"Too Posh to Push" - Mothering Forums

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Old 01-16-2006, 10:53 PM - Thread Starter
 
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LA Times Article today. Increasing acceptance of elective Cesarean births.

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When 'natural' seems too risky
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Old 01-16-2006, 11:00 PM
 
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I can hardly wait. This person is projecting that c-sec's will not peak until they reach 60%. Freakish.

Personally though, if I was planning a birth with half a dozen people standing in a circle screaming at me to push harder and not to breathe while staring at my genitalia, I'd probably also want a c-sec.
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Old 01-16-2006, 11:45 PM
 
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Huh, a good portion of that article, all the stuff about incontinence, seems to actually be an argument against episiotomies.
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Old 01-16-2006, 11:57 PM
 
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Ick. I so-o could not wrap my head around this.
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Old 01-17-2006, 12:00 AM
 
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Hmm. Well, the article as a whole seemed to portray both sides fairly well. They did cite most of the newest research I've read (both pro and con). I am irritated that there's no recognition that many of the problems after vaginal births aren't due to the method of birth, but to the way vaginal births are handled by a typical OB. I'm also floored by this:

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Dr. Patrick Culligan, an obstetrician at the University of Louisville Health Sciences Center, did a statistical analysis of risks and costs, published in the International Urogynecology Journal online in July 2004. He estimated that if 100,000 hypothetical women chose planned surgery over vaginal delivery, the result would be 16.6 fewer permanent nerve injuries to babies' shoulders, a rare side effect of complicated vaginal delivery. He also predicted that there would be 185.7 fewer cases of anal incontinence in women as they aged, and an overall cost savings of $3.2 million.
How can that monetary value be right? C-sections cost so much more, how can doing them on everyone save money?

For me, even though I can never in a million years imagine choosing an elective c/s, I feel like I've got to support that choice. I don't want to but I can't rationalize supporting one woman's choice over another. So really, I think every woman should have a choice to birth however she wants, from planned c/s to planned UC and everything in between. I'd like to see a lot more education and a lot more fairness though--if someone can choose a c/s and get their insurance to cover it, then I shouldn't have to fight and fight and fight to get my HB covered.
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Old 01-17-2006, 12:03 AM
 
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Quote:
Originally Posted by sapphire_chan
Huh, a good portion of that article, all the stuff about incontinence, seems to actually be an argument against episiotomies.
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Old 01-17-2006, 11:44 AM
 
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Originally Posted by tie-dyed
Personally though, if I was planning a birth with half a dozen people standing in a circle screaming at me to push harder and not to breathe while staring at my genitalia, I'd probably also want a c-sec.


I agree!

Mandy, )O(  Proud mommy of Taylor (1/6/05) jammin.gifand Abigail (4/21/11) slinggirl.gif
Loving wife of my gamer boy Michael. modifiedartist.gifBlog link in my profile! ribboncesarean.gif
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Old 01-17-2006, 03:37 PM
 
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I can't read the article because it wants me to log in.

Anyway, I am one of those women who will elect to have a c-section. I believe everyone should have the right the brith as she wants to, but then I'm just one of those "too posh to push" .
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Old 01-17-2006, 03:55 PM
 
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What I don't understand about the "too posh to push" mentality is...

What's posh about being catheterized and peeing in a bag?
What's posh about a longer and often far more painful recovery?
What's posh about scarring?
And why is being cut across your abdomen so much more pleasant than POSSIBLY having a small tear elsewhere?

I just cannot for the life of me fathom why people think a c-section is somehow easier and more dignified than a vaginal delivery (although I do think "standard" vaginal delivery in a hospital is pretty undignified most of the time!).
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Old 01-17-2006, 06:15 PM
 
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Quote:
Originally Posted by sapphire_chan
Huh, a good portion of that article, all the stuff about incontinence, seems to actually be an argument against episiotomies.
I've noticed that. These studies and doctors automatically assume that I won't eat well and exercise, that I'll allow someone to make me labor in bed, push in the lithotomy position, give me an nice deep episiotomy and chant push push push while I push at full dialation until I burst blood vessels- with or without the urge to push.

