Your biggest risk factor for a c-section may be your hospital (article)

[Dmmetler]

The thing to keep in mind with these stats is that often the hospitals with the higher c-section rates are hospitals that take high risk patients and have the NICUs to support them.

 

I've had four c-sections due to complications from a car accident when I was younger. I was a high risk patient and had my children at a hospital with a higher than average c-section rate, but that was because it was where the high risk clinic was located. The other area hospital, where I took my prenatal classes, loved to tout its super low c-section rate, but wouldn't allow me to deliver there. In fact, when I had complications with my third pregnancy, an ambulance took me to the low c-section rate hospital, and the nurses actually said, "Why did you bring her here? We don't have the facilities for this!" They had me ambulance transferred.

 

I was just going to say that. My hospital (where I had two c-sections, the first due to HELLP syndrome necessitating emergency delivery and a failed labor trial, the second because I have too much damage from the first to be able to safely VBAC) has the highest C-section %-but it also has the only level 4 NICU in the region, so that's where all of the high risk pregnancies end up, and a lot of deliveries are transferred there because of the NICU.

[ktgrok]

I was just going to say that. My hospital (where I had two c-sections, the first due to HELLP syndrome necessitating emergency delivery and a failed labor trial, the second because I have too much damage from the first to be able to safely VBAC) has the highest C-section %-but it also has the only level 4 NICU in the region, so that's where all of the high risk pregnancies end up, and a lot of deliveries are transferred there because of the NICU.

 

Yes, but the article was comparing rates for low risk women only. 

[imagine.more]

I drove 3 hours to have my second son in a birthing center....2 hours past the nearest hospital. I did it because the obgyn at the nearer hospital had such a high c-section rate that people nicknames him the butcher. I don't regret it one bit, we had a lovely 2am drive through the mountains and I had DS with no complications 1.5 hours after arriving at the birth center.

 

Having had babies everywhere from at home to birth centers to hospitals I am totally baffled by most hospital policies and OB trends. I had my most recent baby at a hospital and it was cool to get the epidural for the first time but I might forego that and do a homebirth next time just because of all the hassle and how they imprison you for 24 hours after the birth. So annoying.

[Murphy101]

All of the hospitals in my region have between a 27-35% c/s rate and I'm not even slightly surprised. I actually think that's a low ball number. All of those hospitals brag they are level 4 and can handle any high risk critical delivery, so no, none of them are more qualified and thus getting more risky patients even if that was the factor here, and it isn't.

 

And episiotomies, shaving, labor only on the bed on your back the entire time, pitocin an hour or maybe two if you are lucky after your are admitted, you better delivery within 8 hours or they will push that you have to have a c/s and more are the still completely the norm here.

 

Every one of these hospitals will tell you they have the option of not on your back deliveries and various amenities and that they are pro natural labor and VBAC but it's 100% bs. I bet you wouldn't find a single patient outside of the pavilion who actually has any supposedly standard care ever given to her. (Penthouse delivery suite for the very wealthy. I've for sure never been in it, but I suspect like usual money buys better care more concern to listen to the patient.) They talk about how modern and gentle and up to date their practices are, but once they get admit you on the gurney, they just do what they always planned to do anyways. What are you going to do? Get up and leave mid push?

 

For 22 years this has consistently been my experience both for myself and for every pregnant woman I've been with. I've used all the hospitals and 6 OBGYNs. I've gone on the hospital tours and heard them say how they have all these amenities. But only one, maybe two of the actual rooms have any of those amenities. And the staff doesn't like to use them bc it requires more time and effort on their part than you just taking your painkillers and pitocin and staying in the bed. (And to be fair, they don't have the staff to take more time for anything.) Every single OB will look at your birth plan and nod affirmative and encouragingly, knowing for a fact that they have standard orders at the hospital that contradict nearly everything on it and they have no intention of changing any of it. But all the major medical associations say what you want should be standard anyways? So what. It doesn't seem to matter if the OB is male or female either.

 

Yes. I'm very cynical and jaded at this point and bc of this I no longer take what the staff or the OB says as presumed truth.

 

The *consistency* of this has made me so.

Edited April 14, 2016 by Murphy101

[ktgrok]

@Murphy, your experience is the same as mine. They all claim these wondrous things, but it never really happens. The main difference in hospitals is that one of them is more likely to let you have your baby right way after a c-section, the other one has mandatory separation for hours. But nice food supposedly. Oh, and massages. 

[Bluegoat]

I wonder why it's considered a negative to have a c-section?

 

I will forever be SO grateful for mine. My baby was healthy, I am alive, my body is undamaged...a total win all around. Sure it was a surprise, but a negative? Not at all. Just one more of those mommy war insinuations that having one (like having only one child) somehow doesn't make you are "real" mother. I'll insert my vomit emoticon here.

