C-Sections

[VeritasMama]

Oh yes. The recovery period!

 

Every time, I was up and doing housework/cooking the day after returning home from hospital. I don't know if I was healthy or crazy.

 

Each of my recoveries has been different, but we've moved apt and so I've had 6 different OBGYNs. I think the skill of the surgeon plays a role, and of course in my younger days I bounced back much more quickly. My first cs was a piece of cake compared to my fourth, wish I had known it at the time :)

[MedicMom]

I had two c sections, both scheduled. The first was because I had some medical problems with the pregnancy and we weren't sure what was going on. My OB was fine with a vaginal.birth or a c section; I did all the research and decided on a c section. It was great. No pain, I wasn't tired, and I had an easy recovery.

 

My OB really pushed be towards a vbac for my second. I was not at all comfortable and refused. I went into labor anyway the day of my scheduled section and had a partial uterine rupture resulting in another c section. This hurt a little more because of the circumstances but I was up and walking around in three hours. The baby was given to us immediately after birth and was never seperated from both parents.

 

I loved my sections. I had no interest in the birth process so there was no disappointment and being able to schedule them so my husband could take two weeks off from work was fantastic. I have no complaints.

[Stayseeliz]

I've had four c-sections. Two were breech births, one was preeclampsia and the other PTL and PIH. Looking back I'm not sure that I could have avoided them but I would birthed naturally if I could. I never felt like my OB pushed me into them and he did an amazing job during the surgery. Looking back of course I wish I could've given birth naturally but it just didn't happen for me.

[HS Mom in NC]

I had an acquaintance 10 years ago who had her 4th as a VBAC after 3 c-sections for breeches. No problems.

 

My midwife has done dozens of natural deliveries at home of babies in the 10-12# range including a tiny Asian woman (under 5' tall and under 100# pre-pregnancy weight) who had her 6'5", 350# husband's baby that weighted 12# at birth. It was her first baby. No problems, no tears, no episiotomy. I know several women who birthed at home with twins with no problems. Even many breeches can be done safely naturally at home.

 

The problem isn't the occasional individual need for c-sections (10% or less in the general population) it's categorizing large groups of women as needed them without actually looking at the research (see my previous post.) Did you know that delivering a breech with an OB trained to handle breeches is IDENTICAL to the risk of an elective c-section? Yep. That's right. Few OBs know that and tell women otherwise because that's what they were told by the OBs that trained them. Also, most OBs are no longer trained to handle breeches, so they have to do a c-section because they're not competent to handle the situation otherwise-in other worlds they are the risk.

 

My c-section was a hospital transfer from a homebirth due to the placenta tearing off and a spontaneously rupturing fallopian tube during early labor, so I'm not anti-c-setion. I'm glad I got my c-section but it had its own risks. Like the life-threatening infection I got from it. There wasn't an option out of the c-section because my complications were also life-threatening, but people are usually very quick to minimize the complications from intervention rather than giving them equal weight to complications that result from intervention. Weird. When was the last time you heard OBs talking about the increased risks of elective c-sections? You probably haven't.

[TravelingChris]

All I know is that my last pregnancy was considered high risk (due to increased risk of clotting and yes I did get a clot though they didn't discover it then) and I still had a normal non c-section birth (this was a bit over 16 years ago). I know that my one dd will have at least that risk for her but if no other, I would greatly encourage her not to have a c-section. A c-sections increases the risk of clotting so I don't see why anyone would do that to her without other reasons.

[PeacefulChaos]

I don't know why the c/s rate is so high.

My personal experience is not with hospitals or doctors who 'push' for c sections in cases where they aren't necessary. I had my first because I wasn't progressing after 40+ hours (not induced, went into labor on my own - well, my water broke, anyway). He was stuck in one place for what seemed like forever.

Because of that, I chose to have a c section a second and third time. Not knowing what caused my labor to stall or if it would happen again, I didn't want to go through it again. If I had known I could go into labor and not end up with a section after two days time anyway, I would have tried a VBAC. But the reality was, there was just no telling. I think some of it has to do with the shape of my birth canal and such. My doctor for my second got a hard time from her colleagues for allowing me to do a repeat c/s instead of pushing for a VBAC, but she and I both agreed on it being the best course for me.

