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I'm curious how long ago the women in this thread had c-sections? I saw one woman mention 20 years ago... 20 years is quite a bit of time for techniques to improve, as my mother who had waited to have her gall bladder removed through her bellybutton rather than through a cut that sliced her wide open could tell you. Quite a few of us in a moms' group I belong to had them, and we certainly didn't have a long, drawn out recovering. When I was flagged to start exercising again after my 12 week post-partum checkup, I went back to doing p90x, and integrated their ab isolation workout about a month in.
Maybe I am extremely lucky, have a good pain tolerance, or a fantastic OB, I don't know. The only lingering evidence of it (aside from a barely noticeable 4" scar that only myself and my husband should see) was a bit of itchiness as it healed up, and I haven't had that in months. For the record, I am not overweight, though I did have polyhydramnios during my pregnancy.
I don't think people should elect for it, but women shouldn't be scorned for it if it is offered during a difficult labor, either. My son's head was stuck in my pelvis for 7+ hours as I labored, no progression whatsoever, and when I saw that his heart rate was dropping, I made the choice, and have no regrets about it whatsoever.
I've done both - drug free natural childbirth and scheduled c-section. The c-section was definitely easier in every way. It was less stressful, less painful, I recovered much quicker and I was able to breastfeed which I couldn't with my first.
I chose to ask for a c-section because I've seen my body handle childbirth and knew it could not manage with the amount of complications I had. My son was abnormally large because I had gestational diabetes and I also had internal varicose veins which were very painful. I needed to be induced to avoid him growing too large and wanted to limit the amount of drugs he was exposed to. The wound was also much easier to stitch and manage than the tears I had with the first.
I waited until mere days before my scheduled induction date to ask for the c-section because I had hoped to avoid it, but everyone was in agreement once he was born that I had made the right decision. His shoulders were so wide that he never would have fit and I would have ended up in the OR anyway.
I often hear the argument that we know our bodies better than doctors when it comes to fighting for a VBAC or a homebirth, so why shouldn't the same apply to those of us who knew we weren't able to vaginally deliver?
I also have to agree about techniques changing. I have more trouble from the stitches I had after my natural birth over 7 years ago than I do with my c-section scar from just 9 months ago.
I had my first c-section after my son's heart rate dropped during a routine non-stress test. It came back up and my doctor sent me to the hospital for additional monitoring. They were planning to induce me at the hospital when the baby's heart rate suddenly dropped again - and I went straight to the OR for a c-section. I had a healthy baby boy with great APGARS so no regrets on having the section.
My second child was a planned c-section. I had considered VBAC, but after weighing the risks of VBAC vs. repeat c-section, I opted for a scheduled c-section. I still believe it was the right choice in my own personal situation. In fact, I would not hesitate to make the same decision all over again if I was ever faced with a similar set of circumstances.
My c-section scar was numb for a few years but it is no longer numb today. Aside from the scar, I don't really have any lasting effects from the surgery (I've heard that isn't always the case, though).
I've given birth to two children but I have no idea what labor and natural delivery feel like. I do feel that I missed out on the whole "birth experience" sometimes but I've actually found that I'm o.k. with that.
Overall, c-section isn't a surgery to take lightly because it is major surgery, even if it is fairly routine. Women should weigh the risks with their doctors and do what is best in their own situations.
I've given birth to two children but I have no idea what labor and natural delivery feel like. I do feel that I missed out on the whole "birth experience" sometimes but I've actually found that I'm o.k. with that.
Well, it's not fun, I'll tell ya that much.
I do look forward to the days I can tell my boys: "I went through x # of hours of labor for you & this is how you treat me??"
After 2 vaginal, I had an emergency c/s this past summer for #3. It would have been drug-free had his heart rate not dropped so low for I was completely dilated w/in 10 mins of getting to the hospital.
I hear what you wrote a lot from friends who have all had c/s's only due to many reasons; most in my circle are due to twin/triplet births or complications outside their control.
At the end of the day, if we all leave the hospital w/ babies who over time are healthy, thriving, and happy....however the birth occurred is minut compared to how lucky we are we have healthy babies.
I wonder what class the OP is writing a paper for?
The only question to be answered is, "What is the safest way to deliver this baby?"
It is a decision that has to be made for every pregnancy on an individual basis.
And, yes, the Cesarean rate is significantly driven by malpractice concerns. The simple fact is that if an infant has cerebral palsy after a vaginal delivery, the obstetrician will get sued virtually 100% of the time. Lawyers have convinced juries that if there is a single glitch in a fetal monitoring tracing, a Cesarean should be done immediately. That this is scientifically untrue is felt to be irrelevant. Since a suit can result in insurance premiums going from 5 digits to 6 digits and damage an obstetrician's reputation irreparably, any sane OB is going to recommend a Cesarean at the first glitch in the monitor tracing. This is legal CYA and results in some Cesareans that are probably unnecessary, but they are not the OB's fault. They are the legal system's fault.
There are legitimate Cesareans for fetal distress, including distress in very premature babies for which a Cesarean would not have been offered thirty years ago because the baby likely would die from the complications of prematurity anyway.