 

And if, somehow, that isn't the underlying point of this discussion, I really do wonder is.

 

Because, if it isn't medically necessary it increases various risks for mom, for baby, and for subsequent pregnancies.

 

Really, if doctors were doing other unnecessary surgeries out of pressure from insurance or medical incompetence, we would not put up with it.

[Murphy101]

@Murphy, your experience is the same as mine. They all claim these wondrous things, but it never really happens. The main difference in hospitals is that one of them is more likely to let you have your baby right way after a c-section, the other one has mandatory separation for hours. But nice food supposedly. Oh, and massages.

The food sucks at all of them. Think elementary public school lunch room food. Which I wouldn't mind if I could just opt out if being charged several thousands of dollars for not eating it. My dh or friends usually brought me food and we always packed stuff in the hospital bag anyways bc dh is type 1 diabetic and we want to make sure he has a carb boost if he needs it while with me.

 

I don't know if they will give you your baby right away or not. Not with either of mine, one they could have but refused. They just sorta held him to show me and walked into another room. The second it was an unmedicated c/s bc they apparently couldn't handle a truely emergency c/s at that level four maternity hospital and they were half way done sewing me up with they finally figured out how to knock me out. *eye roll*

 

I know at one of them, the nicu and the nursery are literally on a seperate floor from maternity. Which is the most dumbass maternity set up ever. So yeah, ideally you should have your baby in the room anyways, but obviously if your baby has to be in nicu, that's purposely going to make it difficult especially for mothers who just had major abdominal surgery. And once your baby is on that floor, you basicly can't have them back in your room unless you go down there and get them yourself. So they'd take the babies for everything little thing bc the one or two nurses didn't want to go room to room for evaluations and these new moms would wait hours for all the babies to be evaluated before finally a CNA would tell them they could come get their baby. The smart moms aka bitchy helicopter moms to some, would catch in that the nurses don't like observers and would go down or have their dh go down with the baby. This almost always got their baby evaluated first and handed back to dad/mom when done.

 

Holy moly. I've never been offered a massage. Drugs, yes. They seem to prefer a patient half unconscious. I used to think maybe it was just me they wanted unconscious. Lol but no, I've had convo with enough other moms to know it isn't just me.

[ktgrok]

Concierge services, massage, gourmet food, and marble countertops in the bathrooms. But a mandatory separation for several hours after c-sections and over a 41% c-section rate. 

[Crimson Wife]

Okay, but how does demographics explain every hospital in my city having the same high rate? It doesn't. People want to believe it is the demographics, but there is more at play here. 

 

I don't disagree, but you quote the WHO "ideal" rate being 20%. That may be true on a worldwide basis, but the optimal rate for a hospital in an area serving mostly older moms might legitimately be quite a bit higher than 20%. Maybe it should be more like 33%.

 

I don't plan on having any more bio kids, but if I were to get pregnant this month, my risk of a c-section would be much greater at 40 (what I would be by the time I had this hypothetical baby) than it was when I had my 3 previous babies at 25, 28, and 31.

 

[ErinE]

The thing to keep in mind with these stats is that often the hospitals with the higher c-section rates are hospitals that take high risk patients and have the NICUs to support them.

 

I've had four c-sections due to complications from a car accident when I was younger. I was a high risk patient and had my children at a hospital with a higher than average c-section rate, but that was because it was where the high risk clinic was located. The other area hospital, where I took my prenatal classes, loved to tout its super low c-section rate, but wouldn't allow me to deliver there. In fact, when I had complications with my third pregnancy, an ambulance took me to the low c-section rate hospital, and the nurses actually said, "Why did you bring her here? We don't have the facilities for this!" They had me ambulance transferred.

 

Agreed. The regional labor and deliver hospital attached to the world-famous children's hospital has very high c-section rates. But those babies get whisked to NICU immediately.

 

http://blogs.scientificamerican.com/guest-blog/cesarean-sections-in-the-u-s-the-trouble-with-assembling-evidence-from-data/

 

I've looked at neonatal deaths from the 1800s; they are estimated as 14% (140 every 1000 births). Even now, many under-developed countries have a 5-6% neonatal death rate, which doesn't include harm done to the mother. The US, which is considered high for a developed country, is now 0.6% (6 every 1000 births).

 

I was a low-risk patient up until I was required to schedule a C-section because of a breech baby. Every subsequent child was a C-section due to macrosomia (the last was breech as well).  I didn't have gestational diabetes, no excessive weight gain. I exercised and ate right. I've had women, unsolicited, tell me that I shouldn't let the doctors "force" me into another C-section. I had to bite my tongue hard not to snap, "How about you mind your own business?"

