or Connect
Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › Spin-off - Discussing the merit of vaginal birth and elective cesarean
New Posts  All Forums:Forum Nav:

Spin-off - Discussing the merit of vaginal birth and elective cesarean

post #1 of 27
Thread Starter 

[Moderator note: This thread is a spin-off of a topic originally brought up in the Home Birth Forum.  Because it deals with both topics of risk during vaginal birth and the merits of elective cesarean, I split the thread and am hosting this portion here in the Birth and Beyond Forum.] 

 

For me it all comes down to knowing what to expect and trying to stay in control when things don't go as expected.

I had a very supportive midwife and somewhat pro-natural birth hospital with my first birth.  It still ended up very medicalized, despite being vaginal. You need to prepare for this, no matter what. If I could start over I would have scheduled a c-section. I don't know of anyone who regrets scheduling one electively after fully informing themselves and as long as I carry to 39 weeks it's such a relief to know what to expect.

 

Now that I know the risks of vaginal birth (people talk all day about the risks of medicalized births but never of the vaginal traumas) and how my mother and I handle birth, I have decided to schedule an elective c-section for my next birth.  It is quite different from an emergency c-section. The idea of going through a vaginal birth in a hospital scares me because there is such a high chance I would not be in control.  The vast majority of women in hospital do not end up having a truly natural birth.  If the c-section option was not available, I would be very tempted to do a home birth (if it weren't for the experience I had with my first birth).  But I personally can't face that level of pain and further damage to my body again.  But maybe you can; lots of women do it.  But I am not a

 

Whatever your choice is, I strongly feel you should have a midwife or Ob with privileges to the nearest decent hospital and continue your prenatal care as if you were going to birth in a hospital; meanwhile you can keep a separate support team to help you stay informed about your home birth arrangement/attempt, should you determine that's what is best. I think home births can be much more satisfying and safe than attempting a low risk vaginal birth in hospital.  

post #2 of 27
Demeter888 brings up some good points but neglects any info on the baby. A scheduled c/s puts baby at 3x the risk of dying, means a different gut flora and potential life long lung issues. It also at 39 weeks or 42 weeks gives you a premature baby. Perhaps by minutes but who knows. Leilah McCracken wrote about her non-induced children 46 and 48 week gestation 11-12# v. Her up until then seemingly "full term" 9# 42 week babies.
I'm sorry you had a bad experience with the hospital. You don't say what but certainly sounds like a 4th degree tear. Those suck! I will point out there is little data on recurrence but you are right that they are much more frequent in the hospital. However, even with hospital management the recurrence rate is generally 5% whereas the c/s has a 100% chance of major surgery, and breastmilk containing pain meds.
Either way, Birthing From Within classes are geared towards exploring birth fears etc.... Past and present and help immensely with maternal satisfaction but please when we talk about fully informed let's keep in mind that any non labor c/s at any gestational age means that baby will have some degree of prematurity and puts future pregnancies at higher risk.
post #3 of 27
Thread Starter 

Should I have a homebirth?? Help!

Quote:
Originally Posted by Sheepdoc View Post

Demeter888 brings up some good points but neglects any info on the baby. A scheduled c/s puts baby at 3x the risk of dying, means a different gut flora and potential life long lung issues. It also at 39 weeks or 42 weeks gives you a premature baby. Perhaps by minutes but who knows. Leilah McCracken wrote about her non-induced children 46 and 48 week gestation 11-12# v. Her up until then seemingly "full term" 9# 42 week babies.
I'm sorry you had a bad experience with the hospital. You don't say what but certainly sounds like a 4th degree tear. Those suck! I will point out there is little data on recurrence but you are right that they are much more frequent in the hospital. However, even with hospital management the recurrence rate is generally 5% whereas the c/s has a 100% chance of major surgery, and breastmilk containing pain meds.
Either way, Birthing From Within classes are geared towards exploring birth fears etc.... Past and present and help immensely with maternal satisfaction but please when we talk about fully informed let's keep in mind that any non labor c/s at any gestational age means that baby will have some degree of prematurity and puts future pregnancies at higher risk.