 

I'm wondering if a lot of the high rate is due to the number of repeat c sections that are done because hospitals are not well equipped to handle VBACs. The local hospital will do a repeat c but won't do a VBAC because they don't have the necessary stuff should a VBAC go awry. I also think a lot of people get scared of VBACs because of the very low risk of uterine rupture, etc, and so choose the repeat c route.

[StaceyinLA]

I think the heavy use of pitocin has done a lot to increase the number of cesareans. Many women are being induced near their due dates when their body/baby may not be ready for another week or so. The pitocin makes the contractions so intense that doing it without an epidural is immensely difficult. The epidural can make pushing less effective and make it impossible to walk, sway, or move into better positions. If the woman's body wasn't ready to go into labor, she may very well not progress with a mild amount of pitocin, so they up it. The woman can't really feel the contractions anymore anyway, but the unnatural intensity of them can certainly still impact the baby. So...

 

1) Woman isn't ready and doesn't progress even with the pit? Csection

 

2) Pitocin contractions are so intense they start causing problems for the baby? Csection

 

3) Woman gets to the pushing stage, but isn't able to to get the baby to descend because of physical limitations caused by the epidural?

 

 

This.

[StaceyinLA]

Have you ever had a c/s? Because I've done it both ways and a c/s is soooooo much easier. My first was an emergency c/s due to preeclampsia and DS being transverse. No question it was necessary. Despite being on bedrest for the three months prior to delivery, I was up and running within days. (Okay, not literally running, but walking).

 

I opted for a VBAC with #2. OMG! It was horrible! The labor itself wasn't so bad. I labored drug free for about 12 hours before opting for the epideral. But the recovery...horrible. It took almost a YEAR before it didn't hurt to have tEa. It took a lot longer for even the basic recovery after that delivery. Blah.

 

I've had both. I had a c/s with dd1. I had an infection in my incision and had to have it reopened a week and a half after delivery and it was horrifically painful. My baby was kept from me for hours because I had a fever (well duh, I was growing a hellish infection in that incision). The recovery sucked (and it wasn't just the infection because I've had a tubal reversal and hysterectomy with that same incision and they sucked too).

 

My first VBAC was with a midwife in a birthing center, and it was awesome. I had a small tear so there was a tad bit of discomfort for a few days.

 

Second VBAC was a transfer from the birth center due to stalled labor. Dd3 was posterior. They gave me pit for about 30 min, we were able to get dd to turn, and I went from 6-10 cm, delivering her while standing in the delivery room. I had a "skidmark" that required no stitches, and I felt great.

 

3rd VBAC was my homebirth. It was awesome. No tearing, great recovery, and I was having TEA within a few weeks (probably sooner than I should've been) pain free.

 

 

[I.Dup.]

I think it's absolutely about liability and convenience.

 

I don't think many doctors do it out of pure selfishness or malice. I think natural birth is messy and can last a VERY long time. They have to turn those beds over. Having a woman in labor for 15+ hours is not conducive to that. I also think many OBs are grossly undereducated in the function of natural birth. That, and they simply aren't willing to wait out a long labor.

[I.Dup.]

including a tiny Asian woman (under 5' tall and under 100# pre-pregnancy weight) who had her 6'5", 350# husband's baby that weighted 12# at birth. It was her first baby. No problems, no tears, no episiotomy.

 

I will try to remember this when I'm pushing this baby out. Dang.

 

I don't think I could have had my first, second, even third or fourth babies at home. It took me until #5 to be confident enough to birth at home, without the support of the hospital (and drugs, if needed). It amazes me that women home birth their first babies, especially huge babies. Wow.

[Dahliarw]

Part of the issue is that doctors and hospitals do not treat women as individuals. There are all these arbitrary rules and protocol they have to follow (which is definitely where the cascade of intereventions comes into play).

