Interesting article about female OBs who choose CS

[sharr610]

Really interesting article...

Just presenting the Dr.s point of views...I've been thinking a lot about this lately, because I think a lot of the dr.s I've been in contact with over the past few years really are good and reasonable people who want the best for their patients, baby and mama. I know there are exceptions to that rule, but this does a great job of showing the logics a lot of them exist in and how just darn emotional this whole thing is on all sides.

Kinda makes me start likening the(sorry if this gets political!) the whole pro choice movement to the birth choice movement. Reminds me that all choices are valid...
just some ramblings, sorry, but I think its really important to understand all points of view here. I tend to get caught up in one extreme and forget the story is always more complex than I originally thought it was, kwim?

[tpintsch]

Having worked for an health insurance company I personally would like to see all elective c-sections as denied for not medically necessary. Sitting back and watching home birth's and midwives as typically non-covered expenses, I don't understand why a health insurance company would pay twice as much for a birth when it could have been done cheaper and with less of a chance of far reaching (costly) re-occuring medical issues. I know this is an odd angle to take, but it feels much the same as some insurance companies denying circ's due to it being a cosmetic procedure. Sorry if I offended anyone, but I can't believe that people would choose a method of birth that has been medically proven to be the most risky type of birth to have.

[sharr610]

I think thats where I have to let go is at the riskiness of it factor. Whereever we choose to give birth(I tried/intended/intend to at home), we are taking risks. I think this article highlights what risks different folks feel comfortable with, kwim? And we all want healthy kids, so its emotional and deeply personal what we choose and what risks we decide are most acceptable and unacceptable.

And I agree, its ridiculous a company will cover a surgery, and an elective one at that, and not something 1/10 of the price(with prenatals and all) that is equally(or more so, depending on your perspective) safe.

[tireesix]

Having looked into pelvic floor damage, it seems that most damage is actually done BY obs.

I don't know, that Ob states the reason she chose elective section is due to pelvic floor damage and also because she is most scared of having an emergency section, seems to me, that in that case, maybe she should have opted for a home birth with less unnecessary interventions etc.

[mntnmom]

But it impliers that OB's are more aware of the realities of birth than midwives, aren't THEY there for the births too?

It is rather scary that you only have a 50/50 chance of an uncomplicated birth!! No wonder OB's want a C-section, if those are seen as the only 2 options!!

[tireesix]

Lets face it, EVERYTHING that I have read over the past few years seems to indicate that Obs don't really practice evidence based care. Yeah you have good Obs and you have bad Obs and then you have normal Obs who do what they are trained to do, deal with pregnancy and labour as if it is an illness, an accident waiting to happen etc.

You have unnecessary monitoring, unnecessary inductions, unnecessary assisted deliveries and the list goes on and then they get scared to give birth themselves? Its no bloody wonder. They rarely see anything that is normal labour.

I will never forget this Ob who was on TV talking about her first birth. She ASSUMED her birth would be x hours long, she assumed she would be able to get to hospital on time, she kept on assuming.

She went into labour, she never got the chance to birth in hospital, she ended up birthing on the side of the road. She explained how she had NO IDEA that birth could be like that.

This is what it comes down too. If you are constantly dealing with the abnormal or acting as if everything is POTENTIALLY abnormal then you will never get a chance to see it for what it really is.

[Turquesa]

Originally Posted by sharr610

Kinda makes me start likening the(sorry if this gets political!) the whole pro choice movement to the birth choice movement. Reminds me that all choices are valid...

. . . Except that labeling an action a "choice" doesn't necessarily mean that it's ethically acceptable or defensible . . . or even a free choice.

Your post calls to mind a couple of quotes. The first is from feminist Germaine Greer: "A choice is only possible if there are genuine alternatives."

She was saying this in reference to abortion. But as long as you're linking the two issues, the OB in your article isn't seeing genuine alternatives. She is choosing cesarean not based on the full spectrum of scientific information--which does validate that normal childbirth is safer than cesarean--but on fears stemming from personal anecdotes and observation. The article even says so:

It's important to remember that it is the obstetrician's and the surgeon's task to remedy the rarer complications and consequences of childbirth. Unlike midwives, who oversee successful, normal births every day, doctors bear witness to the worst-case scenarios.