<shudder>
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Old 01-17-2006, 08:10 PM
 
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Originally Posted by NYCVeg
What I don't understand about the "too posh to push" mentality is...

What's posh about being catheterized and peeing in a bag for three days?
What's posh about a longer and often far more painful recovery?
What's posh about scarring?
And why is being cut across your abdomen so much more pleasant than POSSIBLY having a small tear elsewhere?

I just cannot for the life of me fathom why people think a c-section is somehow easier and more dignified than a vaginal delivery (although I do think "standard" vaginal delivery in a hospital is pretty undignified most of the time!).
Not sure where you derive your information from but women who have csections are not cathed for three days. Some who have complications after surgery possibly, but the cath is usually out in 12-24 hours. Also, you assume that its a far more painful recovery -- my last two csections were a breeze to recover from. Far better than many vaginal births, even some homebirths, I know of. My friend who had a emergency csection ten weeks ago said it was far easier than her vaginal birth and that had she been able to elect if for her first birth, she would have. (note she had a natural birth for the first)
While I do have a scar, its pretty faint now and I would rather have my six inch cut there then a third or fourth degree tear in my vagina.

Don't get me wrong, I am all for people having the right to choose the birth they want. And I believe in natural childbirth and homebirth, but also support a woman's right to choose a csectoin if that is what she wants and feels is best for her. Its about freedom of choice, for everyone, even when they don't agree with you.

Kim
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Old 01-17-2006, 09:21 PM
 
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Originally Posted by OnTheFence
Not sure where you derive your information from but women who have csections are not cathed for three days. Some who have complications after surgery possibly, but the cath is usually out in 12-24 hours. Also, you assume that its a far more painful recovery -- my last two csections were a breeze to recover from. Far better than many vaginal births, even some homebirths, I know of. My friend who had a emergency csection ten weeks ago said it was far easier than her vaginal birth and that had she been able to elect if for her first birth, she would have. (note she had a natural birth for the first)
While I do have a scar, its pretty faint now and I would rather have my six inch cut there then a third or fourth degree tear in my vagina.

Don't get me wrong, I am all for people having the right to choose the birth they want. And I believe in natural childbirth and homebirth, but also support a woman's right to choose a csectoin if that is what she wants and feels is best for her. Its about freedom of choice, for everyone, even when they don't agree with you.

Kim
Okay...I changed the "three days" thing. I was sort of speaking hyperbolically.

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

I don't "assume" it's a more painful recovery. Statistically, it is. All of the studies that I've come across of on c-sec vs. vaginal delivery say that sections lead to more painful and longer recovery times, on average. That doesn't mean that EVERY woman will have a worse recovery with a section, but that she women are statistically likely to. In one study, for instance:
25% of women reported pain 2 weeks after their c/s
15% reported pain at 8 weeks, including difficulty with normal activities, such as bending, getting out of bed and caring for their babies
(This particular study is cited in Henci Goer's Thinking Woman's Guide to a Better Birth.) I'm perhaps more sensitive to this now b/c a friend of mine was bullied into an unnecessary c/s by her OB and ended up with a horrible and long recovery. She was basically unable to care for her child for weeks and had to hire outside help and she is in deep mourning about the bonding she lost immediately after the birth and in the weeks that followed.

The risks of complications are also much higher with a c/s. Sections have higher maternal mortality rates (numbers I've read, from different sources, are that moms are anywhere from 500-700% more likely to die as a result of an elective c/s). Problems associated with the surgery--hemmorage, blood clots, infection, etc.--are also far less likely with a vaginal birth. C/s babies are more likely to have lower Apgar scores and have difficulty breathing and 1-6% of babies are cut in the surgery itself (the risk is higher for breech babies). Having a c/s also increases the risk of uterine rupture and hemmorage in future pregnancies and deliveries, and the risk of ectopic pregnancies.

