Why Are People Against Elective C-Sections?? - Page 4

[Romana]

Originally Posted by anne1006

I think that if someone wants and elective procedure, then they should pay for it. If there isn't a medical need for it, then it should be out of pocket and not driving up insurance premiums. My premiums won't pay for my homebirth, and I don't want to pay for someone who is too posh to push. If our medical standards and practices went along more with current research, there would be far fewer interventions and elective procedures, and our insurance would be better off. Though the hospital pocket books probably wouldn't be.....

No, no, no, no, no! The answer is not to reduce the available choices! The answer is not to make non-medically necessary elective c/s something that is only available for the rich! I absolutely abhor this kind of approach.

What, some jerk male OB a low-income woman on WIC/medicare gets is going to give her a fair shot at getting her "non-medically-necessary elective c/s" covered because she previously had an extremely traumatic vaginal experienece (rape, birth trauma, whatever)? Probably the same crappy OB who caused the trauma in the first place??

The answer is not to reduce choice by financial prohibitions. That can only hurt those unable to afford the procedure and does nothing about the type of non-medically necessary elective c/s that gets media coverage.

[Romana]

Originally Posted by SneakyPie

Oh for crying in the night. We all know "elective" doesn't mean only "because I don't feel like having a vag. birth." "Elective" also covers every situation in which the mother has any time and warning at all beforehand and makes a DECISION (with her practitioner) that c-birth will be best for her and the baby. The medical profession themselves are the ones who have classified that as "elective," meaning "the opposite of emergency." So ANY non-emergency c-section is "elective" by this definition, and to slam all mothers who have to make that choice as semi-intelligent, not possibly REALLY informed, and undeserving of medical coverage, is just kneejerk and unthinking.

I thought this was clarified earlier in the posts. I for one have specifically been calling the kind of c/s under discussion "non-medically indicated elective c/s" in order to keep that point obvious.

[holly6737]

Originally Posted by thismama

I am pro informed birth choices, including elective c sections.

Me too. If a woman is fully aware of the risks and the benefits, and is not swayed by her practitioner one way or the other, I would support that woman's right over her own body and her right to choose an elective c-section.

Her body, Her birth. It cuts both ways.

[Incubator]

Originally Posted by thekimballs

It's ridiculous to say that no semi-intelligent person can choose an elective section (because of the published risks) unless you're also going to say that no semi-intelligent person could ever have a vaginal breech (where the published risks show that it is riskier than a c-section) or a UP/UC (where the published risks show that no prenatal care is associated with a worse outcome).

Okay okay, wait a minute, here I have problems... Forgive me if I'm wrong but I'm under the impression that a vaginal breech may be riskier for the BABY, but is, in fact, safer for the mother and safer for future babies than a cesarean... And that's not counting how safe the vaginal breech birth might be if the person CATCHING the baby actually has plenty of experience catching them. Were I giving breech birth in a hospital I'd be terrified of the expertise of the CP too, but I'd be insane to deliver a breech vaginally with just ANY care provider... I may as well ask my midwife to do the C-sec, it would probably be just as safe as asking an OB to catch a breech baby.

ETA: I didn't even mention the last part about prenatal care, where the statistics may be skewed by homeless, low income, or drug-addicted mothers who do not seek prenatal care as opposed to generally healthy informed mothers who decline prenatal care...

[barefootpoetry]

Originally Posted by sapphire_chan

Every one done makes doing c-sections for any stupid reason that much more acceptable. And makes people who want natural births have to fight that much more to not get interventions--after all, what's the big deal with an induction? it'll still be a "natural" birth! :

Not all birth choices are treated equally. Every woman doesn't have a chance to choose the birth she wants. Homebirth, VBAC, etc.

YES and YES. It really chaps my @ss that I have to search high and low for a HB MW who will do a HBAC and pay her out of my own pocket, but if I wanted a RECS, the docs at the local hossy would be more than happy to do it for me.

The more "unnatural" births there are, the more unheard-of a true natural birth is, and the more difficult it will be to obtain in a hospital setting. That leads to first-time moms like me (er, like I WAS) getting railroaded into yet more C-sections because the staff either doesn't know or won't allow them to labor naturally.

I'm all for freedom of choice, but not when it affects MY choice too.

[MaterPrimaePuellae]

Originally Posted by LaLaLaLa

I had an elective c-section for my second child. I was VERY much informed of the risks and possible complications, and pressured by my Ob/Gyn NOT to have one. After explaining myself and signing a bunch of waivers, I was in business.