As Marsden Wagner said, fish don't see water. If you're surrounded by risk, you're going to see the world through the myopic lenses of risk.

I'm not condemning the OB for her choice at all. I'm simply saying that had she seen genuine alternatives, she would have based her decision on the true, factual risks and benefits of cesarean v. normal birth.

That leads me to the second quote from Frederick Matthias Alexander: “Choice is: The power to make a decision based on reason and discrimination rather than on fear or habit.”

ETA: In the context of maternity care and childbirth, I couldn't agree more.

[Vancouver Mommy]

How could anybody trust an OB who didn't trust the BIRTH PROCESS?

[tireesix]

Originally Posted by Vancouver Mommy

How could anybody trust an OB who didn't trust the BIRTH PROCESS?

Most women I know don't trust the birth process, its easy for them to put their faith in someone who they think can fix it, it doens't matter whether the Obs believe in natural childbirth or not.

[stacyann21]

How could anybody trust an OB who didn't trust the BIRTH PROCESS?

So true. I agree that most women don't trust it themselves. After having a virtually uncomplicated natural birth it is impossible for me to think of birth as anything but a completely natural process requiring no intervention whatsoever. I'm sure someone who had an emergency c-section because the baby got stuck/had heart decels/just took too darn long thinks of birth as a dangerous, unstable phenomena that requires vigilant intervention. My mom was rushed into an emergency c after laboring for several hours (she went to the hospital after her first few ctxs). It was a terrible experience in every imaginable way. The first thing out of her mouth after my son was born into my arms in a quiet, dimly-lit room at the birth center was, "Thank God you did it naturally!".

[alison_in_oh]

Originally Posted by tireesix

Having looked into pelvic floor damage, it seems that most damage is actually done BY obs.

Yes, this. If you do your kegels during pregnancy your PF will be flexible; if you are relaxed during delivery your PF will stretch; if you do your kegels after pregnancy your PF will return to its place. Much of the PF laxity is due to hormones softening it and a uterus heavy with baby stretching it! Has nothing to do with how the baby comes out. : Unless, of course, they make you push while holding your breath, or they cut into your muscles and squeeze equipment up there that was never meant to go.

[Kidzaplenty]

:

[~Megan~]

I think their viewpoint is skewed because OBs see highly intervened births as regular.

If we looked at the normal practice of midwives which includes interventions only when necessary (usually) the percentage of uncomplicated births is dramatically lower.

I can understand being scared to have a natural birth when all you see are typical hospital births

[tireesix]

Originally Posted by ~Megan~

I can understand being scared to have a natural birth when all you see are typical hospital births

Yes, I can see this, what I don't understand is why are MWs able to see that sometimes birth doeesn't work out but Obs seem incapable of seeing that actually, most births do go alright and 'luck' has nothing to do with it.

The Ob I saw a couple of weeks ago asked about how I plan to deliver, I said homebirth (she already knew from reading my notes) and she said 'just be aware it might not work out'. In fact, every Ob I have ever seen and Gynaes to for that matter are always warning that childbirth 'might not work out'. Its no surprise then that so many women doubt themselves, that Obs doubt their abilities etc.

I have fallen in love with Henci Goer by the way.

[sharr610]

One of the OBs makes it clear that she is basing her choice off of what SHE sees, HER experiences. She's not trying to say that there are not alternatives or other points of view...
Hypothetical case in point, as I think can be the case with many of us here. You have 6 friends, all who are pregnant. 5 choose to give birth in a hospital, 4 of those end up with unnecessary c sections, one just a generally crappy hospital birth. The 6th labors and has a beautiful birth at home.
This then becomes your picture of birth, in addition to readings, etc, but personal experience is the most powerful. So are you choosing home birth simply because its the safest or as an emotional response to what you see, kwim?
Turquesa, you mention this quote:
Frederick Matthias Alexander: “Choice is: The power to make a decision based on reason and discrimination rather than on fear or habit.”
i think this is a great quote, but when it comes to the birth of our child, can any of us say there is not a fair amount of fear tied into it, be it fear of the hospital or fear of "complications?"
Again, don't get me wrong, I agree this is a crazy sentiment these ladies are talking about in this article. I believe in a woman's ability and right to give birth where she pleases as naturally as possible. I choose to give birth at home. I beleive there is a ton of fear mongering that surrounds birth in our country and that it leads to horrible interventions, lots of complications in and of itself and that its a self fulfilling prophecy.
What I find interesting alone is that these women are not unlike ourselves in wanting a healthy birth for their child, I think some of us sometimes forget that, they are simply basing it off a different database of information than we are. Its incomplete, for sure, but I think that none of us have all the information. At best, we read as many sides as we can and make an informed decision from there, but I don't think it can ever be the real picture.
Oh, and Megan, I hate the "it might not work out" comment from OBs as well, but having had a homebirth that didn't work out, I can at least understand their perspective. They ONLY see the ones that don't work out. My OB saw how much it left me kinda traumatized after the fact. Its really annoying, but I have to remember where its coming from.