To me this is less about choice than about practicing responsible medicine. Personally, I believe that performing an elective c/s, in the absence of medical complications warranting surgery and particularly for first-time mothers, borders on malpractice. For a healthy mother and baby, the risks are more serious and more likely. Healthy bodies were designed to give birth vaginally, and I don't just think that there is a good argument that it is safer or more convenient to have major surgery to remove your baby (which is not to say that I don't think that c/s are a blessing for moms or babies with serious complications). Can you imagine if I walked into an ER with kidney stones and demanded that a doctor perform surgery on me to remove the stones because I didn't want to endure the pain of passing them? No responsible doctor would do this.

Now, if one is REALLY well-informed and knows all the risks and still elects to have the c/s, then I can see your point about choice, although I'm not sure I totally agree with it. But very few women take the time to truly research and take responsibility for decisions about their health--MDC is a very abnormal community in this way. In my experience, talking with OBs, doctors systematically downplay the risks of c/s and overplay the risks of vaginal births (same with episiotomies--a family friend who is an OB is STILL trying to convince me that episiotomies are safer and lead to less tearing, even though every single study on them AND the ACOG disagrees with him; he also says that he "would do a c/s every time if he could, b/c they're so much safer").
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Old 01-17-2006, 09:50 PM
 
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I agree Amanda... "in general" the recovery from a c/s is harder. Granted, I have an acquaintance who had a c/s, then vaginal and another c/s. She said the vaginal was the hardest- BUT she also had a hospital birth with the standard interventions including unfortunately an episiotomy <shudder>.
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Old 01-17-2006, 10:20 PM
 
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Quote:
Originally Posted by busybusymomma
I agree Amanda... "in general" the recovery from a c/s is harder. Granted, I have an acquaintance who had a c/s, then vaginal and another c/s. She said the vaginal was the hardest- BUT she also had a hospital birth with the standard interventions including unfortunately an episiotomy <shudder>.
As with all things, you can find plenty of anecdotal evidence on both sides. I'm much more convinced by large-scale studies. I also think the statistics would skew much more in favor of vaginal birth if (medicalized, hospital) vaginal birth in this country was not designed in a way that inhibits virtually all of your body's natural coping mechanisms (e.g., epidurals that suppress the natural release of oxytocin, pitocin that makes contractions harder and longer than they would be, monitors and IVs that restrict movement, lying a position that decreases the amount of oxygen the baby can get, pushing against gravity, episiotomies, bright lights and unfamiliar surroundings, etc.).
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Old 01-17-2006, 10:43 PM
 
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HOLY MOLY!!!!

Are there people right here on this very thread advocating for elective C-birth??

I thought this was a *natural* family living site?
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Old 01-18-2006, 12:41 AM
 
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Hey now.... even bloodletting had it's fans back in the day.

The next vogue will be colostomy bags...do you really think megastars like Britany Spears actually poop the same way you do?!?!?!?!?
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Old 01-18-2006, 01:46 AM
 
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I am going to try and do this point by point.

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

Really? I have read numerous homebirth forums including the one here where 3rd and fourth degree tears took place. Of the 4th degree tears I personally know people having, none of them resulted from an episiotomies.

"I don't "assume" it's a more painful recovery. Statistically, it is. All of the studies that I've come across of on c-sec vs. vaginal delivery say that sections lead to more painful and longer recovery times, on average. That doesn't mean that EVERY woman will have a worse recovery with a section, but that she women are statistically likely to. In one study, for instance:
25% of women reported pain 2 weeks after their c/s
15% reported pain at 8 weeks, including difficulty with normal activities, such as bending, getting out of bed and caring for their babies
(This particular study is cited in Henci Goer's Thinking Woman's Guide to a Better Birth.) I'm perhaps more sensitive to this now b/c a friend of mine was bullied into an unnecessary c/s by her OB and ended up with a horrible and long recovery. She was basically unable to care for her child for weeks and had to hire outside help and she is in deep mourning about the bonding she lost immediately after the birth and in the weeks that followed."

I think recovery is subjective myself. Anyway, I will say that while statisticly (and they are skewed often to fit the bias of whomever is interpreting them) may show that csection are more difficult to recover from, I think on this forum it is highly exagerated. The biggest problem with cesarean recoveries is the lack of information given to patients in boosting their recovery. While I would be interested in reading the EXACT study quoted above, I wonder how many who have vaginal births experience pain at 2 weeks. Most I know of.