 

I have many studies that demonstrate the safety of scheduled c-section being superior to that of vaginal delivery.  If you want to have this debate, I'll be happy to have it in an appropriate thread.

 

OP, should you want data on home birth, I believe there are very few studies.  Here are some studies about c-sections:

 

 

summary:
"An elective pre-labour Caesarean section in a nulliparous
woman at term has a lower risk of life-threatening neonatal
morbidity than spontaneous labour with an anticipated vaginal delivery. However, the increased risk of life-threatening
neonatal morbidity in the spontaneous labour group was
associated with an operative vaginal delivery or emergency
intrapartum Caesarean section and not a spontaneous vaginal delivery. Further research is needed to better identify
women with an increased likelihood of an operative vaginal
delivery or intrapartum Caesarean section, as this may assist
pregnancy caregivers in decision-making about childbirth."
 
"...cesarean was consistently associated with reduced odds of birth trauma across all birth weight subgroups whether or not fetal distress was present"
 
 
"...overall, the frequency of significant fetal injury is significantly greater with vaginal delivery, especially operative vaginal delivery, than with cesarian section, at 39 weeks."
 
"...demonstrates the need to include, assess, and balance the risk of psychological outcomes in different birth plans"
 
"survey of obstetricians in London, in which 31% of female doctors said they would choose a planned cesarean in an uncomplicated pregnancy, compared with 8% of male doctors"
 
"Having only vaginal childbirths was associated with a significantly increased  risk of stress urinary incontinence and pelvic organ prolapse surgery later in life compared with only having cesarean deliveries. ...each successive vaginal delivery increases the risk for prolapse and incontinence; it was not just the first delivery that had the most impact"
 
 
On reviewing the available evidence, it appears that there are sufficient grounds to assume that vaginal delivery (or even the attempt at vaginal delivery) can cause damage to the pudendal nerve, the caudal aspects of the levator ani muscle, fascial pelvic organ supports and the external and internal anal sphincter. Risk factors for such damage have been defined and variously include operative vaginal delivery, a long second stage, and macrosomia. It is much less clear, however, whether such trauma is clinically relevant, and how important it is in the aetiology of pelvic floor morbidity later in life.
 
 
"The occurrence of UI and anal incontinence during the postpartum period is related to the presence of incontinence in pregnancy, and vaginal delivery increases the risk of persistent incontinence."
 
 
The risk of urinary incontinence is higher among women who have had cesarean sections than among nulliparous women and is even higher among women who have had vaginal deliveries.
 
"women who choose a planned cesarean have a lower death rate"
post #4 of 27
Thread Starter 

Sheepdoc,  I posted a way off topic post in response to your claims that c-section is 3X more likely to die.  The point I wanted to make is that this is absolutely not true, and out of laziness I cited a bunch of studies.  But as Identitycrisisma says, the point is that the OP has expressed no interest in a c-section, so I think we should both agree to discuss that another time.  FYI, I did not have severe tearing; Imy decision to "cbav" is not an emotional one like it would have been initially.

 

bthuntamerc:

I am very well aware of the risks of c-section as they pertain to having more children and VBAC, as well as how it can affect initial letdown.  Please feel free to PM me more to discuss your own experience.  .  I plan to have no more than one more child after this so risks are pretty minimal; but let's see how it goes.  My hospital of choice is extremely pro breast and progressive with birthing tubs and everything.  My biggest fear is that I will be judged for choosing a c-section, not for trying to breastfeed or bond with the baby, which I will do!  There is a lot of stigma against women who make my choice.  I know it will be a vastly different experience and the bonding and hormones will also take longer.  All things I'm willing to face.

 

Back to the OP: Even if I was in my little bathroom, just sounds like a safe, good place to do something as personal as giving birth.  My least painful contraction was had in my bathtub.  I am so glad there are a variety of women here to share their experiences with you and if I haven't offered anything useful I am sure many others will!

post #5 of 27

Should I have a homebirth?? Help!

