[swebster]

bleck.

I have such limited time to obsess about other peoples poor choices but I'm finding it hard to shake this one.

I walked in on a conversation between a pregnant co-worker, whom I am not terribly close to but on freindly terms with and a few other colleagues.

She was in the middle of saying how she's decided to breastfeed this time around (has another child who is 3) and wouldn't it be funny if she ended up doing it all "natural". she then relayed an episode of that baby story tv show where a woman "bragged" about having a natural birth and then "begged" for an epidural. Then she told us that she's convinced her doctor to change the date of her planned c-section so that it falls before September 1st since that is the kindergarden cut-off date. Her EDD is September 7th.

Ugh. I had to leave the room. I'm not very good on the spot and knew if I opened my mouth I would sound like a lunatic so I kept quiet.

I've been trying to think about this calmly and see that I have two choices.
a) do and say nothing. forget about it eventually.
b) approach her and offer support, information and resources that might help her make some better choices.

I would like to try plan b, especially since I'm quitting my job soon so if it backfires and I'm seen as a nosey jerk....well.....who cares?

I think the best non-confrontational approach is through email and offering links. I think that I should focus on her wanting to breastfeed and the issues that might arise with regards to a c-section and how to deal with them. I found this link on Kellymom, but are there any others that would be good? She has the same boring desk job as me so she'll have plenty of time to browse websites

. I'd love any links that you think are relevant, ranging from supportive of her choices to maybe a little confrontational/informative. I'm assuming that her doctor is an idiot and that she hasn't done much reading herself.

 

[wifeandmom]

Do you know why she is having a planned c-section? Is it an ERCS? If so, it is common (as well as backed by research) to schedule an ERCS at 39 weeks. That would be August 31st based on the due date of September 7th. Depending on her risk factors for rupture, going into labor on her own may not be in anyone's best interest.

I'd also want to know if she had a 1st trimester vaginal u/s for dating purposes before commenting on the selected date of delivery. IMO, without either reliable info from mom regarding ovulation dates and/or a good 1st trimester dating u/s, delivery at 39 weeks on the dot counting from LMP alone still makes me very nervous, especially with male babies since they tend to mature a bit slower.

Without knowing more about what the reasoning is behind a c-section to begin with, it's hard to say what exactly would be appropriate in this situation.

I guess my point is that without a good bit more information, things that I'm not sure it would be appropriate for a co-worker to start quizzing her on in the first place, it's hard to pass judgment on a c-section scheduled for 39 weeks gestation when that's something that is supported by research in cases where planned section is indicated.

 

[phoebemommy]

I'm running into this "say something or keep quiet" problem in my pregnancy swim class. Most of these women, and some of them are quite well educated, just baffle me with their ideas. Last night it was all about epidurals. How they saw no reason not to get one. There are a couple women there who want them for more legit reasons -- back problems, etc. But the most vocal ones just want epidurals because. And then there's the one who was going to go natural, but is a couple days overdue and is determined to be induced later this week, because why should she wait? I'm just a first-timer like them, so I don't want to get on my soapbox about it. But I do try to throw in little thoughts when I can, and I sometimes see a lightbulb go on. Like once I said something about being more afraid of a needle in my spine than pain, and one had thought an epidural went in your arm. I also saw them stop and think when I said I was having a homebirth. They started in with the "you're so brave" thing, and I said, actually, it's the hospital that scares me. I feel much safer at home. That gave them something to think about.

 

[swebster]

Thanks wifeandmom for the input. It's good to know that c-sections are not always risky scheduled early. I honestly don't know much about them at all and it just *sounded* wrong to be so blase about scheduling a few weeks earlier (her doctor wanted to schedule her for the 11th) in order to make the kindergarden cut-off. Recently, a friend of a friend was induced because of the mythical "big baby" and ended up having a c-section. From what I understand second hand, the baby was really not at all ready to be born and had to spend a week or two in the NICU. I think that my reaction to my co-worker was somewhat clouded by this incident.
I believe that she is choosing a c-section after having a vaginal birth with her first child. It sounded like a very traumatic hospital birth. I suppose that her concern about the kindergarten cut-off could have been a cover for some real fearfulness about the situation, but she was talking as if c-sections are completely risk-free and an easy out of the childbirth experience. I know that it is most likely too late to change her mind about a c-secton, but I was hoping that there might be some gentle birth (or gentle c-section?) type websites that I could pass along. I also was excited to hear her talk about breastfeeding and wanted to find a way to encourage her without getting preachy. I brought my dd to work with me for several months and during that time everyone in the office got to see plenty of breastfeeding

, she tended to ask more questions than most and I'm hoping that I was a positive influence on her (she once told me that her best friend, who is a mother of two, compared breastmilk to pus

and that she got so many cans of formula for her first baby shower that she didn't want to waste it)

Anyway, I'm rambling...but would still like some website suggestions.