 

With my first I planned a birth in a local hospital with an OB. My water broke early in the AM, contractions didn't start, went to the hospital. After 5 hours, they insisted on pit to get my labor going. They warned me taht if I didn't go into active labor within 12 hours and didn't have the baby within 24 I'd have to have a c/s. Being naive, pit seemed like the better option so I consented. Then I needed an epidural after 2 hours on pit. Then they put a drug in my epi that I was allergic to, so I needed more meds to counteract that. Fortunately I was able to have a vaginal birth, but I left the hospital promsing myself next time I would not birth there.

 

My 2nd was a homebirth. 10lbs 10oz. I birthed him on my knees in a birth tub of water. If I'd been flat on my back with an epidural again, I'm sure I would have required a c/s. His head was huge! I needed gravity to get him out (which is unlikely in a hospital situation). Less tearing with him then I had with my 8lb first child!

 

My 3rd was a homebirth that would have been pit and possible c/s in a hospital. Water broke at 5pm. If I'd gone to the hospital they would have started me on pit sometime during the night. With a MW, she had me take my temperature every 2 hours, did not do any vaginal exams to help prevent infection (unlike in the hospital with my first) and she let me wait. I went into labor early afternoon the following day, a full 19 hours after my water broke, and within an hour was holding my 7lb daughter in my hands. No tearing, I was up and about the next day feeling great!

 

My 3rd birth, in a hospital, would have gone a lot like my first. And it would have resulted in totally unnecessary interventions that would have put me at a higher risk for a c/s. Why? Because the RISK of infection goes up with ruptured membranes around 24 hours, so they automatically want to do a c/s then (and administer pit prior). Not watch and wait and monitor for infection while taking percautions to avoid introducing bacteria into the birth canal? Because every woman is "treated the same" they are all subject to the same interventions, whether warranted or not. FWIW, my MW had a c/s rate around 1%. Of course, she did not take on high risk clients, but if you look at the c/s rates in hospitals for low risk women, they are higher then that in every case! Why? Women are not treated as individuals.

 

I'm glad c/s exist. I have several friends who had medically necessary c/s. They are wonderful things when used as medically indicated. The problem comes when arbitrary interventions are forced on women due to a "schedule" or "list of rules" which increased the chance of a c/s that most likely would not have been needed without them.

[ktgrok]

First, let me say that I live this. My local hospitals all have very high c-section rates...two are over 45 percent and the lowest is over 35 percent. They can't ALL be seeing all the high risk patients, you know? Also, elsewhere in the state we have hospitals with over a 70 percent rate, and Miami-Dade County has over a 50% rate. That's the entire COUNTY! It is ridiculous. I'm a member of ICAN, and hear women's stories every month, so have a pretty good feel for what is driving this, and it can be summed up in two words: induction and augmentation. Huge numbers of women are induced, and being induced hugely increases the chance of c-section. Doctors used to wait until after 42 weeks for inducting...I know I was born at 43 weeks with no induction. But now every local doctor insists on labor by 41 weeks. As the average length of labor for a first time mom is OVER 41 weeks, that means MOST women in my area are being induced. I know exactly ONE woman that had a hospital birth that wasn't induced. But lets say you do show up at the hospital in labor on your own. Guess, what, you still get pitocin! In fact, my ex, who recently did a nursing rotation in Labor and Delivery, said he didn't see a single person not get pitocin. Not even one. Pitocin can cause tetanic contractions that stress the baby. (google "pit to distress"). The mom gets an epidural and doesn't feel those crazy contractions but the baby does. Baby gets stressed, and rather than stop the pit, they do a c-section. Then mom tells everyone how the doctor "saved" her baby by doing the c-section and they would have died otherwise. No one talks about how the pitocin probably caused the problem in the first place.

 

So yeah...my experience, in listening to hundreds of women talk about their c-sections, is that induction/agumentation is the leading reason. A second, lesser reason would be fetal position. Women spend more time reclining and sitting then they did many decades ago, which can lead to more badly positioned babies. As most doctors no longer have the knowledge of how to get baby to change positions those women end up with labors that "don't progress" and have c-sections as well. Better education on how to have a well postioned baby, and better educated doctors that know how to correct a poorly positioned one would help.

