What IF C-Section Was Proven Safer Than Natural Birth? - Page 3 - Mothering Forums
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#61 of 143 Old 08-13-2013, 07:23 AM
 
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Dinahx, very true.  

 

  Even if we were to take the surgery risks away and say it was safer, what about consecutive pregnancy risks, assuming the mom would choose to have another "safer" cesearean?  What about health of mother and baby after birth?  Recovery?  Breastfeeding?  Hormone release that comes with vaginal birth?  We would have to ignore all of those things in the scenario that surgery was safer for birth for the general populace and pretend there are no problems.

 

 Regarding cost of elective/emergency, the US is a country of inductions and "failure to progress" which results in those emergency surgeries.  Not saying there aren't some real emergency ceseareans but those would be a small percent compared to the others.

 

 There are risks to vaginal birth.  I don't think anyone has said that there aren't any.  The summary I've found (from reading/talking to women) is that many of the bad vaginal outcomes comes from women not being educated about birth and the medical practice pushing for labors to be quick and using practices not needed.  We're no longer a culture where birth is normal and not medical, so we have these problems.  

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#62 of 143 Old 08-13-2013, 07:33 AM
 
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It seems to me fairly clear that the question is whether or not our choices are purely statistic-based or if we have an a priori bias towards non-intervention or in favor of natural birth, and if so, how far?

Yes, I imagine that's the main point of the hypothetical, right, Demeter?  You want to talk about whether our choices are driven by safety (if we're throwing out access, expense and religious objection) and to what extent. The exercise is to to see how far general ideological attachment to unmedicated birth is a factor when not choosing elective cesarean?  

 

Ok, so scratch my last post.  

 

To answer that question, I'd have to say, "I don't know". Safety gets weighed in for birth choices, sure, but then it gets mixed up with all kinds of other things. I chose to birth at home for both of my kids (my first was a non-emergent transfer).  My choice was not entirely about safety. So, no, I would say that I would not choose elective cesarean even if it were proven safer. By extension, I relate to and support other choices that are made based on similar decision making processes.  

 

 

But, of course it also comes down mostly by what we mean by "safer".  If there was some tragic mutation where 10% of children died as a result of vaginal birth I'm sure I would choose cesarean - of course. But, when we are talking "safer" currently when it comes to birth choices the numbers are too small for me to not let all kinds of other factors in, yk?  


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#63 of 143 Old 08-13-2013, 07:44 AM
 
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First I should state that I dislike thought experiments because I think a lot of the time they are an attempt to lead people to a certain way of thinking rather than their stated goal of just seeing what people think. And thought experiments are often harsh or filled with things that are horrific to think about.  I don't think it's a sign of lesser intelligence or anything to not like them.

 

Anyway, this is an interesting conversation so I'll join.  If a c-section were magically safer for me, my baby, and all women then I would, like many others here, look at how MUCH safer.  There would be a point at which I would have surgery instead based on that. I am also assuming that this safety magically continues for all health outcomes for mother and baby.

 

I'm still making this hypothetical decision for myself so from my perspective I will take into account what value I see in natural birth.  It can be a positive, bonding, transformative event and I wouldn't choose to miss that possibility.  I would feel connected to a traditional way of doing things and I value that.  Most importantly, I would feel human.  Birth is a mammalian human thing to do and I would want to join with the other humans in experiencing that (and like someone said previously, keeping that knowledge alive).

 

The thought experiment I would posit in response to this is what if there were a catastrophe and it was safer for people to move to a new planet in a big shiny space ship and live in a bio-dome on a semi-friendly alternate planet?  Would you go there, or would you stay on Earth with the remaining humans in a world that has no modern conveniences? 

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#64 of 143 Old 08-13-2013, 06:55 PM - Thread Starter
 
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Maybe you can show us some data on risks you believe to be unique to vaginal delivery vs. pregnancy generally. I don't consider my Pelvic Floor to be in grave danger from a vaginal birth, certainly not from an expectantly managed one (just as you are drawing a distinction between scheduled & emergency C, a distinction can be drawn between expectant & active management of vaginal birth). I had a second - third degree tear with my first birth, with my second I just loosened up a stitch that was too tight & opted for no stitching @ all. The end result was a love life that was *better* than before vaginal childbirth. Any pelvic floor issues beyond that are from carrying my children, not delivering them.

I just think in our culture, we cannot get an accurate picture of vaginal birth's real effects (positive & negative) because of persistent sexist inaccurate myths like 'hot dog & a hallway' surrounding vaginal birth . . .

 

 You keep asking for my "sources" that having nothing to do with the thread, and you keep going way off topic on stuff that while interesting is just screaming bias.  I"m going to give you some sources and then I want this matter to be closed.  I didn't come here to educate people I came here to educate myself.

 

I find it comical for women to call their vaginas yonis.  My Indian MIL who does yoga 1.5 hours per day in fact has a YONI (and speaks HINDI) and had an undiagnosed fistula as a result of her YONI birth in which she like many other women had her concerns over tearing dismissed as being "normal".  Not all women have good fortune in childbirth, and most who do know better than to think what works for them should be applied to everybody else and dismiss everything to the contrary.

