Elective Caesarian birth v. natural (vaginal) birth

[hedra]

General news story/summary that sums up both the actual rate and many of the risks. Of particular note:

Women’s risk of death, although small, is three to seven times higher [for c-sections] than during vaginal delivery, says the American College of Obstetricians and Gynecologists. They also have longer hospital stays, a higher risk of post-delivery infection and increased pain.

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The CDC report. with more on the exact numbers.

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The Cochrane Medical Abstracts (evidence based medicine) notes that even in situations where there’s a clear evidence-based benefit to scheduled c-section - such as breech presentation or severe prematurity (where birth may injure the baby), there’s still an increased morbidity/mortality rate for the mother.

It is a cost-benefit situation - if the benefit is sufficient (saving the baby serious injury or death), the cost to the mother is balanced out. If not, well, you do the math. This is why this is an ethics issue in the OB world - elective c-sections are common enough, but are they actually good medical practice? “First, do no harm” comes to mind. If the procedure definitely increases the risk to the mother, and may or may not increase the risk to the infant, then it is questionable as a medical practice. (and since there are no studies that I can find of elective c-section vs vaginal birth, there’s no actual data suggesting that babies are better off either way - though there’s definitely data suggesting that babies born by c-section for medical reasons have more problems - not possible to strictly determine to what degree not going through the process as biologically engineered causes those negatives, though).

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Another article from Medscape (you have to register, but it is free), including:

Proponents of cesarean section maintain that this major abdominal surgical procedure will prevent problems for women in their later years. However, Williams said, “With no solid evidence to demonstrate that a cesarean section will protect older women from problems, like incontinence or uterine prolapse, this is clearly the wrong approach.”

(and they note that the same thing was said of episiotomies, and has been proven wrong)

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ObGyn.net has a nice article that describes the risks of a c-section:

Some complications that can occur during or after a c/section include heavy bleeding, damage to the bladder or intestines, major infections of the uterus, kidneys, lungs, or other areas, opening up of the skin incision, blood clots around the uterus or in the leg veins or lungs, an inability of the blood to clot, and damage to the uterus that makes future childbirth more dangerous. The uterus is a large, muscular organ that has an enormous blood supply. When an incision is made into the uterus, there can be a lot of bleeding. Modern doctors have medications and stitches to stop this, but even so, there are some women who need a blood transfusion during a c/section. (Others, on rare occasions, need a hysterectomy to save their life).

Most women who undergo a c/section need to take oral iron pills, since the blood loss is at least twice as much as during a vaginal delivery. A number of women develop uterine infections, requiring extra days in
the hospital and powerful antibiotics.

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Babies also need special attention during a c/section. Their lungs are not compressed by the vagina during a c/section, so they often have lungs with a little extra fluid in them. Not all problems occur during a c/section; some occur later. These include pelvic pain or pain with intercourse from scar tissue (called adhesions), difficulty using “sit-up muscles,” and development of scar tissue between the afterbirth and the uterine lining in later pregnancies (which can lead to hemorrhage or emergency hysterectomy).

and

When doctors advise a c/section, they are aware that it is preferable to deliver vaginally, but that sometimes it is necessary to perform a c/section.

That site specifically lists the reasons one would consider a c-section - all of them are medical reasons. Not personal preference.

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back to the personal side:

I’ve only done vaginal birth, with no episiotomy, and no tearing (good physical support by the midwife, lots of kegels beforehand, and naturally stretchy tissues). It was the hardest work I’ve ever done, physically (I won’t go into the stories - they come out sounding like horror tales, though they were pretty decent, IMHO), and it was worth it. I felt it was valuable in how much it taught be about my body - increased my faith in my body, and gave me a sense of humility and awe. Might get that from a c-section, too, don’t know. The women I know who have had both experiences value c-sections for saving their lives, or their child’s life, but I only know one who would choose it over vaginal. She is a self-avowed control freak, who dislikes not being able to choose everything about her life. No comment on how that affects her parenting. :rolleyes: Most of the other control freaks I know who had c-sections hated it - they felt they had even less control, though they all also had non-elective c-sections.

And definitely do the kegels - but they only help for urinary stress incontinance (just kegels alone) about 20% of the time (per Cochraine again - but then again, surgery only helps to the same degree, IIRC). I’m afraid doing the kegels helped somewhat for me, but the only thing that really made the difference was (ulp) losing about 50 lbs.