Quote:
Originally Posted by Sheepdoc View Post

A scheduled c/s puts baby at 3x the risk of dying, means a different gut flora and potential life long lung issues.

 

Sheepdoc, could you cite your sources? The '3x the risk of dying' in particular completely contradicts what I've read. Thanks.

post #6 of 27

I'm not SheepDoc, but:

 

Quote:
A recent U.S. population-based study of neonatal and infant mortality by mode of delivery among women with “no indicated risk,” however, showed that neonatal mortality was increased more than two-fold after birth by cesarean, even after excluding infants with congenital anomalies and presumed intrapartum hypoxic events (Apgar score < 4) and adjusting for demographic and medical covariates 2.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475575/

post #7 of 27

from that study. It doesn't appear to be very conclusive

"Available data are subject to a number of limitations, and do not provide conclusive evidence regarding the safety of planned elective cesarean versus planned vaginal delivery"

"Potentially increased risks of neonatal mortality with ECD at term may be counterbalanced by risks of fetal demise in ongoing pregnancies. Patients and physicians considering ECD should carefully review competing risks and benefits; further research is needed to inform these discussions."
 

post #8 of 27
I
Quote:
Originally Posted by Good Enough Mum View Post

Sheepdoc, could you cite your sources? The '3x the risk of dying' in particular completely contradicts what I've read. Thanks.
[/quote
CDC.
Voices.yahoo.com/CDC-says-ceserean-triples-neonatal-death-risk-3877056.html?cat=25
post #9 of 27
"balancing" concerns over fetal demise in "post" date pregnancies v. Known increased fetal death with ceserean is different than choosing a ceserean before 42 weeks. And its funny how few studies back up ACOG on post-date issues but they'll take one as gospel but studies about delayed cord clamping or bed rest require so many more studies before they'll make a policy change.


Quote:
Originally Posted by ummlily View Post

from that study. It doesn't appear to be very conclusive
"Available data are subject to a number of limitations, and do not provide conclusive evidence regarding the safety of planned elective cesarean versus planned vaginal delivery"
"Potentially increased risks of neonatal mortality with ECD at term may be counterbalanced by risks of fetal demise in ongoing pregnancies. Patients and physicians considering ECD should carefully review competing risks and benefits; further research is needed to inform these discussions."

 
post #10 of 27
Thread Starter 

Should I have a homebirth?? Help!

Quote:

Originally Posted by phathui5 View Post
 

I'm not SheepDoc, but:

 

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475575/

 

SInce this is being brought up again, I am simply going to respond to it because there should at least be a balance in views.  Your quote from this article doesn't really include the full scope of what it is saying, so I will post a bit of that here:

 

"some data suggest an association between ECD and increased neonatal respiratory morbidity and lacerations, and possibly decreased central and peripheral nervous system injury. Potentially increased risks of neonatal mortality with ECD at term may be counterbalanced by risks of fetal demise in ongoing pregnancies."

 

The actual study you are referencing is older, and there are other conflicting studies and much more recent data.  

 

Below are some direct and more current studies that indicate a lower neonatal mortality rate in c-section (which my own doctor agrees with). The quotes are an opionated summary not from the publishers.

 

summary:
"An elective pre-labour Caesarean section in a nulliparous
woman at term has a lower risk of life-threatening neonatal
morbidity than spontaneous labour with an anticipated vaginal delivery. However, the increased risk of life-threatening
neonatal morbidity in the spontaneous labour group was
associated with an operative vaginal delivery or emergency
intrapartum Caesarean section and not a spontaneous vaginal delivery. Further research is needed to better identify
women with an increased likelihood of an operative vaginal
delivery or intrapartum Caesarean section, as this may assist
pregnancy caregivers in decision-making about childbirth."
 
"...cesarean was consistently associated with reduced odds of birth trauma across all birth weight subgroups whether or not fetal distress was present"
 
 
"...overall, the frequency of significant fetal injury is significantly greater with vaginal delivery, especially operative vaginal delivery, than with cesarian section, at 39 weeks."
 
post #11 of 27

This is an interesting topic. Having planned two home births, I really know little about the choice for elective cesarean. I do know some mothers who had a risk factor for vaginal birth who chose elective c-section but I don't personally know anyone who chose that birthing option for issues of control, pain management or other reasons a woman may choose to birth that way.  

