Elective Caesarian birth v. natural (vaginal) birth

Great Debates
1

My wife is pregnant. We (actually, heh, she) has done a lot of research on whether or not to opt for a Caesarian delivery.

The advantages of an elective Caesarian seem to be:

  1. safer delivery of baby. In this regard, I have read somewhere (no cite, sorry) that the majority of births in the US are done by C-section. This is because of American litigiousness - doctors try to reduce their exposure by having deliveries in the safest way possible, which is, apparently, a Caesarian. Caesarian delivery avoids cord prolapse (when the umbilical cord gets wrapped around the baby’s neck and can cause suffocation or brain damage by oxygen deprivation) and foetal distress generally;

  2. reduced likelihood of incontinence caused by vaginal tearing;

  3. better sex life afterwards. This is apparently associated with a reduced likelihood of depression;

  4. the fact that some planned vaginal deliveries end up being emergency C-sections - why not plan a c-section in the first place;

  5. being able to choose when the baby is born. We live on an outlying island of Hong Kong, and would not like to have to charter a ferry or a helicopter to cart my wife to hospital at 3am. Convenience may sound like a poor reason, but there are some practical advantages to it.

The advantages of vaginal birth seem to be the disadvantages of a Caesarian:

  1. reduced risk of infection and other complications for the mother. Caesarians are major abdominal surgery, with associated risks. Vaginal delivery seems to be more mother-friendly;

  2. quicker recovery time for the mother.

There are “control” arguments both ways: with vaginal delivery, a mother has relatively more control over the birth (ie. its not all in the hands of the doctors). With a C-section, as I said above, the mother can choose when the baby will be born.

On top of that, the message boards which my wife frequents have posters who talk about the “womanliness” of having to go through the trial of labour and vaginal delivery - they report that it is the fulfillment of womanhood, something which a woman should not miss out on. I’m not a woman, so in all probability I’m missing the point entirely, but that just doesn’t seem like a valid consideration. Still there is some peer group pressure, not just from opinionated on-line mothers, but even from family that vaginal delivery is the “more healthy” option (“the way nature intended”, and all that sort of stuff).

I am interested to hear a reasoned debate on this subject. I am currently in favour of a C-section (as is my wife), but have some hesitation because of the risk of complications.

2

I’m not quite sure where to begin, so I guess I’ll just go through your points.

C-sections

  1. I would like to know where you learned that most American births are through C-section. I know several women who had to deliver their children in this way, and none of them wanted it or planned it. My former Biology professor delivered all 3 of her children this way, and was greatly upset that she didn’t at least get to deliver ONE of them naturally. (It was also because of the pain medication from her C-section that they discovered she was allergic to morphine. She started hallucinating that George Washington and his troops were attacking her and her baby, as she held the infant in her arms. To get away from Washington, she almost threw the baby through the air!) The C-section seems risky to me because you can never completely control what will happen in the OR. At least in a delivery room you can question what the doctors are doing.

  2. How likely is it for women to become incontinent through vaginal birth? I hadn’t heard about that before.

  3. Not sure I buy into this one either. There are ways of pleasing a woman outside of coitus. Just because her vagina is a bit sore doesn’t mean you have to stop ALL sexual activity. Therefore, the lack of “sex” doesn’t necessarily have to equate to depression.

  4. Just because SOME planned natural births turn into C-sections doesn’t mean to me that you have to plan for the C-section to begin with. There comes a point, I think, when our need for convenience is a bit exaggerated. I remember when Uma Thurman and Ethan Hawke had their last baby. Apparently, she still wanted to make movies, so she induced labor so that the baby would be born months early, so as not to interfere with her film schedule. I saw that as a gross mix-up of priorities.

  5. I acknowledge that having a good idea of when the baby will be born is definitely a good thing if you don’t live near any hospitals. I really don’t have a solution for that, other than perhaps investigating a midwife or nurse for hire.

Vaginal births

  1. I hate to say this, but China doesn’t exactly have a great record when it comes to medical procedures. As every major news organization has been harping on for months now, AIDS is reaching epidemic proportions in China, mostly due to its own health workers.

CNN.com says that a UN report

to AIDS.

You want to expose your child to that “crumbling public health system”? Needlessly?

Even though you doubt it’s status as a valid consideration, I think that childbirth is something that shouldn’t be missed out on. On a purely instinctual level, I feel that C-section is a cold medical procedure, done only as a last resort. Do you really want to tell your child when s/he’s 15 that YOU dictated when they would be born, rather than let nature take its course?