 

I'd say 98 percent of the c-sections I know of are connected to pitocin and/or a badly positioned baby. The other 2 percent are for true emergencies like cord prolapse, previa, etc. Thank heavens for the surgeons then!

 

My own c-section was for "failure to progress" and "CPD - aka head to big for my pelvis". His head was a bit crooked and no one knew how to fix that. They also lied to me, and told me they needed to do the surgery for heart rate issues, when my medical records later showed that his heart rate had recovered just fine. But by then the surgeon had been called in, so I was getting that section. Also, they didn't check me after I said I felt pushy, again because they were already prepping the OR and had already called the doctor in. That baby was under 8lbs and skinny. Years later I went on to have two VBACs...one was 9lbs even and one was 10lbs 2oz with a 15 inch head. That one also had a crooked head and the midwife reached up and adjusted it. He was born 7 minutes later. Oh...and that pushy feeling I had with the first? I now know that WAS pushing, and had they checked me I bet I was complete. But if I had just listend to them and the "CPD" label I would have gone on to have two more totally unneeded surgeries.

 

Which leads us to the last factor...the near total lack of VBAC options. In my area you can have a homebirth (very experienced midwife that does LOTS of VBAC births), or there is one group of doctors that says they will do VBAC but you have to go into labor naturally before 40 weeks, which means most of the time no way no how, or another group that says it depends on which doctor is on call when you go into labor. We have had a FEW hospital VBACs in the area, but every single woman showed up pushing. Not the safest option, because that means they labored without anyone monitoring them or the baby pretty much the whole time. The homebirth option at least means you have a trained attendent monitoring you, which is why I chose it.

 

And although you didn't want to discuss it, yes, I know of a few women that were sectioned for doctor convenience. The doctor actually told one woman, "I am supposed to be on vacation and you are ruining my weekend." But the majority were induced before they were ready for labor, the induction "failed" or they baby went into distress, and surgery was done.

[ktgrok]

(Haven't read any other replies yet)

 

Once you have a c-section, for whatever reason, you are more likely to have a c-section with your following pregnancies due to the risk of uterine tearing along the first incision site. There are probably more people who opt for a (considered) safer 2nd c-section rather than a (considered) more risky vbac. This could be uping the stats. My first two were emergency c-sections and even if I don't have an emergency with this one (please, Lord) I will still have a scheduled c-section because I am unwilling to risk a vba2c.

 

 

Part of the problem is that people are of the impression that a c-section is safer than a VBAC, as you stated above. In fact, ACOG now advises trial of labor, and the stats show that the risks for the mom, at least, are lower with VBAC, and not much different for the baby with VBAC. Even VBA2C is now seen as safe by ACOG. I know several women who have had them in fact. But for some reason people FEEL that the risk of uterine rupture is scarier than the risks of surgery.

[ktgrok]

I think you'll also see a higher rate at hospitals with highly rated NICU's. Those that service preemies are going to have a higher rate because many preemies cannot handle a vaginal birthing process. Once it's determined they can't stay in another day, they generally need to be delivered quickly and that's especially true 32 weeks and earlier. So, in my friend's case, she had preemie twins. One born at 26 weeks and one at 28 both by C-section. That really doesn't help her particular hospital's c-section statistics, but her sons are alive and home and thriving.

 

It seems like in Michigan, the more advanced the NICU, the higher the c-section rate for that hospital and for some particular OB's. In our area, it's not uncommon for women on bed rest in danger of premature labor more than six weeks early, to be turfed to U of M and other hospitals. Getting turfed there increases that hospital's section rate while probably lowering the local hospital's percentage since they tend to turf an awful lot of high risk patients down to the U or Beaumont.

 

My Ob's office had a 22% section rate for the doctors, and 7% for the midwives - they had three midwives that handled a LOT of the low risk pregnancies. These were hospital births, but just about zero interventions...very comfy LDR rooms, showers, tubs, choice of birthing positions, etc....kind of a nice compromise between the low key affair of a home birth and yet having emergency care at your fingertips. But, women in danger of delivering little babies definitely got sent on and so that helped keep the OB rates lower. I'd say the OB's in my office did what I would call, mid-risk care which caused the difference between their rate and the midwives. Only one did what I would call truly higher risk care and due to the limitations of the NICU, he sometimes still sent his patients to a colleague at the U.

