I’m not 100% against cesareans. God knows, I had 2 of them, and one of them was absolutely, undeniably necessary. I have no “issues” about that one. I knew why it was done and I agreed that it was necessary.
It’s the question, really, of people being FORCED into major surgery, simply because they got pregnant. And no, Boyo Jim, there is no evidence that a cesarean section is safer than a VBAC, and I’d really challenge you to provide a credible cite that proves otherwise. The UW study, the recent one that got the big coverage, has been debunked thoroughly (and I will get a reference for this a bit later.)
But what is a ‘healthy mom’? I was so angry after my first section, when I realised all the things that might have been done differently, and not left me feeling like I’d been on a medical conveyor belt…things that made me realise I’d been steamrolled…was I healthy? I don’t think so. I had anger so deep at my mistreatment that it was eating me up. Might I have needed a cesarean anyway? It’s possible, about 10% of women honestly do. But I’ll never know. Yes, my baby was healthy, and of course I’m glad for that. But my experience was important too.
Since when is a mother who didn’t push a kid out of her vagina less of a mother? I will never understand those who have had c-sections who feel they have failed, nor will I understand any person who comments that a mother who has c-sections “cheated” or “failed”.
I had three c-sections, the first two were emergencies and the third was planned. I do not feel like I cheated with any of them. I was in labor for over 18 hours with my first child when my doctor suggested doing a c-section. With my second child my uterus ripped almost three weeks before my scheduled c-section ( about 4 weeks before my actual due date ). With my last baby I was watched very carefully and she was delivered two weeks before my due date.
I must have a pretty high pain threshold becasue I didn’t think the recovery time was bad at all. The day I went home from the hospital after having kid number two I vacuumed and carried laundry up and down stairs.
well, when you have absolute strangers commenting that the csection was “unnecessary” (apparently to them), then you can begin to appreciate what some of these moms have gone through. If I could find the ijiot who told my ex husband that my csection was ‘unnecessary’, I’d be happy to give a complete demonstration why their opinion was “unnecessary”.
Even to term them “unnecessary” is a judgement. Medically? according to your standards or theirs? I join Dangerosa in “that’s up to the woman and her doctor” and not up to you to judge. and **Manda ** yes, people are indeed rude enough to comment to folks directly. In any event, you may judge that my reason for having a csection is insufficient for your purposes, but to label it ‘unnecessary’ comments on the validity of my decision for my choice.
My wife had an emergency c-section for our first child and VBAC (vaginal birth after caesarean) for our second. I am thankful we had the option for the first - mother and child both likely would have died otherwise - and glad our OB/GYN advocated VBAC for the second - 15 minutes of pushing and the baby was out, out, out!
I guess I don’t see how it is anyone’s business by the parents. Scheduling a birth via c-section seems small-minded and wrong-headed to me, but I will defend a couple’s/woman’s right to choose it.
But you see, this is thread drift. People are protesting that they should be allowed to choose an elective cesarean if they want to. I have not argued, in my OP or at any point, that they should not be allowed to. It’s a good thing, I think, if people understand the ramifications of the choice before they choose it (like an increased risk of unexplained stillbirth in future pregnancies, a higher risk of placenta accreta, a higher risk of spontaneous rupture before or during labor, a higher risk of infection and abdominal adhesions, with increased risk during future cesareans), but the choice is theirs. Absolutely.
What I protest is that women who, having had a primary cesarean but wish to VBAC are not being given any choice, and this is happening for liability, not for **medical ** reasons. You people who are hollering about your right to choose being inalienable…what about these women? What about their choices?
As for the women who are now hollering that they don’t feel any less a woman for having had a surgical birth, I’m happy for you. Let me tell you how I felt after my primary cesarean: I felt unfinished. I felt, if you will pardon the visual, as if I had been caught at the brink of a sneeze, and had my sneeze taken away. Indeed, I did feel as though I had failed (and it didn’t help that I was labeled ‘failure’), because I had tried so hard, and I couldn’t do it. Did I feel less a woman? Mmmmno. But I still felt like I’d been interrupted mid-project, and not allowed to finish. It was a visceral thing, and I dare say, it was so visceral that it felt like my instincts had been violated. But, that sensation passed. What remained was the realisation that I had been manipulated by the medical people who were “caring” for me, and wound up in surgery because of it. That’s what made me angry. There are a lot of angry women out there, and there will be more.
Oh, I have no doubt that this is the case. My point is just that it is the act of commenting that is rude, not the forming of personal opinions. I mean, I would never tell my brother that I think his big fancy house is a waste of energy and money and pumps unneeded stress into his marrige, and I am well aware that I am not in possession of all the reasons they had for buying it and can’t make and sort of authoritative judgement about whether or not it was the “right” thing to do. But having formulated that opinion made a big impression on me and influenced my own choices when I bought my house.