 

As someone who planned to birth at home, I tend to start my research on a topic from a fairly mainstream source like the ACOG and from there verge off, digging deeper and etc. until I find the information that feels relevant to me, my values and my situation.  

 

If I were deciding whether I wanted to have an elective c-section, I'd probably start with the ACOG, which states: 

Quote:
Washington, DC -- The nation’s largest ob-gyn organization recommends that pregnant women plan for vaginal birth unless there is a medical reason for a cesarean. 

 

Obviously what the ACOG says isn't gospel for anyone who chose a HB, but I would start there and then move forward. 

 

Here is a chart that would appeal to how I think: 

 

Table 2. Outcome Variables With Moderate Quality Evidence Regarding Delivery Route for Term Singleton Gestation With Vertex Presentation
Favor Planned
Vaginal Delivery
Favor Planned
Cesarean Delivery
Maternal length of stay Maternal hemorrhage
Neonatal respiratory morbidity  
Subsequent placenta previa or accreta  
Subsequent uterine rupture  
Data from NIH State-of-the-Science Conference Statement on cesarean delivery on maternal request. NIH Consens State Sci Statements 2006;23:1–29.

 

One of the things I think are so interesting about this discussion, Demeter, is that you have 10 studies that appear to show that c-section the benefits of cesarean but the ACOG is still coming out in opposition to elective c-section. In a way, you have a unique perspective of being able to relate to going against the grain but from a different end of the spectrum of child birth choices. 

 

I am posting mainly to give this thread some direction of it's own since it is a spin-off and may read a bit confusing to our members just joining us.  I will be honest and say that I have not had the time to read all of your links. I've been around this forum long enough to know that a page full of links doesn't always give a clear picture. And, I also don't have enough basic knowledge of cesarean to know all the factors to consider when reading the studies you linked. 

 

 

Heck!  As a HB mama, I don't even feel all that qualified to read the studies of HB and question the outcomes. 

 

For me, (getting more philosophical) I think birth choices are really very emotional. I feel that being truly objective is difficult and perhaps not even desirable. I vote that we let ourselves make some emotional choices about where and how we give birth. To me, it very much is the beginning of the journey to parenthood. I think balancing our objective side with our emotional side is a good way to start.  

 

I chose HB twice. Once with no access to the internet and the hot mess it creates when it comes to reading about a subject like this. I was advised by child development teachers, midwives (both home and hospital), friends and what I could find in books. The second time I had the world wide web. Oh, my gosh!  I had more doubts about the choice to HB for my second in part because of the massive amount of information I had access to. I still chose HB even though I did feel it was not the safest choice when looking at infant morbidity and mortality. 

 

I am saying this to you to get back to the ACOG, what they say about elective c-section and your choice about how you want to birth. I'm saying that I get going against the grain. I get that there are studies that say all sorts of things. Some seem good, some seem like the researchers were trying to prove a point. Some I have used (I'm sure) to confirm what I wanted to believe. Some seemed so biased that I just couldn't give them much credit - no matter what their conclusion. 

 

But, for me anyway, I didn't choose from an objective standpoint. I am me. I had to consider the factors that mattered to me. And, I, personally, never could have even tried for objectivity. 

 

I'm rambling at this point and I want to be clear that I'm talking about myself and trying to relate to the choice to birth by elective cesarean. I really can and as a HB mama, I can relate to choosing something that is unconventional (<3%) that isn't supported by the major medical associations. 

