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#31 of 120 Old 08-18-2012, 11:54 AM
 
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Originally Posted by Alenushka View Post

Why people always talk about cascade of interventions?

 

What about cascade of non interventions?

 

The effect of c-cestion not being done when it should have been done are father graver than c-section done when is should have not been.

 

Loss of perfect birth experience vs loss of the baby and maybe mother.

 

Birth is natural...so is cancer and kidney stones


Oh geez, give me a break! Nobody (certainly not I!) is suggesting anyone choose not to get a c-section if they need one, or an epidural if they need one, for that matter. I'm pretty sure we can all agree that we are truly grateful the miracles of modern obstetrics are available to us.

Nobody is denying that things can go wrong in birth and that mothers and babies lives are saved by interventions.

I am not saying any of that, and I'd appreciate you not putting those words in my mouth.

People talk about the cascade of interventions because it is REAL. It is documented. It is not a figment of the imagination of a bunch of wackadoodle hippies. It actually does hurt people, and cause unnecessary pain and suffering.

In the U.S. the c-section rate is around 33%. The Farm Midwives c-section rate is 1.5%. Will you not admit there's something wrong with that picture??

What we are talking about here is a first-time-mom jumping straight into the interventions without even being aware of the possibility she might not need them, or that they might cause her harm.

Maybe that IS the right choice for HER. Sometimes it's the right choice. But when almost everybody in the population takes that approach, there is something wrong with the culture. That is a public health issue.

"Baby Friendly" hospitals are those whose practices support a good start to breastfeeding. At this time only 6% of U.S. hospitals are doing this! It's crazy.

That's what all the upset is about. Nobody wants to turn down needed medical care or deny it to anyone, or make anyone feel bad for needing it when they do. This is about wanting to make things better!
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#32 of 120 Old 08-18-2012, 12:24 PM
 
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No, a root canal is not "natural," but if a tooth was rotting, would anybody look down on Novocaine for an extraction?

Key words here: "IF a tooth is rotting!" Epidurals are great *when needed.* It's reasonable to assume you don't need an epidural, until you do. Not the other way around.

And epis should be approached with much more caution. As far as I know, Novocaine is unlikely to cause your root canal to go awry, causing you to lose other teeth for example, or risk possible life-long pain every time you chew. (Which can happen when an epi increases chances of an episiotomy, for example.)

Root canal--birth: not an accurate comparison. Epidural--Novocaine: not an accurate comparison.

BTW comparing birth to disease (cancer/kidney stones) is completely ridiculous. Birth is its own beast. It sometimes has complications and does not always go smoothly. But it does not equate to an injury, a disease, or a malfunction by its very nature.

McGucks, in case it needs to be said: I am not saying your birth interventions weren't needed, and I'm not making any judgement on you. I'm glad that you did what you needed to do and that you have no regrets.
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#33 of 120 Old 08-18-2012, 01:06 PM
 
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Thank you Sympathetic Dad.  I had two of my children with epidurals.  For my third I thought, hey I can do this.  I was induced and then went natural.  That is the most traumatic birth by far.  I was so out of it it was unbelievable.  I was scratching my face and flipping out.  I focused on a spot on the ceiling and did fine until closer to the end.  I kicked the doctor out of nowhere.  It was awful.  I cried and cried after that birth.  My next two I had epidurals.  My last one I got one right at the end so went through heavy birth like my 3rd for a while.  Not everyone feels the same way as you all.  My births with the epi's were beautiful!  I could feel them coming down, look at the expressions on people's faces and it was plain wonderful.  I love those births.  I hated my other two births.  I am not a wimp.  I didn't flinch getting a tattoo around my arm.  I know my body was made to do this but MY body does not do well.  

I finally realized that it is because of my SPD.  There is no info on this but I know this is what it is.  I have an extremely hard time nursing too.  The sensation is unbearable.  I literally rub my toes together so they are bleeding so I can concentrate on that pain instead of the nursing sensation.  All of my friends have home births and that is wonderful.  I have come to terms that not everyone thinks birth is beautiful if it is pain free and natural.  FOR ME, I have a different way of achieving beautiful.  Your BF has already been exposed to home birth and I am sure has heard all of its benefits.  I think this is a time for support and encouragement for HER birth plan.  It took me a lot of years to get out of the guilt of getting epi's when everyone around me wasn't and hopefully your friend won't feel that way.  Every birth can be beautiful whether they are born at home, at the hospital, with pain meds or not.   

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#34 of 120 Old 08-19-2012, 01:14 AM
 
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Really? I have heard lots of women talking about spinal headaches and nerve damage and how something still physically bothers them years after.
And it's not the epidural itself that is the most scary thing (although even just the needle is admittedly slightly scary.) It's the cascade of interventions--which I KNOW does not always happen, but happens frequently enough to be serious--that terrifies me.
Also the fact that being forced to be lying down, immobile, strapped to machines, and monitored by other people--it is quite a stretch to say that is a psychologically empowering position to be in.
I suppose you surrender to the process when giving birth no matter what, and some people surrender to medicine and interventions while others surrender by trusting their own body. And in the end it's all the same.
But still I just can't wrap my mind around why someone would willingly choose the medicalized version unless she was forced, or very uninformed.
Alenushka, you seem as much invested in medicalized birth as I am in natural birth. If you have had great experiences with the medicalized version, then that is really wonderful and brings me hope that it can be that way for more women. I just have too many friends who've had *terrible* experiences--I mean like, horror stories, in the hospital with an epi, to believe that a positive empowering hospital experience is anything but an anomaly.
I witnessed one of my best friends birth in the hospital with an epidural, before I had my kids. It was such a shockingly horrible ordeal, took all her power away and hurt her so badly. I am still traumatized by the memory--I can only imagine how she feels. greensad.gif It was a major factor in choosing natural birth for myself later.
I know my friend is just one person. And yes, I know those positive stories exist, just like homebirth-gone-wrong stories exist.
I really do agree with the "birth is a mystery" sentiment.

Woah @ bolded. 

I am constantly amazed at how many people engaged in this particular discussion cannot see that it's an area where reasonable minds can differ. I personally am still on the fence, after reading extensively on both sides of the discussion (and having an educational and professional background that helps make me a relatively sophisticated consumer of scientific literature). 

 

Many women choose medicalized birth after a natural birth. Hard to think of a more informed decision maker than a S+TM, IMO. Other mommas do the opposite. I am wondering what information you think moms who have done both are missing, when they say they'd go medical again?

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#35 of 120 Old 08-19-2012, 06:57 AM
 
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BTW comparing birth to disease (cancer/kidney stones) is completely ridiculous. Birth is its own beast. It sometimes has complications and does not always go smoothly. But it does not equate to an injury, a disease, or a malfunction by its very nature.

 

I have to disagree here with you on a few points.  This may make me a little unpopular.  I apologize in advance.

 

First off, in terms of the pain caused or not caused, it's perfectly valid to compare childbirth to other potentially painful procedures or trauma that can happen to a human body.  I'm aware that we all like to get misty-eyed about the incredible beauty of this miraculous event blah blah - I did it a little myself a few posts ago.  But if you step away from it and just look at what's happening physiologically, you're passing a huge object out of an opening that (in a primipara) has to stretch to a size it's never been before, and to make matters worse orient it in such a way that it passes through the MOST STUPIDLY-SHAPED HIPBONE IN THE NATURAL WORLD.  Childbirth is beautiful, yes.  It is also hugely traumatic, in the dictionary sense of the word.  If the analogy between childbirth and a root canal fails it is only because childbirth is more dangerous (according to several thousand years of human experience) and more painful (according to my wife).

 

Second, a few people on this thread have made reference to women's bodies being not just natural but 'designed'.  This is a misunderstanding of how evolution works.  Over hundreds of thousands of years (and probably tens of thousands of generations), evolution has blindly stumbled, through random mutation, on a geometry for human bodies that allows huge-headed babies to come out of the womb (barely) while still preserving the ability of women to run, upright, presumably to avoid being eaten by bears.  The only thing that this means is that more women with this body geometry managed to reproduce than women with other body geometries.  For all we know, there were mutations for women with much larger hip-bone interiors that gave birth more easily, and more successfully, but then who were devoured by bears moments after birth, or sometime thereafter.  The only thing that matters, evolutionarily, is that enough women were able to reproduce.  A huge number of women could (potentially) die during childbirth, and evolution would happily skate on, blissfully unaware, as long as those who lived could reproduce.  This is why whenever I see the word 'design' in these threads, my eye twitches.  According to the best studies I could find, the 'natural' maternal death rate is estimated at about 1500 per 100,000 births.  That's a death rate of over 1%.  That's a pretty lousy design.  If there was a 1.5% chance you'd die every time you got in a car, you'd never get in it.

 

Fortunately, thanks to modern medicine, the actual modern Western death rate is more like 9 in 100,000, according to the WHO.  In Sub-Saharan Africa, which is rich with folk-wisdom and midwives, but lacking in medical supplies, the death rate is 900 in 100,000.  Let me say that again in another way: when modern medicine isn't available to assist with childbirth, the death rate is two orders of magnitude higher.  So although we can all agree that "birth isn't a sickness!" I actually don't agree with the assessment that "birth isn't a medical event", because we have good statistics, gathered today, that tell us that without medical expertise - which doesn't necessarily mean provided by an O.B., mind you, Certified Nurse Midwives have great results in studies, for example -  it's a hugely risky medical event.