And hi phoebemommy! I grew up in Homer! It's nice to hear from a fellow Alaskan.

 

[wifeandmom]

Quote:

Originally Posted by swebster Thanks wifeandmom for the input. It's good to know that c-sections are not always risky scheduled early.

This only works if there is *certainty* with her dates, thus my hesitation unless she's either very regular, only had intercourse at a certain point in her cycle making conception easy to pinpoint, had a first trimester vaginal dating u/s, etc.

39 weeks is standard for ERCS, and it is supported by research as being the most opportune time to avoid premature lungs while also avoiding the increased risks associated with going into labor (only applies with prior uterine surgery/prior c-section).

Quote:

I believe that she is choosing a c-section after having a vaginal birth with her first child. It sounded like a very traumatic hospital birth.

If this is the case, I can only imagine she must have had very significant tearing. I've known two women personally who opted for an elective c-section after vaginal delivery with prior babies because they tore so badly their care providers were seriously concerned about permanent fecal incontinence should the same tearing occur again.

Both women had undergone reconstructive surgery to 'repair' the damage done during a traumatic vaginal delivery (one was a forceps delivery when baby's heart rate bottomed out during pushing, so no real choice about getting baby out ASAP regardless of how much damage it did to mom, the other I didn't know well enough to really ask detailed questions about what happened, but it must have been awful cause she had 3 prior vaginal deliveries, followed by the elective section).

Quote:

I suppose that her concern about the kindergarten cut-off could have been a cover for some real fearfulness about the situation, but she was talking as if c-sections are completely risk-free and an easy out of the childbirth experience.

This is one thing that totally bugs me about elective sections. I *do* hope she understands the risks she is taking with EITHER type of delivery. BOTH carry their own very unique set of risks. The only person that can truly weigh the risks is the mother herself, but she can only do so if she has all the information. C-sections DO carry additional risks, ESPECIALLY for the mother, and also for any subsequent pg she might wish to have in the future.

I do not believe in glossing over those risks any more than I believe in glossing over the risks of vaginal birth. I hope she has been fully informed and done her own research before deciding that elective section is the route she wishes to take with this baby. With the current VBAC climate as it is, she is likely painting herself into a corner with few options should she have a terrible c-section experience.

 

[Emilie]

I do not think it would harm anything by simply saying to her.... Why are you planning a C-section?

she was talking about it.... so obvioiusly she can answer it.

 

[Sijae]

Oh my goodness! There's a lot of misinformation going on in this thread. For a minute there I thought I had accidentally logged into a mainstream message board!

That said, research does not support early c-sections or c-sections prior to onset of labor. You could say that it does but you could also say that research supports episiotomies to prevent tearing and a 24 hour labor rule which we all know to be false (at least we should all know this).

The truth is that labor induction or planned c-section prior to labor is always more risky and *bad* for mother and baby unless there is a life-threatening medical condition present. I'm thoroughly sickened by the statement that going into labor might not be in her or her baby's best interest.

The risk of uterine rupture from VBAC is seriously increased by induction prior to labor (danger to mom and baby). If they would just leave these moms alone the risk of rupture is extreamly minimal - certainly less significant than the risks of a ERCS! And the risk of respiratory problems is much higher for babies born by cesarean prior to labor as opposed to cesareans after the onset of labor - even at full term (danger to baby). Scheduling a c-section early for no other reason than convenience is taking unnecessary risks with mom and baby. Babies are born when they are meant to be born.

ERCS performed after onset of labor is much healthier. The only problem of course is that it is inconvenient for the doctor and might end up in an accidental vaginal birth - oh my what a tragedy that would be!

:

Laura

 

[Emilie]

I have to agree with you Laura. I have been seeing more of that on the birth pages at mothering..... I am starting to worry about offending people for thinking hb is a good idea! on MDC!!! not to get off topic tho.....

I think that you should talk to this woman.... what if you were her and nobody told yu that you had options?

 

[Emilie]

If this is the case, I can only imagine she must have had very significant tearing. I've known two women personally who opted for an elective c-section after vaginal delivery with prior babies because they tore so badly their care providers were seriously concerned about permanent fecal incontinence should the same tearing occur again.

Here I would be more concerned about the care provider/hospital policies than the womans ability to birth vaginally

Was this woman lying down or able to move freely?- was she medicated or could she feel her baby?
- was she told when to push by nurses or was she allowed to listen to her body and follow her own instincts....