"The risks of complications are also much higher with a c/s. Sections have higher maternal mortality rates (numbers I've read, from different sources, are that moms are anywhere from 500-700% more likely to die as a result of an elective c/s). Problems associated with the surgery--hemmorage, blood clots, infection, etc.--are also far less likely with a vaginal birth. C/s babies are more likely to have lower Apgar scores and have difficulty breathing and 1-6% of babies are cut in the surgery itself (the risk is higher for breech babies). Having a c/s also increases the risk of uterine rupture and hemmorage in future pregnancies and deliveries, and the risk of ectopic pregnancies."

I think you find that cesareans are fairly safe. While they may not be as safe as vaginal births, they are for the most part safe for mom and baby. Also I would LOVE to see the sources that a mom who has an elective csectoin has an increased rate of death of 5-700%. Thats complete rubbish and exageration if I ever read one. Of course natural vaginal birth is ideal and safer, but when dealing with individuals and their own health the ideal can easily change. I can clearly tell you that I had two wonderful cesareans which were pretty painless with excellent recoveries. Also had healthy, nursing babies that were not damaged at all by the surgery. Also, I think its unfair to really say that csection babies fair worse -- often csection babies are being delivered by csection because they are having problems during birth which would result in them having problems breathing and lower apgar scores. Its all a matter of perspective.

"To me this is less about choice than about practicing responsible medicine. Personally, I believe that performing an elective c/s, in the absence of medical complications warranting surgery and particularly for first-time mothers, borders on malpractice. For a healthy mother and baby, the risks are more serious and more likely. Healthy bodies were designed to give birth vaginally, and I don't just think that there is a good argument that it is safer or more convenient to have major surgery to remove your baby (which is not to say that I don't think that c/s are a blessing for moms or babies with serious complications). Can you imagine if I walked into an ER with kidney stones and demanded that a doctor perform surgery on me to remove the stones because I didn't want to endure the pain of passing them? No responsible doctor would do this."

Actually they do, especially for children. You should read up on the new therapies they are performing to break up stones so people can't pass them. Just because you believe its irresponsible doesnt make it so. Women should have the right to choose how they give birth, whether that be in their living room, back yard or the OR. Csections are safe. Safer is in the eye of the beholder. I don't want anyone telling me I have to carry a baby to term, much less if I do how to birth it. Its no one elses business.

Kim, supporter of choice
Now, if one is REALLY well-informed and knows all the risks and still elects to have the c/s, then I can see your point about choice, although I'm not sure I totally agree with it. But very few women take the time to truly research and take responsibility for decisions about their health--MDC is a very abnormal community in this way. In my experience, talking with OBs, doctors systematically downplay the risks of c/s and overplay the risks of vaginal births (same with episiotomies--a family friend who is an OB is STILL trying to convince me that episiotomies are safer and lead to less tearing, even though every single study on them AND the ACOG disagrees with him; he also says that he "would do a c/s every time if he could, b/c they're so much safer").[/QUOTE]
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Old 01-18-2006, 01:48 AM
 
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Quote:
Originally Posted by busybusymomma
I agree Amanda... "in general" the recovery from a c/s is harder. Granted, I have an acquaintance who had a c/s, then vaginal and another c/s. She said the vaginal was the hardest- BUT she also had a hospital birth with the standard interventions including unfortunately an episiotomy <shudder>.
Most women are not educated on how to help their recoveries from csections or any surgery for that matter. If women were informed, and allowed to make educated choices about their recoveries they would be better. Also keep in mind that many csections take place after long labors, difficult labors, or other complications which can compound a recovery. With my two elective csections I was better prepared to facilitate a healthy recovery.
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Old 01-18-2006, 01:50 AM
 
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Quote:
Originally Posted by goodcents
HOLY MOLY!!!!

Are there people right here on this very thread advocating for elective C-birth??

I thought this was a *natural* family living site?
Yes, I am. Just like I am prohombirth, I am procsection. Its about choice. The right to choose to do what you want with your body. Its a fundamental right.

