Phlosphr, you are a fucking idiot (re: home birth)

A post-cesarean woman in the US is FAR more likely to have a scheduled c-section with subsequent births.

A post-cesarean woman in the US is FAR more likely to be under the care of any sort of trained health care provider who might spot early indications of either high risk for rupture or the first actual signs of a rupture. It’s a heck of a lot easier to get ultrasound screening to asses the thickness and soundness of the uterine scar in the US than in Nigeria.

Basically, in the US (and other, even more medically enlightened countries) it’s possible to screen a post-cesarean woman for risk factors for uterine rupture and, if appropriate, even surgically deliver a subsequent child a bit early to avoid such a rupture. Much less likely to happy in Nigeria.

Not to mention, of course, that a woman is more likely to survive a uterine rupture in the industrialized world. Yes, I’m sure Nigeria has competent doctors and in major urban centers this might not be too dissimilar from many places in the US, but the fact is that Nigerians in Nigeria have far less access to medical care than people in the US.

Thus, the risk to a post-cesarean woman in Nigeria is higher than it would be if she remained in the US.

Was your wife seen by an OB/GYN throughout her pregnancy? Was a medical history taken while she was being considered for VBAC? Did she undergo ultrasound screening? Was she monitored closely during the pregnancy? Did she have the VBAC in a hospital setting?

If the uterine scar is thin or starts to dehiscence it is possible to avoid a rupture via surgery but that’s something a layperson is probably not going to spot until it’s too late.

Yes, quite.

First of all, those odds are for first world nations, not places like Nigeria. Now, if she’s a wealthy and powerful Nigerian woman perhaps access to care is not an issue, but it sure is for the average Nigerian woman, which is what I’m assume we’re talking about here. In a lot of places in Nigeria there aren’t OB/GYN’s on call, just the village midwife who may or may not have any formal training, the emergency facilities are inadequate to non-existent, and transport to fully equipped ER’s and OR’s may likewise be completely unavailable. You’re essentially looking at a home birth VBAC, and on top of that, a home birth with no immediate access to emergency care. Do you still think the risk is less? Or even acceptable?

In other words, the US and Nigeria are not comparable. The doctors did not listen to her concerns, or consider her reasons for refusing medical treatment which, supposedly, competent adults are supposed to be able to do in the US. No, no, saving the baby now was more important than putting her at risk in the future and leaving surviving children orphaned in a third world country.

Again, much easier for people who are NOT getting their belly cut open to make such decisions, particularly when the decision makers won’t have to live with the consequences of that decision in the future. Justice would be at least offering her a subsequent surgical sterilization to alleviate her fears of future pregnancy, although it wouldn’t surprise me if she was reluctant to undergo the knife again. The people who sliced her open won’t have to worry about locating decent pre-natal care in a third-world nation, or finding someone to asses a high-risk pregnancy, or having any access at all to an equipped hospital just to be on the safe side should she get pregnant again.

Agreed.

Like in our case, the efficient way they did the emergency C when it turned out the cord was wrapped around Dibblet’s neck.

I have nothing against home birth historically, some of my best siblings were home births. But fuck’s sake, we’ve moved on. I wouldn’t want one for any child of ours. I don’t like the risks. My daughter would be dead if we’d homebirthed. RN/CNM or no.

Yes, there have been studies conducted that have shown that men and women expressing pain get treated quite differently by some medical personnel. There are also differences due to ethnicity, age, poverty/wealth, and a host of other factors.

On top of that, there are studies showing that men and women react differently to different pain killers, some work better on men and some better on women.

And on top of that, many people with red hair also react differently to painkillers and anesthesia than non-redheads.

And… yes, one more… there is a VAST difference in pain tolerance between different individuals, and an individual’s pain tolerance also varies over time.

So… between the social-cultural issues, and the physical differences, the question of who hurts and how much and how seriously they’re taken and what they’re given is more complicated than you might think.

However, with childbirth there is the complication that it’s not about just the woman - in no case does medicating a man mean someone else gets involuntarily medicated at the same time*. If you medicate a pregnant woman you are always also medicating an infant at the same time.

  • Well, OK, conjoined twins, but those are pretty freakin’ rare.

This was exactly the question I asked a few times in the other thread:

Given that many home births come out just fine AND that many hospital births are positive experiences, where would you want to be in the slim chance that something goes catastrophically wrong?

I never quite got an answer to that.

