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"Too Posh to Push" - Page 2

post #21 of 73
Thread Starter 
Sorry about not quoting the article in my OP. I totally forgot that the article would go to a login type situation after the first 24 hours. How much can I quote and get away with?

"Too posh to push" is what some OBs call their high income, executive type patients who prefer to schedule their cesarean sections instead of waiting for labor to begin on its own.
post #22 of 73
I just want to say that this thread is crazy and a bit disturbing really. hmmmmm
post #23 of 73
"To Posh to Push" is also the title of an article from Time magazine, the April 19, 2004 issue. At that time, almost 2 years ago now, the c-sec rate in the US was at the highest ever, 26%, up 150% from 1975.
post #24 of 73
I too am all for a woman choosing, however the problem is that OB's do not give a an accurate picture of what a cesection entails, nor do they give an accurate picture of how it can affect a woman's future choices. This article doesn't even do that.. "less likely to have anal incontinece" ??? vaginal birth doesn't cause anal incontinece, lost of things can and the mis-handling of a vaginal birth can certainly contribute but so can the slip of a scalpel during a c-section... actualy bladder lacerations are quite common during a c-section.

The point is that for women to truly have a choice they need all the facts, including how a section can limit thier future birthing choices, that a managed vaginal delivery increases thier risk for pelvic damage, that any medication used during labor/birth transfers to the baby and may have long term effects including issues with breastfeeding and the bonding experience of mothers... etc etc... there are so many things that the average woman isn't aware of
and if she's not aware of them how can she truly make a choice?

and it's 5-700% more likely to die, doesn't mean that 5-700% die just that the risk factor is higher. It's like saying 5-7 times more likely.

according to this study, it's 4x's more likely
Quote:
Perinatal mortality rate - babies that die:
3 per 1000 for planned vbac
4 per 1000 for elective cesarean


Maternal mortality rate - moms that die:
2.8 per 10,000 with a trial of labor
2.4 per 10,000 with an elective cesarean


The risk of a mother dying from a cesarean is small but is still considerably higher than with a vaginal birth:
Maternal death with cesarean: 4 in 10,000
Maternal death with all vaginal births 1 in 10,000
Maternal death with elective cesareans 2 in 10,000
Maternal death with all normal vaginal births 0.5 in 10,000

Countries with some of the lowest perinatal mortality rates in the world have cesarean rates under 10%. The World Health Organization says, "Clearly there is no justification in any specific region to have more than 10-15% cesarean section births."

The infant mortality rate in the US is currently 6.9/1,000. This report states "The United States continues to rank poorly in international comparisons of infant morality."

The maternal mortality rate in 1996 (the last year statistics were available) was 12 per 100,000 births. There has been no decrease in maternal mortality in the US for 20 years according to a Mortality and Morbidity Weekly Report.


Sources:
Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-1999
National Vital Statistics Reports, Volume 49, Number 13, December 27, 2001
A Guide to Effective Care in Pregnancy and Childbirth, Chapter 38, Labor and birth after previous cesarean, M. Enkin, M.J.N.C. Keirse, J. Nielson, C. Crowther, L. Duley, E. Hodnett, and J. Hofmeyr. Oxford University Press, 2000
Annual Summary of Vital Statistics: 2000, Hoyert DL, Freedman MA, Strobino DM, Guyer B. Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA
post #25 of 73
fitmama,

Thank you for the link to the article. Personally, think this a bad option for the moms and the doctors who do it.
post #26 of 73
Quote:
Originally Posted by OnTheFence
I am going to try and do this point by point.

"Fourth degree tears (and most third degree tears) to the vagina are caused almost exclusively by episiotomies, not normal vaginal deliveries. "

Really? I have read numerous homebirth forums including the one here where 3rd and fourth degree tears took place. Of the 4th degree tears I personally know people having, none of them resulted from an episiotomies.
Yes, really. You can go to the ACOG website or search PubMed for one of the many studies done on episiotomies in the last 20 years. The reason ACOG now recommends against routine episiotomy is because they found that they were more likely to cause the very problem that they were supposed to prevent. As I said before, you can always find anecdotal evidence on both sides of issue. But statistically, your risk of a 3rd or 4th degree tear is FAR higher with an episiotomy--and most of the women in these studies were having hospital births, where the position of the mother makes her far more likely to tear. Does this mean that women who have homebirths or vaginal births NEVER have 3rd or 4th degree tears? Of course not.
post #27 of 73
I really believe elective c-sections to be a step in the process of women reclaiming the birth process. Typically substantial change in history tends to go to an extreme, peak, and setlle back down.