 

The bizarre notion that you can do all the right things and have a baby vaginally is absolutely inaccurate. It leads to feelings of guilt for mothers told they need a C-section, and no one is willing to tell them: "Hey natural birth means natural death for many women and babies. Be thankful for modern medicine."

 

So many women I've known had completely normal pregnancies up until the point a C-section was required. My oldest and I would likely be dead without the C-section and my subsequent children never born. Thank you, modern medicine, for keeping my babies and me alive.

Edited April 14, 2016 by ErinE

[MEmama]

Because, if it isn't medically necessary it increases various risks for mom, for baby, and for subsequent pregnancies.

 

Really, if doctors were doing other unnecessary surgeries out of pressure from insurance or medical incompetence, we would not put up with it.

I guess. It's interesting though that the argument here is focused on the risks of c-sections, when childbirth (the "normal" way, ahem, as someone put it) was until recently the number one killer of women--and babies. Vaginal birth is a remarkably unsafe procedure, given that the survival of the species relies on it.

 

Anyway, can a woman not deny the opportunity for a c section if their doctor suggests one? At least until they are actually at death's door, at which point the doctor might be obligated to save at least one of the two lives in his care? With that choice to face, I can't say I blame them for pushing it when it doubt, honestly.

 

I don't mind hanging out with the unpopular crowd on this issue. ;)

[ktgrok]

I don't disagree, but you quote the WHO "ideal" rate being 20%. That may be true on a worldwide basis, but the optimal rate for a hospital in an area serving mostly older moms might legitimately be quite a bit higher than 20%. Maybe it should be more like 33%.

 

I don't plan on having any more bio kids, but if I were to get pregnant this month, my risk of a c-section would be much greater at 40 (what I would be by the time I had this hypothetical baby) than it was when I had my 3 previous babies at 25, 28, and 31.

 

 

Hmm...I'd be interested in reading how that plays out, actually. Mainly because I had my c-section young and my vaginal births at advanced maternal age. I know the risk of pre-E goes up with age, but I'm not sure what other risk factors go with age that would indicate c-section? Gestational diabetes maybe? Now I'm curious! But even then, an increase that big seems like a lot, especially when you figure women here have better prenatal care, have vitamin supplements to prevent rickets, etc. 

[Murphy101]

Because, if it isn't medically necessary it increases various risks for mom, for baby, and for subsequent pregnancies.

 

Really, if doctors were doing other unnecessary surgeries out of pressure from insurance or medical incompetence, we would not put up with it.

Absolutely. I have had medically necessary cesareans. Only a moron is against all cesareans ever. Legitimately necessary cesareans saves lives and thank god for them. That's not what this is about.

 

It's about purposely giving women a major surgery that absolutely does have risks and that they have *no medical need for*. And often lying to them about their medical situation to do it. That's just wrong. And IMO at least borders on being criminal. I'm betting it would be criminal if it wasn't happening to pregnant women.

 

That's not mommy wars. If it is, it's fighting for the right of every mother to be honestly told her medical situation and to be able to trust that a dr would never push her, or flat out force her, to have a surgery she doesn't genuinely need.

 

No, doctors and hospitals do not get to say that as long as they didn't kill you or you baby, you have no rights to expect honest care that is actually in the best interest of your health and to be treated with dignity.

 

When else do we say it's okay for a dr or a hospital to push surgeries they make millions off of and know damn good and well their patients don't need but scare them into thinking they have to have? Most would think that the height of unethical and possibly criminal medical care if it were happening to 30% of any other demographic besides pregnant women.

Edited April 14, 2016 by Murphy101

[Murphy101]

Concierge services, massage, gourmet food, and marble countertops in the bathrooms. But a mandatory separation for several hours after c-sections and over a 41% c-section rate.

Oh geez. *Head to palm*

 

Classic make them feel like they are at the ritz and they'd think they are getting great care whether they are or not. *smh*

[ktgrok]

I guess. It's interesting though that the argument here is focused on the risks of c-sections, when childbirth (the "normal" way, ahem, as someone put it) was until recently the number one killer of women--and babies. Vaginal birth is a remarkably unsafe procedure, given that the survival of the species relies on it.

 

Anyway, can a woman not deny the opportunity for a c section if their doctor suggests one? At least until they are actually at death's door, at which point the doctor might be obligated to save at least one of the two lives in his care? With that choice to face, I can't say I blame them for pushing it when it doubt, honestly.

 

I don't mind hanging out with the unpopular crowd on this issue. ;)

 

 

To the first point, c-sections are three times more likely to lead to a woman' death or serious injurry than vaginal birth. And as the article states, the neonatal mortality rate has NOT gone down with the increase in cesareans, instead we've seen a rise in maternal mortality. There are risks with both surgical and vaginal birth, and the risks and benefits need to be weighed carefully. 