 

And while you might not consider your pelvic floor in grave danger from an expectantly managed birth, a great number of women have pelvic floor damage as a result of giving vaginal birth.  There is a reason a great number and majority of urogynecologists themselves would opt for elective cesareans.  You keep throwing in additional information as if you can somehow change my hypothetical scenario; just let it go as you clearly aren't interested in the thread as it is.

 

I am really tired of being asked for sources. I will post several recent studies demonstrate how several assertions/beliefs are very possibly wrong in this thread particularly about pelvic floor damage which you ask for.  The point is, if you wanted this data all you have to do is look for it yourself.  

 

 

summary:
"An elective pre-labour Caesarean section in a nulliparous
woman at term has a lower risk of life-threatening neonatal
morbidity than spontaneous labour with an anticipated vaginal delivery. However, the increased risk of life-threatening
neonatal morbidity in the spontaneous labour group was
associated with an operative vaginal delivery or emergency
intrapartum Caesarean section and not a spontaneous vaginal delivery. Further research is needed to better identify
women with an increased likelihood of an operative vaginal
delivery or intrapartum Caesarean section, as this may assist
pregnancy caregivers in decision-making about childbirth."
 
"...cesarean was consistently associated with reduced odds of birth trauma across all birth weight subgroups whether or not fetal distress was present"
 
 
"...overall, the frequency of significant fetal injury is significantly greater with vaginal delivery, especially operative vaginal delivery, than with cesarian section, at 39 weeks."
 
"...demonstrates the need to include, assess, and balance the risk of psychological outcomes in different birth plans"
 
"survey of obstetricians in London, in which 31% of female doctors said they would choose a planned cesarean in an uncomplicated pregnancy, compared with 8% of male doctors"
 
"Having only vaginal childbirths was associated with a significantly increased  risk of stress urinary incontinence and pelvic organ prolapse surgery later in life compared with only having cesarean deliveries. ...each successive vaginal delivery increases the risk for prolapse and incontinence; it was not just the first delivery that had the most impact"
 
 
On reviewing the available evidence, it appears that there are sufficient grounds to assume that vaginal delivery (or even the attempt at vaginal delivery) can cause damage to the pudendal nerve, the caudal aspects of the levator ani muscle, fascial pelvic organ supports and the external and internal anal sphincter. Risk factors for such damage have been defined and variously include operative vaginal delivery, a long second stage, and macrosomia. It is much less clear, however, whether such trauma is clinically relevant, and how important it is in the aetiology of pelvic floor morbidity later in life.
 
 
"The occurrence of UI and anal incontinence during the postpartum period is related to the presence of incontinence in pregnancy, and vaginal delivery increases the risk of persistent incontinence."
 
 
The risk of urinary incontinence is higher among women who have had cesarean sections than among nulliparous women and is even higher among women who have had vaginal deliveries.
 
"women who choose a planned cesarean have a lower death rate"
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#65 of 143 Old 08-13-2013, 07:01 PM - Thread Starter
 
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Asking us to ignore the reality of birthing a baby by operating on the baby's mother & pretend it is safer for both parties is idealogical in nature because it posits a future where that could & will become reality. I am saying, based on the nature of what we are discussing & all existing data that medical science will never make universal, elective Cesearean a safer choice for mothers generally. Statistically it is quite far from being so now. So I am asking OP to examine the biases that lead her to believe that either Ceseareans are just about to become or could ever become the safer choice for the mother OR that the mother's safety is not important.

 

I am going to try to break this down one more time.  First of all, asking a hypothetical question doesn't convey an ideology. I HAVE my own ideology, but that had nothing to do with the question. And in case you need more sources, here is one:

http://www.merriam-webster.com/dictionary/ideology

 

 

  You seem to repeatedly ignore te actual question and draw something from it that has nothing to do with what I asked.  

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#66 of 143 Old 08-13-2013, 07:09 PM
 
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Hypothetically speaking, if there was concrete evidence that a c/s birth would be safer for both mom and baby I would have no problem making that choice. My two births were completely different (one vaginal, one c/s) and each resulted in some post birth challenges but in the end, for me, a safely delivered child was most important.
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#67 of 143 Old 08-13-2013, 07:11 PM - Thread Starter
 
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I do think it has been demonstrated through evolution that vaginal birth works pretty well. If we were to move over to birthing mainly through cesarean, I would worry about the outcomes of that. Honestly, it feels a little sci-fi even. On your other thread I think I also talked about this...  What if it were proven that it is safer to eat some weird nutritional concoction out of a feeding tube? It probably would be. Right? We could ensure optimal nutrition, everyone would have the same experience, things could be controlled. It think it would be kinda weird and would not be worth the few people who would die choking on a hot dog. Sorry to be crass. 

 

I know this is kind of hyperbolic but if this is a though experiment as someone called it, it seems like fair game. ;-)  

 

Hi, nice to see you again:-)

I don't think vaginal birth "works pretty well", but that's my own opinion.  I think for human beings in particular, vaginal birth is a very complex and often risky event and one in which changes to a woman's body are not good for her often enough that it warrants consideration of medical intervention.