 

Faith

 

 

The problems with that theory are that in many areas ALL the hospitals have high c-section rates. In my area they are ALL over 35%, some much much higher. So yeas, if one hospital does all the high risk cases that would make sense for them to have a high rate, but then all the others should have lower rates, right? But they don't. Even the doctors you mention are not "mid range", they have a high rate. Anything over 10-15% is high. And the midwives rate is pretty high for midwives. Low risk births should have a rate more like 2%, as seen at birth centers and such.

 

Again, yes, the hospital in my area known to have the "best" NICU has a 48% c-section rate. But the one across the street has a 45% rate. And the others in town range from 35-45%. So yeah....it SHOULD average out to about 15-20% maximum, but it doesn't.

[StaceyinLA]

41 weeks before induction? Where do you live? In our area, most women are induced on or BEFORE their due dates! I don't know a single soul in recent years that was allowed to go past their due dates, unless they were birthing with the midwives (or a random one or two doctors that actually support their patients).

[sassenach]

Coming in late here, so I didn't read all of the replies.

 

In my vbac research after ds12 was born via csection, what I came to believe is that induction is the primary reason for high c section rates. Induction has become so incredibly common, I know hardly anyone who doesn't do it. Most first time moms think it's completely safe and normal. It's often done purely for convenience and planning purposes.

 

From the induction stems many complications that then lead right to a c section. At that point, the surgery might absolutely be needed, but if they just waited till the body was ready for labor, they might have had an uneventful birth.

[ktgrok]

Well, I pretty much had a voluntary c-section. I was in labor for 11 hours, the doctor came in and asked if I was done. I said absolutely and 30 minutes later was wheeled into operating. My recovery was wonderful, back to normal (with minor stiffness) in 2 days. And I would absolutely choose to have a c-section again - without the 11 hour labor! - if I could do it again.

 

Oh the other hand, with all the nasty environmental/food/etc factors going on these days, I wouldn't be surprised if more and more women are finding that their bodies don't know exactly how to give birth anymore.

 

I'm not judging, because there are so many factors that go into these decisions. I am wondering though, if when you made the decision for the c-section if you knew at the time the risks of the surgery? Were you informed of the higher rate of maternal death, or the very very real risk of placental problems with future pregnancies (accreta/percreta/previa)? I just wonder how much real informed consent is taking place at that moment. Now, if you were informed and chose it based on your own personal reasons that it totally cool and a good thing for everyone. But I do find it a bit upsetting when the surgery is presented to the woman, who is tired and in pain, as a "quick fix" with no real lasting implications. The rate of placental problems, specifically accreta, is skyrocketing and the main reason is prior c-section. I don't think most women know this, and I blame the doctors for that.

 

As for your labor, i'm sorry it was so hard for you. First time labors are generally quite long...I hope they didn't imply that your labor was abnormal in any way because of the length of it.

[ktgrok]

I think also CS rates are higher is because they scare you to death that you are going to burst open if you have had a previous c-section!!! I was also reading on one sight that more emergency c-sections are done between the hours of 8am-5pm and drops during the docs off hours :). My 1st baby was c-section because I didn't progress fast enough then my doc told me that my pelvis was very small and I probably wouldn't of been able to push my 6 lb baby out. My 2nd was a VBAC and I had no problem pushing my 8 lb baby out ;) (used the same doc too). We moved states for #3 and she was ok with me doing a VBAC even though she had never done one before. She admitted to me it would be malpractice if she didn't allow it but when time came the ultrasound showed my baby was big so we had to immediately do a c-section (ok she was a whopping 9lb 11 oz baby). Our last one was done with midwife at Vanderbilt Hospital and they let me do a VBA2C. It was an amazing experience. I was given the option of having a c-section as soon as I got there but really didn't want to do that if not totally necessary. Anyway, most people around here who have known that I had a VBAC seem to be totally shocked that I survived the experience and didn't pop open so my thoughts are fear of the unknown and lack of knowing that they are just as many different risks for having more c-sections :)

 

Glad you got that VBA2C!