 

Lastly, I need to say something about the "cascade of unnecessary interventions".  The problem is that there is a fundamental misunderstanding, in this country at least, about what the job of a doctor is.  We all think (and I used to think this way too) that a doctor is a woman or man in a white lab coat who runs a lot of tests and then figures out what is wrong with you by looking through a microscope.  Maybe there's something completely new wrong with you - that's ok!  The doctor will figure it out!  Likewise, if you're pregnant, the doctor will look at you and just be able to tell "A-ha!  Your blood-pressure is X, and your skin tone is Y, this means that you are just beginning to go into pre-eclampsia! TO THE HOSPITALMOBILE, we will save you!"

 

I'm here to tell you that you are wrong about what doctors do.

 

What doctors know is statistics and how to use them.

 

With many syndromes in pregnancy, by the time there are obviously visible symptoms, it is often too late to save the baby; pre-eclampsia is a great example of this (disclaimer: i am not a doctor, and i don't actually know anything about pre-eclampsia.  I'm just using this as an example of the sort of analysis you'd prefer to do before there is an acute problem).  The analysis is statistical.  Does the patient have risk factors for pre-eclampsia?  Well, let's see.  Her mother had pre-eclampsia in a pregnancy.  This is her first pregnancy, and she's 18, obese, gets frequent migraines, and has gestational diabetes.  Based on the totality of those factors, this patient has X% of developing pre-eclampsia.

 

In walk two patients, Alice and Betty.  Alice and Betty, let's say, present with the exact same medical histories and yield the same statistical chance of developing pre-eclampsia.  Let's make it easy and say it's a 50% chance.  Either one (or neither) of Alice or Betty might get pre-eclampsia and lose their babies or their lives.  No doctor in the world can tell which one of them it will be.  All they can tell you is that, statistically, half of the patients with these symptoms end up in pre-eclampsia.  Thus, since 50% is a really, really huge chance when lives are on the line, the doctor will probably recommend extremely frequent examination coupled with early induction or c-section at the first wisp of trouble.

 

The thing about statistics and probability is that the statistics are only meaningful before the outcome is revealed.  This is super-hard for non-mathematicians to understand, but it's true.  If you flip a fair coin, you have a 50% chance of getting heads.  If you look at the coin, and it's tails, it's nonsensical to say "well, I might still get heads half the time I look at this coin."  Once you've looked at that coin, the chance of it being tails is 100%, and the chance of it being heads is 0%.  A proper statistical analysis is about future events.

 

The 'Unnecessary cascade of interventions" language is all about proving, after the fact, that the coin was tails so therefore the interventions were not needed.  But just because the coin happened to turn out to be tails does not mean that before we knew the outcome the 50% chance of it being heads didn't exist.  Analogized a different way: just because you arrived at your destination safely doesn't mean that there wasn't risk from being in the car with a drunk driver.  Yes, sometimes a doctor can look at an X-ray, and say "Welp, your arm is broken.  Let's put a cast on it."  But more often, particularly in pregnancy, all they can do is say "Other women with your presentation had this good outcome X% of the time, and this bad outcome Y% of the time.  My medical opinion is that we should do (some intervention) to try to avoid the bad outcome, because I think Y is a big number."

 

Anyway, I've gone far afield from the topic here.  But I just wanted to address some of these points because I see this language all the time, and I think it does everyone a disservice when we fail to remember that medicine is, by and large, about understanding and applying probability and statistics.  Mothers (and, more generally, patients) always have the right to make their own decisions about whether to accept or refuse treatment.  But I think it's important to do that from a position of knowledge, based on data and an understanding of probability and statistics, rather than a position of weakness, based on intuition and superstition.

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#36 of 120 Old 08-20-2012, 10:44 AM
 
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SympatheticDad,
 

What I am saying is that the experience of childbirth is not necessarily painful.  Your wife experienced pain, so do many other people.  I told myself that birth would either be so painful I wanted to die, be orgasmically wonderful, or somewhere in the middle of those two extremes.  I happened to have a labor that was a lot of hard work but was an overall amazing enjoyable experience.  Not because I was misty-eyed, but because I was working hard to do something important and I liked it and had interesting sensations. There were moments that hurt a bit but then I would just recognize that and try to relax more.  It worked for me. Everyone's experience is different. Please don't discount my experience and the possibility that a woman could be missing out on this type of experience if they choose a more medical birth. 

 

Maybe another woman would try to "go natural" and find it so bad that they needed pain relief or a c-section.  That's cool, they have that available to them here in the U.S. and that's great. I think it's also great that a woman can choose to do whatever she wants for birth, and that she can decide ahead of time or in labor.  Whatever works for her.  But to have a culture that only talks about how painful birth is, is missing a lot to the discussion.  

 

I believe birth isn't a medical event until some specific problem presents itself that makes it a medical event for that particular birth.  Until then, women are just doing the best they can to get the baby out of them.  And the body has a really impressive way of doing that.  It's not like a baby just squeezes itself out of a regular everyday uterus, cervix, and vagina.  Things happen in the body to get it all prepared to birth.  Penises change shapes and sizes every day, then go back to how they were. That seems pretty wild to me.

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#37 of 120 Old 08-20-2012, 10:54 AM
 
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I'm one of thos lucky people who have fast and manageable births.  Manageable as in hurts for maybe 20 seconds of a 60 second long contraction, fast as in 86 mins with #1. 61mins with #2.

 

I fully accept my births are so "abnormal" that there's no point in me telling other people anything other than "my story" - i can't say it doesn't hurt, only that it doesn't really hurt me.  I can't tell them it's not exhausting, only that it doesn't really exhaust me.

 

The thing that would really worry ME in your friend's plans is what will happen if....  I'm in the UK.  You're not going to get an epidural the second you want it.  Not unless you're pretty lucky, there's not that many anaesthetists and those there are are split between theatre and labour ward, so you really might have to wait for 1-4 hours for that epidural.  So for that reason i'd be encouraging her to think of how she'll cope if the epidural isn't immediately available.  In addition it only partially works for A LOT of women.  It doesn't work at all for very few but many have partial relief or windows of no relief, so a pain free birth isn't in any way guaranteed, even if she DOES get her epidural right away.

 

Birth, like the rest of life, is not perfect.  Contingency planning is only sensible.

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#38 of 120 Old 08-20-2012, 11:23 AM
 
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Woah @ bolded. 

I am constantly amazed at how many people engaged in this particular discussion cannot see that it's an area where reasonable minds can differ. I personally am still on the fence, after reading extensively on both sides of the discussion (and having an educational and professional background that helps make me a relatively sophisticated consumer of scientific literature). 

 

Many women choose medicalized birth after a natural birth. Hard to think of a more informed decision maker than a S+TM, IMO. Other mommas do the opposite. I am wondering what information you think moms who have done both are missing, when they say they'd go medical again?


I'm sorry, you are right. I meant, and should have said, not just "someone," but specifically, a low-risk, first-time mom. I specifically had the OP's friend in mind when I said that, and did not mean to make a blanket statement. A low-risk first-time mom should give herself the greatest chance for the least amount of stress/danger/damage/etc. Moms who have done both (home/hospital, or whatever...) clearly have more insight into themselves and what their available options can offer them. Someone with no insight, when everything is a huge great unknown, should prepare for the worst but expect the best--meaning, have your "Plan A" be smooth sailing, simple, no interventions--because hey, chances are good it will go down that way, especially if you take measures to increase your chances, by carefully choosing your care providers and arming yourself with knowledge and confidence in yourself. With medical interventions only being used IF necessary, as "Plan B." That is what I was trying to say.

 

I understand that this is an area where reasonable minds can differ. I even acknowledge that for some low-risk first-time moms, the medical route is the best decision, because when it comes down to it, the best circumstances for a mother to birth in are often those where she feels safest. If those circumstances also open her up to additional risk, it *still* may be the best decision given all the factors.

 

What I am just wishing is that more women had the option to FEEL safe, and BE safe, at the same time. This won't happen until the majority of practicioners switch to an evidence-based midwifery model of care. And/or the majority of the population becomes more informed and demands better options.

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#39 of 120 Old 08-20-2012, 11:53 AM - Thread Starter
 
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I've really loved reading all of the responses to this post, they have all given me new insights into looking at birth differently for different people.  I had two wildly different births, the first being an unnecessary c-section, the last one being a home birth almost 5 months ago that still has me on cloud nine and I've unfortunately fallen into the trap that my birth is best.  Reading these replies has helped me learn how to be a better friend and support her decisions regardless of what they might be.  I may still spout some solid research studies when she asks my opinion though (just recently she asked about induction at 40 weeks and I sent her some info on bishops scores), but only if she asks. I think a lot of times doctors still leave out the "informed" in informed consent. 

 

That being said, I will forever feel birth is a natural and normal experience that should not be treated as a medical event in MOST situations and I will continue to speak openly about the joys of natural childbirth that I myself experienced. 