 

That said, I also like and support home birthing for low risk women.  I just wish there was more data on home birthing AND elective c-sections, and that more research was put into understanding it to make it either safer.  I find it bizarre how the denial process both women and doctors end up in causes birth to be even more medicalized as a result. 

 

It is a thought experiment; I don't want to be cornered about my sources or have somebody tell me I think the way I do because I was "traumatized".  I very obviously would not have taken the time to ask the questions I do if I had ended up with a blossoming power yoni of sexual delight thanks to my birth experience.

:-)

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#68 of 143 Old 08-13-2013, 07:23 PM - Thread Starter
 
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Yes, I imagine that's the main point of the hypothetical, right, Demeter?  You want to talk about whether our choices are driven by safety (if we're throwing out access, expense and religious objection) and to what extent. The exercise is to to see how far general ideological attachment to unmedicated birth is a factor when not choosing elective cesarean?  

 

Ok, so scratch my last post.  

 

To answer that question, I'd have to say, "I don't know". Safety gets weighed in for birth choices, sure, but then it gets mixed up with all kinds of other things. I chose to birth at home for both of my kids (my first was a non-emergent transfer).  My choice was not entirely about safety. So, no, I would say that I would not choose elective cesarean even if it were proven safer. By extension, I relate to and support other choices that are made based on similar decision making processes.  

 

 

But, of course it also comes down mostly by what we mean by "safer".  If there was some tragic mutation where 10% of children died as a result of vaginal birth I'm sure I would choose cesarean - of course. But, when we are talking "safer" currently when it comes to birth choices the numbers are too small for me to not let all kinds of other factors in, yk?  

 

Yes, to the first question, except that we aren't throwing out the access; access to it is assumed.  Religious objection and cost stand as valid reasons to say no to c-section in my scenario.  The question was basically to what extent our ideologies interfere with the best/safest outcome for mother/baby. Period. I think the emerging answer for a lot of women is an emotional one and for some it's one about identity/relationship to the world.  

 

Another missing piece of the puzzle is the lack of studies and academic research available into the safety of home births, which very well might be safer over all than any hospital birth for a large number of women. If only more people asked! That is yet another example of how one's (my own, in this case) personal experience and ideology shapes the direction of where I educate or don't educate myself, and how thew same data could get published in order to answer one public questions vs. another.

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#69 of 143 Old 08-13-2013, 07:29 PM - Thread Starter
 
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The thought experiment I would posit in response to this is what if there were a catastrophe and it was safer for people to move to a new planet in a big shiny space ship and live in a bio-dome on a semi-friendly alternate planet?  Would you go there, or would you stay on Earth with the remaining humans in a world that has no modern conveniences? 

 

LOL. I like this question.  I have done remote solitairy hiking and enjoyed it.  I'm pretty hardcore about to being close to the earth: when it doesn't put my life or family in obvious risk.  But if day to day living were as risky as birth, then I would move to the big shiny planet.  

 

However, the point that you are making is that in the way you chose to answer the scenario, the safety is not significantly more, so you would choose your own personal values to tip the scales.

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 I find it bizarre how the denial process both women and doctors end up in causes birth to be even more medicalized as a result. 

It is hard to discuss hypotheticals because so often there is a personal motivation behind the question (I think that's what some people are talking about when they say this is an ideological question).  

 

When I said that vaginal birth worked pretty well I meant it got us through many millions of years. My mind went to cesarean section being WAY safer and removing financial obstacles it went to birthing entirely by cesarean as a species (not an individual)...and then I wondered how long we could go with that method of giving birth. I'd be weird, wouldn't it? 

 

My mind skipped right over the current birth debate because if we were going there I do think I'd have similar trouble that others are having with separating out all the issues that we know are related and it wouldn't be a hypothetical. 

 

 

Anyway, I hope you find the answers you're looking for and I wish you well for your birth. 


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#71 of 143 Old 08-13-2013, 08:08 PM
 
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The question was basically to what extent our ideologies interfere with the best/safest outcome for mother/baby. Period.

To that question I would say that I object to the term "interfere". If we substitute "influence", I think they play a HUGE role (if talking about basically the current state of what we know if just slightly tweaked in favor of cesarean). I think we all do it. Some, probably, more than others. 

 

If this is the question another way to ask would be to ask parents to list their top ten reasons for choosing birth interventions in order of most to least important. I'd be telling to see where safety falls for people and how they phrase that, wouldn't it? 


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#72 of 143 Old 08-13-2013, 09:13 PM
 
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The mother/baby in a birth scenario are not interchangeable and never ever will be. Their safety is measured individually. I maintain that there will never be a scenario where an elective surgical birth is safer for BOTH the baby and the mother, it is sorta close, if OB was practiced correctly (ie always waiting for 39 actual IRL weeks vs. 39 LMP weeks) to being safer for the baby. That's it. But you don't get a I'm a Better Mama award for choosing one. Just as you said, there is risk inherent in birth, and past a certain point it can only be shifted around, not completely eliminated. Tradeoffs.