 

As for refusing, its not like the doctor says, "hey, I have no real reason to suggest surgery other than my own convenience, so what do you say?" No, they say something indicating to the woman that it is the safest or only choice, so of course she agrees. In my own case I agreed to surgery for low fetal heart tones. I was NEVER told that by the time we got to the OR the heart rate was totally fine (probably due to me changing position). If I had been told I would not have consented. The doctor never even examined me, and my claims that I was pushing were ignored in the rush to "save my baby". 

 

I was at another birth, as moral support, when a doctor told my friend who was pregnant with twins that she needed a section to avoid bleeding out. Mind you, her other doctor had told her there was no reason she couldn't have a vaginal birth, twins were in a good position, etc. But that doctor got called away to a family emergency and this one felt all twins must be surgical. So she said the mother would bleed out and die because the uterus was stretched too big from carrying two babies. When I asked, well, what is the difference in blood loss with a c-section versus vaginal birth she blinked and admitted there was usually less blood loss with a vaginal birth. My friend stood her ground, but it was her third birth and she had a lot of support there. Another woman would have ended up in surgery when it wasn't needed (twins were born vaginally with no problem at all). 

 

So yes, women CAN say no, but it is VERY difficult and are usually threatened with the loss of their baby, or even with CPS. There have been cases in my state where the police were called and judges orders filed to force c-sections on women. But most of the time they just flat out lie about it. Like the doctor that told a woman I know that if you try for a VBAC there is a 90% chance of rupture and the baby dying. (um, less than 1%). Stuff like that. 

 

[Guest]

Ugh, the dead baby card. It's like obstetric's favorite cudgel against women who don't smile and nod.

[ktgrok]

Ugh, the dead baby card. It's like obstetric's favorite cudgel against women who don't smile and nod.

 

Also used after the fact. OBs admit that there are too many c-sections being done, but when it's the surgery THEY just did, it was totally needed. I've never once heard a doctor say, as they sew you up, "Huh, probably didn't need to do that. oh well."

[AnnE-girl]

My hospital's primary rate is 12%. I presume it's the midwives who are responsible for the low rate. I drove almost two hours to have baby number three there because I loved my experiences with the first two. They are pretty well known in the area for supporting vbacs in too.

 

Even the hospital with one of the best nicus in the state doesn't have a ridiculously high csection rate. My aunt had her 30 week twins there vaginally, but that was twenty-five years ago. I'm not sure if they still support non-surgical twin births.

[hornblower]

I wonder where they're getting the WHO stating 20%? 

Because the stuff I've seen is lower than that: 

"Since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10-15%."

" Two new HRP studies show that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. When the rate goes above 10%, there is no evidence that mortality rates improve."

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

[ktgrok]

I wonder where they're getting the WHO stating 20%? 

 

Because the stuff I've seen is lower than that: 

 

"Since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10-15%."

 

" Two new HRP studies show that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. When the rate goes above 10%, there is no evidence that mortality rates improve."

 

http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

 

I want to say I've seen the 20% number somewhere in regards to high risk populations..something like, even high risk hospitals shouldn't be above 20%. But I don't get much sleep and could be making that up. 

[HS Mom in NC]

Yes, first it's the hospital because they have policies the doctors have to follow. 

Next it's the doctor or midwife.

 

If you want a natural childbirth, go to a hospital that routinely (the vast majority of the time)  does natural deliveries.  Then pick a doctor or midwife that routinely does natural deliveries. Or have a homebirth with a midwife if you fit their criteria.

 

Don't go to a Mexican restaurant and demand they serve you French food.  They don't do that there.  It's not their thing. They don't know how.

Also, you can blame sue happy people who started the problem.  Now the doctors and hospitals are all have to lawyer up and practice hysterical defensive medicine.

[ktgrok]

So true, I use the restaurant analogy all the time when talking about this. 

 

Also, I did look up the maternal age and delivery method info...it's interesting for sure. Some of the factors were filtered out by the consumer report study, namely multiple births and breech, but the rest might fit. 

 

http://www.pregnancy.org/article/c-section-whats-age-got-do-it

[Matryoshka]

I was at another birth, as moral support, when a doctor told my friend who was pregnant with twins that she needed a section to avoid bleeding out. Mind you, her other doctor had told her there was no reason she couldn't have a vaginal birth, twins were in a good position, etc. But that doctor got called away to a family emergency and this one felt all twins must be surgical. So she said the mother would bleed out and die because the uterus was stretched too big from carrying two babies. When I asked, well, what is the difference in blood loss with a c-section versus vaginal birth she blinked and admitted there was usually less blood loss with a vaginal birth. My friend stood her ground, but it was her third birth and she had a lot of support there. Another woman would have ended up in surgery when it wasn't needed (twins were born vaginally with no problem at all)

 

I feel very lucky to have had a great OB who was willing to let me try for a vaginal birth even though the second twin was breech. Worked out fine - she even flipped on the way out so the breech extraction didn't even turn out to be needed...