[WV_Woman]

So Dave …

ya never did tell us when she’s due and what you guys are having

Need details!

[Dave_Stewart_v3.0]

Thanks to one and all for your comments. Both me and my wife appreciate what you have all said. Its quite nice to come into Great Debates and not feel like I have to have my itchy trigger fingers lurking above my holster.

We are having a girl, and she’s due on 14 October.

Dealing with the more interesting issues:

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.

Hong Kong has a top rate medical system. It is quite apart from and different to the rest of China, according to the one country two systems policy initiated in 1997 when HK was handed back to the PRC. I have a lot of confidence in the HK medical system.

China Guy, nice to hear from you. Your guess is a little off - I’m an Australian and my wife is a Swede. Close, though I actually thought the PRC government had only just realised - or perhaps acknowledged - the extent of the AIDS epidemic on the mainland?
2. Autz

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.

Do you have a cite for that? That is quite a compelling argument, if its true. The WHO doesn’t call for things like that out of a whim.

3. The Sex Life Issue

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.

I was actually referring to “better sex life” for the mother, DDG!

I doubt I’ll be the one getting depressed…

…hmmm.

Moving along.

4. W V Woman

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?

Yes, my wife has encountered that very thing, and its a bit intimidating. Certainly my father’s reaction to being told that we were considering an elective c-section was not positive - he thought we were joking. With respect to Superkarlene and her views, her comment:

I think that childbirth is something that shouldn’t be missed out on.

has shades of this. If I was shown a study that women who experienced vaginal birth were less likely to suffer from depression, or something more quantitative than “failure to fulfil your destiny as a woman”, then I’d be more convinced.

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.

Doctors in HK are very happy to do c-sections. In fact, we have been told that most deliveries in HK are by c-section.

(PS, it’ll be inconvenienced anyway for the next 18 years once the kid is born.)

LOL.
5. Dangerosa

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).

To be honest, I have wracked my brains trying to remember where I read that doctors prefer C-sections in the US, and I haven’t a clue. The fact that you have challenged it undermines my preference towards a c-section.

So, although I thank you all for your valued input, I must admit I’m more uncertain than ever.

[BiblioCat]

I’ve had two kids, one natural and one c-section.
Please, please, please, try for a natural if you can.
The natural-birth recovery was so much easier. I felt pretty much like myself within days. I walked to my recovery room.

After my c-section, I felt like shit for about 3 weeks.
I never had any incontinence problems till after my c-section.
I was exhausted all the time. The incision drained…it was just gross. I won’t go into details.

And the “no-sex” rule was the same, 6 weeks, for both.

[Palo_Verde]

Dave Stewart, here’s the cite you requested.

“As a rough estimate, WHO has estimated that caesarean delivery might be necessary in 5-15% of all deliveries.”

cite: http://www.who.int/reproductive-health/economics/mother_baby_package_costing_spreadsheet_RHR99-17/rhr99-17.pdf

page 15

By the way, the current c-section rate in the US is 23 percent.

[jane_says]

I’ve had two vaginal births myself (thirteen months apart) and cannot relate to any of the horror stories about bad sex, flabby hootches, stifling pee-screams, or itchy butt-stitches.

After my first child, we were back to normal, sexually speaking, within 2 1/2 - 3 weeks (yeah, I don’t follow directions well). For us sex actually improved afterward. Neither Mr. Jane nor I noticed any difference in size or “flabbiness”, as someone so eloquently put it. As soon as my stitches, which I barely noticed, dissolved, I was fine. After the second child, I healed just as fast. I had far worse problems, both physically and emotionally, from the birth control pills I took for the two months after my first child was born than I ever did from either birth.

I never did any Kegels, and I never peed myself. And I can say with some authority that Mr. Jane has never had to strap anything to his backside to keep from falling in.

Guin, ingore the martyr. For the VAST MAJORITY of mothers, getting over having a child isn’t that big a deal. We all got here okay, apparently, and many of our mothers actually suvived the event right along with us.