 

I don't get how someone would be NOT idealogical and not eager to link to data. There is really a very clear motivation behind this hypothetical. 

 

I wholeheartedly believe that Homebirth is NOT quite exactly as safe for the baby, but women still get to choose one. And they aren't bad mamas for choosing the option that is safer for themselves & acceptably safe for their baby. Medical care in birth is totally wonderful, and expectant management with trained professionals in the developed world does NOT frequently entail Fistulas. Trying to imply that that is a real & common risk of expectant management & SVD in a medical setting would be like someone attacking Cesareans to post women who had to have limbs amputated or ended up in comas after their surgical births.

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I also object to the term 'interfere' and it gets back to my dislike of hypotheticals. I'm pretty sure everyone can see this is not just a hypothetical but something the OP actually believes to be true.

As far as using ideology or whatever to tip the scales of my hypothetical choice, you might be surprised how much weight I would give my own ideology compared to other people. I'm assuming other people would be in line for the c-section before me. But that doesn't make me a bad mom. That doesn't mean I don't care about the safety of my hypothetical baby.
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#74 of 143 Old 08-14-2013, 06:08 AM
 
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I also object to the term 'interfere' and it gets back to my dislike of hypotheticals. I'm pretty sure everyone can see this is not just a hypothetical but something the OP actually believes to be true.
 
 
I really don't think so. Sometimes members are on this journey as they are having a tough change or some reaction to birth (or whatever topic) and Mothering can be a great place to process that. It can seem funny because for a variety of reasons we are not comfortable asking a direct question - or often don't quite know what the direct question is until we've had a chance to discuss the issue. I've been a member since Demeter's first thread here and admire her process and soul searching!  
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That is yet another example of how one's (my own, in this case) personal experience and ideology shapes the direction of where I educate or don't educate myself, and how thew same data could get published in order to answer one public questions vs. another.

Yes! I think this is a cool thing to dwell on, really. To me, it's the path to really being self-aware. It's one thing to be educated on a variety of subjects and to let our passion settle on a few things...it's another to really get deep on the process that we use to get there. 

 

One of my observations about myself and others is the tendency to decide what we want to be true first...and then apply research after. Right?  

 

Another funky little pitfall is that once something is on our radar we naturally start to "see it".  It's like getting a new model of car - have you noticed that you suddenly see that car everywhere?  

 

Then, of course whatever confirms what we want to be true is great & valid and whatever contradicts it deserving a deeper look or we decide is trivial or worth it. Or, more likely, we don't even see it because it's not what we're looking for. Funny how we can understand it for ourselves (on some level...? or maybe we don't?) but have so much trouble understanding when someone else does it, right? 

 

If this is what you mean by ideologies interfering, I can see where you're coming from. 

 

What I guess I would say to that is that I think it better to work on our own stuff in that department - work on where our own ideologies may be leading us astray. It's *really hard* to discuss other people's ideologies and where that's interfering with rational choices without them feeling defensive or tricked. If that's part of the question, I think maybe a really clear, direct question about that would be a good way to go.  However, I do think that being really self-aware of our own choices and process may make us less invested in the choices others make. 

 

The reality of all of this is that if any of us were really clear we would probably be focusing on something like access to medical care, ending heart disease, or education, or global warming or whatever. Even what we choose to talk about or think about reflects our own ideologies. 


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#75 of 143 Old 08-14-2013, 06:50 AM - Thread Starter
 
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I also object to the term 'interfere' and it gets back to my dislike of hypotheticals. I'm pretty sure everyone can see this is not just a hypothetical but something the OP actually believes to be true.
 

 

That's a very indirect way of making an accusation.  I AM a human being here part-taking in this thread, so if you have something to challenge in my viewpoints, go ahead.  I made very clear what my motive was in the thread.  Latter posts of mine no doubt indicate I do have ideological bias, but the purpose of the question was to see if people even answered it.  FOr the most part, they had trouble with it.  I wanted to understand why.  Indirectly suggesting I have an ulterior motive  or am not being honest is really just more scapegoating.

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I don't get how someone would be NOT idealogical and not eager to link to data. There is really a very clear motivation behind this hypothetical. 

 

 

Yes, there is! And if you actually read and understood one single thing I said, instead of constantly veering off-topic or demanding "sources", you'd have no reason to even make this statement.

  I've been clear from the start.

 

For the most part, people who reject the hypothesis do so without trying to "defend" their reasoning with arguments that had nothing to do with the scenario in the first place.  IT's purely hypothetical.  What evidence there is to support the possibility that cesarean IS definitely safer for some women has no bearing on what I wish to understand.  There is plenty of evidence, sources, Etc.  None of them prove a hypothetical.  That's ridiculous.  If you were sincerely interested in sharing information, learning, or otherwise contributing something beyond your own ideological agenda I think by now you would have done so.  