In my particular case, things worked out better for everyone involved. My first birth was traumatic. My dd tore through my body to the extent that moments after she was born she was handed to my dh and I was rushed off to have emergency repair surgery under general anesthesia. I didn't hold her. I didn't breastfeed her. Dh gave her a bottle. I don't remember anything from the first day or so, and I was on a great deal of medication (morphine, I think). Our nursing relationship (either as a result of this or a totally separate issue) was never really strong. I couldn't stand without assistance for two weeks. My body wasn't right for months afterward.

Before I became pregnant again, I made certain that my doctors would perform a c-section. If they had said no, I probably would not have had my ds.

Ds's birth: I knew exactly when it would occur, which eliminated any stress of childcare for dd. My parents live a couple of hours away and there was nobody else I felt confident watching dd if I were to go into labor in the middle of the night or something. A childhood friend of mine is a labor and delivery nurse at the hospital, and she specifically planned to be there to work with me. After ds was born, he was brought to me to touch and examine before visiting with dh for a few minutes as I had my tubes tied (since my abdomen was already going to be open and all, it made more sense to us than scheduling a separate surgery) and was sewn up. Ten minutes after ds was born, we were cuddled in bed together, breastfeeding. The next day I was up and showering, a feat it took me two weeks to accomplish after my first birth.

In terms of recovery time, things were better for me. In terms of stress, things were better for all involved. After having dd, dh and my mom really thought I might die, as the blood loss and the doctors' reactions were so dramatic. In terms of medical costs, I would imagine things were similar, as my first birth ended in emergency surgery, as opposed to planned surgery the second time around, plus I avoided an additional surgery by having a tubal ligation at the same time as the c-section.

An elective c-section is by no means right for everyone, and I made the decision the first time around that it was not right for me. But for my second pregnancy.... I wouldn't have had it any other way.

Wow-- I am so sorry for your first birth experience!! What a nightmare. I don't think I would even categorize your c-section as "elective." I don't know exactly what happened with your first birth, but it seems to me like the c-section was medically indicated.

Bethany

[alegna]

Originally Posted by SneakyPie

So ANY non-emergency c-section is "elective" by this definition, and to slam all mothers who have to make that choice as semi-intelligent, not possibly REALLY informed, and undeserving of medical coverage, is just kneejerk and unthinking.

I don't see anyone here doing that. I see lots and lots of disclaimers to that effect.

-Angela

[hanno]

Originally Posted by thekimballs

It's ridiculous to say that no semi-intelligent person can choose an elective section (because of the published risks) unless you're also going to say that no semi-intelligent person could ever have a vaginal breech (where the published risks show that it is riskier than a c-section) or a UP/UC (where the published risks show that no prenatal care is associated with a worse outcome).

just want to point out that UP does not mean NO prenatal care

[thekimballs]

Originally Posted by Incubator

Okay okay, wait a minute, here I have problems... Forgive me if I'm wrong but I'm under the impression that a vaginal breech may be riskier for the BABY, but is, in fact, safer for the mother and safer for future babies than a cesarean...

Originally Posted by hanno

just want to point out that UP does not mean NO prenatal care

This is exactly what I am talking about. When you apply aggregated statistical risk to a vaginal breech or to a UP, you totally disregard the fact that there are individual factors involved--that caregivers are very different, that some women may want to assume (or reject) individual risk in favor of baby's risk, that UPs are radically different depending on the woman in question, and a hundred other issues.

We MUST do the same thing for "elective" sections. Making a flat statement like no semi-intelligent woman would ever choose a section or that a woman who chooses a section is ipso facto "not informed" because of exactly those same types of aggregated risk statistics dismisses ALL those individual factors, and also dismisses the preferences and emotional involvement of the mother.

[rmzbm]

Originally Posted by thekimballs

We MUST do the same thing for "elective" sections. Making a flat statement like no semi-intelligent woman would ever choose a section or that a woman who chooses a section is ipso facto "not informed" because of exactly those same types of aggregated risk statistics dismisses ALL those individual factors, and also dismisses the preferences and emotional involvement of the mother.

Yup! Lots of factors play in. I have a section coming up in March, non emergency & elective. I consider myself VERY educated.