 

Seems like c-section rates have skyrocketed since I had kids... :(

[Murphy101]

I want to point out a key part of the problem is that OBs are no longer trained to handle a delivery that develops any kind of complication in any way other than surgery - bc OBs are surgeons.

 

In countries and in states where best medically proven practices are actually trained and used, the mortality rate is much lower for both vaginal deliveries (of which they have a much higher rate of also) and cesareans than in most of the United States.

 

An OB is not going to tell you that they have never had training or experience in handling many of the common delivery scenarios that under proper training are routinely and safely delivered vaginally in other 1st world countries. I've never met nor heard of an OB who would admit they were demanding surgery bc they just didn't know how or lacked the confidence to assist in a vaginal delivery because they are trained to be surgeons first in this country.

 

And again, I'm thrilled for my cesareans (even tho they were shoddily done to most people's horror) bc I NEEDED a surgeon.

 

It's completely possible to be entirely for necessary surgery and also think it unethical and unsafe practice to put women and babies under the knife when it is not necessary.

Edited April 14, 2016 by Murphy101

[hornblower]

it seems to me age & bmi are the major factors 

[DesertBlossom]

Yes, first it's the hospital because they have policies the doctors have to follow.

 

Next it's the doctor or midwife.

 

If you want a natural childbirth, go to a hospital that routinely (the vast majority of the time) does natural deliveries. Then pick a doctor or midwife that routinely does natural deliveries. Or have a homebirth with a midwife if you fit their criteria.

 

Don't go to a Mexican restaurant and demand they serve you French food. They don't do that there. It's not their thing. They don't know how.

 

Also, you can blame sue happy people who started the problem. Now the doctors and hospitals are all have to lawyer up and practice hysterical defensive medicine.

I also think it requires more education about natural childbirth on the woman's part. Often women don't realize their "emergency c-section" was the result of a cascade of interventions that put their baby in distress. Then they think their doctor saved their baby when he/she likely caused the problems in the first place.

 

I think a lot of women go into childbirth planning for a vaginal birth, but lack natural pain management techniques and easily give into the interventions, which they don't realize can have serious consequences.

 

I know I'm a weird one, but I find the birth process totally fascinating. And while I know not everyone wants to or can have an unmedicated birth, even just being confined to the bed sets a woman up for potential problems.

Edited April 14, 2016 by DesertBlossom

[ErinE]

To the first point, c-sections are three times more likely to lead to a woman' death or serious injurry than vaginal birth. And as the article states, the neonatal mortality rate has NOT gone down with the increase in cesareans, instead we've seen a rise in maternal mortality. There are risks with both surgical and vaginal birth, and the risks and benefits need to be weighed carefully.

 

 

The scientific American article linked debunks the 3x myth. The authors subsequently went back and discovered, taking into account factors normally controlled for in medical studies , the rate is 1.6x. This still doesn't take into account the facts of each medical case (mother's BP, baby's pulse rate, etc). It wouldn't surprise me that a more detailed study would show the factor narrowing even more. Edited April 14, 2016 by ErinE

[Murphy101]

it seems to me age & bmi are the major factors

Right.

 

The age thing is a chicken/egg conundrum. As we age, most of us develop other issues. Those issues of course can sometimes make pregnancy and delivery more difficult. A woman without those age related issues tho, might not have a higher risk just bc she happens to fall in an age bracket that commonly does.

 

Bmi (to be clear, being over weight or very under weight) does make it more difficult too. Bc those things, like age, also tend to come with additional health issues.

[ktgrok]

it seems to me age & bmi are the major factors 

 

In the ICAN group I'm part of, the majority of moms we have join are young and fit. And although BMI can cause hypertension and diabetes, on it's own doesn't preclude vaginal delivery. I was morbidly obese with my vaginal births and not obese with my c-section. My experiences with doctors during that time had nothing to do with my size or age and everything to do with their "protocol".  I do think often the babies of large women are larger, and that can spook a doctor into a c-section, needed or not. 

 

In fact, when I was visiting the local hospital to see my sister, who had just given birth, two different staff members tried to convince me to just check in and have my labor induced, since I was about due anyway! And then when I explained no, and told them I was planning a VBAC one said, "I didn't know VBAC was legal." This was a labor and delivery nurse, and not only had she never seen a VBAC she had so little understanding of informed consent that she thought women had to consent to repeat surgery because of a law! That tells you a lot about how they view the bodily autonomy of women. 