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#40 of 120 Old 08-20-2012, 12:14 PM
 
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I have to disagree here with you on a few points.  This may make me a little unpopular.  I apologize in advance.

 

First off, in terms of the pain caused or not caused, it's perfectly valid to compare childbirth to other potentially painful procedures or trauma that can happen to a human body.  I'm aware that we all like to get misty-eyed about the incredible beauty of this miraculous event blah blah - I did it a little myself a few posts ago.  But if you step away from it and just look at what's happening physiologically, you're passing a huge object out of an opening that (in a primipara) has to stretch to a size it's never been before, and to make matters worse orient it in such a way that it passes through the MOST STUPIDLY-SHAPED HIPBONE IN THE NATURAL WORLD.  Childbirth is beautiful, yes.  It is also hugely traumatic, in the dictionary sense of the word.  If the analogy between childbirth and a root canal fails it is only because childbirth is more dangerous (according to several thousand years of human experience) and more painful (according to my wife).

 

Second, a few people on this thread have made reference to women's bodies being not just natural but 'designed'.  This is a misunderstanding of how evolution works.  Over hundreds of thousands of years (and probably tens of thousands of generations), evolution has blindly stumbled, through random mutation, on a geometry for human bodies that allows huge-headed babies to come out of the womb (barely) while still preserving the ability of women to run, upright, presumably to avoid being eaten by bears.  The only thing that this means is that more women with this body geometry managed to reproduce than women with other body geometries.  For all we know, there were mutations for women with much larger hip-bone interiors that gave birth more easily, and more successfully, but then who were devoured by bears moments after birth, or sometime thereafter.  The only thing that matters, evolutionarily, is that enough women were able to reproduce.  A huge number of women could (potentially) die during childbirth, and evolution would happily skate on, blissfully unaware, as long as those who lived could reproduce.  This is why whenever I see the word 'design' in these threads, my eye twitches.  According to the best studies I could find, the 'natural' maternal death rate is estimated at about 1500 per 100,000 births.  That's a death rate of over 1%.  That's a pretty lousy design.  If there was a 1.5% chance you'd die every time you got in a car, you'd never get in it.

 

Fortunately, thanks to modern medicine, the actual modern Western death rate is more like 9 in 100,000, according to the WHO.  In Sub-Saharan Africa, which is rich with folk-wisdom and midwives, but lacking in medical supplies, the death rate is 900 in 100,000.  Let me say that again in another way: when modern medicine isn't available to assist with childbirth, the death rate is two orders of magnitude higher.  So although we can all agree that "birth isn't a sickness!" I actually don't agree with the assessment that "birth isn't a medical event", because we have good statistics, gathered today, that tell us that without medical expertise - which doesn't necessarily mean provided by an O.B., mind you, Certified Nurse Midwives have great results in studies, for example -  it's a hugely risky medical event.

 

Lastly, I need to say something about the "cascade of unnecessary interventions".  The problem is that there is a fundamental misunderstanding, in this country at least, about what the job of a doctor is.  We all think (and I used to think this way too) that a doctor is a woman or man in a white lab coat who runs a lot of tests and then figures out what is wrong with you by looking through a microscope.  Maybe there's something completely new wrong with you - that's ok!  The doctor will figure it out!  Likewise, if you're pregnant, the doctor will look at you and just be able to tell "A-ha!  Your blood-pressure is X, and your skin tone is Y, this means that you are just beginning to go into pre-eclampsia! TO THE HOSPITALMOBILE, we will save you!"

 

I'm here to tell you that you are wrong about what doctors do.

 

What doctors know is statistics and how to use them.

 

With many syndromes in pregnancy, by the time there are obviously visible symptoms, it is often too late to save the baby; pre-eclampsia is a great example of this (disclaimer: i am not a doctor, and i don't actually know anything about pre-eclampsia.  I'm just using this as an example of the sort of analysis you'd prefer to do before there is an acute problem).  The analysis is statistical.  Does the patient have risk factors for pre-eclampsia?  Well, let's see.  Her mother had pre-eclampsia in a pregnancy.  This is her first pregnancy, and she's 18, obese, gets frequent migraines, and has gestational diabetes.  Based on the totality of those factors, this patient has X% of developing pre-eclampsia.

 

In walk two patients, Alice and Betty.  Alice and Betty, let's say, present with the exact same medical histories and yield the same statistical chance of developing pre-eclampsia.  Let's make it easy and say it's a 50% chance.  Either one (or neither) of Alice or Betty might get pre-eclampsia and lose their babies or their lives.  No doctor in the world can tell which one of them it will be.  All they can tell you is that, statistically, half of the patients with these symptoms end up in pre-eclampsia.  Thus, since 50% is a really, really huge chance when lives are on the line, the doctor will probably recommend extremely frequent examination coupled with early induction or c-section at the first wisp of trouble.

 

The thing about statistics and probability is that the statistics are only meaningful before the outcome is revealed.  This is super-hard for non-mathematicians to understand, but it's true.  If you flip a fair coin, you have a 50% chance of getting heads.  If you look at the coin, and it's tails, it's nonsensical to say "well, I might still get heads half the time I look at this coin."  Once you've looked at that coin, the chance of it being tails is 100%, and the chance of it being heads is 0%.  A proper statistical analysis is about future events.

 

The 'Unnecessary cascade of interventions" language is all about proving, after the fact, that the coin was tails so therefore the interventions were not needed.  But just because the coin happened to turn out to be tails does not mean that before we knew the outcome the 50% chance of it being heads didn't exist.  Analogized a different way: just because you arrived at your destination safely doesn't mean that there wasn't risk from being in the car with a drunk driver.  Yes, sometimes a doctor can look at an X-ray, and say "Welp, your arm is broken.  Let's put a cast on it."  But more often, particularly in pregnancy, all they can do is say "Other women with your presentation had this good outcome X% of the time, and this bad outcome Y% of the time.  My medical opinion is that we should do (some intervention) to try to avoid the bad outcome, because I think Y is a big number."

 

Anyway, I've gone far afield from the topic here.  But I just wanted to address some of these points because I see this language all the time, and I think it does everyone a disservice when we fail to remember that medicine is, by and large, about understanding and applying probability and statistics.  Mothers (and, more generally, patients) always have the right to make their own decisions about whether to accept or refuse treatment.  But I think it's important to do that from a position of knowledge, based on data and an understanding of probability and statistics, rather than a position of weakness, based on intuition and superstition.


First I would like to thank you for the good discussion, Sympathetic Dad.

 

I do not share your wife's experience, not even a little bit. I did not find either of my births to be hugely traumatic, either during or after, and certainly not more painful than a root canal. When breastfeeding my first baby for the first month, we had problems getting a good latch. That painful latch was by FAR more painful than my labor or birth of said baby. Like I mentioned earlier, the pain of labor, for ME, was very very intense, but so far removed from any other type of "pain" I've experienced in my life that I'm not even sure that "pain" is the right word. With my second baby, I did not experience pain, at all. Well, it was a little painful after she was born, waiting for the placenta to come, but that was it. (Hypnobabies FTW.) Obviously this is a highly subjective experience.

 

I do not deny that birth is an uncertain event, and some scary things can happen. I don't deny that it's a major physical event that there's really no other comparison to, in the scope of all other human physical events. I don't deny that some women will require medical assistance when giving birth, and I'm not suggesting those women should forego it and just let themselves or their babies die. I think it's interesting that you found the rate of maternal death in nature to be about 1%, and The Farm Midwives' c-section rate is about 1.5%. It seems they are doing it right, then. The rate of maternal death in nature is certainly not 33%, can we agree on that?

 

I find your implication that I (and others) don't understand what doctors do, or how they use statistics, or how the application of statistics works in real life, very insulting. In fact, I arrived at my very strong feelings on these matters through extensive research and reading about birth-related statistics, and through my studies developed an understanding of what factors contribute to successful birth outcomes. In the U.S. (I assume you're in the U.S. like me?) OBs as a whole do NOT base their practices on what is likely the best thing for the mother and baby. It's not because they're malicious.

 

It's because most of them do not even have an understanding of the natural process of birth. Most of them are not shooting for the goal of "most straightforward, complication-free birth." Because OBs do not specialize in birth, they specialize in *surgical* birth. They are also covering their own asses, so are not willing to wait and see if the woman is fine on her own before intervening--they think it safer, certainly for themselves, and I think they often *believe* for the mother/baby, to practice "defensive medicine," using interventions as preemptive measures rather than as *necessary* measures. It's an important distinction. Even the slightest *possibility* of risk means they will take action immediately. Trigger-happy doctors hurt women and babies.

 

Most first-time moms in this country get epidurals because 1) they are scared because they assume the pain will be unbearable, 2) they are probably unaware of the very real risks of an epidural and 3) most doctors love epidurals because it makes it easier for the doctors. As the OB, when you take away the unpredictability of a woman's natural labor, you also take away your risk of malpractice suit--at least, that's what they're thinking. When you monitor the woman and baby excessively--never mind that by doing that you may *cause* things to go wrong--nobody can claim you didn't do everything in your power. As a side bonus, you don't have to wait around if she's taking too long and inconveniencing you. You can just label her as "failure to progress" and apply more interventions until you force that baby out on your own terms. (I'm sorry if I sound cynical. Don't dismiss everything I'm saying just because I have a 'tude.)