[alegna]

Originally Posted by rmzbm

Yup! Lots of factors play in. I have a section coming up in March, non emergency & elective. I consider myself VERY educated.

As has been added by disclaimer, posters here are not talking about medically indicated sections, which yours most certainly is Marie

-Angela

[CNutty]

I am not personally agienst fully informed woman having elective c-sections, but 2 questions come to mind...

1. If this woman was trying to avoid labor at all, they potentually could take place WAY to early for the baby, and cause health problems. I guess this could be solved if the woman was willing to go into labor first, and then have the section, but I doubt that is the way it happens.

2. If all woman have this option, then couldnt it become a slippery slope leading to all sorts of people being able to demand whatever kind of elective surgury they wanted? Like say a Doc thought that some other treatment besides surgury was the best option for someone who say had a gullblatter problem, could that person just demand removal and trump the Docs opinion?

[rmzbm]

Originally Posted by CNutty

2. If all woman have this option, then couldnt it become a slippery slope leading to all sorts of people being able to demand whatever kind of elective surgury they wanted? Like say a Doc thought that some other treatment besides surgury was the best option for someone who say had a gullblatter problem, could that person just demand removal and trump the Docs opinion?

I do actually think all sorts of surgery should be readily available. The patients preference should always win in the end, right or wrong....and they should be willing to take FULL responsability for it. Medical, legal, emotional, etc.

[CNutty]

Originally Posted by rmzbm

I do actually think all sorts of surgery should be readily available. The patients preference should always win in the end, right or wrong....and they should be willing to take FULL responsability for it. Medical, legal, emotional, etc.

I agree with you, but I dont see this happening, I see legal fees and law suits going through the roof...as if they already arent

[rmzbm]

Originally Posted by CNutty

I agree with you, but I dont see this happening, I see legal fees and law suits going through the roof...as if they already arent

Yes, and it is a huge irritance to me. Very unfortunate. I won't LISTEN to the MD, but I will BLAME them for everything...come on! :

[ktbug]

Multi-quote reply coming up here; what a good thread! First, OT:

Originally Posted by sapphire_chan

OB who trained in Brazil (90% c-section rate) who's now a malpractice lawyer in the U.S.?

Holy ... what now? 90%? What the hell is going on in Brazil?
I need to find me some sociological studies about this.

Originally Posted by 1006baby

How can the people (doctors and hospitals) who are financially incented to encourage c-sections be responsible for ensuring informed consent for an elective c-section?

Such an important point. The money really is the bottom line in a great many cases of dodgy informed consent. But, that isn't going to change until the dominant model of prenatal care changes. And the dominant model of the doctor-patient relationship, and the medicalization of our society, and the blind trust many health care consumers put into their doctors.

Originally Posted by anne1006

My premiums won't pay for my homebirth, and I don't want to pay for someone who is too posh to push. If our medical standards and practices went along more with current research, there would be far fewer interventions and elective procedures, and our insurance would be better off. Though the hospital pocket books probably wouldn't be.....

The first sentence ... should be your dddddc. And I agree with you, I don't want to pay for that either, but that's sadly how the health insurance system (scam?) works.
The second point of your post - if insurance companies based their coverage decisions on hard research and fact ... ... I'm trying to count in my head how many major corporations would have to declare bankruptcy ...
I wish it worked that way, too, but I don't know why the belief so stubbornly persists that insurance companies are in the business of keeping us healthy. They are not. They are in the business of making money, which often correlates to keeping us - wait for it - sick! If they were concerned with our health and well-being, they wouldn't make nearly as much money.

Originally Posted by thekimballs

This assumption that no woman who is truly informed can possibly choose X is very, very dangerous. How would you like it if an MD used that type of logic against you? Or if the courts assumed that type of logic when granting court orders for medical treatment? It's the polar opposite of individual empowerment; it's enslavement to statistical risk.

Nicely put, Joanna. I'd like to add that having all the information doesn't really equate to making the best decision based on the available information. And the feeling of empowerment is quite subjective, as you point out. Some women feel very empowered by wearing pants, or driving a car. Some men feel empowered by hurting women. Some people feel empowered by spending money, or by NOT spending money. Here at MDC we tend to focus on the "empowering" aspects of vaginal birth, but not all women who give birth vaginally feel empowered by it.

Originally Posted by Romana9+2

The answer is not to reduce the available choices! The answer is not to make non-medically necessary elective c/s something that is only available for the rich! I absolutely abhor this kind of approach.