Wealthy women went from hiring wet nurses [breastfeeding being only for the poor], then later to feeding their babies themselves without the breast [bottles], to a peak in formula usage, to it settling back down and women now having individual control over their option of feeding. Breastfeeding, I would guess now being on the slow rise.

While I prefered not to have a csection, I can support that women are taking contol over their births as a step in change.

We can all agree that it is important for women to have full
post #28 of 73
Quote:
Originally Posted by OnTheFence
I think you find that cesareans are fairly safe. While they may not be as safe as vaginal births, they are for the most part safe for mom and baby. Also I would LOVE to see the sources that a mom who has an elective csectoin has an increased rate of death of 5-700%. Thats complete rubbish and exageration if I ever read one.
Okay...try:
1) Rochat R W et al. Maternal mortality in the United States: report from the maternal mortality collaborative. Obstet Gynecol 1988; 103(5): 459-63
2) Schuitemake N et al. Maternal mortality after cesarean in The Netherlands. Acta Obstet Gynecol Scand 1997; 76(4): 332-34
3) vam Ham M A, van Dongen P W, Mulder J. Maternal consequences of cesarean section. A retrospective study of intra-operative and post operative maternal complications of cesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74(1): 1-6
4) Hall M. H. Commentary: confidential inquiry into maternal death. Br J Obstet Gynaecol 1990; 97:752-3

There's tons of research on the increased risk of c/s. If you go to PubMed and investigate, the preponderance of evidence is overwhelming. Even many of the perceived benefits of c/s (that c/s mothers are less likely to have urinary incontinence later in life, for instance) have been shown to be false.

You keep citing your personal experience, but I protest once again that anecdotal evidence is NOT statistically valid and should not be used by doctors/women in making most surgical decisions. That's like saying, "Well, I was spanked and I turned out fine, so spanking is okay." Or, "My kids did great on formula, so formula is just as good as breastmilk." Or put another way: Most infants who ride in cars without car seats will not be killed or seriously injured in accidents (because most of them will not be in accidents), but because the risk is HIGHER without a car sear, it is legally mandated that all infants be put in them.

Quote:
Safer is in the eye of the beholder.
Actually, it's more than that. I agree 100% that a woman may FEEL safer in a hospital than at a homebirth, for instance. But to me "safer" is what has been shown, over time, statistically, by an overwhelming number of reproducable studies and an aggregate of outcomes to be safe. Out-of-hospital birth, for example, has been proven in study after study to be as safe as hospital birth for the majority of low-risk women. C/s has never been proven to be as safe as vaginal birth, but has been proven to have more and more serious risks.

Quote:
Can you imagine if I walked into an ER with kidney stones and demanded that a doctor perform surgery on me to remove the stones because I didn't want to endure the pain of passing them? No responsible doctor would do this."

Actually they do, especially for children. You should read up on the new therapies they are performing to break up stones so people can't pass them. Just because you believe its irresponsible doesnt make it so.
I hardly want to get into this (as a person with recurring kidney stones, I do in fact know quite a bit about them), but I actually think it's relevant. For most people, the technology to break up stones is non-invasive (sound waves are used; it's an outpatient procedure). For some people with very severe stones that cannot be passed or broken up, surgery is the best option--this correlates to women who, for medical reasons, will likely fare better with a c-section (placenta previa, toxemia, etc.). For people who have smaller stones that can be easily passed, however, surgery is not performed, particularly because pain medications are effective treatments. It's beyond irresponsible--it's malpractice, plain and simple. My dad has a patient who has chronic, debilitating kidney stones (several times a year)--bad enough that she needs morphine to get through them. But because they are small and can be passed, no doctor in her many years of treatment has suggested surgery. It would simply cause more damage, pain, and difficult recovery, when the stones are passed in a relatively short amount of time.