 

Add to that the fact that the majority of OBs arrived at certain practices NOT because they have looked at the statistics and probabilities but simply because that's what they were taught and what everyone else does. Episiotomy is a case in point. Totally unnecessary close to 100% of the time. Almost *always* causes more damage than the *hypothetical* *possible* natural tear that would have happened. Often results in long-term complications and suffering. Seriously, nobody should practice this anymore. But they still do, in huge numbers. Just one reason amongst many that hospitals are not currently a safe place for low-risk women to labor and birth.

 

What you described: coming "from a position of knowledge, based on data and an understanding of probability and statistics," is EXACTLY what I did when making decisions about my children's births, and it is THE main reason I chose natural birth.

 

Of course I used my intuition as well--I think dismissing the value of one's intuition about what is happening in one's own body is extremely foolish. Listening to your intuition about your body does not equate to superstition or weakness.

 

Something that most people in our culture do not understand, especially men (understandably so, as they have no first-hand experience being pregnant or birthing) is how extremely important the mind-body connection is during pregancy and birth. I mean, it is an absolutely crucial factor, one of the primary factors, in how a woman's birth plays out. Please don't misunderstand me--I am not suggesting that the other factors are not also crucial (like whether her particular body is able to give birth unimpeded, or whether unforeseen complications arise, or whether those around her are providing support or causing her extra problems.) But how fearful you are, how much your guard is up, whether or not you believe you can do it, all those things have a HUGE effect on how you enter the experience and on your outcome. If you feel you are prepared, and if you feel you are safe and supported, all the energy you would've put towards worry and fear is now available to put towards inner focus. If you think inner focus has nothing to do with labor, it's only because you've never been in labor.

 

Are you familiar with "sphincter law?" Even just having a stranger in the room can impede a woman's labor significantly.

 

If you are interested in learning more about how a woman could come to be strongly in favor of natural birth through rational information-seeking, intelligent behavior (as opposed to "weakness and superstition") I suggest you do some more research. Michel Odent, Ina May Gaskin, and Henci Goer are a good place to start.

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#41 of 120 Old 08-20-2012, 12:26 PM
 
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I have to disagree here with you on a few points.  This may make me a little unpopular.  I apologize in advance.

 

No need to apologize.  It's a discussion!  thumb.gif

 

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Fortunately, thanks to modern medicine, the actual modern Western death rate is more like 9 in 100,000, according to the WHO.  In Sub-Saharan Africa, which is rich with folk-wisdom and midwives, but lacking in medical supplies, the death rate is 900 in 100,000.  Let me say that again in another way: when modern medicine isn't available to assist with childbirth, the death rate is two orders of magnitude higher.  So although we can all agree that "birth isn't a sickness!" I actually don't agree with the assessment that "birth isn't a medical event", because we have good statistics, gathered today, that tell us that without medical expertise - which doesn't necessarily mean provided by an O.B., mind you, Certified Nurse Midwives have great results in studies, for example -  it's a hugely risky medical event.

 

I only have time to respond to this part of your post.  

 

Bolding mine.  You are wrong with this.  You are assuming that accurate information is collected & kept w/ regards to mothers who die from childbirth related causes.  Like many other instances in this society, we are terribly short sighted when it comes to the tracking of the after effects of what we do to other humans (treat them as guinea pigs really - vaccines, circumcision, formula feeding, c-sections, etc.)  The fact is, that in America, if these records are kept at all, they are far from comprehensive.  There is not a space on the death certificates in most states that asks if the mother gave birth recently (or within a time frame that would be appropriate).  If you would like to learn more about how this impacts the statistics, you can read up on Ina May Gaskin.  She has been working for a long time (since before 2007 when I heard her speak on the topic) to get accurate information collected & compiled so we can know the true maternal morbidity rate in the US.  Since it was five years ago, I don't recall much of the information, but I do remember enough to know that relying on this information to make an argument is shaky at best.

 

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#42 of 120 Old 08-20-2012, 12:29 PM
 
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SympatheticDad,
 

What I am saying is that the experience of childbirth is not necessarily painful.  Your wife experienced pain, so do many other people.  I told myself that birth would either be so painful I wanted to die, be orgasmically wonderful, or somewhere in the middle of those two extremes.  I happened to have a labor that was a lot of hard work but was an overall amazing enjoyable experience.  Not because I was misty-eyed, but because I was working hard to do something important and I liked it and had interesting sensations. There were moments that hurt a bit but then I would just recognize that and try to relax more.  It worked for me. Everyone's experience is different. Please don't discount my experience and the possibility that a woman could be missing out on this type of experience if they choose a more medical birth. 

 

Maybe another woman would try to "go natural" and find it so bad that they needed pain relief or a c-section.  That's cool, they have that available to them here in the U.S. and that's great. I think it's also great that a woman can choose to do whatever she wants for birth, and that she can decide ahead of time or in labor.  Whatever works for her.  But to have a culture that only talks about how painful birth is, is missing a lot to the discussion.  

 

I believe birth isn't a medical event until some specific problem presents itself that makes it a medical event for that particular birth.  Until then, women are just doing the best they can to get the baby out of them.  And the body has a really impressive way of doing that.  It's not like a baby just squeezes itself out of a regular everyday uterus, cervix, and vagina.  Things happen in the body to get it all prepared to birth.  Penises change shapes and sizes every day, then go back to how they were. That seems pretty wild to me.


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#43 of 120 Old 08-20-2012, 01:05 PM
 
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Yep-  Thanks, SymapatheticDad for the conversation. smile.gif  I love having gentlemen on MDC.

Welcome!
 

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#44 of 120 Old 08-26-2012, 06:22 PM
 
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Childbirth is beautiful, yes.  It is also hugely traumatic, in the dictionary sense of the word.  If the analogy between childbirth and a root canal fails it is only because childbirth is more dangerous (according to several thousand years of human experience) and more painful (according to my wife).

 

I've gone through both and neither has been painful. Teeth pulled with medication wearing off too, still not that painful. You sound as if you are stating facts, which in your case might be true, but this is not the case for *every* woman and certainly not every birth experience. That is what it sounds like and I feel extremely disrespected by this blanket statement.

 

I must say, however, that a father coming on here saying that birth is *hugely traumatic* also makes me angry as I did not have a traumatic birth in any sense. It's like if I assumed all men will go bald, because I know one man who did. I know this is a horrible metaphor, but I think you get the idea. You are a man and, therefore, do not know what birth is like. Your wife had a traumatic experience and that is unfortunate, but that is just one mother's experience. Sorry to repeat myself, but you shouldn't state it as fact that all women will experience a birth that is *hugely traumatic*. (This might have been written in the *heat of the moment* so I will try to assume you didn't mean it as fact for all birth being traumatic.)

 

Dictionary:

 

trau·mat·ic/trəˈmatik/

 
Adjective:
  1. Emotionally disturbing or distressing.
  2. Relating to or causing psychological trauma.

 

 

 

From this own website (http://mothering.com/pregnancy-birth/midwifery-in-the-united-states):

The U.S. has one of the highest infant mortality rates in the modern world, ranking about thirtieth among developed nations, and the rate is higher for infants of color. Although the U.S. maternal mortality rate has improved over the past century, it has not improved at all since 1982 and appears to be increasing.

 

Sources: 

38. World Health Organization. “The World Health Report: Make Every Mother and Child

Count,” 2005. Available at: <http://www.who.int.whr/2005/en>.

39. Centers for Disease Control and Prevention, National Center for Health Statistics,
Accessed Dec 2009. <http://www.cdc.gov/nchs/data/databriefs/db09.htm>.

40. World Health Organization, “The World Health Report”, 2005.

41. Centers for Disease Control and Prevention. “Maternal Mortality—United States, 1982-
1996”, Morbidity and Mortality Weekly Report 47.34, 1998.

42. Centers for Disease Control and Prevention. “Safe Motherhood, Promoting Health for
Women Before, During and After Pregnancy”, 2008. Accessed December 2009. <http://

www.cdc.gov/NCCDPHP/publications/aag/pdf/drh.pdf>.

 

Overall this thread has been very enlightening to read everyone's posts and the discussion in general. 

 

Personally I had a wonderful home birth experience, completely natural without pain medications and really without much pain. Hardly 7 hours of labor, which felt like menstrual cramps and 20 minutes of pushing without tearing. I know this is not the case for all women. A friend, with tiny hips, tore horribly in a natural birth as it progressed so fast. My mother had me naturally at home with pain for a few hours and a c-section for my twin brothers. The doctor *messed up*. She was cut wrong and in pain for months afterwards, and still has a weird pooch thing for her lower belly. Today she still regrets she was *scared* into it by her doctor, literally. The doctor said if you tried naturally one baby would die. That was obviously not true as many women, even though not all, deliver twins naturally today. So obviously different women will have different experiences.

 

However, the most saddening thing about this discussion is that society deems birth needs to be hospitalized for a safe delivery, as if it was a disease or something. Movies show women in birth screaming in pain and on their backs (which is worst position as the tailbone gets in the way). Even on the show Bones she wanted a natural birth, outside a hospital. She still gave birth on the show on her back. From her supposed background as an anthropologist it would have made more sense for her to squat or something. 