I hope Im making sense here.

[RomanGoddess]

Obstetricians (including the ones in the UK) have no idea what a real natural birth is like. For them, a "natural birth" involves going to the hospital, sitting on your back in stirrups, and then risking all of the other hospital interventions (including emergency c-section) that follow. From that perspective, I understand her point of view that she would prefer just to go with the elective caesarian.

[kitkatkaddoodle]

I personally think that OBs having elective primary c/s are often doing it because of the complications they see every day and the fact that natural childbirth requires you to let go and let things happen without your control. Doctors are usually required to DO something, to have a plan, to be on a timetable, and like to limit the variables--surrendering to your body's signal and being open to the many paths of the labor experience are probably against their nature and training.

They are used to crisis and intervention--it's no wonder the definitive sharp edge of the scalpel seems the better option to some of them than the more open-ended plan of vaginal birth.

[urklemama]

It makes me angry that almost all women are required to abide by the nonsense created by MDs, but MDs won't abide by their own nonsense. If you labor in a hospital, you are prevented from eating because of decisions made by some committee. If you live in a state where homebirth is illegal, your options are seriously limited and you even risk losing your child to CPS if you birth at home, because of some rot that MDs came up with. But if you're a female OB, you feel perfectly ok using your power and privilege to go against your own professional association's recommendations about elective c-sections. You do it because you can, and you don't stop a minute to think about all the other women who are prevented from have the birth they want because of the actions of your profession.

[elanorh]

I have a friend who finished her OB residency last summer. She tells me that when she has a baby, she won't be "one of those women" who tries to have a natural birth - she's going to get an epidural right away.

So she doesn't want to go straight to a c/s, but she hasn't seen many good normal childbirths (intervention-free or pain-med free). She did tell me awhile ago that she'd seen the most amazing birth, a mother vaginally delivered an induced 10+ pound baby who was presenting forehead first and the mother delivered without pain meds.

And of course, I'm thinking - bet the weird presentation was because you induced her.

Anyway, we had a long conversation once about breech deliveries etc. (she's never seen a vaginal breech delivery) and she said that she's done hundreds of c/s (this as just a recent resident! ) and that she's proficient at those, and skilled, and wouldn't most moms prefer that the doctor handle these things in the way that they are best trained to handle them (that if she'd had vaginal breech training she'd do it, but she didn't so c/s it is).

It was sad. Such distrust of women's bodies and the whole birth process. And again, when something like 80% of births have epidurals (I don't remember where I read this - Pushed?) - and when so many deliveries are induced, and many doctors still routinely perform episiotomies (which I'd lay $$$$ are causing a lot of that "vaginal delivery pelvic floor damage" mentioned in the linked article) ..... when the doctors haven't seen normal deliveries, only the "cascade of interventions" then of course they'll feel this way.

But it doesn't justify them continuing to practice medicine as they have been. The largest issue is that most of the timetables and interventions which they foist upon their patients, aren't based on any evidence-based science. They're just tradition, and as superstitiously based (and practiced) as a lot of other traditions. That's fine when the traditions don't affect the health and safety of women and their children; but these ones most assuredly DO.

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[honeybee]

Notice how the one doc talked about the "madness" of homebirth while in the same breath talking about how "choice" for elective c's should be valid?

What I hate about the whole talk of "choice" is the double standard depending on who is doing the talking: elective c-section is about mothers' choice according to ACOG, but homebirth is a "fad." And if you talk to many hb supporters, elective c-sections should be banned because they are not the "right" choice. Either women have the right to make their birth choices or they don't. Period.