I would have many questions regarding the manner of delivery before a Cesarean.

 

[wifeandmom]

Quote:

Originally Posted by Sijae I'm thoroughly sickened by the statement that going into labor might not be in her or her baby's best interest. ERCS performed after onset of labor is much healthier. The only problem of course is that it is inconvenient for the doctor and might end up in an accidental vaginal birth - oh my what a tragedy that would be! : Laura

Just so you know, this is NOT accurate information in *all* cases.

Women with prior uterine rupture or prior T incision in their uterus do NOT 'benefit' from going into labor prior to their repeat section. Since the OP did not originally state WHY she was having a section to begin with, it was my belief that perhaps more information would be appropriate before jumping to the conclusion that allowing her to go into labor prior to section would be most appropriate.

Cause that simply is not always the case.

 

[wifeandmom]

Quote:

Originally Posted by Emilie If this is the case, I can only imagine she must have had very significant tearing. I've known two women personally who opted for an elective c-section after vaginal delivery with prior babies because they tore so badly their care providers were seriously concerned about permanent fecal incontinence should the same tearing occur again. Here I would be more concerned about the care provider/hospital policies than the womans ability to birth vaginally Was this woman lying down or able to move freely?- was she medicated or could she feel her baby? - was she told when to push by nurses or was she allowed to listen to her body and follow her own instincts.... I would have many questions regarding the manner of delivery before a Cesarean.

As I would hope ANY woman would question things before opting for surgery.

What happens if mom DID all of those things and STILL tore badly enough to require reconstructive surgery after delivery? It's rare, but that doesn't mean it never happens.

And no matter what mom did in prior deliveries, if she is faced with the possibility of tearing again so significantly that she's likely to never recover fecal continence again...well, that's something to consider when making birthing plans.

 

[Emilie]

really? I do believe that you are not familiar with NATURAL CHILDBIRTH. Have you attended a homebirth, spoken to more than you neighbor about her HOMEBIRTH experience? What knowledge do you have regarding natural childbirth? My mw delivers breech babies without tears. At all. I have a hard time believing that a vaginal birth naturally with no drugs at home- would result in a 4th degree tear. Can you refer me to a place I can find some statistics?
Thank you.

 

[swebster]

ok...so I haven't visited this forum much since my daughter was born last July (can it really have been that long?

: )

Obviously there are some issues going around....but really, doesn't anyone have any good web resources specific to my situation? I appreciate a good debate just like anyone, but c'mon....I want websites!

 

[zinemama]

Hi OP,

I wouldn't even get into the c-section thing with her. A decision has obviously been made and a co-worker's pov isn't going to sway things.

I'd concentrate your energy on the breastfeeding, which she's already said she wants to try. Much easier to help someone on a path she's already on than to get them on a whole 'nother one.

My advice: get her a copy of Janet Tomaso's "So That's What They're For" (revised, Third edition). It is the absolute best book for mainstreamers and those who have never given bf yay or nay any consideration. Lighthearted, informative, encouraging, from the pov of someone who used to think bf was just kind of weird, it is the perfect book for your colleague.

As for websites, definitely point her to Kellymom.

 

[wifeandmom]

Quote:

Originally Posted by Emilie I have a hard time believing that a vaginal birth naturally with no drugs at home- would result in a 4th degree tear.

Never? Really? Surely you are not that naive.

You can do everything *right* and still have a poor outcome in terms of tearing.

Is it COMMON? Don't think I ever said that in the first place. It is NOT common in unmedicated births with moms pushing in positions other than on her back without someone telling her when to push, etc etc etc. I understand that completely. I also happen to know that it doesn't ALWAYS prevent horrible tearing that results in the need for reconstructive surgery.

You can do a handy search and find women right here on mothering that have had 3rd and 4th degree tears AT HOME. It happens. It is not impossible. Surely you are not suggesting otherwise.

Quote:

Can you refer me to a place I can find some statistics? Thank you.

I have read more than once that significant tearing is most often attributed to episiotomy (makes complete sense to me, but there ARE times when episiotomy is the best option...you know, if baby is *almost* out and in severe distress). But that is simply not ALWAYS the case.

In the woman I mentioned, her baby went into SEVERE distress during the final moments of pushing. What else was supposed to happen exactly? She was pushing as hard as she could. Baby was literally dying inside her. The midwife cut, clear through to her rectum, something that she RARELY does. Baby was out and eventually perked up and is a bright, healthy 7 year old today.