 

I think the problem with our society is that the majority of women are ignorant (dictionary: Lacking knowledge, information, or awareness about something in particular). This is part in fault by the media, part by the doctors, and part by the woman herself. We should be well informed and educated on the different options available so we can make the best informed decision for us. The OP's friend has had experience with natural births and chooses a hospital birth. She obviously has some information and I wish her the best in her decision, it is *her* decision. 

 

The problem, and I think many will agree, is the ignorance of people.

 

For example, let's say that a woman is in the hospital giving birth and the labor is taking a little long. The doctor comes in and says they can give a drug/medication to speed it up. If that was all the information given to them, then yes, many women would choose that route. This would be more likely if the drug allowed the pain to go away too. The problem is the doctor not explaining all the reasons why, the possible side effects and other problems that might come up. The problem is also women trusting their doctor's opinion so much that they don't question it or ask any questions, even if they have them.

 

Instead the doctor should be giving more information. Maybe say the labor might take a few more hours, OR it could be sped up with this drug. Women will still choose the drug many times. What if the doctor said labor might take a few more hours, OR it could be sped up with a drug... BUT that drug doesn't always work for *all* women (even though many it does), might cause us to give you this other drug for this reason, or might cause this problem. At this point the woman is fully informed and can make a better decision. Sure some women will choose the drug, but not all of them. This is the underlying problem. We are simply misled or misinformed. For now we are, unfortunately, the ones responsible in learning what the best decision for us would be and how to continue.

 

I hope that makes sense. I'm not trying to be disrespectful to doctors (even though I don't respect someone simply for being a doctor as that just requires schooling - they need to earn my respect just like anyone else) as not all are misleading or misinformed, or women for that matter. Just that we should be treated with enough respect to be given the information so we can make the most informed decision for us and our bodies. After all, birth is on us, it's our body's job and many women are fortunate enough to have uncomplicated and natural births. Others (like my cousin with type 2 diabetes) will need to be in a hospital as she is high-risk.

 

To each their own. If they choose something, hopefully it was an informed decision, and it goes well for them. :)

 

I guess what I'm trying to say is that not every woman is the same, so why are we usually treated as if we were?

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#45 of 120 Old 08-29-2012, 05:47 PM
 
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Someone with no insight, when everything is a huge great unknown, should prepare for the worst but expect the best--meaning, have your "Plan A" be smooth sailing, simple, no interventions--because hey, chances are good it will go down that way, especially if you take measures to increase your chances, by carefully choosing your care providers and arming yourself with knowledge and confidence in yourself. With medical interventions only being used IF necessary, as "Plan B." That is what I was trying to say.

 

I understand that this is an area where reasonable minds can differ. I even acknowledge that for some low-risk first-time moms, the medical route is the best decision, because when it comes down to it, the best circumstances for a mother to birth in are often those where she feels safest.


I think you are really trying to be very open-minded about this, and that's awesome :-)

I'm glad you realize that the type of birth where a mother feels safest is often the best (as long as it is actually a safe option - not all birth choices are safe, regardless if the mother feels it is the safest or not); may I point out, though, that you're still basically saying that women "should" choose natural, unmedicated birth, while also paying lip-service to actual choice? I think that seems disingenuous, though I don't think you neccesarily mean it to be.

I fully admit this probably rubs me the wrong way partially because I hope to have a Maternal Request CS (I would be a first time mom); I have looked at the risks and benefits of both modes of delivery (vaginal v. cs) and feel much, much more comfortable with the controlled environment of a CS than taking my chances that I'll have an uncomplicated vaginal delivery. To hear over and over that this is somehow "less than" a vaginal delivery and a poor choice....well, it irritates after awhile ;-)

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#46 of 120 Old 08-30-2012, 05:59 AM
 
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I think you are really trying to be very open-minded about this, and that's awesome :-)

I'm glad you realize that the type of birth where a mother feels safest is often the best (as long as it is actually a safe option - not all birth choices are safe, regardless if the mother feels it is the safest or not); may I point out, though, that you're still basically saying that women "should" choose natural, unmedicated birth, while also paying lip-service to actual choice? I think that seems disingenuous, though I don't think you neccesarily mean it to be.

I fully admit this probably rubs me the wrong way partially because I hope to have a Maternal Request CS (I would be a first time mom); I have looked at the risks and benefits of both modes of delivery (vaginal v. cs) and feel much, much more comfortable with the controlled environment of a CS than taking my chances that I'll have an uncomplicated vaginal delivery. To hear over and over that this is somehow "less than" a vaginal delivery and a poor choice....well, it irritates after awhile ;-)


OK I'm just curious and mean no disrespect, but WHY would you choose to have major abdominal surgery to deliver your baby without a medical reason for it? I had my first son that way, but not by choice, and then had a vaginal birth for my second son, and hope to continue having vaginal births with any future children. I honestly don't mean to be disrespectful, but every other mama I've met who has had a c-section had it for medical reasons at the time of birth, and I've just never met someone who would choose to go through such major surgery by choice for no medical reason.


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Over the years, I've changed my POV on c-sections quite a bit. I know women who choose not to VBAC because they just don't want to deal with the stress, women who don't want to put up a fight for their right to have a vaginal birth, women who choose not to birth vaginally because of emotional reasons (such as assault, rape, or negative pain associations) and women who have breech or transverse baby that they are just letting work on his position and if by the time 40 weeks comes, if baby hasnt turned then they opt for the section. I understand all of those choices- It's hard to be pregnant, and sometimes we just dont care- we just want the baby to come out.

 

I do have a hard time understanding why someone who is a first time mom, without much reason, would just opt for a scheduled section. It is major surgery. One thing that surprised me recently, was finding out how much the maternal mortality rate has risen in the past 100 years. We have an insanely high maternal mortality rate in the united states. I recently read this quote from the Journal of Obstetrics and Gynecology:

 

 

Quote:

“C-section or caesarean section risks are roughly fewer than 1 in 2,500, significantly more than the one in 10,000 risks for vaginal birth.

About 36 women per 100,000 die while undergoing a Caesarean section, or C-section, compared with 9.2 deaths per 100,000 vaginal deliveries."

I'm at a higher risk for a csection this time, and have thought and thought about just scheduling it and not dealing with vaginal birth right now- I've been through a lot in the past year and I honestly do not feel up to a big fight with doctors about it right now. But these statistics really make me realize that Im putting myself at a greater risk by avoiding something that I know my body can do. (because I've had two successful vaginal births)


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#48 of 120 Old 08-30-2012, 07:07 AM
 
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OK I'm just curious and mean no disrespect, but WHY would you choose to have major abdominal surgery to deliver your baby without a medical reason for it? I had my first son that way, but not by choice, and then had a vaginal birth for my second son, and hope to continue having vaginal births with any future children. I honestly don't mean to be disrespectful, but every other mama I've met who has had a c-section had it for medical reasons at the time of birth, and I've just never met someone who would choose to go through such major surgery by choice for no medical reason.

How do you know she has no medical reason? Why does she have to explain herself? If it's all about the mother's choice, why does she have to justify that on here? She says she is informed, why isn't that enough?
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#49 of 120 Old 08-30-2012, 08:28 AM
 
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I think you are really trying to be very open-minded about this, and that's awesome :-)


I'm glad you realize that the type of birth where a mother feels safest is often the best (as long as it is actually a safe option - not all birth choices are safe, regardless if the mother feels it is the safest or not); may I point out, though, that you're still basically saying that women "should" choose natural, unmedicated birth, while also paying lip-service to actual choice? I think that seems disingenuous, though I don't think you neccesarily mean it to be.

I fully admit this probably rubs me the wrong way partially because I hope to have a Maternal Request CS (I would be a first time mom); I have looked at the risks and benefits of both modes of delivery (vaginal v. cs) and feel much, much more comfortable with the controlled environment of a CS than taking my chances that I'll have an uncomplicated vaginal delivery. To hear over and over that this is somehow "less than" a vaginal delivery and a poor choice....well, it irritates after awhile ;-)

 

Bolding mine.  Though, for some women it is less than because it was what they tried really to avoid.  I feel so grateful for myself & my children that I have not had a c-section.  I was born via c-section though (I'm 38) & to think that the risks of cesearan section are only to the mother and/or during the surgery/immediately after is terribly short sighted (which is an affliction that most Westerners face :-().  My current health issues & those or my children are directly related to the fact that I was born that way (but that is not the only thing that contributed to my/our problems).  Feel free to PM me for why.

 

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OK I'm just curious and mean no disrespect, but WHY would you choose to have major abdominal surgery to deliver your baby without a medical reason for it? I had my first son that way, but not by choice, and then had a vaginal birth for my second son, and hope to continue having vaginal births with any future children. I honestly don't mean to be disrespectful, but every other mama I've met who has had a c-section had it for medical reasons at the time of birth, and I've just never met someone who would choose to go through such major surgery by choice for no medical reason.

 

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How do you know she has no medical reason? Why does she have to explain herself? If it's all about the mother's choice, why does she have to justify that on here? She says she is informed, why isn't that enough?