[Dangerosa]

jane_says,

Well, first there is getting over - some changes are permanent, others heal. Or are you implying emotionally getting over it? I don’t think anyone is claiming that they can’t emotionally deal with the stretch marks. Or if they’d only known they were going to pee when they sneezed they’d never have had children. And certainly most of us survive (I do have a former co-worker whose wife did die during delivery, so it isn’t a universal occurance, but certainly in the first world, in this century, maternal death is rare). Then there is the “big deal” part.

For some women, the stretch marks and need for a tummy tuck is a big deal. For others, you need to go into gestational diabetes that doesn’t go away when baby comes or post natal depression to hit big deal category. Most people will probably say that no matter what changes pregnancy and delivery brought their body (mind, life) the outcome is worthwhile (certainly my friends with gestational onset diabetes aren’t wishing they’d never gone through pregnancy). However, in my experience, your experience is atypical. Most of the people who tell pregnancy stories tell about a lasting change to their body that their body never quite recovers from. For most its as minor as droopy breasts or an increased shoe size or five pounds that just doesn’t seem to come off no matter how much time you spend on the stairmaster. Hemmoroids that never came before you were pregnant, leaky bladder, changes in your hair or skin - my obstrician assures me that these are normal (and permanent) changes to my body I am just going to have to get used to (or accept a couple of stitches to change - there is always a tummy tuck or whatever they do to take care of the leak while sneezing). Other changes heal. For every “I had sex after 2 weeks” story I’ve heard there is my cousin who finally had sex again after nine months (tear doesn’t begin to cover what happened) or my girlfriend (can you say emergency reconstructive surgery?). I don’t think these were typical experiences - but I can’t discount them entirely.

I’m not being a martyr (and I don’t think WV_Woman is either), just realistic. You don’t escape droopy breasts by not breastfeeding, you don’t escape incontinence by a c-section, if you are prone to stretch marks you are going to get them (although being 32ish when having your children doesn’t help), and your butt will likely never be in the same place again. You may end up as roomy as a sixty year old whore - or may emerge tight as a sixteen year old virgin. If you emerged unscathed from two pregnancies with the same body you started with, congrats - but that sure as hell wasn’t my experience, nor the experience of anyone I know. Just as you wouldn’t appreciate me saying “Gee, the vast majority of people have no problem with birth control pills.” - That should not invalidate the experience you had - you did and wouldn’t much like being called a martyr or having your experience questioned.

Dave,

You are right about the “natural childbirth is best” with the implied “you aren’t fully a woman and a mother if you haven’t done it” school of thought. I can’t recommend an elective c-section, but I do highly recommend an open mind going into labor. Whether you have a natural no drugs plan, or a scheduled c section on the 21st plan, babies have a way of throwing a curve ball at you when they decide to arrive. Take anything that happens in stride and anything that produces a healthy mom and baby in the end as a good thing.

[doreen]

The part of the natural childbirth is best school of thought that’s wrong is the implied “you aren’t fully a woman and a mother if you don’t have a no drug, vaginal delivery” .I had a pre-term natural delivery ( no drugs), an unplanned (but not emergency)Caesarian , and a sort of planned one - it wasn’t really elective, as the problems leading to the first C-section were expected to recur , but I knew that it would be a C-section. Recovery from the C-sections took much longer, and years later, the area around the scar is still numb.

Something I haven’t seen anyone mention regarding the elective C-section is the date issue. A due date isn’t really a date, it’s the middle of a range of dates (my doctor had said two weeks either
side of the due date is normal), so it’s possible that the planned date is too early , or since transportation is an issue, too late. My second C-section was planned for about a week before my due date, but I went into labor before it was scheduled. Still leaves you chartering a ferry at 3am
As for this

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;

I think you misremember what you read. The majority of births in the US are not done by C-section, although there was a time when the rates were rising , in part due to doctor’s fears of lawsuits.Other reasons that have been blamed are for the convenience of the doctor ( fewer 3am phone calls for him) and higher fees. But they weren’t afraid of the lawsuits because C-sections are always safer than a natural delivery. A C-section just provides a better defense of “we did everything possible” if there’s a bad outcome, even though the C-section didn’t affect the outcome. (if it did no defense would be needed)

[Dave_Stewart_v3.0]

*Originally posted by autz *
**Dave Stewart, here’s the cite you requested.