 

I'm interested to hear what others have to say on the subject. 

post #12 of 27
Thread Starter 
Quote:
Originally Posted by Sheepdoc View Post

I
Quote:
Originally Posted by Good Enough Mum View Post

Sheepdoc, could you cite your sources? The '3x the risk of dying' in particular completely contradicts what I've read. Thanks.
[/quote
CDC.
Voices.yahoo.com/CDC-says-ceserean-triples-neonatal-death-risk-3877056.html?cat=25

My mom used to work for the CDC and I am extremely cautious of believing reports they put out because of how politically driven it is.   Especially this CDC report. It is simply wrong. There is at least one counter to the report with a very sound case as to why the report is flawed here:

 

http://www.sciencebasedmedicine.org/does-c-section-increase-the-rate-of-neonatal-death/

post #13 of 27
nm.
post #14 of 27
Thread Starter 

One of the things I think are so interesting about this discussion, Demeter, is that you have 10 studies that appear to show that c-section the benefits of cesarean but the ACOG is still coming out in opposition to elective c-section. In a way, you have a unique perspective of being able to relate to going against the grain but from a different end of the spectrum of child birth choices. 

 

I am posting mainly to give this thread some direction of it's own since it is a spin-off and may read a bit confusing to our members just joining us.  I will be honest and say that I have not had the time to read all of your links. I've been around this forum long enough to know that a page full of links doesn't always give a clear picture. And, I also don't have enough basic knowledge of cesarean to know all the factors to consider when reading the studies you linked. 

 

.  

I am saying this to you to get back to the ACOG, what they say about elective c-section and your choice about how you want to birth. I'm saying that I get going against the grain. I get that there are studies that say all sorts of things. Some seem good, some seem like the researchers were trying to prove a point. Some I have used (I'm sure) to confirm what I wanted to believe. Some seemed so biased that I just couldn't give them much credit - no matter what their conclusion. 

 

 

Identitycrisismama:

 

I saw the ACOG chart and am familiar with their opinion on elective c-sections.  But there is a reason informed doctors are willing to not only perform these themselves, but would choose maternal request for themselves as well.  

 

I have delved further into understanding the political, financial, and ideological motivations of ACOG and many other sources of these opinions and concluded that it's best if I TRY to understand the data myself.  That's what I love about this forum; so many women willing to think for themselves!  My conclusion is never final but you are right; there is slight emotional bias because it affects me.  I am willing to whole-heartedly consider all data, and took time this afternoon to continue learning.  

 

Although the data is still incomplete and more studies should be done, the odds of a widely published study supporting the facts are just hard to come by because the public does not want to hear that.  It raises a deeply ideological question about nature and science.

 

My conclusion, and my obsetrician's conclusion, is that elective c-section at 39 weeks gestation is the safest option in the hospital I am going to and with his expertise and based on his 20+ years in practice.  However, I had to do a lot of arm-twisting for him to admit it because he is also a proponent of natural birth.  I wanted to be sure my choice was understood and respected and we had a long discussion about the data vs. doctors personal biases.

 

Just to clarify:  My reason for wanting c-section are many, but it comes down to avoiding further nerve damage, avoiding the possibility of an emergency epesiotomy, avoiding increased urinary and fecal incontinence, avoiding the risks of vaginal birth trauma (which are very highly under-discussed imo), and, yes, avoiding the feelings of trauma I went through the last time.  I am 35 and overweight and there is no question, aside from all of this, that a planned cesarean is far safer for me.  My own mother, who assisted the HB of two of my cousins at home and attempted HB herself, has said she would definitely do an elective c-section if she had to go through it again today.  I just wish I had not listened to everyone but her during my last pregnancy.

 

As I said before, if I am going to choose a hospital birth, for me personally it should be an outright medicalized birth.  Otherwise I'd stay home too!

 

ETA: I mean perineal and related nerve damage; I know c-section can carry it's own risks for nerve damage (particularly when it's an  emergency)

post #15 of 27
Thread Starter 
Quote:
Originally Posted by IdentityCrisisMama View Post

Keeping in mind that the author of that article is equally biased. 

 

Everyone is biased but the facts are clear; the study is inherently flawed.  It's too bad.  I wish I had more time to put more together on this.

post #16 of 27
Thread Starter 

This topic raises a question for me that I would love to know other's answers to:

 

What if it could be proven that elective cesarean was definitely safer than vaginal birth in most cases?

