Once a cesarean, always a cesarean

The BBQ Pit
1

Now it’s true, back in the days when cesarean section surgeries were less than 10% of all deliveries, and they were done in the ‘classical’ cut rather than the ‘bikini’ cut, doctors said that ‘once a cesarean, always a cesarean’. The rupture risk to classical incisions was, and remains, very high in subsequent pregnancies and labors.

But now, due in large part to crackdowns by insurance companies (not by physicians practicing evidence-based medicine), in many area of the country we’re right back there again. If you’ve had a c/s for any reason, and you get pregnant again, you WILL have another. Period. No choices offered, no opportunity to sign a consent form or a waiver… no hospital will “allow” you to VBAC, no OB will attend you, and in most of these locations, no licensed midwife dares to do it either.

What’s a woman to do? Submit to unnecessary major abdominal surgery simply because she got pregnant? How many times? What if she wants to have five or six kids, and got stuck with a breech presentation in the first pregnancy, a circumstance unlikely to recur?

I’ll tell you, women will start staying home to give birth - particularly the ones who have had traumatic cesarean experiences in the past and would rather risk death than go through it again - and they’ll have unqualified (or no) birth attendants, and some of those women will die of birth-related problems that could have been detected with a competent, trained attendant…and everyone will blame the for being so selfish, and not trotting in like little sheep to have their bellies cut open.

Over 26% of all births in the USA were done by c/s last year. In some locales, over 30%. A large number of those were not for medical reasons. The immediate and cumulative risks of cesareans are pooh-poohed by everyone from talk show hosts to the kind of OB who offered me an elective one in my first pregnancy “so you won’t get all stretched out down there, so sex will be better for your husband.” (He wound up cutting me after all, the bastard, after “accidentally” rupturing my membranes just when he happened to be on call the next two days, and failing to tell me at any point how to get my baby into a good position to be born. I didn’t know, I couldn’t do them, and voila’, she didn’t come out. And so I had to fight tooth and nail for my chance to VBAC - a process that admittedly carries inherent risks also - but which to me was a million times preferable to the pain and debilitation of cesarean surgery. I’m lucky. My local hospital still “allows” them. My OB still attends them - for now.)

My heart goes out to every woman forced under the knife, not because she’s sick, or injured, but because she’s got a baby in her belly and no competent attendant willing to observe her through a (desired) normal birth - or intervene if something goes wrong. There are a lot of them out there. There will be more.

2

I’m trying to see the CDC stats and haven’t come up with anything easily digested - can you point me to your source for that number? It seems pretty damned high. So far the only numbers I’ve found were pointing to a primary c-section rate of 14%, with total c-cection rates at about 20% and that was from 1997-1998. While I don’t want to throw out the secondary c-sectons I would think that the bigger threat would be if the primary c-section rate is rising that far that fast.

As a c-section baby - I thought that everyone would prefer vaginal birth whenever possible.

3

I agree with you about the high incidence of cesarean sections in women who do not at all need them. I forget the title of the book I read: the American Way of Birth or something like that. If I ever want children, which right now I don’t really, I will have a midwife and refuse 1. drugs 2. c-section and 3. episiotomy. All of these things are done practically standard now, when they aren’t needed. From what I remember of the book, the first one slows down labor. The second one is a money-making and time-saving measure. The third is something that doctors are taught to do as a matter of course at a birth, and is not necessary and may not be painful for the mother but will be painful and perhaps dangerous later.

I know it appears that I am blindly following one book, but all of those things have been substantiated by my own observations in real life. I may not want to have children right now, but I am interested in women’s issues, so I pay attention to those things.

I just wanted to let you know that there are alternatives to the purely doctor and hospital-oriented way of giving birth. There are midwives who are taught better (I think) methods that are better for the mother. So the women who want to stay home and not have a cesarean have a choice, and I think that if I ever have children, it’s a choice I am going to make.

4

The emergency c-section I had with my second son saved both our lives. I’d never in a million years wish that experience away because of what it gave me, but damn! C-sections suck, and I’d go through a dozen natural births before I’d willingly sign on for another C. There’s the pain, and the wooziness, and the drainage, and the pain, and the way it made my baby choke for two days, and an inability to move much or lift for at least a week when you’ve got a new baby to care for, and the pain, and the way it FUBARed my tummy–not a fun package. I’d love to go VBAC should I ever have another child, and I hope the OPs fears don’t come to fruition.