[ktgrok]

The scientific American article linked debunks the 3x myth. The authors subsequently went back and discovered, taking into account factors normally controlled for in medical studies , the rate is 1.6x. This still doesn't take into account the facts of each medical case (mother's BP, baby's pulse rate, etc). It wouldn't surprise me that a more detailed study would show the factor narrowing even more.

 

I'll look that up, thank you. That's still a significant number of complications though, when you consider it's the most commonly performed surgery in the country. 

[MEmama]

Eh, I was young and a size 2 before pregnancy (and normal weight gain and perfect health while pregnant).

 

It just never occurred to me to *care* how the baby came out, just that he was healthy. I still don't understand why c sections are being talked about like something to avoid, but whatevs. To each their own. :)

[Murphy101]

I'll look that up, thank you. That's still a significant number of complications though, when you consider it's the most commonly performed surgery in the country.

There's that but also, I've reached a point of questioning the ability of American science to do more that support it's current desired practice.

 

Everything out of other 1st world countries and even some second world countries, that have better mortality and complications rates for both vaginal and cesarean deliveries doesn't support some of the common American practices.

[hornblower]

because nobody should have a surgery that is not needed 

because there are costs associated with it 

because there is a correlation with lower breastfeeding 

 

because there can be lifelong implications 


Cesarean versus Vaginal Delivery - long term infant outcomes & the hygiene hypothesis 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

 

 

It's a wonderful lifesaving intervention but  it has its own risks and benefits and is riskier than vaginal delivery for the normal healthy woman and infant. 

Edited April 14, 2016 by hornblower

[ktgrok]

Eh, I was young and a size 2 before pregnancy (and normal weight gain and perfect health while pregnant).

 

It just never occurred to me to *care* how the baby came out, just that he was healthy. I still don't understand why c sections are being talked about like something to avoid, but whatevs. To each their own. :)

 

 

Because recovery from major surgery is painful and makes it hard to take care of your baby and the other kids? Because it greatly increases your risk of placenta problems in your next pregnancy? Because it costs a whole lot more? Because it increases the risk of infection, blood clots, blood loss, etc? Because it can cause issues for the baby including respiratory distress? 

 

Saying you don't know why someone would want to avoid a c-section they don't need is like saying you don't understand why someone would want to avoid a gallbladder surgery they don't need. 

 

[MEmama]

[quote name="ktgrok" post="6946386" timestamp="1460673195

 

Saying you don't know why someone would want to avoid a c-section they don't need is like saying you don't understand why someone would want to avoid a gallbladder surgery they don't need.

 

 

Is it? Well okay then, thanks for telling me how I feel!

 

Shakes head.

[Murphy101]

Eh, I was young and a size 2 before pregnancy (and normal weight gain and perfect health while pregnant).

 

It just never occurred to me to *care* how the baby came out, just that he was healthy. I still don't understand why c sections are being talked about like something to avoid, but whatevs. To each their own. :)

What part of NOT MEDICALLY NECCESARY MAJOR Surgery don't you understand most people try to avoid and what about pregnancy makes you think it should be the exception to the natural desire to avoid a NOT MEDICALLY NECCESARY major surgery? In any other demographic, if a doctor conned a patient into a surgery he knew they probably didn't need, people would be understandably angry. And it should be that way for pregnant women too.

 

This is not about caring about how their baby arrives. And it's condescending to suggest it is.

Edited April 14, 2016 by Murphy101

[hornblower]

The other elephant in the room is elective c-sections. 
It's an issue everywhere & particularly in certain communities where beliefs regarding fortunate days and times are combined with the wealth to pay for this service. 

[ktgrok]

Is it? Well okay then, thanks for telling me how I feel!

 

Shakes head.

 

I wasn't trying to tell you how to feel, I was trying to use an analogy to explain why women would want to avoid c-sections if they could. I thought putting it in terms of another surgery might make it more clear. I was telling you how it sounded, not how you feel. 

 

Can you understand why someone would want to avoid surgery, of any kind, that they don't need?

[Murphy101]

The other elephant in the room is elective c-sections.

It's an issue everywhere & particularly in certain communities where beliefs regarding fortunate days and times are combined with the wealth to pay for this service.

I don't know I'd call it an elephant in the room. I'd say it's a beast of a different stripe.

 

Although I still don't think it wise, it's also a far different thing from terrifying a vulnerable woman in an artificially created high stress situation into thinking she or her baby are going to die if they don't do it.

Edited April 14, 2016 by Murphy101

[melbotoast]

When I went for my initial visit with my second, the OB told me I was an ideal candidate for VBAC. Then we moved, and the next OB told me that she didn't do VBACs, so she would just schedule me for a repeat c-section at 39 weeks. The doctor and the hospital makes a huge difference. I know in some areas it is really hard to find a doctor that is willing to do VBACs so if you have a c-section once, then you're stuck with it. It is sad to hear some women say that they "have to have c-sections now" when they could try if they could only find a doctor willing to follow ACOG recommendations! (We were only in that area for a few months and I made sure to find a VBAC friendly doctor in our new place!)

