally to investigate bleeding), pelvic infection, blood clots, pneumonia, septicemia (blood poisoning), or clotting dysfunction (a result of severe hemorrhage). Nearly 1/3 of cesarean mothers experienced minor complications, including fever; hemorrhage; blood-filled swelling (hematoma); urinary tract, wound, or uterine infection; leg clots (phlebitis); or paralyzed bowel or bladder. In addition, long-term and chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse.
Cesareans cause more maternal deaths than does vaginal birth. A 1989 analysis in Great Britain revealed that women were 550% more likely to die of an elective cesearean than a vaginal birth (9 vs. 2 per 100,000). A Dutch study found that between 1983 and 1992, c-sections caused 700% more deaths than vaginal births did (28 vs. 4 per 100,000). Obviously some factors that lead to c-section also threaten the mother's life. However, the British study compared elective cesarean, where there was no medical indication for the surgery, to vaginal birth to minimize that possibility, and the Dutch study investigated the exact cause of death. The numbers in the British study may also be low. Studies have found that data culled from vital statistics undercount cesarean death rates by 40-50%.
A cesarean poses risks to the baby as well. The baby may be cut, a complication that occurred in a little over 1% of head-down babies and 6% of breech babies in one hospital and in 1% of babies in the 10-year review. Cesarean-delivered babies are more likely to be in poor condition at birth. When researchers looked at 700 normal-weight babies born with low Apgar scores after healthy pregnancies, they found they were nearly half again as likely to be elective cesareans as vaginal births. Cesareans also increase the likelihood of breathing difficulties. Researchers compared outcomes for over 800 babies born by c-section for reasons unrelated to the baby's condition with 10,900 low-risk vaginal births. Babies born by cesarean were over 3 times as likely to be admitted to intermediate or intensive care (2.6% vs. 8.7%) and 5 times more likely to need assistance with breathing (0.3% vs. 1.5%). Another study compared elective cesareans--again, a situation where complications must be attributed to the cesarean, not the baby's condition--to women having trial of labor after a previous cesarean. It also documented more newborn breathing problems and more jaundice as well.
...Yadda-yadda phychological fallout/negative feelings/postpartum depression/nightmares/flashbacks, etc. (Skipping this part because maybe it doesn't apply as much to elective c-sections, I'm guessing...although who knows...) ...The trivialization of cesarean surgery compounds the situation. While it has long been recognized that major surgery has adverse psychological consequences, a recognition that enables medical staff to help surgical patients and their families expect and cope with those consequences, doctors and nurses rarely extend that acknowledgement to cesarean mothers.
Finally, the scar tissue poses considerable risk to subsequent pregnancies and births. Cesarean section increases the risk of infertility and ectopic pregnancy, a life-threatening complication in which the embryo implants outside of the uterus, usually in the fallopian tube leading to the ovary. Because the scar tissue interferes with placental attachment, cesareans increase the risk of the placenta detaching before the birth (abruptio placentae), growing over the cervix (placenta previa), or growing into or even through the muscular wall of the uterus (placenta accreta or percreta). The odds of placental complications soar with each succeeding cesarean, and the hemorrhage that results from placental attachment abnormalities or ectopic pregnancy can threaten the life and health of both mother and baby. The scar can also give way, causing massive bleeding and possibly expelling the baby into the abdominal cavity, an event that occurs in 4 per 1,000 women with horizontal scars and more often in women with vertical scars. In addition, pelvic scar tissue makes subsequent cesareans more technically difficult and injuries to other organs more likely.
And that's just the basics of what is known. It seems like every other day now I'm seeing a new article finding more and more benefits related to vaginal birth (the intestinal gut flora thing is the big one that comes to mind right now.)
I have lots of friends who have had c-sections, and I can tell you, witnessing what they went through in recovery was truly shocking and horrifying to me, especially when compared to my own experiences. Having a newborn is hard enough without having to recover from abdominal surgery! I have one friend who was very happy with her c-section, and bragged about how quickly she healed. She was saying, "I was back to my normal self after 3 weeks!" and part of me was thinking "good for her, I'm happy that she's happy" but part of me was thinking, "three WEEKS! OMG! That's awful!" since after my vaginal births, especially the second one, sure I was a little sore, but I was walking around feeling great like, the next day. I know that some women have difficult vaginal births and difficult recoveries, but with a c-section, those difficulties are a given!
I'm not saying c-sections don't save lives, but it seems to me that any reasonable person would avoid having one that isn't saving a life. Elective cesarean is perhaps the most irrational thing I've ever heard of. I simply cannot conceive how someone can decide to choose a c-section when it is not conclusively necessary in order to get the baby out safely. That doesn't mean it's not a valid choice sometimes, for some people. It's just so far from rational decision-making, from my point of view, that I can't understand that choice.
That said, I definitely do believe in actual choice--I am truly not just paying lip service. In your case, based on what you wrote anyway, your reason for choosing the massively riskier option (elective c-section) is that your discomfort with the other option (i.e. vaginal birth as Plan A with *necessary* c-section as Plan B) is massive enough to balance that out and tip the scale in favor of the c-section. I respect your choice, and you need to do whatever you feel is the best thing for you.
But with that in mind, may I respectfully give my point of view? If my amount of discomfort at the idea of the uncontrolled nature of birth was massive enough that I'd be willing to take on medically unnecessary risk to myself and my child just to avoid it, I'd want to deeply examine and work through my fears, and re-evaluate everything just to make absolutely sure that I was making a sound and rational choice. You may just come to the exact same conclusion, but with some added confidence. Or you may change your mind. (Perhaps, our assertions that at least an attempt at natural birth is the most rational choice would not "rub you the wrong way" if you didn't on some level realize that we have a point?) If you are confident that your choice is the absolute best one for YOU, then nothing anyone else says will be able to bother you.
You could choose an elective c-section with eyes wide open, knowing it's the best thing for YOU, while also acknowledging that because it comes with unnecessary medical risk and consequence that YOU are okay with, taking on those risks and consequences would be a terrible choice for most other healthy women.
Regardless, I wish you the best. If you go through with the unnecessary c-section, I hope it goes as smoothly as possible, your baby is healthy, and you recover quickly.
Edited by artekah - 8/30/12 at 12:27pm