 

And fyi, for anyone reading this, there is NO medical science saying that a c-section should be preformed for a suspected big baby. ACOG doesn't even advise it unless the baby is over 11lbs. I say that as a 5 foot tall woman that gave birth to 9lb and 10lb2oz babies vaginally, after having a c-section for my 7lb13oz baby. Baby fat squishes!

[ktgrok]

 

I'm wondering if a lot of the high rate is due to the number of repeat c sections that are done because hospitals are not well equipped to handle VBACs. The local hospital will do a repeat c but won't do a VBAC because they don't have the necessary stuff should a VBAC go awry.

 

I can't understand why hospitals say this. If they can't handle the rare complication from VBAC, then they shouldn't be delivering babies at all, as ANY woman could have a complication. The complications from VBAC are not some special thing that requires a different care than say, a placental abruption in a first time mom. Both require immediate surgery. If a hospital can handle a placental abruption it can handle a uterine rupture. If it will take the chance on one, then it should take the risk on the other. Drives me NUTS.

[AimeeM]

Many doctors do c-sections because the hospital they practice in doesn't allow for vbacs and a previous OB already performed a c-section on the woman in question.

 

My OB is very pro-natural birth when possible, but a c-section was necessary because I'd had two previous with another OB.

[ktgrok]

Many doctors do c-sections because the hospital they practice in doesn't allow for vbacs and a previous OB already performed a c-section on the woman in question.

 

My OB is very pro-natural birth when possible, but a c-section was necessary because I'd had two previous with another OB.

 

No, a c-section wasn't necessary, it was your only option, but not necessary. It is ridiculous that women can't make their own medical decisions, especially given that ACOG says VBA2C is perfectly fine to try. I'm sorry you didn't get to make your own choice.

[ktgrok]

you can find the rates at your local hospitals here: http://www.cesareanrates.com/hospital-level-cesarean-rates/

 

My state as a whole has a 37.8% rate for c-section. There is NO excuse for that.

[Word Nerd]

 

Oh the other hand, with all the nasty environmental/food/etc factors going on these days, I wouldn't be surprised if more and more women are finding that their bodies don't know exactly how to give birth anymore.

 

 

I don't follow your logic here. I think a key problem is that women and doctors have preconceived notions of how long pregnancy and labor "should" take, and if it takes longer than that somewhat arbitrary window, interventions are done and presented as necessary.

 

When I was pregnant with DD2, I read a thorough, research-based look at various childbirth-related interventions, and the author explained why once the interventions start, more become necessary. The chain reaction of interventions often results in the need for c-sections. I'll edit if I remember the title name.

 

ETA: The Thinking Woman's Guide to Better Birth by Henci Goer

[Ameena]

you can find the rates at your local hospitals here: http://www.cesareanr...cesarean-rates/

 

My state as a whole has a 37.8% rate for c-section. There is NO excuse for that.

 

Thanks for posting the link!

 

The hospital I delivered at has a 46.2% rate for c-section - which is actually LOWER than I thought it would be.

 

And there is a hospital in my state with a 100% rate - WOW.

[HS Mom in NC]

I will try to remember this when I'm pushing this baby out. Dang.

 

I don't think I could have had my first, second, even third or fourth babies at home. It took me until #5 to be confident enough to birth at home, without the support of the hospital (and drugs, if needed). It amazes me that women home birth their first babies, especially huge babies. Wow.

 

It depends how women are raised. My mother had my bio brother and I in a hospital with an OB who required patients to take Bradley Childbirth Classes (high natural delivery rates.) The OB sat and knitted at the foot of the bed while my mother labored undrugged in a darkened room in various positions. The OB had recently switched to hospital births after doing homebirths because the travel time in homebirths was getting to be too much for her. It was the early 70s.

 

So, I was raised by someone who didn't believe childbirth was an illness to be treated with drugs and surgery. She had obstetrical care with someone whose background was experiencing first hand that the vast majority of births require little or no intervention that requires drugs and surgery. Those exceptions do not negate the rule that the vast majority of time, mothers and babies can be safely supported for a natural delivery.