[ktgrok]

The other elephant in the room is elective c-sections. 

It's an issue everywhere & particularly in certain communities where beliefs regarding fortunate days and times are combined with the wealth to pay for this service. 

 

That does play into the high rate in Miami. Although, I do wonder how much informed consent there is...are women truly informed of the risks of placental problems, uterine rupture in future pregnancy (not just in labor, but in pregnancy), etc or are they walking in, saying "I want a c-section" and the doctor schedules it with no more conversation? The woman should absolutely have the right to pick how she wants to have the baby, but the doctor should be making sure there is informed consent. 

[medawyn]

I'm driving an hour away to deliver at a VBAC friendly hospital with a VBAC friendly doc. With luck, I'll have my second successful VBAC in the next few weeks. I moved to a community that was not super VBAC friendly at 26 weeks, so it's definitely worth the driv this time.

 

I feel confident about my ability to advocate for myself in a hospital setting as long as I have a supportive doc. I just didn't have the time to shop around or make a mistake this pregnancy. With a history of rapid labors, I would love a closer hospital, but I am definitely prioritizing the VBAC.

 

I am grateful that life saving C-sections are possible. I just wish there was a lot more education about labor, all the many (workable) issues that can happen, and the acknowledgment that a C-section is a major surgery.

[Murphy101]

A lot of women, especially working women, face a TON of pressure to plan the date. They can't afford to take off work longer than absolutely necessary or at the last minute or their support network is limited in when they can help.

 

My mil told me point blank if I didn't schedule my deliveries then I needed to find another sitter bc she has a job and can't just take off whenever. (Not that it matters. I never even asked her to begin with. And I didn't schedule any of mine.)

 

Maternity policies in America are rather draconian in general and I think the attitude towards women's maternity care (and in general) in many ways reflects that attitude.

Edited April 14, 2016 by Murphy101

[Murphy101]

I really wish there was better comprehension of cesarean being a major surgery and the support that a major surgery should get is nearly completely lacking in our society.

 

I got more sympathy and understanding and help for my gallbladder surgery than any of cesareans. It was really astonishing to me. People were worried and making sure I didn't do too much for my other kids and just generally very kind and supportive and understanding that I was healing from a surgery for several weeks afterwards.

 

With my first cesarean they sent me home less than 12 hours afterwards and I got nada. No pain meds. No offers to help out with the two toddlers. No instructions to take it easy and rest.

 

With my second cesarean it wasn't much different, tho dh was around and helped a lot. So did my friends.

 

But general people act like a cesarean is like getting your wisdom teeth pulled. Once the meds during the procedure wear off you should be achy but fine and a day or two later? Geez. Get over it already. When are you getting back to usual work?

Edited April 14, 2016 by Murphy101

[Lawana]

Is it? Well okay then, thanks for telling me how I feel!

 

Shakes head.

It is an analogy. Saying one statement is like another in an important way. It has nothing to do with feelings. It is certainly not telling you how you feel.

 

I am as happy as I can be that you are satisfied with your birth experience. Many women who have c-sections are not. They feel they have been lied to and bullied. The main thrust of this discussion is on an impersonal, society wide level of why there are too many c-sections performed and the real risks of unneeded surgery.

[ktgrok]

A lot of women, especially working women, face a TON of pressure to plan the date. They can't afford to take off work longer than absolutely necessary or at the last minute or their support network is limited in when they can help.

 

My mil told me point blank if I didn't schedule my deliveries then I needed to find another sitter bc she has a job and can't just take off whenever. (Not that it matters. I never even asked her to begin with. And I didn't schedule any of mine.)

 

Maternity policies in America are rather draconian in general and I think the attitude towards women's maternity care (and in general) in many ways reflects that attitude.

 

This is A HUGE point! I remember a coworker scheduled an induction for her second just due to her husband and her's leave time, and needing to maximize it. This was knowing that an induction increased the risk of a c-section. Sure enough, she had a c-section, and this was after a previous vaginal birth. She was very vocal about wishing she hadn't done the induction, and hating that she felt backed into a corner because of her limited maternity leave. 

[MEmama]

I really wish there was better comprehension of cesarean being a major surgery and the support that a major surgery should get is nearly completely lacking in our society.

 

I got more sympathy and understanding and help for my gallbladder surgery than any of cesareans. It was really astonishing to me. People were worried and making sure I didn't do too much for my other kids and just generally very kind and supportive and understanding that I was healing from a surgery for several weeks afterwards.

 

With my first cesarean they sent me home less than 12 hours afterwards and I got nada. No pain meds. No offers to help out with the two toddlers. No instructions to take it easy and rest.