Yeah, in Philosphr’s case, I’m especially curious about this. They’ve got a great hospital, WITH a birthing center that they think is terrific. Isn’t that the best of both worlds? Why not take advantage?

It’s the chemicals, man. Plus the music.

The midwife talked them out of the birthing center, the one who has thinks stillborn babies are a success story and who has never had to transport ever in 26 years.

I can understand the appeal of someone guaranteeing you that everything will be just fine and dandy, but dismissing the “scary statistics” from the doctor is putting your head in the sand. Not a very good position for giving birth I’d say.

Yeah, I said I’d drop the grey floppy baby story, because Philosphr says that he gets that this is a dire situation. But…I really really worry about the midwife not advising transfer appropriately. It makes no sense to me that she’s been a midwife as long as she has, and has delivered over 1000 babies, and never, NOT ONCE, has she seen a situation that she thought indicated need for transfer. I stated, I think in the other thread, that if that is true then I strongly question her judgment, and nothing that’s been said has made me change my thinking on that.

Yeah, 1000 births and not one of them has required an emergency c-section? Those are some weird statistics.

Precisely. He might as well cancel the ambulance standing by, because if she won’t transfer for that case, she ain’t gonna transfer for anything short of somebody bleeding out. And if that happens, they’re too far away from the hospital to do any good. If that’s a risk they’re comfortable taking that’s fine, but it troubles me that they’re putting so much faith in her being willing to transfer if things go badly.

I don’t know if even then, because he said she’d dealt with placental abruption, and still never had a reason to transfer.

I’m still trying to figure out how a newborn tells the difference between home and hospital and how they can change the nature of the bonding experience based upon their observations…

“Shit, I was born in a hospital. Fuck you mom - no hormones for you!”

“Hell yeah, I was born at home. We’re going to hormone party like it’s 1999!”

Heh. Yeah, good point. Both locations are just as alien to the baby.

If this midwife has said she’s attended over 1000 deliveries without ever once encountering a need for a C-section, she’s a liar. Most likely, she’s lyiong about how much experience she’s had. I wouldn’t take her word for anything about her credentials. You know she’s told at least one huge lie. That should be a red flag.

All your points are well taken. I think the big issue from my point of view is that she was perfectly willing to kill her term fetus because of the possibility of being pregnant in the future in Nigeria without good health care.

It just seems easier to do the damn C-section and either not have more kids, get good prenatal/delivery care in Nigeria, or roll the dice, instead of killing your baby.

I’m going to go out on a limb and assume that she was fairly familiar with her own life circumstances and the medical care available in Nigeria. Do you think it possible that she could make the decision in this wrenching case that involved her and not us?

C sections aren’t without risk, and they are overused: One of many cites:

http://www.msnbc.msn.com/id/20427256/ns/health-pregnancy/t/more-us-women-dying-childbirth/

Re: the Nigerian woman: I think it’s a fairly standard part of how most people think that we don’t want to kill an innocent person now just to reduce the possibility of killing other innocent people in the future. And if I were a doctor and a patient expressed their wishes to let their baby die based on possibly having a better outcome in the future on very specific facts that may occur, I’m pretty suyre I’d say “Fuck that, I’m saving this baby.”

The baby has had to put up with mom’s bad habits for nine months. Then has a lifetime ahead of them of getting McDonalds Happy Meals instead of tofu and broccoli. Mom is about to have the right to knock them out with Benedryl and let them drink Diet Coke. Even if you raise your kids in a granola hippy organic vegetarian world (which some of my girlfriends do, and my own kids get about 40% of their diet that way - organic, vegetarian - but we do 50% in a more standard American diet and 10% in the pure junk) they still manage to get junk food, exposure to chemicals, pollution - unless you take them out to the Unabomber shack and raise them there. I figure that the kid is in for much worse than a little Nubain and some through the placenta epidural blockers.

Home birthing is something you do when you’re snowed in or appearing in the season finale of a sitcom. Giving birth at home because you want to is even stupider than not immunizing your kids because Jenny McCarthy said not to.

I’m going to take issue with this. I know you were going for hyperbole, but homebirth is categorically not stupider than leaving your kids unvaccinated. Leaving your kids unvaccinated is one of the stupidest possible things you can do as a parent and has an impact on society at large.

To be clear, I’m not defending homebirth, I’m attacking anti-vaxers.

Reliable birth control and the ability to take it (and not have it taken away from you by your husband or his brothers) is not as easy in Nigeria as it is here, either.