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#77 of 143 Old 08-14-2013, 07:05 AM
 
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That's a very indirect way of making an accusation.  I AM a human being here part-taking in this thread, so if you have something to challenge in my viewpoints, go ahead.  I made very clear what my motive was in the thread.  Latter posts of mine no doubt indicate I do have ideological bias, but the purpose of the question was to see if people even answered it.  FOr the most part, they had trouble with it.  I wanted to understand why.  Indirectly suggesting I have an ulterior motive  or am not being honest is really just more scapegoating.

In that case a better use of everyone's time would be to ask, "If asked, 'If C-section were proven safer than vaginal birth', would you answer the question. And, if you would have trouble answering, why do you think that may be."  winky.gif

 

I can tell you why I thought the question was troubling. It's because I don't know what you want to know and in clarifying, you've given several different explanations. I suggest getting deep on what the question is and try again. Ulterior motive, no, but an unclear one for sure. Hugs and support for the work you're trying to do! 


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#78 of 143 Old 08-14-2013, 07:05 AM - Thread Starter
 
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To that question I would say that I object to the term "interfere". If we substitute "influence", I think they play a HUGE role (if talking about basically the current state of what we know if just slightly tweaked in favor of cesarean). I think we all do it. Some, probably, more than others. 

 

If this is the question another way to ask would be to ask parents to list their top ten reasons for choosing birth interventions in order of most to least important. I'd be telling to see where safety falls for people and how they phrase that, wouldn't it? 

 

I agree, the use of 'interfere' was a poor choice, and skewed the hypothetical with my own ideological bias.  That's why I've tried not to append too much to the question because I think it was pretty clear to begin with.

 

We all have an ideology and I don't want mine to interfere with the way the question is understood and I think for the most part that has been accomplished.  In fact, trying to understand  information without prejudice is a part of my ideology; but it's fallible because I'm human. However, my agenda has been very clearly explained.  

 

I think the reason I posed my question the way I did is because most people are not even aware of their own biases and that is what I wanted to get to the heart of.  This is too vast a topic to contain in one thread so my efforts to keep it simple started with a simple hypothetical.

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In that case a better use of everyone's time would be to ask, "If asked, 'If C-section were proven safer than vaginal birth', would you answer the question. And, if you would have trouble answering, why do you think that may be."  winky.gif

 

I can tell you why I thought the question was troubling. It's because I don't know what you want to know and in clarifying, you've given several different explanations. I suggest getting deep on what the question is and try again. Ulterior motive, no, but an unclear one for sure. Hugs and support for the work you're trying to do! 

 

I am going to have to disagree with you here:-)  My motive has been explained in detail throughout the thread and is really quite simple. I wanted to know if people could answer a hypothetical and very straight question when the scenario is one they are not comfortable with.  

 

People often have trouble with answering the question simply and directly because they are uncomfortable with the scenario right off the bat.  People are not even willing to answer the question without digressing.  The question was very clear.  If it is proven best/safest for mother AND baby.  If it was available to you where you are.  Still, people seemed to gloss right over these details.

 

If people are not even willing to consider the question without digressing, it illustrates how their personal feelings/biases can potentially prevent them from being receptive to information.  That might be arguable, but it's my own experience and conclusion.

 

My impression so far is that this is one topic people feel very strongly about and the end result is an insidious amount of misinformation and deficit in proper education for women like myself.   I've been very privileged to make the birthing choices I made, despite the errors I made due to my own biases at the time.  I made some fear-based decisions, and in MY ideology, that is now recognized to be a very grave mistake.  I have no agenda to convince anyone of this, just to revisit where my head was before I took on a different way of seeing things.

 

One thing I like about the moms in this forum however is the large number of them who understand that each woman deserves to make her own choice.

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#80 of 143 Old 08-14-2013, 08:03 AM
 
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 It looks like the reasons why most here are having trouble with choosing the hypothetical, is the safety and all that goes with it, is hard to ignore.  A few posters mentioned personal motivation behind our ideals, when you get to the root of it.  I think that's partly right.  We would have to completely remove emotion (religion etc) out of the equation, and that's difficult to do, no matter how much we deny it. 

 

 A friend of mine once said that we can find any information to back our beliefs-another example- it was just put out last year if I remember right, that vbacs should be explained to all women with prior csec and attempted if the woman is a candidate for it, due to the safety/birth benefits. I'm sure there are many that would dispute that fact or moms having fear of a vbac, just like many would be in favor of it.

 

Demeter, it seems that you are having a hard time with this decision?  Or looking for more support in ceseareans over vaginal birth, given the hypothetical question?  Momma, this is your/family birth choice.  If you feel that it is right for you, then that's what you do.  I'm sure if you were to make an elective cesearean thread, those having one or had one would pop in :) 

   

 

I think one thing to remember, is to not be judgemental toward each other.  Especially with birthing choices, it can be a hard decision, especially if our prior birth experience was not ideal for us.  How many of us had not great experiences with birth the first time so looked for a different way the second?  How many of us had to fight for our decision that second time, especially if it was very different?  How many of us changed our ideals to support that choice?

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#81 of 143 Old 08-14-2013, 08:07 AM
 
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I am going to have to disagree with you here:-)  My motive has been explained in detail throughout the thread and is really quite simple.