OtakuLoki–I can’t remember her name now, but there was one poster a while back who argued that a pre-planned c-section was her birth method of choice.
As insane as I find that, I’m afraid she’s unlikely to be alone in her delusion.

5

Aiyiyiyiyiyi That’s just wrong on so many levels…

There are times a c-section is necessary. But to plan on it without a medical reason for it?

6

It’s probably because “medical reason” has been replaced by “convenience” and “expediency”.

The custom of having women give birth while in a prone position (along with other phenomena you described in your OP), was created for the convenience of doctors. Now that we have moved to an obsession with individualism and the rights of consumers, we are creating new customs for the convenience of the mothers (the consumers).

7

I don’t doubt your reasoning, but, egads, don’t these women realize they’re having children? The most annoying, inconvenient, and inexpedient things in the world?

I love kids, really, but let’s not blind ourselves to the reality of the work involved in raising them.

8

What you posted makes a lot of sense, but don’t forget: Western culture (and medicicne) has a long and illustrious (NOT) history of classifying and treating menstruation, menopause, pregnancy and childbirth as “illnesses”. They are not seen as biological reality, or as part and parcel of motherhood. They are seen as bothersome events that must be gotten around, endured or denied.

9

This is a FOAF story so I can’t swear to its truth, but I had a friend in college who was briefly involved with a guy who was apparently delivered by pre-planned C-section…because his mother didn’t want him to be born under a star sign she was incompatible with. Yes, she had a C-section not for medical reasons, not even for cosmetic reasons, but for Zodiacal reasons.

10

Excuse me…my body, my baby…what the hell business is it of yours? If my doctor and I agree on a c-section, and I or my insurance is paying for it, that’s my concern, not yours.

11

Given the choice, I’d go the midwife/birthing center route myself, but for medical reasons if I managed to get through a pregnancy (which would be hideously difficult at best) I’d HAVE to have a section. What’s more, they would have to put me out for it, epidurals or spinals don’t fly when your spine is fused along almost its entire length. This has nothing to do with the c-section rate in general, but only to establish that this is a procedure I have all sorts of reasons to want to avoid, even more than a lot of women. If I have kids, I want to adopt, largely for this reason. I don’t want kids enough to go through this to have 'em.

I can understand doing them when it’s necessary, but I do not understand doctors doing it when it’s really not. It’s major surgery, it’s not like removing a mole or something.

If the malpractice lawyers would back the fuck off, maybe VBAC would become more acceptable. I thought it was the New Thing To Do anyway, I guess something changed somewhere?

12

I live in Boca Raton Fl, and I was told by a coworker with a pregnant wife that he found out the hospital here does the most c sections in the country, because of all the rich wives wanting to “schedule” the birth (and not stretch out their trophy cootches).

13

But how we decide what we want to do for ourselves is by evaluating other’s choices. Doesn’t mean it wouldn’t be hidiously rude to express such an opinion to someone who has had an elective C-sectin, doesn’t mean that there should be a law against it (which no one has proposed). But how am I suppossed to make judgements about MY body and MY (hypothetical) babies if I don’t make judgements about what others do? To do otherwise is to make every decision in a contextuless vaccum.

14

Yes, it is your choice. I’m not trying to take your right to choose away from you. I simply don’t see the major abdominal surgery of a c-section as being any kind of preferable experience to vaginal birth, and can’t understand why someone would plan on that, without a strong medical reason.
By the way, may I ask, why single me out for this response? I was not the first in this thread to express the sentiment (though, perhaps the most vocal) nor the only one. Just being nosey. :slight_smile:

15

Of course, you can decide what is right for yourself - and you make those decisions in part by evaluating the decsions of others - but anyone who doesn’t agree with you isn’t wrong. You really don’t know why they make the decisions they do.

I really have hot buttons on pregnancy, delivery and nursing. Seems to me that the very same people so quick to criticize the medical profession for too many c-sections and pushing formula and not letting a woman make choices about no medication, no intervention except in an emergency, discouraging formula, are the very same people quick to criticize a woman’s decision to do something other than what they would do. Seems very hypocritical to me. I mean, if the argument is about allowing me to control my body and having input into the medical decisions regarding my body, then I get to control my body.

And I HATE the backlash. I’ve hated watching friends who have had emergency c-sections feel like failures because of all the pre-birth propaganda - even though they know “healthy mom, healthy baby” is the best outcome - they still feel like crap because they didn’t have the planned birth they wanted. I have a lot of granola-y, all medication during birth is bad, midwife hiring, birkenstock wearing, vegetarian friends who have had emergency c’s. I went through the breastfeeding backlash.