Kim
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Old 01-18-2006, 01:58 AM
 
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I have to chime in here.


I have had three vaginal births and one hysterectomy.

I never needed narcotic pain relievers after a vaginal birth.
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Old 01-18-2006, 02:38 AM - Thread Starter
 
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Sorry about not quoting the article in my OP. I totally forgot that the article would go to a login type situation after the first 24 hours. How much can I quote and get away with?

"Too posh to push" is what some OBs call their high income, executive type patients who prefer to schedule their cesarean sections instead of waiting for labor to begin on its own.
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Old 01-18-2006, 02:57 AM
 
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I just want to say that this thread is crazy and a bit disturbing really. hmmmmm

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Old 01-18-2006, 03:33 AM
 
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"To Posh to Push" is also the title of an article from Time magazine, the April 19, 2004 issue. At that time, almost 2 years ago now, the c-sec rate in the US was at the highest ever, 26%, up 150% from 1975.
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Old 01-18-2006, 04:50 AM
 
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I too am all for a woman choosing, however the problem is that OB's do not give a an accurate picture of what a cesection entails, nor do they give an accurate picture of how it can affect a woman's future choices. This article doesn't even do that.. "less likely to have anal incontinece" ??? vaginal birth doesn't cause anal incontinece, lost of things can and the mis-handling of a vaginal birth can certainly contribute but so can the slip of a scalpel during a c-section... actualy bladder lacerations are quite common during a c-section.

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

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

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


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


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

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

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

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


Sources:
Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-1999
National Vital Statistics Reports, Volume 49, Number 13, December 27, 2001
A Guide to Effective Care in Pregnancy and Childbirth, Chapter 38, Labor and birth after previous cesarean, M. Enkin, M.J.N.C. Keirse, J. Nielson, C. Crowther, L. Duley, E. Hodnett, and J. Hofmeyr. Oxford University Press, 2000
Annual Summary of Vital Statistics: 2000, Hoyert DL, Freedman MA, Strobino DM, Guyer B. Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA
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Old 01-18-2006, 11:44 AM
 
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fitmama,

Thank you for the link to the article. Personally, think this a bad option for the moms and the doctors who do it.
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Old 01-18-2006, 12:21 PM
 
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Quote:
Originally Posted by OnTheFence
I am going to try and do this point by point.

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

Really? I have read numerous homebirth forums including the one here where 3rd and fourth degree tears took place. Of the 4th degree tears I personally know people having, none of them resulted from an episiotomies.
Yes, really. You can go to the ACOG website or search PubMed for one of the many studies done on episiotomies in the last 20 years. The reason ACOG now recommends against routine episiotomy is because they found that they were more likely to cause the very problem that they were supposed to prevent. As I said before, you can always find anecdotal evidence on both sides of issue. But statistically, your risk of a 3rd or 4th degree tear is FAR higher with an episiotomy--and most of the women in these studies were having hospital births, where the position of the mother makes her far more likely to tear. Does this mean that women who have homebirths or vaginal births NEVER have 3rd or 4th degree tears? Of course not.
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Old 01-18-2006, 12:36 PM
 
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I really believe elective c-sections to be a step in the process of women reclaiming the birth process. Typically substantial change in history tends to go to an extreme, peak, and setlle back down.

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

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

We can all agree that it is important for women to have full
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Old 01-18-2006, 01:03 PM
 
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Originally Posted by OnTheFence
I think you find that cesareans are fairly safe. While they may not be as safe as vaginal births, they are for the most part safe for mom and baby. Also I would LOVE to see the sources that a mom who has an elective csectoin has an increased rate of death of 5-700%. Thats complete rubbish and exageration if I ever read one.
Okay...try:
1) Rochat R W et al. Maternal mortality in the United States: report from the maternal mortality collaborative. Obstet Gynecol 1988; 103(5): 459-63
2) Schuitemake N et al. Maternal mortality after cesarean in The Netherlands. Acta Obstet Gynecol Scand 1997; 76(4): 332-34
3) vam Ham M A, van Dongen P W, Mulder J. Maternal consequences of cesarean section. A retrospective study of intra-operative and post operative maternal complications of cesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74(1): 1-6
4) Hall M. H. Commentary: confidential inquiry into maternal death. Br J Obstet Gynaecol 1990; 97:752-3