In general, I agree with Thmom. While I personally believe that primary elective c/s borders on malpractice, I'm not saying they should be made illegal or anything. But it's more than "just a choice." Doctors have a responsibility to REALLY educate their patients on risks of elective surgery, both to themselves and their babies and not paint c/s as an "easier" solution to childbirth (which is what the "too posh to push" idea promotes). This is not likely to happen in a medical system where doctors have all the incentive in the world to perform c/s (it brings in more money, it can be "conveniently" scheduled, it takes less time, hospitals have c/s quotas, it gives doctors more control over births, it's a way of sidestepping malpractice suits, etc.). And women, of course, have a responsibility to REALLY educate themselves. But outside of this board, I rarely see that. When most women I know hear something from their doctors, they believe it. One (admittedly) anecdotal example to make this point: my VERY well educated sister (Ivy League college, business school, runs her own company) was told by her pediatrictian that "there are no real benefits to bfing after 3 months, so if you're having difficulty, you can just stop." So she stopped. Zero research. Zero investigation. Sadly, I think this is pretty typical.
post #29 of 73
I read the article and I have also had a c/s & 2 vaginal births. The woman in the beginning of the article that chooses a section has a very valid reason to have a section IMO. The writer could have chosen a woman who chose a section just for convenience or because she was worried about stretching her vagina. Both seem like silly reasons for major surgery. The woman quoted had 2 miscarriages and a stillbirth. She obviously couldn`t trust pregnancy so why is it surprising if she couldn`t trust birth? I don`t blame her at all, and I`m sure not many of us here have walked in her shoes, so why judge?

On the other hand, scheduling a section for no good reason is scary because it can take us all further from what is normal and healthy. Yet, deciding whose section is necessary can be awkward and a waste of energy. I remember wondering why a friend had to have 3 sections while I was planning my 2nd home birth. I was like, doesn`t she know about VBAC? Later I learned that she had one emergency c/s transfer during a birth center birth, one baby die during a VBAC due to severe shoulder dystocia and the last one was planned at her request. Fellow natural minded mamas still asked her why in the world she was scheduling that third section. Like they had any clue what she went through.

When a similar situation happened to me, I was amazed at the judgemental attitudes in the natural community surrounding elective sections. All I can say is, I was the same way & if I hadn`t been unlucky enough to have all my well laid plans thwarted, I would still be that way. Those of you who have had everything go the right way, you are very fortunate, it could have been different. Everybody seems to agree that a small percentage of women really need a section, the tricky part is respecting people`s choices without picking them apart. Having a section for emotional reasons can be valid too.
post #30 of 73
I don't care if women choose c/s (though I do care that so many women are coerced into c/s and I do care that the consequences to subsequent pregnancies are not typically discussed thoroughly by doctors with anyone having a c/s, planned or not). But what irritates me with these articles about choice, is WHERE THE HELL IS MY CHOICE FOR VBAC? That's being written about too, but less and some of the restrictions are getting close to being nonconstitutional, IMHO. The majority of docs won't attend them, a large number of hospitals (probably the majority of hospitals if not the majority of hospital beds, when you balance out small vs. large facilities) don't permit them and due to the bottom line of one insurance co., I couldn't have a VBAC pretty much with an OB in a hospital in the entire state of Oklahoma if I wanted to. A lot, if not most, birth centers can no longer get insurance coverage on VBAC. In some states midwives can't attend them at home (like NJ, where the c/s rate is the highest in the nation) legally, in many others required physician consent for mw-attended homebirths pretty much causes the same result. In most others the legal situation is grey as to HBAC and HBACers live in fear of CPS in case (God forbid) they do rupture at home or anything else goes wrong. I know why this is, I know the doctors are often put in a tough situation because of liability and insurance (which is one reason I'm not asking one to attend my VBAC), but the fact is, whereas a first time mom in my area could easily find someone to do her nonmedical c/s, my choices for VBAC are much more limited, esp if I want to maximize my chances of success rather just ending up with a c/s that's planned later rather than sooner (which is where many VBAC plans go ultimately once the doctor starts getting third trimester jitters).