No, it really wasn't - at least not to me. Communication is part asking, part listening and part being understood. I'm trying to listen to the question...and it is feeling more like an a discussion of other people's biases than anything else. 

 

Have you ever heard the saying, "90% of drivers think they are a better than average driver"?  Most us to think we are aware of our own biases. 

 

I do not think this is a simple question or that the question is clear or that it has been clarified well. If there is something to be gained in learning that people are having trouble with this question, I struggle with understanding what that is. You seem resistant to the possibility that it is just a poorly constructed question, which I think is a pretty good example of one form of bias. 

 

 

 

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#82 of 143 Old 08-14-2013, 08:13 AM
 
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Demeter, I've been skimming through this thread and I admit, I am not always following the conversation. But what does stand out for me is that you're trying to process an unexpected and difficult experience with birth, and that's something I can relate to, having had an unplanned c-section after a long & difficult labor.

 

You also seem to be asking about how we use information, specifically, statistics, to make decisions.

 

I'd like to offer a few thoughts, which may or may not be in line with what you're aiming for. I present all thoughts as my opinions.

 

No statistic, whether real or "experimental" will ever be 100% true for all births. Some of them might be vanishingly close to 100%, but there is nothing in birth that will apply to absolutely everyone. My experience with looking at stats is that I wanted to know not only "what are my chances of having a good outcome" but I wanted to know "will a bad outcome happen to me?" I think it is easy to confuse wanting to know your statistical risk of having something happen with being able to predict what will actually happen to you during birth. As rational as I hope my mind is, I was hoping that having the stats on my side would mean that nothing bad would happen.

 

I think there's a difference between how we look at information when we're preparing for the unknown, and how we look at it as we're processing after the fact.

 

Now that I'm on the other side of birth, having had a difficult experience that I had felt was not very likely, I have found myself tending towards two different ways of processing it:

 

A) Deciding that my bundle of "birth beliefs" was a load of crap and feeling duped by what I did not know or anticipate.

B) Blaming myself for doing something wrong (because birth can't be flawed, but I can be).

 

I think these are very common responses to difficult experiences. I'm sure I'm not the only one who does this. The internet makes this pretty clear. No matter what bundle of birth beliefs one holds, there's a website out there devoted to poking holes in those beliefs, trotting out examples of where those beliefs have served women poorly, and rallying a community that wants to counteract that set of beliefs, etc. And the same holds true for option B. I'm pretty good at self-blame on my own, but if needed reinforcement, I can find ample voices on the internet that would join me in picking apart every detail of my birth experience and pointing out every mis-step that I made.

 

I don't want to gloss over the fact that some bundles of birth beliefs truly are dangerous and detrimental to women. Care providers can do things that harm women, and women themselves can undermine their birth experiences by being poorly informed or making poor choices. I know that can happen, and when it does, I think it's important to call out the bad beliefs or the bad care providers, and it's important for women to decide for themselves what ownership they want and need to take in their own experiences in order to move forward. And the internet is also a great place to see all of that in action.

 

I find it harder to get support for what I think of as the 3rd path, which is the path that I have been trying to walk for the past 4+ years. And that is the path where birth doesn't get blamed, care providers don't get blamed, and women don't get blamed, because there is a mystery at the heart of birth, and the mystery is that some births are really difficult, and there isn't always a simple, clear reason why. That's what feels most true in my experience, and that's the place I try to stay, though there is very little support for it.

 

I don't know if that addresses what you're getting at, but I just wanted to share in case you find any of this helpful. If not, feel free to ignore all of this!

 

I wish you peace on your journey.


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#83 of 143 Old 08-14-2013, 08:54 AM
 
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Demeter, I'm sorry for talking about you without talking directly to you. I was confused by some of the side conversation that was about people's current knowledge of safety, as opposed to the hypothetical. I was purposely ignoring your situation and journey because that wasn't what the question was about. I don't mean to be cold about that though. You're definitely a human and I'm glad you're here talking about all this.

One thing that maybe a pp just touched on is that when I look at statistics I try to decide how they apply to me. In the thought experiment that is not part of it because it is assumed that they just DO apply to me, or it is assumed they are not statistics but rather a crystal ball knowledge of the future. That might be where some of the side conversation stems from.
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#84 of 143 Old 08-14-2013, 09:00 AM
 
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Demeter, are you expecting there to be a common number representing safety that everyone will agree on? By that I mean, if c-section were 80% safe but vaginal birth was 60% safe do you think all moms would/should choose c-section? I'm wondering if your question is about what the numbers are for each person, or if your question is about (given the numbers) what would influence a person to choose the less safe path.

I guess I'm curious if we can or should add more details to the thought experiment in order to get more specific responses. Like, hypothetical numbers.
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#85 of 143 Old 08-14-2013, 09:44 AM
 
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I've been reading along to see what others have had to add to this conversation, and it's been interesting. I've decided there are a few things I would like to say.