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

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

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

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

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

In general, I agree with Thmom. While I personally believe that primary elective c/s borders on malpractice, I'm not saying they should be made illegal or anything. But it's more than "just a choice." Doctors have a responsibility to REALLY educate their patients on risks of elective surgery, both to themselves and their babies and not paint c/s as an "easier" solution to childbirth (which is what the "too posh to push" idea promotes). This is not likely to happen in a medical system where doctors have all the incentive in the world to perform c/s (it brings in more money, it can be "conveniently" scheduled, it takes less time, hospitals have c/s quotas, it gives doctors more control over births, it's a way of sidestepping malpractice suits, etc.). And women, of course, have a responsibility to REALLY educate themselves. But outside of this board, I rarely see that. When most women I know hear something from their doctors, they believe it. One (admittedly) anecdotal example to make this point: my VERY well educated sister (Ivy League college, business school, runs her own company) was told by her pediatrictian that "there are no real benefits to bfing after 3 months, so if you're having difficulty, you can just stop." So she stopped. Zero research. Zero investigation. Sadly, I think this is pretty typical.
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Old 01-18-2006, 01:46 PM
 
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I read the article and I have also had a c/s & 2 vaginal births. The woman in the beginning of the article that chooses a section has a very valid reason to have a section IMO. The writer could have chosen a woman who chose a section just for convenience or because she was worried about stretching her vagina. Both seem like silly reasons for major surgery. The woman quoted had 2 miscarriages and a stillbirth. She obviously couldn`t trust pregnancy so why is it surprising if she couldn`t trust birth? I don`t blame her at all, and I`m sure not many of us here have walked in her shoes, so why judge?

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

When a similar situation happened to me, I was amazed at the judgemental attitudes in the natural community surrounding elective sections. All I can say is, I was the same way & if I hadn`t been unlucky enough to have all my well laid plans thwarted, I would still be that way. Those of you who have had everything go the right way, you are very fortunate, it could have been different. Everybody seems to agree that a small percentage of women really need a section, the tricky part is respecting people`s choices without picking them apart. Having a section for emotional reasons can be valid too.

Married Catholic mami : to 5 boys, : 9 6 3 : 5 mo. 5/6/02-6/22/02 (HIE)
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Old 01-18-2006, 02:43 PM
 
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I don't care if women choose c/s (though I do care that so many women are coerced into c/s and I do care that the consequences to subsequent pregnancies are not typically discussed thoroughly by doctors with anyone having a c/s, planned or not). But what irritates me with these articles about choice, is WHERE THE HELL IS MY CHOICE FOR VBAC? That's being written about too, but less and some of the restrictions are getting close to being nonconstitutional, IMHO. The majority of docs won't attend them, a large number of hospitals (probably the majority of hospitals if not the majority of hospital beds, when you balance out small vs. large facilities) don't permit them and due to the bottom line of one insurance co., I couldn't have a VBAC pretty much with an OB in a hospital in the entire state of Oklahoma if I wanted to. A lot, if not most, birth centers can no longer get insurance coverage on VBAC. In some states midwives can't attend them at home (like NJ, where the c/s rate is the highest in the nation) legally, in many others required physician consent for mw-attended homebirths pretty much causes the same result. In most others the legal situation is grey as to HBAC and HBACers live in fear of CPS in case (God forbid) they do rupture at home or anything else goes wrong. I know why this is, I know the doctors are often put in a tough situation because of liability and insurance (which is one reason I'm not asking one to attend my VBAC), but the fact is, whereas a first time mom in my area could easily find someone to do her nonmedical c/s, my choices for VBAC are much more limited, esp if I want to maximize my chances of success rather just ending up with a c/s that's planned later rather than sooner (which is where many VBAC plans go ultimately once the doctor starts getting third trimester jitters).

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

So I support the choice to have a totally elective primary c/s, I just wish those electing it and the doctors supporting it would support VBAC too, but almost always they don't.
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