As for what recovery is worse and the dangers of surgery vs. vaginal birth for a particular birth itself, there are arguments on both sides (although I would argue for the vast majority of babies and mothers vaginal birth produces overall better results), so in that case I say--- whatever works best for you. However, if a woman thinks there is a possibility she wants 3+ kids, then the odds tip much more heavily in favor of vaginal birth. After 2 c/s the numbers get worse for placenta accreta and after 3 c/s and esp after 4 c/s they are a lot scarier (why many doctors in addition to refusing to attend VBAC, will not take on a patient AT ALL in pregnancy (even for ERCS) who has had 3 or 4 c/s). There aren't a lot of studies on uterine rupture after multiple c/s, but it does go up and would include the risk of rupture prior to labor (ie, prior to one's scheduled surgery). Scar tissue also tends to get worse with each surgery which makes the surgery more complicated. So whereas I think one can balance the risks in a reasonable way to go either way up to 2 kids, after that I think it's pretty hard to argue that c/s is a safe alternative to vaginal birth. Of course, most women who choose c/s for no medical reason probably aren't planning on more than 2 kids. But what about those women who are and ended up with a primary c/s often b/c of their doctor's liability fears and find it almost impossible to find a VBAC attendant? Why do they not get to balance the risks and benefits and make the choice that's best for them? There was an article published (the abstract is on pubmed) that had a "decision tree" for VBAC based on the various risks of c/s vs TOL after c/s that made it clear that if a woman desired 3+ kids VBAC should be encouraged, yet instead doctors push the tubal at the second c/s, and many women who wanted more kids and wanted vaginal births but for whatever reason did not have them the first two times, tired of fighting, tired of the pain and emotional heartache they may have suffered from the surgeies they've had, give up their dream for a bigger family and give in and their doctor has essentially made their reproductive choices for them....last I heard, it's unconstitutional to make a reproductive choice for a woman.

So I support the choice to have a totally elective primary c/s, I just wish those electing it and the doctors supporting it would support VBAC too, but almost always they don't.
post #31 of 73
"WHERE THE HELL IS MY CHOICE FOR VBAC?" Aprilushka

This is a good point & it should be equal. I would love to have a VBAC this time, but it is a slim possibility & so the rest of your post just scared the pants off me. I know those are real risks though & they need to be made clear to all pregnant women. How do people in Brazil and other places with super high section rates deal with these rising risks?

I see you are in No. Va, Aprilushka and planning an Hbac. Not for you, but other moms you might know, I know of a proVBAC female OB who delivers at Alex. hospital. Pm me if you ever want her info.
post #32 of 73
Quote:
Originally Posted by liseux
"WHERE THE HELL IS MY CHOICE FOR VBAC?" Aprilushka

This is a good point & it should be equal. I would love to have a VBAC this time, but it is a slim possibility & so the rest of your post just scared the pants off me. I know those are real risks though & they need to be made clear to all pregnant women. How do people in Brazil and other places with super high section rates deal with these rising risks?

I see you are in No. Va, Aprilushka and planning an Hbac. Not for you, but other moms you might know, I know of a proVBAC female OB who delivers at Alex. hospital. Pm me if you ever want her info.
Thanks liseux, see your pm. I know your story and understand why you might make different choices from me.

As for Brazil (and some other Latin American countries), I imagine the doctors push the tubal after 2 or 3 c/s, although I haven't studied this question. The huge c/s rate is more among the middle and upper class in the cities, where people I think have fewer kids. Rural poor people are still more likely to have vaginal births (and more kids) in Brazil I think, so it's not the same issue for them (though they have all the issue of poverty and birth obviously). At any rate, I'd be interested in knowing what their national previa/accreta rate is compared to countries with low c/s rates and no restrictions on childbearing. China is the other big c/s place, and we all know about how many kids you are legally supposed to have there, so health wise it's a much smaller problem.
post #33 of 73
OntheFence....just curious

do you include shooting drugs as someone's right to do with their bodies what they like?

How about shooting while pregnant?
post #34 of 73
OntheFence....just curious

do you include shooting drugs as someone's right to do with their bodies what they like?

How about shooting while pregnant?
post #35 of 73
Quote:
Originally Posted by boobybunny
I have to chime in here.


I have had three vaginal births and one hysterectomy.

I never needed narcotic pain relievers after a vaginal birth.
You didnt but some have.
Also, some homebirthers, not saying anyone here drink alcohol, smoke dope and do other drugs/herbs to help with pain relief during labor. I really don't see a difference.
post #36 of 73
Quote:
Originally Posted by goodcents
OntheFence....just curious

do you include shooting drugs as someone's right to do with their bodies what they like?

How about shooting while pregnant?
They have the right to do it, buts its illegal and they should go to jail and their kids taken from them, especially if their child is born addicted.

This has nothing to do with elective csections.

The thing is, all the statistics pointing to greater risks during a csection are for ALL csections. Not elective ones. Many women who have csections have them due to problems during birth -- which is going to skew the actual risks associated with having a cesarean birth. My decision to have a planned csection has far different risks than a woman with HELLP syndrome or a woman who is having problems in birth.