What did Poogles0213 write that makes you think Lynann should *know* that this person has no medical reason?  What did anyone say that makes you ask why she has to explain herself?  What did Lynann say that makes you ask why there needs to be justification?

 

One way people learn is by asking questions.  I, for one, am glad she asked because I am curious also.  Anyone who doesn't want to answer questions does not have to.

 

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#50 of 120 Old 08-30-2012, 09:02 AM
 
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How do you know she has no medical reason? Why does she have to explain herself? If it's all about the mother's choice, why does she have to justify that on here? She says she is informed, why isn't that enough?


 I didn't say it wasn't enough. I did make it clear that I was simply curious about why anyone would make that choice? I also made it clear that I meant no disrespect, nor did I try to change her mind. I was simply curious, and that is all. Poogles0213 is quite within her right to ignore my question if she wants to, nobody is going to make her answer it.


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I think you are really trying to be very open-minded about this, and that's awesome :-)

I'm glad you realize that the type of birth where a mother feels safest is often the best (as long as it is actually a safe option - not all birth choices are safe, regardless if the mother feels it is the safest or not); may I point out, though, that you're still basically saying that women "should" choose natural, unmedicated birth, while also paying lip-service to actual choice? I think that seems disingenuous, though I don't think you neccesarily mean it to be.

I fully admit this probably rubs me the wrong way partially because I hope to have a Maternal Request CS (I would be a first time mom); I have looked at the risks and benefits of both modes of delivery (vaginal v. cs) and feel much, much more comfortable with the controlled environment of a CS than taking my chances that I'll have an uncomplicated vaginal delivery. To hear over and over that this is somehow "less than" a vaginal delivery and a poor choice....well, it irritates after awhile ;-)

Not all women "should" choose natural birth, of course not. But yes, most low-risk women really should--that is, of course, in a better world, where all women are confident and well-read. (I am NOT saying you're not these things, to be clear, just that if all women were, more of us would choose natural birth as "Plan A.") In a better world, safe birth options would also be available to all women, and they are not. In the world we live in, however, I realize that medical birth for many women seems a more rational choice than it really is. It's more complicated than just choosing the most rational thing based on facts, because 1) facts can be twisted and even fabricated, and you have to be very motivated to find the closest thing to actual truth and 2) emotions are involved, for many women emotions around birth trump knowledge about birth, and emotions actually do have a profound effect on birth outcome. It becomes further complicated when you look at each individual person, as people are SO widely varied in what options are available to them, everything they know to be true, in their physical limitations, and in their own personal fears, etc. That is why I can't say for certain what would ever be the best choice for anyone else, and why I concede that medical birth in the absence of medical need is definitely the best choice for SOME people. I respect women's right to choose that, but in most cases, I really do think the choice would be a different one if women just had a teensy bit more education and support. **Again, not a personal judgement on you.

 

You say you have looked at the risks and benefits of elective c-section vs. vaginal birth. I believe you. But just for the benefit of others reading this, here is a bit of info, again from Thinking Woman's Guide, not because it's the only source of this info but just because it happens to be on my desk:

 

Quote:

 

Benefits & risks of cesarean section:

 

Benefits: A c-section delivers the baby when vaginal birth would put mother or baby at risk or when the mother cannot deliver the baby vaginally (**might I say, a seriously huge benefit, IF the c-sec is legitimately NEEDED**)

 

Risks:

 

Intrinsic to cesareans are pain, debility, and a longer recovery period, all of which interfere with bonding with the baby and breastfeeding. In one study, 1/4 of the women reported pain when interviewed 2 weeks after their c-sections, and 15% still reported pain at 8 weeks. More than 15% reported difficulties with normal activities such as getting out of bed, walking, bending, lifting, and tending the baby at 2 weeks. 1 in 10 still reported problems at 8 weeks.

 

Some cesarean complications relate strictly to the surgery and never occur with vaginal birth. Of those associated with both, all occur much more commonly with cesarean delivery.

 

During the operation, women with an epidural or spinal anesthetic may experience breathing difficulties if the anesthetic goes high enough to affect the breathing muscles. In some cases, women may have areas where there is no anesthesia. Hemorrhage and anesthesia complications may occur. According to one medical literature review, 1-6% of women lose enough blood to require a transfusion. Hemorrhage may sometimes require a hysterectomy. Accidental surgical injury to the bowel, bladder, uterus, or uterine blood vessels occurs in 2% of cases, although a 10-year review at one hospital reported that uterine injury occurred 10% of the time.

 

Postsurgical complications are also a problem. According to the same medical literature review, infection occurs 8-27% of the time after cesareans, 1% of women experience a paralyzed bowel (ileus), 6-18 women per 1,000 experience blood clots in their legs, and 1-2 per 1,000 experience clots that lodge in the lung (pulmonary embolism). The 10-year hospital review reported a 4.5% incidence of major complications--that is, severe hemorrhage, need for repeat surgery (generally to investigate bleeding), pelvic infection, blood clots, pneumonia, septicemia (blood poisoning), or clotting dysfunction (a result of severe hemorrhage). Nearly 1/3 of cesarean mothers experienced minor complications, including fever; hemorrhage; blood-filled swelling (hematoma); urinary tract, wound, or uterine infection; leg clots (phlebitis); or paralyzed bowel or bladder. In addition, long-term and chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse.

 

Cesareans cause more maternal deaths than does vaginal birth. A 1989 analysis in Great Britain revealed that women were 550% more likely to die of an elective cesearean than a vaginal birth (9 vs. 2 per 100,000). A Dutch study found that between 1983 and 1992, c-sections caused 700% more deaths than vaginal births did (28 vs. 4 per 100,000). Obviously some factors that lead to c-section also threaten the mother's life. However, the British study compared elective cesarean, where there was no medical indication for the surgery, to vaginal birth to minimize that possibility, and the Dutch study investigated the exact cause of death. The numbers in the British study may also be low. Studies have found that data culled from vital statistics undercount cesarean death rates by 40-50%.

 

A cesarean poses risks to the baby as well. The baby may be cut, a complication that occurred in a little over 1% of head-down babies and 6% of breech babies in one hospital and in 1% of babies in the 10-year review. Cesarean-delivered babies are more likely to be in poor condition at birth. When researchers looked at 700 normal-weight babies born with low Apgar scores after healthy pregnancies, they found they were nearly half again as likely to be elective cesareans as vaginal births. Cesareans also increase the likelihood of breathing difficulties. Researchers compared outcomes for over 800 babies born by c-section for reasons unrelated to the baby's condition with 10,900 low-risk vaginal births. Babies born by cesarean were over 3 times as likely to be admitted to intermediate or intensive care (2.6% vs. 8.7%) and 5 times more likely to need assistance with breathing (0.3% vs. 1.5%). Another study compared elective cesareans--again, a situation where complications must be attributed to the cesarean, not the baby's condition--to women having trial of labor after a previous cesarean. It also documented more newborn breathing problems and more jaundice as well.

 

...Yadda-yadda phychological fallout/negative feelings/postpartum depression/nightmares/flashbacks, etc. (Skipping this part because maybe it doesn't apply as much to elective c-sections, I'm guessing...although who knows...) ...The trivialization of cesarean surgery compounds the situation. While it has long been recognized that major surgery has adverse psychological consequences, a recognition that enables medical staff to help surgical patients and their families expect and cope with those consequences, doctors and nurses rarely extend that acknowledgement to cesarean mothers.

 

Finally, the scar tissue poses considerable risk to subsequent pregnancies and births. Cesarean section increases the risk of infertility and ectopic pregnancy, a life-threatening complication in which the embryo implants outside of the uterus, usually in the fallopian tube leading to the ovary. Because the scar tissue interferes with placental attachment, cesareans increase the risk of the placenta detaching before the birth (abruptio placentae), growing over the cervix (placenta previa), or growing into or even through the muscular wall of the uterus (placenta accreta or percreta). The odds of placental complications soar with each succeeding cesarean, and the hemorrhage that results from placental attachment abnormalities or ectopic pregnancy can threaten the life and health of both mother and baby. The scar can also give way, causing massive bleeding and possibly expelling the baby into the abdominal cavity, an event that occurs in 4 per 1,000 women with horizontal scars and more often in women with vertical scars. In addition, pelvic scar tissue makes subsequent cesareans more technically difficult and injuries to other organs more likely.

 

End quote.

 

And that's just the basics of what is known. It seems like every other day now I'm seeing a new article finding more and more benefits related to vaginal birth (the intestinal gut flora thing is the big one that comes to mind right now.)

 

I have lots of friends who have had c-sections, and I can tell you, witnessing what they went through in recovery was truly shocking and horrifying to me, especially when compared to my own experiences. Having a newborn is hard enough without having to recover from abdominal surgery! I have one friend who was very happy with her c-section, and bragged about how quickly she healed. She was saying, "I was back to my normal self after 3 weeks!" and part of me was thinking "good for her, I'm happy that she's happy" but part of me was thinking, "three WEEKS! OMG! That's awful!" since after my vaginal births, especially the second one, sure I was a little sore, but I was walking around feeling great like, the next day. I know that some women have difficult vaginal births and difficult recoveries, but with a c-section, those difficulties are a given!