 

With my second cesarean it wasn't much different, tho dh was around and helped a lot. So did my friends.

 

But general people act like a cesarean is like getting your wisdom teeth pulled. Once the meds during the procedure wear off you should be achy but fine and a day or two later? Geez. Get over it already. When are you getting back to usual work?

Yeah, recovering from wisdom teeth removal was way worse for me. With the c section I felt like I was getting away with something, it was so easy compared to friends' experiences with (and lasting effects from) vaginal birth. Of course everyone's experiences are different. I'm sorry your recovery was rough. Edited April 14, 2016 by MEmama

[Murphy101]

This is A HUGE point! I remember a coworker scheduled an induction for her second just due to her husband and her's leave time, and needing to maximize it. This was knowing that an induction increased the risk of a c-section. Sure enough, she had a c-section, and this was after a previous vaginal birth. She was very vocal about wishing she hadn't done the induction, and hating that she felt backed into a corner because of her limited maternity leave.

I was working ft when I was pregnant with my first two.

 

So with my first I swear I was dilated to 6-7 for literally over a month before I went into labor with him. Three weeks before my due date my dr started with the "I bet I get a call from you within a day or so." The kid was 2 weeks to the day over due. But it was my first. I didn't know his can be normal. So I went into work and repeated what my OB said and went on maternity leave. My boss was ticked off when I didn't have he baby for 5 weeks instead of "just go in and have it". You'd have thought they'd understand *I* was the one with cause to be upset as I was looking at 12+ weeks without pay instead of 6. But even being married to a supportive husband, I cried a lot about whether I should let my health or schedule be the deciding favor.

 

And once you have children to need a sitter for, that does bc a difficult thing too. I know many people where I am literally the only person they know who wouldn't have an employment conflict to schedule around. Even most grandparents are still working and need their job.

Edited April 14, 2016 by Murphy101

[Bluegoat]

I guess. It's interesting though that the argument here is focused on the risks of c-sections, when childbirth (the "normal" way, ahem, as someone put it) was until recently the number one killer of women--and babies. Vaginal birth is a remarkably unsafe procedure, given that the survival of the species relies on it.

 

Anyway, can a woman not deny the opportunity for a c section if their doctor suggests one? At least until they are actually at death's door, at which point the doctor might be obligated to save at least one of the two lives in his care? With that choice to face, I can't say I blame them for pushing it when it doubt, honestly.

 

I don't mind hanging out with the unpopular crowd on this issue. ;)

 

I don't follow your logic here.  With any medical procedure, if it is used appropriatly it can save lives.   If it is used inappropriatly, it can make things worse.

 

The fact that women died in childbirth does not mean using c-sections inappropriatly is good or acceptable, or leads to better medical outcomes.  Like, let's take everyone's appendix out prophylactically.  Of course for most people that would not be helpful and would simply expose them to all kinds of risks.

 

No, women cannot necessarily just deny doctors a C-section.  Hospitals hold all the power over a woman in labour who is in a poor position to advocate - try having doctors yell at you over something you know is bogus and argue with them through contractions.  And they are in a position of power because in the moment, the patient is often not going to be able to tell if the advice of the doctors is legitimate or not.

 

Hospitals can also refuse service to people who don't toe the line or punish them in other ways.

 

It isn't a question whether C-sections are being done inappropriately, so I'm not sure why people think this is something to be blasé about.

[Bluegoat]

I want to point out a key part of the problem is that OBs are no longer trained to handle a delivery that develops any kind of complication in any way other than surgery - bc OBs are surgeons.

 

In countries and in states where best medically proven practices are actually trained and used, the mortality rate is much lower for both vaginal deliveries (of which they have a much higher rate of also) and cesareans than in most of the United States.

 

An OB is not going to tell you that they have never had training or experience in handling many of the common delivery scenarios that under proper training are routinely and safely delivered vaginally in other 1st world countries. I've never met nor heard of an OB who would admit they were demanding surgery bc they just didn't know how or lacked the confidence to assist in a vaginal delivery because they are trained to be surgeons first in this country.

 

And again, I'm thrilled for my cesareans (even tho they were shoddily done to most people's horror) bc I NEEDED a surgeon.

 

It's completely possible to be entirely for necessary surgery and also think it unethical and unsafe practice to put women and babies under the knife when it is not necessary.

 

Yes!

 

When I was working as a doula, there was a couple I worked with who were being cared for by an OB.  The woman was laboring on her knees and wanted to stay that way, but the OB told her she had to deliver on her back.  When they asked why, she told them she didn't know how to deliver a baby any other way.

 

I was a little shocked TBH.  How could someone be a specialist in delivering babies and not know how to manage a woman on her knees, which is comfortable for many and had advantages in some deliveries?  It seemed completely bizarre.