While you can post risks and articles pointing out the risks of csections, until there are actual and completed studies strictly on planned, elective cesarean births those risks are not going to truly apply.

Kim
post #37 of 73
Quote:
Originally Posted by OnTheFence
They have the right to do it, buts its illegal and they should go to jail and their kids taken from them, especially if their child is born addicted.

This has nothing to do with elective csections.

The thing is, all the statistics pointing to greater risks during a csection are for ALL csections. Not elective ones. Many women who have csections have them due to problems during birth -- which is going to skew the actual risks associated with having a cesarean birth. My decision to have a planned csection has far different risks than a woman with HELLP syndrome or a woman who is having problems in birth.

While you can post risks and articles pointing out the risks of csections, until there are actual and completed studies strictly on planned, elective cesarean births those risks are not going to truly apply.

Kim
I won't get into that (Maternity Center Association says it all in their document based only on the best studies), but all c/s elective or not produce greater risks of placental problems for subsequent pregnancies. It's a function of the scar and messing with the uterus, not how the surgery is done or circumstances or controlled and it's these risks that are usually the most dangerous consequence of c/s. So yes, if you only want one kid you can make your argument, but for 2 it gets tenuous and for 3+ you pretty much can't make it.
post #38 of 73
This is kind of crazy, that we are even discussing this on MDC. It's a natural family living site...hence...natural birth. I'm just surprised, but I guess dialogue is always good so we're not just in our little bubble

I just want to say that in the SPECIFIC instance where someone chooses a csec because of cosmetic/convenience reasons, I think they are bananas. I get why some people have them - the ones who have lost babies during birth, or had stillborn babies. In their shoes I would seriously consider it. And I have two IRL friends who don't seem able to birth babies on their own - actually have the huge baby/small pelvis mismatch. What I dont get is those above reasons, and the ones I've met who are just too scared to give birth vaginally - the ones who also argue for the universal epidural because 'it's just so horrifically painful'. Okay, yes, sometimes the pain for some people is unbearable. But get over it, ok, lots of people can handle it and birth babies just fine without all that crap. And honestly, if you're too busy to have a baby when it wants to come, then maybe you should question the whole parenting thing. Kids are so darned inconvenient, aren't they?
post #39 of 73
Quote:
Originally Posted by aprilushka
I won't get into that (Maternity Center Association says it all in their document based only on the best studies), but all c/s elective or not produce greater risks of placental problems for subsequent pregnancies. It's a function of the scar and messing with the uterus, not how the surgery is done or circumstances or controlled and it's these risks that are usually the most dangerous consequence of c/s. So yes, if you only want one kid you can make your argument, but for 2 it gets tenuous and for 3+ you pretty much can't make it.
The risks are still low. Its all about cost/benefit. The same measuring stick should be used for all statistics used in this venue, however it isn't. I have had three successful pregnancies without placental issues in a deformed uterus. My chance of having placental problems is greater than average, yet I was more than willing to take the risk, considering it was very very small.
post #40 of 73
I haven't read the article or all of the posts yet but this just strikes me as another situation where Dr.s think they know better and then 20 years down the road we all find out no, they didn't. But there is never any admission of a mistake. Its all the same story with different characters...formula is better than breastfeeding, babies should cry all on their own so they don't "manipulate" you, you should absolutely circumcise your son...its for his health (and don't worry babies don't feel pain), you should be strapped flat on your back for birth because the Dr's know how to control the situation, your baby should sleep on their stomach, no wait...side...hang on a sec...back. Thats right, back., you should only eat margarine its far better for your heart, sugar replacements are much better for you than sugar and 100% safe (okay so mainstream medicine hasn't back peddled on that one yet but its coming). Do you think we ever reach the point where we see whats coming and just head it off at the pass?

Anyway...I think it will just be a matter of time til the dangers of extreme intervetions in birth (especially elective interventions) are another thing added to the list of medical "ooopsies".

And with all of that being said...I think it was OnTheFence who originally posted somthing along these lines...I have to agree with every woman's right to choose the birth experience she wants for herself. If you are against elective c-sections then you are also against elective homebirth, or water birth since those aren't the norm either...the beauty of a free society is that everyone gets to decide for themselves. Even if what they chose looks pretty stupid to the rest of us. And if we rule out elective c-sections then where do we draw the line? Is a woman who has had five failed vaginal births forced to attempt a sixth because we don't allow elective c-sections?

Enough rambling from me ...I'll go actually read the article now

Casey
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