Breech presentations are about 4% of total term pregnancies. Some breeches can be turned to head first by manipulating the baby through the mother's abdomen, a procedure called external version. This is not easy, depending on how many pregnancies the mother has had, how much fluid surrounds the baby, and how relaxed mom's abdominal muscles are. For those breech babies that do not turn by themselves or cannot be turned with external version, many years of research showed that Cesarean section is safest for the baby. Yes, the majority of breech babies can deliver vaginally without problems, but there is no way to determine reliably ahead of time which babies will not do well. Therefore, few obstetricians are willing to do vaginal breech deliveries any more. The people currently in OB residencies are not even being trained to do it.
Women are waiting until they are older to get pregnant. This increases the risk of complications of pregnancy like diabetes (which tends to result in fat babies, with an increased risk of the shoulders getting stuck during vaginal delivery, a condition called shoulder dystocia) and high blood pressure.
New reproductive technologies (and increasing maternal age) are producing more multiple births. Each additional fetus increases the risk of complications. Triplets and up most likely will be delivered by Cesarean.
With ultrasound, fetal anomalies can now be diagnosed in early pregnancy. For many of these babies, Cesarean is safest.
Obesity? Surely plays a part. When I had my babies in the late '70s, my doctor's scales only measured up to 250 pounds. In my Gyn doctor's office now, they weigh folks up to 350 pounds and still have some patients who exceed 350. We are talking about morbidly obese women --- who will have more diabetes and high blood pressure --- having babies. I recently was in a local hospital and went into the ladies room. The toilets are attached to the walls, but now have heavy duty metal supports underneath the bowls. I will leave the reasons to your imagination.
The real issue is not the overall Cesarean rate, which includes repeat Cesarean sections, but the primary (Cesarean for first pregnancy) rate. The only way to reduce the repeat rate is to lower the primary rate. And the only real target to attack is the Cesarean for labors that do not progress well. Some women do not have good contractions and do not respond well to medication --- pitocin --- to try to improve the situation. How long should the OB push for a vaginal delivery? Twenty four hours? Forty eight? The old adage is that the sun should not set twice on a woman in labor. Should the OB wait until mom is exhausted and put the baby through hours of stress, or should the Cesarean be done at some point when further progress is deemed unlikely. Failure to progress is very likely due to a combination of factors, including the size and shape of mom's pelvis and the size and position of the baby. This is very much a decision that reflects the art of obstetrics.
How about vaginal delivery after Cesarean section - VBAC? The pendulum swung toward more VBACs, but at the cost of some babies' lives. Can it be done safely? Yes, but there will be some women who will rupture the uterus and have a stillbirth. Many of those women, no matter how well they were counseled about the risk, will sue their doctors. Result: some malpractice insurers will not cover VBACs.
How long should mom be allowed to push after becoming fully dilated? The goal in the past was for delivery to occur within two hours. Now, some OB's will extend that (especially if mom has an epidural), but is it truly in the best interest of mother and baby? The longer she pushes, the more tired she gets and the more swelling of the vaginal tissues. That predisposes to tears which can be difficult to repair. Prolongation of this stage also increases the risk that there will be difficulty delivering the shoulders.
Another issue is forceps and vacuum delivery. Many babies that are now delivered by Cesarean would have been delivered with forceps thirty years ago. Most forceps deliveries are easy, with no risk of injury to mom or baby. Some were very difficult, with increased risk of tears for mom and injuries to the baby. So the babies that would have been difficult vaginal deliveries in 1975 are delivered by Cesarean now.
The perception of Cesarean purely for the convenience of the doctor is totally overblown. There may be some OBs that do it, but they are definitely in the minority. And Cesarean purely on the request of the mother is very uncommon in the US.
So why has the Cesarean rate gone up?
* A lot has to do with interpretation of fetal monitor results and fear of a lawsuit if there is a bad outcome for the baby. Now, the majority of labors are monitored electronically. Thirty years ago, it was mainly used only if a problem was suspected.
* Just about all breech babies are delivered by Cesarean.
* Legitimate Cesareans for fetal problems, including very preterm infants that would have been delivered vaginally in the past.
* More Cesareans for multiple births, including some twins that would have been delivered vaginally in the past.
* Older, fatter mothers with more medical problems.
* More large babies, related to older, fatter, diabetic moms.
* Difficult vaginal forceps deliveries abandoned in favor of Cesarean.
So, the best obstetrician will decide on a case to case basis: is Cesarean the best way to deliver this baby? If so, s/he will recommend it and not be concerned about the effect on the Cesarean rate.
Pitocin can be an appopriate intervention; it helps the uterus to contract. It also bugs me for people to blame nurses for stuff that happens in the hospital, where everything is directed by the doctors. The nurse would not be the one to administer the epidural, in any case.
I don't see C-section as a "choice". I don't think it should be offered as a choice. I haven't worked in OB for a long time, so I'm not up on what exactly is the latest thinking, but I think the need for a C-section should be a medical need.
Oh, you're a nurse! That explains your oversensitivity to all things nurse related. I'm sure you're one of the good ones, but they're not all good.