“As a rough estimate, WHO has estimated that caesarean delivery might be necessary in 5-15% of all deliveries.”

cite: http://www.who.int/reproductive-health/economics/mother_baby_package_costing_spreadsheet_RHR99-17/rhr99-17.pdf

page 15

By the way, the current c-section rate in the US is 23 percent. **

autz - I went to your link (Its actually page 19). I think you’ve got it out of context. What you have said is correct - that caesarian section deliveries are necessary in 5-15% of deliveries. WHO does not say:

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).

at least, not within this report (I went through it).

Incidentally, for what its worth, on page 75 of the report, it points out that 80% of all caesarean deliveries are non-emergency.

Special thanks to Bibliocat for her compelling comparison.

[doreen]

[/quote]
Incidentally, for what its worth, on page 75 of the report, it points out that 80% of all caesarean deliveries are non-emergency.
[/quote]

I’m sure this is true, Dave, but non-emergency doesn’t mean elective. For example, my first C-section was not planned, but neither was it an emergency.From the descriptions I’ve seen, an emergency C-section consists of get the mother under anaestheric as quickly as possible (a general) and get the baby out as soon as possible (apparently usually the up and down incision). My first C-section, which occured because labor was not progressing, was not an emergency. I didn’t get to the delivery room for at least an hour (maybe longer) after the decision was made- wait for the anaesthesiologist, get the epidural , wait for it to take effect, wait for the room to be available.

[Palo_Verde]

That link I sent was the only one I found on the WHO web site about this. But several other site say that WHO recomends reducing the c-section rate.

I don’t know if they read the same thing I sent you in the link and misinterpreted it, or they are referring to a different document.

I rather think they are referring to something I can’t access. Most documents on the WHO web site you have to pay to access. And reputable organizations (not heavy propaganda places) quote the information about WHO wanting to reduce c-section rates. (For example see http://www.ihi.org/collaboratives/breakthroughseries/bts-csectionrates.asp or http://www.childbirth.org/section/CSFact.html)

So I assume the information is legitimate, but accessible only by paying for it. But I can’t guarentee it.

[elfkin477]

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

Sheesh! **

I haven’t had kids, so maybe someone can correct me if I’m wrong. I thought that the whole “no sex for 4-6 weeks” thing wasn’t just because of vaginal stretching, but because it takes about that long for the uterus to shed all of the lining (why have so many moms described these post birth horrors to me, in graphic detail? Do they want to ensure I never choose to have kids?) If this is so, doesn’t it happen to you no matter which way you have the baby? Or do they do a D&C during a C-section to take care of that right then and there?

[VDarlin]

Elfkin When you have a C-section, they do clean out as much of the lining as possible, while they have the mother open. This does not get rid of all of the excess, but it does cut down on the post-partum bleeding tremendously. TMI warning - After my C-section, I had one day where I was passing huge clots, something I never experienced with my two vaginal deliveries, and then there was just mild spotting for a few weeks. With my first two, I had heavy bleeding way past the typical 6 week mark.

As for the depression issue, I don’t have a cite, but I have a hard time believing that a C-Section cuts down on the possibility of PPD. I have never heard this, and I know a few women who suffered from PPD after having a C-Section. The cause of PPD is due to the hormones, and more specifically, the dramatic drop in pregnancy hormones, once the baby is delivered, not the method of delivery.

~V

[jane_says]

Dangerosa, just so you know, the martyr coment wasn’t about you. Sorry I didn’t make that clear. It was for the Martyr-in-Residence.

I realize everyone has different experiences. Mine were wonderful. I was attempting to balance for Guin the gloom and doom notions that seemed to prevail in this thread. Many, many people have great birth experiences. I was one of them, thank God. I hate it when someone who’s had a bad experience with something, whether it’s childbirth, skydiving, or learning to cook a pot roast, and they attempt to taint it for everyone or scare others with their own horror stories.

I know plenty of women who spout a lot of horrific things about terrible childbirth experiences. I know a lot more who had either a pleasant experience or an unremarkable one, and perhaps because they’re not so vocal as the ones who had a negative experience, we don’t think about giving birth as being rewarding, even fun event.

FWIW, both of mine were completely natural. I had no drugs of any kind, and everything went exactly as we had hoped when we made our birth plans. I’m sorry that not everyone has it so easy.

Again, the martyr comment was not directed at you. I respectfully disagree with your opinion that no one else here is painting herself in that light.