“Dad…tell me about the day I was born!”
"Kid, it was great! We planned it for weeks!’
“Really? You were looking forward to it?”
“No, I mean I planned it for weeks. We told the doctor we wanted you born at 10:00 am, on a Saturday morning.”
“Why?”
“So that your Mom and I could have sex quickly!..Oh, wait, did I say that out loud?”
“Ew, Dad, gross!!”
Besides all of this, isn’t it part of the joy to be surprised?

Maybe I’m just a hopelessly old-fashioned gal. But C-section would NOT be the choice for me.

3

Unless you have an extremely laid-back doctor, you don’t get to pick anyway.

I had a horrible labor and I begged them to cut me open and get the kid out. No dice. I had to suffer the whole 22 hours and pop her out myself. Doctors are not going to do a major surgery on you just because you don’t want your sex life to be inconvenienced for a few weeks. (PS, it’ll be inconvenienced anyway for the next 18 years once the kid is born.)

Maybe Hong Kong docs are different, though.

Do you really want to tell your child when s/he’s 15 that YOU dictated when they would be born, rather than let nature take its course?

Um … what do you think happens when a woman is induced?

Granted, in an induction you don’t get to declare the baby’s birthdate and time of birth, but once they break your water, that’s it. That baby is coming out.

Dave, if your wife can talk the doc into doing a C-section, more power to her, I say. I had a brutal episiotomy and frankly I would have much rather had a sore abdomen instead. This whole thing about how it’s just so “womanly” and wonderful to deliver vaginally is pure BS. When I was pregnant and on parenting message boards I was amazed at the things women would come up with to try to make themselves feel superior to other moms (like the natural childbirth camp nagging the epidural people, the breastfeeders trying to lay guilt trips on the bottle moms, etc.). The idea of labor is to get the kid out, who the hell cares how it happens?

PS: C-section babies, at birth, are typically prettier than those delivered naturally because they don’t have the whole conehead thing goin on.

When is she due, by the way? Do you know the baby’s sex?

4

Hmm. My eight-months-pregnant colleague and I were having this exact same discussion in the ladies’ bathroom at work. The billion dollar question:

Flabby tum, or flabby vag?

Horrible either way, but probaby worth it for the end product.

5

Hate to break this to you but all my girlfriends have incontincy problems - the ones that only had c sections and the ones that went through 36 hours of labor. Its the pregnancy.

If you are worried about stretching after a vaginal birth, the doctor can take a few stitches to tighten things back up. Often done after the second or third child. But you don’t have sex once the kids are born anyway.

Most births in the US are vaginal. Few US doctors will do an elective C Section. (Many would love to - its easier for them and there is no middle of the night elective c-section - but insurance companies don’t pay for elective c-sections). Some people think vaginal delivery is better for the baby. The contractions squeeze the child and work some of the fluid out of the lungs, so babies born vaginally have better outcomes.

C Sections tend to have longer recoveries associated with them for mom (which I can’t imagine, my daughter was a fairly easy vaginal birth and I could barely walk for two weeks - then again, my girlfriend who had a c-section about the same time could barely walk for a month).

Some women swear by them, and I think its up to you and your wife. But in my experience, vagainal birth wasn’t that bad, and none of my girlfriends who did c-sections would have them voluntarily again.

6

Dave, in China and HK, a lot of women seem to think that a c section is easier. They just don’t want to go through the labor process. Doctors seem to be a lot more agreeable on this issue than in the US.

I’m assuming your wife is Chinese and you’re an american?

I’ve never given birth nor am I a doctor, but I am a father. Daughter born in a local Chinese hospital, thank you very much. With the chief surgeon a 20 year vetern of delivering a whole lot of babies every week. A c section is not easy and may not be easier than a delivery. Every birth book I read as an expectant father (Sears and others) suggested that a natural birth was usually the best for the baby and mother.

You yourself wrote that you are hesitant because of the risk of complications. Well, there ya go.

Superkarlene, with all due respect, do you really believe the crap they peddle on CNN for a headline? The aids epidemic in China is real, but it wasn’t generally instigated by the public health system. You can do lots of google research, but long story short it was peasants in the impoverished countryside donating blood to unlicensed collectors.