I just wanted to make the point that bearing and rearing children are some of the most important things a person can do, and there is no reason to be shy in your heart of hearts about passing judgements about other people’s choices–not definitive judgements, becuase you never have all the information, and not permanent judgements because you should always be open to reevaluation as new information comes in (as it always, always does when suddenly you are on the hotseat), but judgements all the same.
once again, my objection is to the term “unneccessary c section”, unless (as unlikely as it is) the person using the term is a person referring to their own c-section.
My mother had a c-section while giving birth to me and my twin.
She got so badly infected that she almost died. 
C-sections aren’t to be taken lightly at all.
I found an abstract regarding use of ultrasound to predict risk of rupture of previous uterine scar.
Also, here is a rebuttal to the University of Washington VBAC study which has been used widely to refuse woman the opportunity to attempt VBAC if they wish. It is a thoughtful piece with extensive journal citations, and is worth the read.
There are a number of ways to reduce the risk of catastrophic uterine rupture during any birth, and the most vital is to avoid artificial uterine stimulants whenever possible. This is particularly true for a woman with a previous cesarean scar. When I went to attempt my VBA2C, my doctor and I came to these decisions together:
- I was given no prostglandins, oxytocin, or misoprostol (the last has been associated with catastrophic ruptures of unscarred uteri, let alone scarred ones). We agreed that if my labor did not begin spontaneously by 42 weeks, I would go in for an elective repeat cesarean rather than use these to start labor. Alternatively, we might have attempted to start labor by artificial rupture of membranes.
- I agreed to continuous fetal monitoring (this eventually required internal fetal monitoring via scalp probe)
- I agreed to a hep-lock IV site in case of emergency
- I labored without epidural anaesthesia as long as possible, so that the pain of deshience (scar separation), if any, would not be masked)
- Prior to labor, I went in and had my previous scar site measured via ultrasound. If the scar thickness had been under 4mm, we agreed I would go in for an elective repeat cesarean rather than try laboring. Scars with a thickness under 4mm have a considerably higher observed rate of rupture. My scar, however, was 1cm thick across its entire width.
I was successful. My recovery was many, many times easier on me physically than even my scheduled section, done due to fetal distress in one of my twins. I am glad, very glad, that my current OB was willing to attend me.
What about the physician who is not comfortable offering a VBAC? What if she feels it’s not in the patient’s or fetus’ best interest? Why should that physician be forced to compromise her medical judgement to accomodate the woman’s choice?
Now if the doc adheres to the (IMHO unnecessary rule) of once a section, always a section, then they need to tell the patient this early on, so the patient can exercise her right to choose another physician. But if it’s nearly time for delivery, and the doctor says “In my judgement, and for these reasons, I’m not comfortable with a trial of labor”, then should that doctor be forced to give a trial of labor?
I think everyone should be able to make informed choices about their healthcare. And that is why the cesarean rate, and the increasing problems finding a VBAC friendly hospital, make me angry.
Of course, I don’t know the specifics of every individual case, but in general it seems that doctors are telling patients that c-section is a lot safer than it really is, while also painting vaginal birth, whether it comes after a c-section or not, as a lot more dangerous than it really is. It seems that doctors themselves are ignorant of the facts regarding these issues. For instance, it is really sad that Jennifer Berman, an M.D., thinks that an elective c-section will protect her from incontinence, when recent research indicates it won’t.
Generally it seems that doctors gloss over the risks of c-section, from infection to bladder and bowel paralysis. They also seem to minimize the inherent results of c-sections, like the pain of the incision, and the risks to the baby (there are good reasons why a peds team has to be on hand for a c-section, but not a vaginal delivery). The general attitude seems to be that the baby is safe as long as you can “rescue” him from his mother’s body as quickly as possible, when in fact the squeezing of the contractions and the trip through the birth canal are *beneficial * to the newborn.
The other thing that drives me bananas is that lots of the complications of vaginal birth are in fact iatrogenic, yet doctors use these complications as reasons why cesareans are safer!
I think that women should be able to choose whether to have a second c-section or a VBAC, hell should be able to choose elective cesarean in the first place, I suppose. But doctors have an obligation to fully inform themselves and pass the information on to their patients before going ahead with a surgery. And for Pete’s sake, they should “allow” women to give birth vaginally under the same circumstances, rather than putting their financial interests above their patients’ health. (For this reason I think a no-fault birth injury compensation system might be a really good idea.)
Chotii,
I’m sorry your thread got hijacked into elective c section territory.
I agree with you that more doctors should be willing to perform VBAC. My husband was a VBAC - and this was back in the days of big scars. He was born in Holland, where, in 1965, they didn’t cut unless necessary.