 

So, it was perfectly natural for me to see a homebirth midwife for my deliveries. Could I birth at home both times? The first one was normal so we delivered at home and the second had two life threatening complications and so we transferred for a blessed c-section. The system works.

[HS Mom in NC]

Two other big factors in the c-section rates are:

 

1. Doctor shortages. When you have a high number of women to a low number of doctors, there's just going to be incentive to manipulate labor with interventions which always increases the need for more intervention.

 

2. Women are weird about firing birth attendants. I am shocked at how most intelligent women choose childbirth options. Most do no research about all the options available to them. They don't look into c-section rates, statistics about intervention risks, they don't compare hospital policies, etc. They get a recommendation from a friend based on content free statements related to vibes or feelings about him/her and then stick with that one no matter how many red flags go up. They don't even look for red flags. Most will not change OBs even if they're unhappy with him/her. They'll do more research on buying a TV than they will about who they'll have around at their delivery.

 

We have to do a better job of raising girls in America. We have to teach them that they are capable of looking into options, comparing options, questioning those who are telling them things, and making informed decisions for themselves and their babies. They don't have to be passive and submissive just because someone has a medical degree.

[Word Nerd]

2. Women are weird about firing birth attendants. I am shocked at how most intelligent women choose childbirth options. Most do no research about all the options available to them. They don't look into c-section rates, statistics about intervention risks, they don't compare hospital policies, etc. They get a recommendation from a friend based on content free statements related to vibes or feelings about him/her and then stick with that one no matter how many red flags go up. They don't even look for red flags. Most will not change OBs even if they're unhappy with him/her. They'll do more research on buying a TV than they will about who they'll have around at their delivery.

 

 

You raise some valid points, but the above also assumes women have a lot of options for OBs and even hospitals where they live. If I wanted to choose a different hospital for L&D than the one (there is only one) in the city nearby, I would have to drive a minimum of an hour and a half from home. To have multiple hospital options available, I'd have to go 2.5 hours. Small-town hospitals in my area usually do not do obstetrics.

[I.Dup.]

It depends how women are raised.

 

I don't think it's necessarily about this. I heard nothing about birthing or OBs as I was growing up. I had my daughter when I was a teen, and when that first contraction hit after my water broke, there's no way I could have done it at home. I thought I was going to die.I had never experienced anything like that level of pain in my entire life. With my second he came out posterior with a nuchal hand and I screamed and panicked my way through pushing. Screamed like a crazy woman. I didn't have drugs that time (except the pitocin- no pain meds) but I know I needed the support of the hospital staff, even then. My 3rd and 4th came early, so I couldn't have had them at home, anyway.

 

I have never screamed like I did with my 2nd since then because it made the whole experience so much worse for me, but I will never forget the fear and terror I felt. Just because of the pain, not any preconceived notion of birth or anything.

[StaceyinLA]

you can find the rates at your local hospitals here: http://www.cesareanr...cesarean-rates/

 

My state as a whole has a 37.8% rate for c-section. There is NO excuse for that.

 

 

 

39.9% overall here in Louisiana. I am disgusted, but not surprised.

[staceyobu]

I don't have time to read all the other threads... I'm sure my list will have been mostly covered by this point.

 

Reasons the c/section rate is high:

 

1. Necessary c/s for baby or mother in distress. Other problems might include a baby that is too big, a baby with known defects that they want a very controlled delivery for.

 

2. Most hospitals/obs do not want to do VBACs. So, anyone who has had a c/s for any legitimate reason, will require c/sections for all future babies.

 

3. Inductions. If you induce before a mother is ready for labor, there is a chance that it won't progress. Then you have to do a c/section. Induction rates are over 90% in many places. I really think this is a HUGE factor in the c/s rate.

 

4. Epidurals. I really believe that epidurals can start a chain of events that can cause a baby's heart rate to crash and thenan immediate section is needed.

 

5. Continuous monitoring. It has been proven that continuous monitoring does not improve outcomes for infants, but does increase the c/s rate. If you watch a baby's heart rate meticulously for 12 hours, chances are you will see something that might concern you enough to do a c/s.