 

I'm not saying c-sections don't save lives, but it seems to me that any reasonable person would avoid having one that isn't saving a life. Elective cesarean is perhaps the most irrational thing I've ever heard of. I simply cannot conceive how someone can decide to choose a c-section when it is not conclusively necessary in order to get the baby out safely. That doesn't mean it's not a valid choice sometimes, for some people. It's just so far from rational decision-making, from my point of view, that I can't understand that choice.

 

That said, I definitely do believe in actual choice--I am truly not just paying lip service. In your case, based on what you wrote anyway, your reason for choosing the massively riskier option (elective c-section) is that your discomfort with the other option (i.e. vaginal birth as Plan A with *necessary* c-section as Plan B) is massive enough to balance that out and tip the scale in favor of the c-section. I respect your choice, and you need to do whatever you feel is the best thing for you.

 

But with that in mind, may I respectfully give my point of view? If my amount of discomfort at the idea of the uncontrolled nature of birth was massive enough that I'd be willing to take on medically unnecessary risk to myself and my child just to avoid it, I'd want to deeply examine and work through my fears, and re-evaluate everything just to make absolutely sure that I was making a sound and rational choice. You may just come to the exact same conclusion, but with some added confidence. Or you may change your mind. (Perhaps, our assertions that at least an attempt at natural birth is the most rational choice would not "rub you the wrong way" if you didn't on some level realize that we have a point?) If you are confident that your choice is the absolute best one for YOU, then nothing anyone else says will be able to bother you.

 

You could choose an elective c-section with eyes wide open, knowing it's the best thing for YOU, while also acknowledging that because it comes with unnecessary medical risk and consequence that YOU are okay with, taking on those risks and consequences would be a terrible choice for most other healthy women.

 

Regardless, I wish you the best. If you go through with the unnecessary c-section, I hope it goes as smoothly as possible, your baby is healthy, and you recover quickly.

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#52 of 120 Old 08-30-2012, 01:15 PM
 
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How do you know she has no medical reason? Why does she have to explain herself? If it's all about the mother's choice, why does she have to justify that on here? She says she is informed, why isn't that enough?


She said so herself. A Maternal Request CS, as a first time mom--by its very definition its reason is "maternal request," NOT "medical reason."

 

It isn't just about the mother's choice. Informed choice is really, really, important. So, it's also about making sure mothers are informed when they make the choice. I actually feel is is a moral imperative, after seeing so many people I care about harmed because they made uninformed birth choices. The downside of feeling like morally, you have to make SURE women know things about birth choices, is that you can often come across as condescending and/or disrespectful even though you don't mean to be. So be it--by speaking up and questioning maybe we will make a real positive difference for somebody.

 

She clearly stated that she "feels much, much more comfortable with the controlled environment of a CS than taking her chances that she'll have an uncomplicated vaginal delivery." It seems obvious to anyone aware of what research is out there that the "chances" of an uncomplicated vaginal delivery are really quite high when the process is not tampered with. And it seems that Poogles thinks the "controlled environment" factor of a c-section is much more important than the "risks to mother and baby" factor or the "recovery from major surgery" factor, which seems illogical to me. But I suppose I get it, in a way. Giving up control is something everyone has to do when giving birth, and it's very difficult for some of us to do.

 

Electing to have an un-needed c-section probably does bring more "control" to the situation, although I'd argue even that is mostly an illusion. But the thing is, it doesn't bring a better outcome for the mother or the baby, in MOST cases.

 

As an aside, electing to have an episiotomy is a good comparison. You do have more "control" over the situation, as you are 100% certain your taint will be sliced open. Whereas if you choose not to get an episiotomy, you are very much "taking your chances"--you may tear naturally, or you may not, and you do have some control over that through pushing technique and preparation beforehand, but your control IS limited. Therefore you must mentally surrender to the process and stop trying to control things that can't be controlled. Life=Risk, always. The difference is, c-sections are sometimes necessary while episiotomies almost never are, but it's still a good comparison. By choosing the option that gives you more control, you are choosing the WORSE option of the two!

 

confused.gif dizzy.gifheadscratch.gif

 

Nobody said she has to justify anything. Just that we are honestly curious about how someone could arrive at that choice. It flies in the face of reason. (From our *outside* perspective, that is.)

Poogles, your reasons are your reasons, and I hope I have not offended you.

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#53 of 120 Old 08-30-2012, 02:18 PM
 
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OK I'm just curious and mean no disrespect, but WHY would you choose to have major abdominal surgery to deliver your baby without a medical reason for it? I had my first son that way, but not by choice, and then had a vaginal birth for my second son, and hope to continue having vaginal births with any future children. I honestly don't mean to be disrespectful, but every other mama I've met who has had a c-section had it for medical reasons at the time of birth, and I've just never met someone who would choose to go through such major surgery by choice for no medical reason.

 

I'm probably only having one child, two at most, so risks to future pregnancies don't factor in at all really. I feel the risks associated with a CS without labor (a truly "elective" CS) are more controllable and preferable (to me) than the possible risks associated with a vaginal delivery. If I could somehow be guaranteed an uncomplicated birth with no (or very minor) immediate or future problems for either myself or the baby, I would go with that, no problem. Without that guarantee though, I'd rather take my chances with the CS (not that I think a CS is a guarantee, btw).

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Originally Posted by Adaline'sMama View Post

I do have a hard time understanding why someone who is a first time mom, without much reason, would just opt for a scheduled section. It is major surgery.

 

 

 

Now, to be fair, just because you don't know/understand/agree with my reasons does not mean I am making this choice "without much reason" :-)

 

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Originally Posted by mama24-7 View Post

Though, for some women it is less than because it was what they tried really to avoid.  

 

 

I can absolutely understand that, the same as if I had to have a non-medicated birth, when that was what I was trying to avoid - I would find the experience "less than" what I had desired. My irritation and objections come from the blanket statements and implications that natural, unmedicated birth is always better than CS, regardless of the mother's desires or expectations.

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#54 of 120 Old 08-30-2012, 02:41 PM
 
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As an aside, electing to have an episiotomy is a good comparison. You do have more "control" over the situation, as you are 100% certain your taint will be sliced open. Whereas if you choose not to get an episiotomy, you are very much "taking your chances"--you may tear naturally, or you may not, and you do have some control over that through pushing technique and preparation beforehand, but your control IS limited. Therefore you must mentally surrender to the process and stop trying to control things that can't be controlled. Life=Risk, always. The difference is, c-sections are sometimes necessary while episiotomies almost never are, but it's still a good comparison. By choosing the option that gives you more control, you are choosing the WORSE option of the two!

This is a big assumption to make. Just because YOU feel something, such as an episiotomy, is almost never necessary doesn't make it right. Regardless, the only person who can decide what the worse option is is that person, not an bystander who assumes he/she is more educated through research.

One of the things MDC encourages is educating oneself about pregnancy and birth. Considering the OP has been a member here longer than a majority of posters on this thread I think it's safe to assume that she isn't lying when she said she has researched her decision. Do you have to agree with that decision, of course not, but she deserves the same consideration & respect that a mom who were to announce that she had decided to have a UC for what may seem to others as a high risk pregnancy.
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#55 of 120 Old 08-30-2012, 02:41 PM
 
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 You are wrong with this.  You are assuming that accurate information is collected & kept w/ regards to mothers who die from childbirth related causes.  Like many other instances in this society, we are terribly short sighted when it comes to the tracking of the after effects of what we do to other humans (treat them as guinea pigs really - vaccines, circumcision, formula feeding, c-sections, etc.)  The fact is, that in America, if these records are kept at all, they are far from comprehensive.  There is not a space on the death certificates in most states that asks if the mother gave birth recently (or within a time frame that would be appropriate).  

 

 

I can't speak for "most states,"  but I have personally filled out death certificates in three different states and all have had a section where it asks if the decedent was pregnant in the year preceding death.

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#56 of 120 Old 08-30-2012, 03:04 PM
 
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As an aside, electing to have an episiotomy is a good comparison. You do have more "control" over the situation, as you are 100% certain your taint will be sliced open. Whereas if you choose not to get an episiotomy, you are very much "taking your chances"--you may tear naturally, or you may not, and you do have some control over that through pushing technique and preparation beforehand, but your control IS limited. Therefore you must mentally surrender to the process and stop trying to control things that can't be controlled. Life=Risk, always. The difference is, c-sections are sometimes necessary while episiotomies almost never are, but it's still a good comparison. By choosing the option that gives you more control, you are choosing the WORSE option of the two!

This is a big assumption to make. Just because YOU feel something, such as an episiotomy, is almost never necessary doesn't make it right. Regardless, the only person who can decide what the worse option is is that person, not an bystander who assumes he/she is more educated through research.

One of the things MDC encourages is educating oneself about pregnancy and birth. Considering the OP has been a member here longer than a majority of posters on this thread I think it's safe to assume that she isn't lying when she said she has researched her decision. Do you have to agree with that decision, of course not, but she deserves the same consideration & respect that a mom who were to announce that she had decided to have a UC for what may seem to others as a high risk pregnancy.