My doctor wasn't even at the hospital when the nurse was trying to push an epidural on me. She may have been in contact with my OB, but I hadn't been examined yet.
I am blaming the nurse for not listening to me because she didn't. She also rolled her eyes when I told her that I had a natural childbirth with my first child and wanted one again with my second. She also told me that a lot of "girls" (I was 35) think that's what they want. I didn't need a lecture. I needed medical staff who listened to me instead of trying to push their own agenda. And when I say no pitocin, I don't want it administered routinely because that's how *we do it*. I want to be treated like an adult (and a consumer, I might add, since my insurance company and I are footing the bill) and have all *interventions* explained to me so that I can decide whether or not I want them. My uterus will contract naturally after childbirth. If it isn't contracting, we can discuss interventions. I should get to have some say over what drugs are put into my body, and they shouldn't be put into my body without my consent, provided that I am conscious and capable of making these decisions. I was.
And I never said a C section was a choice. No idea where you got that.
And for the record, I have no judgement whatsoever about what other mothers have gone through or the choices they've made in the interests of delivering healthy babies. I am fortunate that I had two very fast labors and deliveries. I only pushed for four minutes with my first daughter and about 10 with my second. In both cases, I was only at the hospital for about an hour and a half before giving birth. I understand that it's not this easy for everyone, and I'm grateful to have been so lucky.
Last edited by lucygirl951; 02-13-2011 at 03:08 PM..
I've never heard the overweight explanation before, and anecdotally, not a single one of the women I know who had a C section could be described as overweight. About half of the women I know have had C sections, all of them at the doctor's insistence.
The US C section rate is high, and there are plenty of theories behind it, the most prevailing one is it is part of the increased medicalization of childbirth. In my own experience, I agree. With my second child, my OB wanted to schedule an induction a week before my due date, and she made it clear to me that she was quite unhappy with me when I refused. Then, I had to tell the nurse at the hospital three times that I did not want an epidural. After my daughter was born, I looked up at the IV stand and noticed a bag of pitocin that I had not agreed to. Both of my girls were born naturally and within two hours of me arriving at the hospital. No distress. No gestational diabetes. No pre-eclampsia. No reason whatsoever to push interventions, and yet the interventions were pushed on me repeatedly.
Yes, look how commonly women died in childbirth a century ago. Or the babies died or both died. Now they go on living and also whatever made it a problem in the past to give birth is now passed on to the next generations.
Plus a lot more babies are well developed with very large heads - brain sizes - from better nutrition.
It's not just the legal risk, it's also that doctors don't want to risk cerebral palsy when conditions are questionable. It's terrible for doctors to consider after the fact that it would have been better to have done a c-section because now the baby will suffer disabilities for life.
The c-section rate isn't the important one, it's the healthy baby rate that really counts most. If Hospital A has 15% c-sections and 10% cerebral palsy cases and hospital B has 25% c-sections and 0% cerebral palsy cases, the higher c-section rate is better.
[SIZE=3]Q: The issue of cesarean sections can be a sensitive topic. There are several pros and cons to delivering via cesarean:[/SIZE]
[SIZE=3][/SIZE]
[SIZE=3]PROs[/SIZE]
[SIZE=3]+ Can save mother or baby’s lives[/SIZE]
[SIZE=3]+ Convenient and quicker[/SIZE]
[SIZE=3]+ A quick response to fetal in distress & breech presentation[/SIZE]
[SIZE=3]CONS[/SIZE]
[SIZE=3]- Complications from surgery and longer recovery time[/SIZE]
[SIZE=3]- Operation is being used too frequently when not needed[/SIZE]
[SIZE=3]- Very expensive for families[/SIZE]
[SIZE=3][/SIZE]
[SIZE=3]The current rate of cesareans is the US is 32%. Research suggests that it could be lowered to 15% and still be safe for mothers and babies. Given the pros and cons of cesareans, do you think efforts should be made to reduce the national rate? and Why do you feel this way?[/SIZE]
Sure it can always be lowered. However you will always find people that will prefer C-section or for medical reasons will desire one. If I were to get pregnant again I could be a candidate to have a VBAC but I think I would choose not to have it given all the complications related to VBACs...I'd rather get it over with with a specified plan and have the child with C-section. My first pregnancy was all great, except after nonprogression we decided on c-section. Very personal choice for families. I would like to know what exactly are you trying to get out of this question. Give us more info.
Yes, look how commonly women died in childbirth a century ago. Or the babies died or both died. Now they go on living and also whatever made it a problem in the past to give birth is now passed on to the next generations.
Plus a lot more babies are well developed with very large heads - brain sizes - from better nutrition.
It's not just the legal risk, it's also that doctors don't want to risk cerebral palsy when conditions are questionable. It's terrible for doctors to consider after the fact that it would have been better to have done a c-section because now the baby will suffer disabilities for life.
The c-section rate isn't the important one, it's the healthy baby rate that really counts most. If Hospital A has 15% c-sections and 10% cerebral palsy cases and hospital B has 25% c-sections and 0% cerebral palsy cases, the higher c-section rate is better.
These are all excellent points.
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There is no perfect Cesarean Section rate