7

Hmmm…I know you said that you didn’t have a cite, but I am interested in finding out where you read that most deliveries in the US were via C-section. There has been a bit of a push towards C-sections in cases where a woman goes into labor naturally, and due to complications, ends up in the OR for the final outcome, regardless of whether she would have been able to have delivered vaginally, or not, but unless there is a clear cut complication beforehand, I am unaware of people opting for planned C-sections.

The only exception to this being from several years past, when doctors either felt that a mother could not, or was at major risk, for delivering vaginally after having previously delivering a child via C-section. That is not an automatic practice anymore, as it was in the 60’s, as VBAC(Vaginal Birth After Cesearian), has become the norm, and a goal that most women having a 2nd, 3rd, 4th, etc, child after a C-section.

I would say that if you want to plan the delivery, as much as you can with a vaginal delivery, discuss your living situation with your wife’s doctor, and see what he/she has to say about induction. I don’t know how readily a doctor will agree to do so, without reason, however. My oldest child was late, and my doctor allowed me to decide whether I wanted to induce at a week past due, or wait, and possibly have to do it at 2 weeks past due. I opted for 1 week past due, and had the induction. I have also had a child where I went into labor naturally, and most recently, had an emergency C-section. Honestly, neither the induction, or the C-section were any fun, but knowing what I do now, given the option, I’d go for the induction any day, over a Cesearean.

~V

8

Hate to break this to you but all my girlfriends have incontincy problems - the ones that only had c sections and the ones that went through 36 hours of labor. Its the pregnancy.

You’re right.

9

Recovery time varies regardless of the method of birth.

I went through hell for about 6 weeks after I had my baby, but my friend who had a c-section was fine and dandy after about 2 weeks or so. (Fine and dandy meaning not in any pain, I don’t
know how long she had her staples/stitches/whatever they use these days.)

10

So, basically, after having kids, there’s no way to ever get pleasure from intercourse-is that what we’re saying?

:confused:

Also, how can you have sex more quickly after a C-section? She’s going to be recuperating from that!

Sheesh!

11

Guin nobody ever said that sex isn’t any good once you’ve had a baby.

Squeeze an 8 1/2 pound kid out your vagina, have your perineum cut with scissors so the baby can get out, and have it stitched back up again. Bleed like a stuck pig for a month. Your stitches are maddeningly itchy and you cannot pee without stifiling a scream. Who in their right mind is going to be in the mood for sex right away after that? It simply takes a while to heal, is all (some women have soreness, albeit very slight, for months or years afterward).

You can have sex more quickly after a C-section because the only place you are in pain is at the cut site on your abdomen. Get into the right position and, while you may have problems with your abdomen, vaginally speaking sex is going to be the same as it was before.

12

Oh, I didn’t mean RIGHT AWAY. I mean, it almost sounded like forever after your vagina is ruined-flabby, stretched, etc.

I know RIGHT AWAY you’re not going to want to have sex.

13

Guin, my guess is it would depend on the woman’s body.

Some women’s vaginas are shot after the first baby. Some never get stretched out.

It’s all about Kegels.

14

**

Ummmm…Noooo…

[minor hijack]

Guin, in regard to WV Woman’s Horror Stories, above: Do you know what the word “Catharsis” means? It means she had a bad time and she needs to dump it all out on us.

Ignore what she says, dear. I’m here to tell you that having babies is just like riding a roller coaster–somebody talks you into it, you’re terrified, you wish you hadn’t started, sometimes you puke, sometimes you hurt, when it’s all over you clamber out and vow wearily never to go through it again…

And a while later, there you are again, riding the roller coaster.

I rode it three times myself. The secret is–you get a prize at the end.

A baby.

Who looks–Just. Like. You.

That’s why people do it, Guin, for the moment when the labor room nurse finally puts the surprisingly small bundle in your arms and you brush the sweaty hair out of your face and look down and see a tiny chin that looks just like her daddy’s chin.

Ignore the “I was screaming in agony for 22 hours!” horror stories, 'kay?

[/minor hijack]

As far as “sex after childbirth”, with a vaginal delivery you wait 6 weeks to let your cervix close up completely–that’s if you’re being Good. If you’re being Bad, you pick up where you left off after 3 weeks, and keep your fingers crossed on the post-partum infection thing.

And believe me, you have much more important things to think about during those 6 (or 3) weeks than how long it’s been since you got laid–you’ve got a newborn baby in the house, and when you get some free time, you may find that you’d rather sleep than screw.