At the same time, I understand why the doctors and hospitals won’t do it. I don’t blame them, I blame an overly litigious society where we can inform someone of all the risks, then - if something goes tragically wrong - have them successful sue the doctor and the hospital. Even if the risks aren’t greater, they are perceived to be greater - and an attorney will play them into a nice malpractice settlement.
Well. No.
But what then? Suppose all local hospitals have now adopted a no-VBAC policy (and this is true in many locales now)? What should those women do? Should they be forced to undergo major surgery? Should they turn to (possibly) unqualified attendants, or attempt unattended birth?
What should these women do, when they are offered no choice?
It’s not so much that the doctor is “forced” to “allow” labor. It’s that he shouldn’t completely abandon his care for a patient simply because that patient made a decision (about her own body) that he disagrees with.
Imagine a cancer patient has a doctor who both performs surgery and administers chemotherapy to patients. The doctor recommends both interventions to his patient. He explains the risks and benefits of both interventions, and the consequences if the patient doesn’t have surgery. If the patient wanted to forgo surgery, and just have chemotherapy, is it OK for the doctor to say, “I won’t treat you at all then!” Remember, this is a doctor who offers chemotherapy in other situations, and the patient is fully aware of the risks and has signed a statement that he understands the risks of forgoing surgery. Now imagine that this patient couldn’t find *any * doctor or hospital to give him chemo. Isn’t that a little messed up?
I believe the problem is that when the woman goes into labor if something should happen to her (like a uterine rupture or other complication) the doctor is the one left with the malpractice suit.
If the patient elects chemotherapy - I don’t see many chemo patients suddenly needing emergency cancer surgery in the middle of their chemo appointment.
[QUOTE=Chotii]
But what then? Suppose all local hospitals have now adopted a no-VBAC policy (and this is true in many locales now)? What should those women do? Should they be forced to undergo major surgery? Should they turn to (possibly) unqualified attendants, or attempt unattended birth?
[QUOTE]
Is a c-section so bad that its worth ruining your matress over in a home birth?
Point taken. No doc should abandon their patient. But no doc likes to get into a situation where their best professional judgement is being refused, especially when the potential is to lose two lives, not one. I’ve seen a case where both mother and fetus died, over the refusal of mom to accept blood.
I used to do OB. It’s a scary position to be in, when your patient is in pain, the baby is showing some signs of distress, and suddenly your patient is refusing what you feel to be sound medical advice. It’s one of the reasons I gave up OB. (There were other, bigger reasons too.)
Informed consent is important. I keep my patients informed of what we’re doing and why, and ask the patient to believe I am trying to act in their best interest. They are free to refuse what I offer, unless there is a court order mandating treatment (and boy, do I hate those!). But I don’t want my patient dictating what treatment they will accept from me, then expect me to provide what they want. Not if I think that course will actually be harmful.
Each situation is unique, and there is no “one size fits all” rule in this sort of area. But what would you do in the presence of an early catastrophic OB disaster, where C-section is clearly indicated right here right now, yet the patient refuses to sign the consent? When you, as the physician, suspect a greater than 90% chance of mortality for both mom & baby if it’s not done? While doing the surgery will reduce that to less than 10%?
Now, with a cancer patient, that decision is easier. Only one life involved, and it’s their right to choose. I’d not force surgery unwilling on someone with an underlying disease, who gave informed consent.
But in a natural process (childbirth) gone awry (and childbirth is a very normal process, which normally results in a significant loss of both mom and infant when intervention is not done appropriately), it is not so clear cut. At least not to me.
This is what chux pads are for. And plastic shower liners. And towels. And by the way, inflatable kiddie swimming pools.
If my membranes had ruptured in bed during labor with my 4th child (I was actually on the toilet, for which I am grateful), my mattress might well have been ruined anyway, and SROM is very common no matter where one plans to ultimately deliver. At least, when one plans a homebirth, one can make necessary preparations for cleanup. (Of course there are sometimes unplanned homebirths, which may very well result in ruined mattresses.)
I am not, I should point out, advocating that women should casually attempt VBAC at home (or certainly not without a qualified attendant). I opted out of attempted VBA2C at home despite having access to a qualified local midwife who would have attended me, because I felt my risk level was high enough to be in hospital (during my second cesarean, in my twin pregnancy, my primary scar was found to be ‘paper thin’). However, I did semi-jokingly tell my OB that if I couldn’t attempt my VBAC in hospital, I would go with the homebirth midwife, because I refused to have surgery “just in case”. She, naturally, felt that I would be safer in the hospital. It all worked out quite well.
But we’re still not talking about the same thing. When there is clearcut, immediate indication that intervention is needed, then it’s needed.
This is different from “just in case” surgeries.