 

There's been a few mentions of us making decisions emotionally, and then backing them up afterward with the "facts"/statistics/etc. that most conform to our pre-made decision. There's actually a really awesome book about this topic that I highly recommend called The Righteous Mind by Jonathan Haidt. It's way too long to get into his theories in detail here, but it basically boils down to the fact that deciding and THEN reasoning is what humans do. It's far more interesting than that, though.

 

I also agree with the statement that no, honestly, the hypothetical situation presented at the beginning of the thread is NOT clear, and that's part of the reason people have been struggling to answer it. Just to quote it one more time:

 

Quote:

If you happened to see strong supporting evidence that proved to you that giving birth via scheduled c-section at 39 weeks is now safer/better for mom and baby than giving or even attempting birth vaginally at 40+ weeks in an uncomplicated scenario, would you still go ahead and attempt vaginal birth?

 

Why or why not?  (Assuming you lived in an area and had access to care that had been included in the studies proving the safety of the procedure).

 

The biggest thing that is unclear to me about this is whether or not the scheduled c-section is safer for mom and baby only in the short term (i.e., no/fewer injuries to mother & baby, no/fewer perinatal infections, no/fewer respiratory issues for baby, etc.), or if it is the short AND long term - i.e., 20 years later, moms/babies who went the section route were physically healthier than moms/babies who attempted vaginal delivery. The word "better" on its own is totally meaningless, IMO. I do not understand if the OP means "better" physically (which I would think would be covered by "safer") or better emotionally (which is an entirely subjective and personal thing, and there will never be a one-size-fits-all "best" in that area), or in some other way. It is also entirely unclear from this scenario (as has been brought up several times) whether in this hypothetical world, the risks of repeat cesareans to future babies still exist. Perhaps the lack of future risks is, in the OP's mind, implied by "safer", but again, this is not directly stated. As has also been brought up, all surgery requires a recovery period, even if there are zero complications from the surgery and recovery proceeds flawlessly. If this hypothetical is meant to be about a future where abdominal surgery magically no longer requires any recovery time, that should be stated directly. There is also the question many have brought up about breastfeeding - having a c-section is known to increase the risk of breastfeeding issues. If, in this hypothetical scenario, that risk has been eliminated, it should be stated. Again, perhaps the OP thinks that is implied in the "better/safer" portion of the hypothetical, but that is very unclear.

 

I have already answered the question quite directly, but I will answer it again just to be clear: If the evidence proved to me that a scheduled c-section was safer than attempting vaginal delivery, I would want to know how much safer. If it were significantly safer (reducing risks from, say, 1 in 10 to 1 in 1000), I would probably do it, even if there were risks to subsequent pregnancies. If the risk reduction was less pronounced (say reducing risks from 1 in 1000 to 1 in 10,000), I would probably not do it, due to the risks to subsequent pregnancies and the necessary recovery time. I understand (and have experienced) that vaginal deliveries also have recovery times to some greater or lesser extent. However, there is at least a chance with a vaginal delivery that that recovery time will be minimal, and there is not really a chance of that with c-sections.

 

If I were rewriting the hypothetical as I am guessing (perhaps incorrectly) that the OP intended, it would look like this:

 

If you saw evidence that proved to you that giving birth via scheduled c-section at 39 weeks is now always much safer* for mom and baby, in all measures of short- and long-term physical and emotional health, than giving or even attempting birth vaginally at 40+ weeks in an uncomplicated scenario, would you still go ahead and attempt vaginal birth? Assume that there is no recovery time from the c-section (you're up and moving normally the next day, no pain or risk of injury to the incision site), and that breastfeeding is in no way hindered by your surgery.

 

Why or why not?  (Assuming you lived in an area and had access to care that had been included in the studies proving the safety of the procedure).

 

*Assume, too that the evidence meets your definition of "much safer", whatever that may be.

 

The answer to this question is yes, of course I would. Do I find it incredibly unfathomable that such a scenario could ever exist? Yes. But if it did? I have no reason to have a vaginal birth if it isn't better in any way, shape, or form for anyone involved.

 

I think the biggest reason people are struggling with even contemplating this scenario is because it posits a world in which we KNOW, absolutely and beyond any doubt, that a complex intervention that affects a myriad of things in two different, complex human beings, potentially for the rest of their lives, will be better in all measures than the alternative. Science simply doesn't offer that kind of certainty about anything. All science can do is offer odds. It is not entirely unfathomable to me that scheduled c-section could someday be a better option for a large percentage of women. (Unlikely, to my mind, but not unfathomable.) But absolutes are always difficult to contemplate, because we do not live in a world of absolutes.

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#86 of 143 Old 08-14-2013, 10:20 AM
 
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What I meant was that it is very common in our medical world for them to decide and present strong evidence for something (Like formula feeding is better decades ago) and then take it back only a few years later. Just like circumsision. Before they said to not do it, now they are saying to do it. In the end this cycle is common and if they did come out saying csection at 39 weeks is better (which we know will not happen as studies continue to come out to show this is not the case at all) I would not trust it as it is pretty normal for these things to bounce back and forth. In my ecperience the natural way almost always wins out in the end (not saying there are not exceptions as I myself am one) but for the most part it seems as much as we fight the natural processes the more it ends up that it was the best way all along.
 