The answer is not to reduce choice by financial prohibitions. That can only hurt those unable to afford the procedure and does nothing about the type of non-medically necessary elective c/s that gets media coverage.

I agree with this 100%. Either cover it all, or don't cover any of it. Picking and choosing only gives advantage to some at the expense of others; usually to the wealthy at the expense of the not wealthy.

And, finally ...

Originally Posted by holly6737

Me too. If a woman is fully aware of the risks and the benefits, and is not swayed by her practitioner one way or the other, I would support that woman's right over her own body and her right to choose an elective c-section.

Her body, Her birth. It cuts both ways.

Yup, yup. Though the salient point is obviously "...is not swayed by her practitioner ...", and you should remember that a lot of times, the swaying is subtle, and not admitted to or acknowledged by the woman.

Haha, "cuts".

Holly, I always find myself agreeing with you in posts outside the vaccinations forum.

[Ironica]

Originally Posted by thismama

She is informed. We have had the discussion. She can talk circles around me with her medical knowledge and stats about various risks, she is not just some ignorant woman under the spell of her OB because she chooses differently than I would. That is my point here.

She's a medical malpractice lawyer... of COURSE she can talk circles around anyone who isn't with medical knowledge and stats about various risks. That's her job. If she sucked at it, she'd be something else. ;-)

Her job is also one that exposes her repeatedly to all the things that go WRONG. Yes, she can tell you about this risk and that risk and it all adds up to make vaginal birth seem VERY dangerous. But when you take it piece by piece, the various risks are infinitesimal compared to risks we assume every day. And how much does she talk about the risks of surgical birth? One thing she may not have mentioned is that, when someone dies on the operating table or in recovery (which happens more often with c-sections than vaginal births), there's much less likely to be a lawsuit... because the risks of surgery are much better understood and acknowledged. When someone dies after surgery, the doctors can explain it in a way that removes their culpability (often because it truly is a normal risk of surgery... which there are MORE of than normal risks of vaginal birth). So, from her professional perspective, c-section is "safer", because it's less likely to cause a lawsuit. Also, since it's less likely to cause a lawsuit, the arguments about how much more DANGEROUS vaginal delivery is are very well-established. There's tons of case law, statements, and decisions she can read and learn that lesson from. There's a lot less available to argue the other side, since a lawsuit is less likely to happen after a surgical birth.

There may be certain things about HER situation that truly make c-section safer for her, I suppose. But she doesn't have a perspective that allows her to weigh the information in an unbiased manner. My FIL is a personal injury attorney, and I see how that colors his perspective of everyday life. He sees all kinds of ways people could trip or slip or fall as so HUGELY dangerous, while ignoring other very real risks, such as routine kitchen hazards. He's not *wrong* that a cord strung across a pathway could cause someone to trip and fall and hurt themselves, but his perspective of the *relative* danger is skewed by his years of practice arguing that THIS type of hazard is far bigger.

[sapphire_chan]

Originally Posted by rmzbm

Yup! Lots of factors play in. I have a section coming up in March, non emergency & elective. I consider myself VERY educated.

I don't consider your planned c-section to be elective. Having a c-section because you've been told by a doctor and a midwife that there will be strong possibility of you dying as a result of vaginal childbirth is not arbitrarily deciding to have a c-section with no thought.

[sapphire_chan]

Originally Posted by ktbug

Holy ... what now? 90%? What the hell is going on in Brazil?
I need to find me some sociological studies about this.

Sorry, it's actually just some private clinics in Brazil that have that rate. http://www.time.com/time/magazine/ar...993857,00.html However an OB who trained at one of those clinics would still have a seriously distorted view of birth.

[groovynaturemama]

statistically speaking we (the US) could potentially see c-section rates soar to 50% of all births in our lifetime if we continue at the rate we're going. i believe it is 30 something % at this time. despite our ever climbing c/s rate, we still have the 2nd highest infant mortality rate in the developed world... if nearly 1/3 of our babies are delivered in this manner, then why the high mortality rate? why is our infant death rate higher in this country than in a country where 70% of all births are midwife attended, and the c/s rates are waaaaay lower?

with that known, and being informed about the risks of elective c/s as well as the potential for them to drive up healthcare costs, it almost seems (IMO) irresponsible to have one unless it is medically indicated or an emergency. a c/s really should only be offered if there is a true medical need. this too posh to push stuff is just over my head