 

6. An overall atmosphere of medicalized birth... in labor too long? c/section. water broken too long? c/section. baby looks big on ultrasound? c/section

[Dahliarw]

I don't think it's necessarily about this. I heard nothing about birthing or OBs as I was growing up. I had my daughter when I was a teen, and when that first contraction hit after my water broke, there's no way I could have done it at home. I thought I was going to die.I had never experienced anything like that level of pain in my entire life. With my second he came out posterior with a nuchal hand and I screamed and panicked my way through pushing. Screamed like a crazy woman. I didn't have drugs that time (except the pitocin- no pain meds) but I know I needed the support of the hospital staff, even then. My 3rd and 4th came early, so I couldn't have had them at home, anyway.

 

I have never screamed like I did with my 2nd since then because it made the whole experience so much worse for me, but I will never forget the fear and terror I felt. Just because of the pain, not any preconceived notion of birth or anything.

 

 

If you had been taught about birth prior and had coping mechanisms to deal with the pain (which are taught) that would not have been the case. The problem is that is not provided by default, women have to know to seek it out.

 

And yes, support is key in labor, but my 2 midwives and doula along with my husband and sister provided that for me at home. Couldn't have done it without them. And none of them were strangers I just met!

[AimeeM]

 

No, a c-section wasn't necessary, it was your only option, but not necessary. It is ridiculous that women can't make their own medical decisions, especially given that ACOG says VBA2C is perfectly fine to try. I'm sorry you didn't get to make your own choice.

 

I would have chosen another c-section, frankly. I've had a good run with them and they're my preferred birthing method, lol.

On that note, it was necessary because it was my only option (and my doctor's only option).

[VeganCupcake]

It depends how women are raised.

 

I birthed both of my children at home, and I don't think it had anything to do with my upbringing--other than we knew a lady who had had a homebirth for twins when I was a kid. My family considered her very strange.

 

What influenced me was that I did a lot of reading and research, and I was 32 when I first got pregnant, so I had a lot of time to develop my own opinions.

 

2. Women are weird about firing birth attendants. I am shocked at how most intelligent women choose childbirth options. Most do no research about all the options available to them. They don't look into c-section rates, statistics about intervention risks, they don't compare hospital policies, etc. They get a recommendation from a friend based on content free statements related to vibes or feelings about him/her and then stick with that one no matter how many red flags go up. They don't even look for red flags. Most will not change OBs even if they're unhappy with him/her. They'll do more research on buying a TV than they will about who they'll have around at their delivery.

 

We have to do a better job of raising girls in America. We have to teach them that they are capable of looking into options, comparing options, questioning those who are telling them things, and making informed decisions for themselves and their babies. They don't have to be passive and submissive just because someone has a medical degree.

 

I do think it's surprising that more women don't do more research, beyond the very-mainstream What To Expect, for instance. I suppose that counts as research and I shouldn't discount it.

 

I have known several women who didn't like their OBs and yet didn't switch--and they lived in metro areas and presumably had a number of other choices. One was a friend who felt intimidated by her OB and didn't like the OB's philosophy, but didn't feel like she could switch. She hired a doula and had a pretty good hospital birth.

[lea_lpz]

I think the heavy use of pitocin has done a lot to increase the number of cesareans. Many women are being induced near their due dates when their body/baby may not be ready for another week or so. The pitocin makes the contractions so intense that doing it without an epidural is immensely difficult. The epidural can make pushing less effective and make it impossible to walk, sway, or move into better positions. If the woman's body wasn't ready to go into labor, she may very well not progress with a mild amount of pitocin, so they up it. The woman can't really feel the contractions anymore anyway, but the unnatural intensity of them can certainly still impact the baby. So...

 

1) Woman isn't ready and doesn't progress even with the pit? Csection

 

2) Pitocin contractions are so intense they start causing problems for the baby? Csection

 

3) Woman gets to the pushing stage, but isn't able to to get the baby to descend because of physical limitations caused by the epidural? Csection

 

 

My homebirth turned into a transfer for a cesarean, and I'm very grateful for my surgery. They definitely save lives when they are necessary.

 

That's exactly why I had a c-section for my first.