And yeah, it’s pretty loose down there at first, or so the Better Half reports, but a week or so of rigorous Kegels at odd moments during the day work wonders, for both of you, although it’s not likely that it will ever go back to that glorious pre-partum tightness. But if your relationship is based only on having a tight vagina to “stimulate him properly”, then you’ve got more problems than we can help you with here. A truly “Significant” Other will deal with the fact that you (and he) just had a baby, and you’ll never be “really tight” again.

After the first delivery and stretching-out, it pretty much stays the same size–in other words, it doesn’t keep on getting bigger and looser inside with every delivery, until you’re of a size to smuggle your own pocketbook through Customs.

All babies are pretty much the same size, and it only needs to stretch out enough to let a baby’s head out. Which it does, on the first outing. And then you tighten it up a bit after each delivery with Kegels.

As far as “being sore for years”, I had a really big episiotomy (that’s the “they cut my perineum with a pair of scissors!” thing :rolleyes: ) with The Cat Who Walks Alone, and yeah, the scar is still ouchy today–BUT–all it means in actual practice is that we can’t Do It Doggy Style, because it pulls on the scar. That’s all. Gee, I’m deprived, I’m scarred, I’m warped forever by my horrible vaginal delivery, there must be somebody I can sue for this… :rolleyes:

15

Guin,

Sex is great after pregnancy - just not right away. As DDG said, there are more important things to worry about than being a snug fit. And it doesn’t happen as often - or as loudly.

However, sneezing after pregnancy will never be the same again. I’ve heard if you do enough kegals, that will change, but I’m on my 1,265,395th and I still leak.

16

In fact sex can be better after pregnancy as the increased blood flow to the area can mean more intense orgasms.

There’s a recently released study which shows that the move to vaginal birth after a c/sec may in fact be misguided. It looks like once a c/sec, always a c/sec may be the safer path.

C/sec is a major operation. Some women have pain with adhesions afterwards for years. It can decrease fertility due to scar tissue. Nobody’s gonna argue that they should never be done but elective c/sec is a sucky idea. Going through major surgery so you can remain ‘honeymoon fresh’ is just not worth the risk.

17

Oh! DDG, you know me better than that! I don’t have kids NOW, or SO (grumble), but someday, I want to have kids and such.

And I really do think that it IS worth it all.

I was just really skeptical-because it sounded like the old, “Oh, once you have kids your relationship and romance go out the window!”

I don’t buy THAT. I was told that our bodies are meant for this. Yes, there are somethings that change, but we adapt. It’s not oh my god-sex is over!!!

(Not that I’D know anything about that…grumble…)

18

As a father of two, naturally birthed, and by caesarian, I found no difference. Sex does seem to get better with age though.

Because natural childbirth is an experience of fufillment (no pun intended) that can not be compared to anything else

The labour for my second child was induced. But complications did develop resulting in the caesarian option. But there is choice of date available for natural birth if that’s what you want. (Once you’ve reach term of course)

After the birth of my eldest daughter, the doctor, wink wink, asked me if he should put in a couple of extra stitches. (67 in total I found out afterward). I was totally taken by surprise, and with little time available to consider my answer and selfish concerns coming immediately to the fore I said “sure”. No regrets !:smiley: That option is not available through caesarian.

19

YIKES!

Avoid a c-section if you can! Because…

It’s not as safe for the mother:
The surgery itself, as opposed to medical problems that might lead to a cesarean, increases the risk of maternal death, hysterectomy, hemorrhage, surgical injury to other organs, infection, blood clots, and rehospitalization for complications.

Its not as safe for the baby:
The surgery itself also increases the risk of the baby being born in poor condition or having trouble breathing. Also, because of scar tissue, the incidence of placenta previa and placenta accreta, complications that kill babies and mothers, soars with each successive cesarean. Infertility and ectopic pregnancy associate with previous cesarean section as well.

C-sections also have a much longer recovery time, and a much higher percentage of women with c-sections have difficulty breast feeding.

I can provide cites for all of the above, if you want me to.

By the way, I am also the mother of 3 children born naturally.

20

Before any one gets on my case, I’m not talking about medically necessary c-sections. The OP is only about c-sections for personal preference.

The World Health Organization and the Public Health Service have called for a reduction in C-section rates to no more than 15 percent (about half the current rate in the US).

Obviously it is generally thought that we should be doing fewer c-sections, not more.