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#87 of 143 Old 08-14-2013, 10:31 AM
 
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I've been reading along to see what others have had to add to this conversation, and it's been interesting. I've decided there are a few things I would like to say.

 

There's been a few mentions of us making decisions emotionally, and then backing them up afterward with the "facts"/statistics/etc. that most conform to our pre-made decision. There's actually a really awesome book about this topic that I highly recommend called The Righteous Mind by Jonathan Haidt. It's way too long to get into his theories in detail here, but it basically boils down to the fact that deciding and THEN reasoning is what humans do. It's far more interesting than that, though.

 

Thanks for the book recommendation. Sounds like a very interesting read.


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#88 of 143 Old 08-14-2013, 10:58 AM - Thread Starter
 
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Demeter, it seems that you are having a hard time with this decision?  

 

You are referring to my decision to have an elective cesarean? Not in the slightest.  I know what is best and safest for me and my baby.  I have no problems with people not seeing it that wa because I understand where it comes from.  I have read more than one side of the reports and done my homework.  There is an ideological bias for the majority of people.  What I posted this thread for was to revisit my own thinking back when I thought along similar lines.  Now I do.

 

You are very right in that people can find "data" to support whatever ideas they want to, and in the natural childbirth industry, there is no shortage of bias and miseducation either. "Nobody is saying vaginal birth doesn't have risks", is a far cry from educating women about what the risks are.  "Our bodies are designed to give birth" is clearly not applicable to all women and grossly dismissive, insensitive, and ignorant of the realities.  We who hold steadfast to the dogma do so for a reason.  It is just the flip side of the coin for those who dismiss what they consider less important.

 

I take no pride in the idea of a "natural" birth because I don't believe it is inherently better than any other type birth.  Safer? Sometimes.  More enjoyable? Sometimes.  Better if you plan to have more than 2 or 3 babies? Absolutely.  But most women don't.  Nothing is perfect but so few people are willing to talk about the imperfections of nature.  Mother nature is imperfect and quite cruel and that is based on the data.  That is the crux of where the denial seems to lay.

 

I have seen too many times women who have put pressure on themselves to be whatever the ideal is in terms of having a natural childbirth.  Until we remove the judgmental attitudes we carry towards ourselves and women who choose differently for themselves, we are all wrong.

 

My question was very clear. My motive was very clear.  Those who wanted to understand better asked rather than assumed.  Those who were scared jumped to conclusions or tried to invalidate my question (or motive).  

 

All in all a good and interesting discussion.  I will take my time to learn all there is to learn from this as I come to understand my OWN biases and refine my own ideology.

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#89 of 143 Old 08-14-2013, 11:12 AM - Thread Starter
 
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No, it really wasn't - at least not to me. Communication is part asking, part listening and part being understood. I'm trying to listen to the question...and it is feeling more like an a discussion of other people's biases than anything else. 

 

 

 

It is not a discussion of other people's biases, it is a discussion of everyone's biases.  Implying that this is somehow one-sided is just not representative of the thread or what I have said personally.  The question itself, while it definitely raised other questions, really raises all the valid questions I wish more people would ask in the first place:

 

1. What are the true potential complications of vaginal birth compared to c-section for me, really? 

2. Is safety what I value most about giving birth?

3. Why does the idea of mother nature being inferior to scienctific (or created) intervention bother me?

 

There are a lot of assumptions and dogma.  These are all questions I wish I had asked myself sooner.  My motive is to understand why I didn't.  It's still a bit of a mystery.  

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#90 of 143 Old 08-14-2013, 11:22 AM
 
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I think actually experiencing a Cesarean is the only thing that can disrupt the current set of ideas that you are espousing. I actually developed my passion for expectant management of childbirth after seeing my mother go though four classical Sections (the first of which saved my life) and then 5 years later, a Hysterectomy for adenomyosis, etc. Classical sections are definitely on a higher order of impact, it makes the tradeoff a lot more clear, but there is still a tradeoff today.

 

There are a lot of assumptions being made in this thread about those who interpret the available evidence on birth safety differently. 

 

That we are scared of medicine, that we are under the spell of dogma, that we think just because something is natural it is always better in a very rube like simplistic fashion, that we are basically starry-eyed pawns of the natural childbirth 'industry'. Those assumptions are not correct, but I suspect that until you experience the other method of resolving birth, you won't see where we are coming from. I hope dearly that when this is all done, that you have such a wonderful and problem free experience that you can hold on to your assumptions, but the reality is that just as getting a low-impact vaginal birth is a combination of skill (in preparing, in selecting a setting and provider), health, and luck, getting a low-impact cesarean is dependent on the same factors.

 

I have seen women who WANTED cesareans howling @ the moon afterwards and feeling totally trapped by the recovery time and the pain. And I have seen women who didn't want them do awesome! I have also seen women who thought it would go fine get horrible post-op infections and women who had health conditions that should have made recovery complicated back to work & love @ 3 weeks . . . So it just isn't 100% predictable or even close . . . 

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