1. No assumptions here. I don't "feel" episiotomies are unnecessary. They ARE unnecessary. If you have ANY evidence that routine episiotomy is a necessary, evidence-based practice, I would love to see it!

2. Poogles0213 is not the OP. The OP was frustrated because a first-time-mom friend of hers said that birth is not normal, therefore she'd be going the medical route.

I never accused Poogles0213 of lying about her research--in fact I specifically said that I believed her.

I also believe that I spoke with consideration and respect. Giving consideration and respect is not mutually exclusive with questioning someone's line of reasoning. You can do both.
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#57 of 120 Old 08-30-2012, 04:58 PM
 
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artekah, I will have to reply to you later - I started to but I do not have the time right now  redface.gif
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#58 of 120 Old 08-30-2012, 05:12 PM
 
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I can't speak for "most states,"  but I have personally filled out death certificates in three different states and all have had a section where it asks if the decedent was pregnant in the year preceding death.


And, as someone who has given birth twice in the past two years and has gone to the doctor and dentist for numerous other reasons, every single piece of paper I have had to fill out asks when the last time I was pregnant was. And upon going into the appointment, when the doctor said, "I see here that you have had two children. Were they c-sections or vaginal deliveries." Even my therapist asked me that. Maybe that's just Kentucky- but I feel like everywhere I go Im having to give out way more information that I thought I needed to.

 

 

And Poogles, you are right, I don't know your reasons. I should have phrased that "without any medical reasons". Sorry.


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#59 of 120 Old 08-31-2012, 01:35 PM
 
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I have lots of friends who have had c-sections, and I can tell you, witnessing what they went through in recovery was truly shocking and horrifying to me, especially when compared to my own experiences. Having a newborn is hard enough without having to recover from abdominal surgery! I have one friend who was very happy with her c-section, and bragged about how quickly she healed. She was saying, "I was back to my normal self after 3 weeks!" and part of me was thinking "good for her, I'm happy that she's happy" but part of me was thinking, "three WEEKS! OMG! That's awful!" since after my vaginal births, especially the second one, sure I was a little sore, but I was walking around feeling great like, the next day. I know that some women have difficult vaginal births and difficult recoveries, but with a c-section, those difficulties are a given!

 

 I would not assume that a CS = difficult recovery. As you mentioned, easy and difficult recoveries can happen after a vaginal delivery and they also can for a CS. It is definitely possible to be back to normal or feeling great less than 3 weeks after a CS, even some as early as a few days after, just as it is possible to still be in pain and healing from a vaginal delivery weeks or months later. I will freely admit that a quick, easy recovery is more probable after a vaginal delivery, and I weighed that in my decision-making.

 

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I'm not saying c-sections don't save lives, but it seems to me that any reasonable person would avoid having one that isn't saving a life. Elective cesarean is perhaps the most irrational thing I've ever heard of. I simply cannot conceive how someone can decide to choose a c-section when it is not conclusively necessary in order to get the baby out safely. That doesn't mean it's not a valid choice sometimes, for some people. It's just so far from rational decision-making, from my point of view, that I can't understand that choice. 

 

Remember that there are many times when you cannot know if a CS was "conclusively necessary in order to get the baby out safely" until after the fact, and sometimes even then you can't know for sure (when a CS is done and the baby comes out pink and screaming - was it unecessary or was the baby, thankfully, gotten out in time to avoid being compromised/damaged?).

 

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Orginally Posted by artekah View Post
 
That said, I definitely do believe in actual choice--I am truly not just paying lip service. In your case, based on what you wrote anyway, your reason for choosing the massively riskier option (elective c-section) is that your discomfort with the other option (i.e. vaginal birth as Plan A with *necessary* c-section as Plan B) is massive enough to balance that out and tip the scale in favor of the c-section. I respect your choice, and you need to do whatever you feel is the best thing for you.

 

That's not exactly it...I do not see elective CS as the "massively riskier option". Both vaginal delivery and CS delivery have their own risks, I simply prefer the risks associated with the CS, for both myself and my (as yet hypothetical) baby. The "discomfort" I have with a vaginal delivery is mostly due to the possible risks of vaginal delivery for both me and baby. I have personal reasons, as well.

 

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Orginally Posted by artekah View Post

 

But with that in mind, may I respectfully give my point of view? If my amount of discomfort at the idea of the uncontrolled nature of birth was massive enough that I'd be willing to take on medically unnecessary risk to myself and my child just to avoid it, I'd want to deeply examine and work through my fears, and re-evaluate everything just to make absolutely sure that I was making a sound and rational choice. You may just come to the exact same conclusion, but with some added confidence. Or you may change your mind.

 

There are no fears that can be "worked through" per se...I've looked at the risks and decided which set looked better to me for the health of myself and my baby. Fear doesn't really play too much of a part in it, other than the "fear" I have about the risks associated with childbirth - though I'd probably rather term that "healthy respect".

Having originally assumed all babies were born in the hospital, vaginally if possible, to wanting a homebirth, and then wanting a UC, then deciding to go to the hospital "ready to push" for an unmedicated birth, then deciding I would get an epidural and cEFM for birth at the hospital, then finally deciding on a Maternal Request CS (if I can get one) - I feel quite confident I have explored all my options, and the arguments on all sides, and have come to my decision rationally and it is very unlikely to change at this point.

 

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(Perhaps, our assertions that at least an attempt at natural birth is the most rational choice would not "rub you the wrong way" if you didn't on some level realize that we have a point?) If you are confident that your choice is the absolute best one for YOU, then nothing anyone else says will be able to bother you.

 


If you were suddenly in an area or time where the prevailing message was that formula was much better for babies, and moms could choose to breastfeed, but it was "irrational" and "riskier", would that irritate you or rub you the wrong way?

 

How about when pro-circ people talk about all the reasons baby boys should be circed? That not circing is putting them at risk for more UTI's or STD's or what-have-you? Does that irritate you or rub you the wrong way (or maybe even piss you right off winky.gif)?

 

Would you then assume it must be because they have a point, and you must just not be confident enough in your own choices? I would assume not. Just because something irritates someone or rubs them the wrong way does not mean it is because they are insecure in their decisions.

 

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You could choose an elective c-section with eyes wide open, knowing it's the best thing for YOU, while also acknowledging that because it comes with unnecessary medical risk and consequence that YOU are okay with, taking on those risks and consequences would be a terrible choice for most other healthy women.

 

I understand it seems an irrational choice to you, and most other women. Most women would rather avoid a surgery if given the choice. I am not one of those women; doctors, hospitals, surgery, medications....none of that stuff freaks me out. It is only a terrible choice for other women if they are forced into it and do not desire a purely elective CS, otherwise it is a completely legitimate choice.

 

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Orginally Posted by artekah View Post
Regardless, I wish you the best. If you go through with the unnecessary c-section, I hope it goes as smoothly as possible, your baby is healthy, and you recover quickly.

 

Thank you, though I'd appreciate if you'd consider not repeatedly including the word "unnecessary". I would not refer to home births or UCs as "unecessary", even though I, personally, believe they introduce a ton of risk into the situation for no "medically indicated" reason; just the desire and wishes of the mother/parents, coupled with their interpretation of the risks and benifits of different birth choices - which are the same things that factored into my decision for a CS.

 

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She clearly stated that she "feels much, much more comfortable with the controlled environment of a CS than taking her chances that she'll have an uncomplicated vaginal delivery." It seems obvious to anyone aware of what research is out there that the "chances" of an uncomplicated vaginal delivery are really quite high when the process is not tampered with.

 

Again, we will have to just disagree about what the research shows regarding the risks and benefits of various modes of delivery. Overall, most vaginal deliveries result in healthy baby, healthy mom, this is true. It's the percentage of births that will go wrong that concern me - it is a gamble I do not wish to take.

 

 

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And it seems that Poogles thinks the "controlled environment" factor of a c-section is much more important than the "risks to mother and baby" factor or the "recovery from major surgery" factor, which seems illogical to me.

 

No, you misunderstand - the controlled environment is what lowers the risks that I am concerned about; I would NOT choose an option that I thought was riskier to my baby. Recovery is not too much of a consideration, honestly - to me it would be worth it and a most likely nothing more than a minor inconvenience.

 

Quote:
But I suppose I get it, in a way. Giving up control is something everyone has to do when giving birth, and it's very difficult for some of us to do.

 

Electing to have an un-needed c-section probably does bring more "control" to the situation, although I'd argue even that is mostly an illusion. But the thing is, it doesn't bring a better outcome for the mother or the baby, in MOST cases.

 

I absolutely admit that even in a purely elective, pre-labor CS there are possibilities of complications, up to and including death (just as there is for vaginal delivery) - I just prefer those particular complications and risks to the ones possible in vaginal delivery.

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#60 of 120 Old 08-31-2012, 01:53 PM
 
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I absolutely admit that even in a purely elective, pre-labor CS there are possibilities of complications, up to and including death (just as there is for vaginal delivery) - I just prefer those particular complications and risks to the ones possible in vaginal delivery.

The maternal death rate is 246% higher for women during a csection than during a vaginal delivery.

 

 

 

What are the risks associated with vaginal delivery that concern you?


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