16

I work in a hospital Education center, and we just offered our last VBAC class about a month and a half ago. There was a lot of discussion about it.

My only contribution to make is, the decision wasn’t made lightly, or arbitrarily. Risk of VBACs are substanitally higher than a 2nd Cesarean. And it’s not just a matter of an OB going along with a woman who chooses to accept the higher risk. Because if something DOES go wrong, the odds are very good the OB and hospital will be sued, no matter what kind of informed consent was signed.

BYW, there are stil a couple of OBs in town who will do VBACs if all the indicators are good (what the indicators are, I don’t know). But so few that we had to drop the education component – we can’t afford to run the class about the procedure because we don’t get enough students to pay the teacher.

17

Salon had an article on the topic of elective csections recently:

http://archive.salon.com/mwt/feature/2004/07/09/optional_c_sections/index.html

And here’s Dr. Jennifer Berman’s article about why she chose an elective csection for her second baby, after having a vaginal delivery with her first:

http://www.newshe.com/articles/csection.shtml (you can also read Part 2, a followup written after the baby’s birth, and an article by Dr. Berman’s OB)

I know this isn’t exactly on the topic of VBAC, but I thought some might find it interesting.

18

Because you were the most vocal and the most judgemental.

BTW, my daughter was born vaginally.

My son is adopted from South Korea. His paperwork indicates a full term vaginal birth. We suspect that it was an induction at 37 weeks which is apparently quite common for unwed mothers in Korea. This is somewhat shocking to us here - that you would induce that early. Over there, its an economic necessity - most unwed mothers can only work until they “show” then they are dependant on family and charity until the baby is born. So they need to get the pregnancy over as soon as possible - both because a short term makes the pregnancy easier to hide and because they need to get back to work.

The important thing about a birth is that mom and baby leave healthy. Personally, I wouldn’t do a scheduled c, I can, however, see the charm. Labor was not pleasant, and the pain post birth for me was pretty severe (I did rip fairly significantly). My girlfriend and I gave birth a week apart, she had a c-section (emergency - baby went into fetal distress during labor and was out minutes later). Her recovery was no worse than mine. The people I know who have had scheduled c’s (for twins, diabeties, etc) have had relatively pleansant experiences - they’ve known exactly when they and their husbands will be leaving work (unless they’d go into labor early), they don’t go through hours and hours of labor. They can schedule their family to be around. The worst seems to be those of my girlfriends who went through 20-40 hours of labor and ended up having the c section anyway - worst of both worlds - and very common in my circle. If there was a good chance that I’d have had a c section, I may have scheduled it.

19

And another thing, they will be blamed because they will* be at fault if they stay away from the medical community and deliver with untrained helpers.

How do you get to judge it is “unnecessary” surgery, regardless of why it was needed the first time? It is the damage from the first surgery that makes subsequent surgeries safer, on the whole, than subsequent vaginal delivery. The point is that in many cases it IS necessary, and that the risks of surgery are less than the risk of a vaginal delivery – IF a rupture occurs. Unfortunately the science of determining individual risk rather than statistical risk isn’r really there.

It might be that something will come along fairly soon that will change the equations. For instance, detailed scans of abdominal tissues may reveal whether an individual woman is, well, “Structurally sound enough” doesn’t eactly sound right, but it’s the closest term I can come up with. That’s being looked at somewhere. As you may have gathered, and I will make clear now in case you hadn’t, I am not a medically trained person, but I work with professional birthing people – teachers, nurses, OBs and and pediatricians, every day.

20

I had 2 emergency C-sections. We discussed a VBAC but with my medical problems the odds were I would need to be induced and the risk of a uterine rupture with induction is very high.

Uterine rupture is extremely dangerous. This was not a risk either my doctor or I or my husband were comfortable with. There are so many different factors in every pregnancy. I can understand why doctors are not willing to let patients take that risk. The malpractice rate for OBs is so high that many are not delivering babies at all any more!

I was surprised how well my surgical recovery went both times. Especially with everything else happening.

I wouldn’t trade my kids for anything. I also cannot go through another pregnancy. I beat myself up for weeks after my daughter was born because I felt like I failed by having a Csection even though the surgery saved my daughter’s life. I thought “sheesh she’s just born and already I’m screwing things up.”