We can argue all day about whether or not 4th degree tearing happens during certain circumstances, but I'd bet my last dollar that YOU cannot find a reliable source that proves these tears NEVER happen under your 'perfect' scenerio.

Cause it simply isn't true.

And really, it's not the point.

If mom tore badly enough to require reconstructive surgery during her first delivery (NOT COMMON, but it DOES happen), it really doesn't matter if she was doing everything right or everything wrong or something in between. The fact is, the damage is done, and NOBODY can tell her if she'll tear along the old scar the next time...REGARDLESS of what kinds of precautions she takes. And if *several* well respected, very pro-vaginal birth care providers tell the woman that taking the risk of tearing open again could very well lead to permanent damage that cannot be fixed....

Like I said, it's simply information that must be considered when deciding what course to take in future pg. That's not to say that an automatic section is the 'right' answer, cause it isn't for many women. But that doesn't make it the 'wrong' choice automatically either.

Birthing choices are not always so black and white, or at least that's how I've always looked at it. You can talk in general terms, you can encourage natural methods and ways of doing things, and you will be absolutely 100% smart to do so in the VAST MAJORITY of cases.

But then there are the times when surgery makes more sense for whatever reason. And really, why does a co-worker (or neighbor or friend or relative) owe anyone else an explanation as to her decision? I certainly don't go around demanding to know why someone else is choosing to birth in a way that I don't agree with. I might ask RESPECTFUL questions (and 'Don't you KNOW any better than to x,y,z' questions aren't my idea of respectful). I might offer MY opinion on what *I* think of the matter or what *I* have read on the matter, but I am always very careful to qualify my statements so the other mother doesn't walk away feeling judged or misunderstood.

 

[wifeandmom]

As for the OP, I would google something along the lines of 'tips for breastfeeding after c-section'. I am sure there is a wealth of information out there.

I would encourage the co-worker to inquire into her hospital's policy for where the baby is while mom is in recovery. Different hospitals do it differently. It is ideal, as long as both baby and mother are doing well, for baby to at least be brought to mom for a few minutes in the recovery room for initiating breastfeeding.

It isn't doomsday if that doesn't happen, it just makes things easier in general terms. And in some places, it is routine to take baby to nursery for a couple of hours while mom is in recovery for a couple of hours, yet many places will work with you if they possibly can to bring baby to recovery, even if it is only for 15 minutes to at least try nursing that first time.

I'd encourage her to stay on top of pain meds afterwards, esp the first 48-72 hours, as I cannot imagine trying to nurse a baby round the clock while in horrific pain. Women here have done it, but I find it unnecessary personally.

She can expect sleepiness from the baby, as obviously she'll have some sort of anesthetic for delivery. Of course, with a scheduled procedure, the exposure to drugs is much less than a baby who is exposed to an epidural running for hours prior to delivery, so that will help.

She can expect to need to try various positions for nursing in case holding the baby in certain positions is uncomfortable for her incision. I never had this problem with any of mine, but it is common from what I hear/read.

A good BF pillow is nice to have, not essential, but nice...even for non-section moms.

I'd also encourage her to inquire into whether or not the hospital has a lactation consultant, and to ask again when she has the baby, so the nurses know she is interested in meeting with someone if possible.

 

[annakiss]

Quote:

Originally Posted by wifeandmom Never? Really? Surely you are not that naive. You can do everything *right* and still have a poor outcome in terms of tearing. Is it COMMON? Don't think I ever said that in the first place. It is NOT common in unmedicated births with moms pushing in positions other than on her back without someone telling her when to push, etc etc etc. I understand that completely. I also happen to know that it doesn't ALWAYS prevent horrible tearing that results in the need for reconstructive surgery. You can do a handy search and find women right here on mothering that have had 3rd and 4th degree tears AT HOME. It happens. It is not impossible. Surely you are not suggesting otherwise.

That is the most assinine reason to schedule a c/s I have ever heard. Women who birth naturally and instinctively are not likely to have 4th degree tears. It is almost so unfathomable as to be impossible, but I won't say that on the off chance that it may have happened at some point in history. Management of birth and episitomies lead to 4th degree tears and 4th degree tears are NOT A REASON to have a scheduled c/s. No way, no how.

 

[annakiss]

http://www.askdrsears.com/html/2/T021400.asp
http://breastfeed.com/resources/arti...faftercsec.htm
http://www.lalecheleague.org/FAQ/cesarean.html
http://www.breastfeedingbasics.com/h...cesarean.shtml
http://www.obgyn.net/pb/pb.asp?page=...es/bf_cesarean

also, on cesareans: http://www.ican-online.org/resources/faqs.php

 

[Emilie]

thank you anna.