 

That doesn't mean it wouldn't still carry the risks and issues it already has, but simply that it is safer over all and in most situations.

 

How would you feel about it? What would it say of your beliefs about science, medicine, nature, God, Etc?  

 

And, what kind of birth would you want, given that information?

 

Mod:  It's kind of a spinoff on the topic, I am fine with it being placed in a new thread too!

 

 

FWIW, My personal feelings about it would have been that I would have still wanted to try a vaginal birth with my first child.  

 

There is an unquestionable and special bond that I have no doubt was helped by my giving birth as I did.  But I experienced a difficult labor, and now I would swing the opposite way.

post #17 of 27
Quote:
Originally Posted by demeter888 View Post

What if it could be proven that elective cesarean was definitely safer than vaginal birth in most cases?

Obviously the answer to this question would very from mother to mother but I don't think I would opt for elective cesarean even if a really good study (studies) could prove it safer than vaginal birth.

 

For one, this would worry a great deal about the equality aspect here. So long as health care is a privilege in in the world, I would not support a situation where I worried a more basic approach to health care was not practiced (or only practiced by the poor).  

 

Also, something I often think about when we discuss NFL issues is that science (of which I am a fan!) still is only what we know now. One does not need to be all that well informed to know that science sometimes makes mistakes and, more often/more importantly, science only knows what it knows. One of the more interesting things I learned about childbirth was that (and this was 10+ years ago so maybe this has changed) scientists/doctors/midwives still don't know exactly what triggers birth. The "what we don't know" has informed some of my choices because my guess is that this is the tip of the iceberg.  

 

Then there is the fact that I don't think we always use the measure of what is safest when we make decisions about our kids or our health. I think it's a little disingenuous to bring that out for birth but not discuss it for other aspects of life. I mean, what if it could be proven that eating only some weird concoction of pureed foods out of a feeding tube was safer than eating foods from our rich cultural traditions?  To me, birth is sort of like that.  

post #18 of 27
Quote:
Originally Posted by demeter888 View Post

Now that I know the risks of vaginal birth (people talk all day about the risks of medicalized births but never of the vaginal traumas)  

I keep coming back to this comment and want to be sure you know that we have an entire forum dedicated to dealing with issues as a result of birth trauma. It can be found by clicking on the link below: 

 

http://www.mothering.com/community/f/502/healing-birth-trauma

post #19 of 27
Quote:
Originally Posted by demeter888 View Post

http://www.ajog.org/article/S0002-9378(10)01037-9/abstract

"Having only vaginal childbirths was associated with a significantly increased  risk of stress urinary incontinence and pelvic organ prolapse surgery later in life compared with only having cesarean deliveries. ...each successive vaginal delivery increases the risk for prolapse and incontinence; it was not just the first delivery that had the most impact"
 

I wanted to look into some of these and picked this one at random to read. I'm only getting the abstract in the link, which doesn't contain the quote your used here, or does it and I'm blind? Oh, no, it's there but I'd still like to read one of the whole article. Do you have a link to the source of this quote or the full study? 

 

And, reading through your other links can I just say, "anal incontinence". That sounds TERRIBLE and I may consider a cesarean if I experienced that after vaginal child birth. 

post #20 of 27

I'm a labor and delivery nurse in a busy urban setting---basically, I've seen it all.  I don't object to elective cesareans in individual circumstances---I've known and supported patients who have chosen a C/S after a stillbirth, or a 3rd or 4th degree tear, or a broken pelvis, or due to a history of sexual abuse or trauma.  I do have some hesitations opening it up to anybody, mainly due to the effect it can have on later pregnancies and children.  Overall, I feel the same way about elective cesareans as I do about out of hospital birth---it is a safe and reasonable choice.  It can go terribly wrong, but typically that's only in a small percentage of the population and can usually be handled effectively by a competent team.

New Posts  All Forums:Forum Nav:
  Return Home
  Back to Forum: Birth and Beyond
Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › Spin-off - Discussing the merit of vaginal birth and elective cesarean