C-sections

[Hockeygurl]

I respect your professional opinion, but consider this. From 1981 through 1997, I gave birth to 7 children, the last one was a twin breech presentation at 37.5 weeks and that one WAS a C-Section. We now have 5 grandchildren, and ALL have been C-Sections. I find it hard to believe that this generation is no longer capable of giving birth without major surgery.

Trust me this is not because Dr’s WANT to rip people off by doing unnecessary surgeries. You can blame our legal system and our “sue happy” way of life for this. OB/GYN’s have one of the highest rates of being sued for malpractice… they have now by NECESSITY had to be overly cautious and C-sections are a good way to bypass any complications during. labor. Many Family practitioners have stopped delivering babies for this reason alone.

The Next person to pin blame on is the Patient. I know MANY patients who if given the choice for a VBAC or a C-section CHOOSE the C-section… why?

1. Convenience- they can plan the delivery date.
2. Vanity- The # of plastic surgeries on the vagina are skyrocketing… surgery prevents stretching, tearing and yes… sagging.
3. Fear- it’s hard work and painful at that.

I have never seen a C-section that was clearly not 1. necessary ( or at least a valid reason for concern) or 2. requested by the patient.

 

[manualman]

It is only because of advanced medical treatment that the mortalities have reduced significantly.

Good post until this point. The vast majority of maternal deaths were caused by a lack of BASIC medical treatment, not the super advanced stuff. In the third world, just the presence of a midwife with basic training reduces maternal death rates dramatically.

IIRC I have read that the AMA is concerned at the high incidences of C-section in this country. As I recall, it’s suspected to be driven more by liability insurance concerns than direct profit motive (insurance companies LOSE money on C-sections vs natural births). Lawyers can always win lawsuits by painting a picture of a suffering woman in labor and a greedy doctor bullied by his HMO into cutting back on needed C-sections…

 

[Rau]

As a Healthcare provider I disagree. Do you know how many babies and mothers DIED when advanced medical treatment was not available. Not everyone can or SHOULD deliver naturally. There are numerous reasons why one would choose to go the C-section route.

1. Breech Presentation- risk of the babys head not being able to pass through the bony structures of the pelvis. When the doctor gives you the risks… you choose what is SAFEST for you and your baby.
2. Depends on the prior C-section. the location and the type of incision will dictate whether or not uterine rupture is a high risk with a Vaginal delivery.
3. Complications: HELLP syndrome, Cord prolapse, placental abruption, eclampsia, fetal distress, prolonged rupture of membranes, failure to progress, BIG babies, and more I can’t think of right now.

as for the IV fluids etc. We have valid reasons why we do what we do… I have been in many deliveries where the mother or fetus came into a crisis and a crash C-section had to be done. We can get the baby out in 60 seconds if needed but, we NEED an IV established in order to do this… to wait to put an IV in… even for another minute or two can make all the difference in how the baby does. And not having them eat means we can intubate if needed without the risk of the patient aspirating vomit.

Home births can and are generally safe for a LOW risk pregnancy, but no midwife in thier right mind would home deliver a mother who is at risk. The mother also has to be aware that if emergency medical treatment is warranted it may take up precious time to call for an ambulance.

It is only because of advanced medical treatment that the mortalities have reduced significantly.

All sounds reasonable. But overall, the % of births which are c-sections seems high at nearly 1 in 3 in the US, whereas the WHO believes the optimal rate is around 5-10%. Here is a short discussion of the issue:
childbirthconnection.org/article.asp?ck=10456

 

[KimberlyCat]

As a Healthcare provider I disagree. Do you know how many babies and mothers DIED when advanced medical treatment was not available. Not everyone can or SHOULD deliver naturally. There are numerous reasons why one would choose to go the C-section route.

1. Breech Presentation- risk of the babys head not being able to pass through the bony structures of the pelvis. When the doctor gives you the risks… you choose what is SAFEST for you and your baby.
2. Depends on the prior C-section. the location and the type of incision will dictate whether or not uterine rupture is a high risk with a Vaginal delivery.
3. Complications: HELLP syndrome, Cord prolapse, placental abruption, eclampsia, fetal distress, prolonged rupture of membranes, failure to progress, BIG babies, and more I can’t think of right now.

as for the IV fluids etc. We have valid reasons why we do what we do… I have been in many deliveries where the mother or fetus came into a crisis and a crash C-section had to be done. We can get the baby out in 60 seconds if needed but, we NEED an IV established in order to do this… to wait to put an IV in… even for another minute or two can make all the difference in how the baby does. And not having them eat means we can intubate if needed without the risk of the patient aspirating vomit.

Home births can and are generally safe for a LOW risk pregnancy, but no midwife in thier right mind would home deliver a mother who is at risk. The mother also has to be aware that if emergency medical treatment is warranted it may take up precious time to call for an ambulance.

It is only because of advanced medical treatment that the mortalities have reduced significantly.

I respect your opinion however I did mention if the mother or baby were sick and if the mother was older than I’m all for it. I was just talking about healthy mother’s with no risks. I guess I’m just old fashion. I think is is torture to starve a birthing mother. I never thought of breech positions, Cord prolapse, placental abruption, eclampsia, fetal distress, prolonged rupture of membranes, etc. However sometimes I think that even if the mother is high risk I bet she could deliver naturally with a cheeseburger, fries and a milkshake in her system. I’m stubborn. God Bless You for your work and care delivering these beautiful brand new babies.

 

[Hockeygurl]

Yes, BUT we also need to look at infant mortality. I agree… basic medical care saves lives and access to advance medical care saves even more.

I never said I agreed with the # of surgeries performed in this country, only that the reasons driving them were/are valid. Can we do better? absolutely. Only about 10% of women who are medically able to attempt a VBAC actually choose to go that route. And when they do they are counseled that there is ALWAYS a risk of uterine rupture and the patient needs to make the choice that is right for them. Many won’t take the chance especially when they realize that future pregnancies may not be possible if the uterus ruptures.

Yes we should be doing more VBAC’s, and patients could be educated more about this, but ultimately that mother with her doctor has to make the choice that is best for the welfare of her and the baby.

 

[Stilldreamn]

I feel that I could have done a better job at discussing the work of labor and delivery so perhaps our daughters (and sons-in-law!) were better prepared for the process. At the births that I witnessed, it seemed that the epidurals were placed rather early in the course of labor which really slowed down the whole thing, and made a c-section look like a very good idea. Natural childbirth was not really on their agendas although I suggested it. I hope their doctors suggested it to them as well.

However sometimes I think that even if the mother is high risk I bet she could deliver naturally with a cheeseburger, fries and a milkshake in her system. I’m stubborn. God Bless You for your work and care delivering these beautiful brand new babies.

Yes Kimberly! After our first child, I figured out I should stay at home as long as possible so I could avoid being starved and worse yet, hooked up to the monitor. It’s difficult to labor comfortably laying down, or even with the internal monitors. A milkshake would have been heavenly.

 

[Rau]

I feel that I could have done a better job at discussing the work of labor and delivery so perhaps our daughters (and sons-in-law!) were better prepared for the process. At the births that I witnessed, it seemed that the epidurals were placed rather early in the course of labor which really slowed down the whole thing, and made a c-section look like a very good idea. Natural childbirth was not really on their agendas although I suggested it. I hope their doctors suggested it to them as well.
.

Was there a reason to utilise epidural at all, or was it the mother’s election (pre-planned, or at the time). Do such treatments mess up the natural course of childbirth?

 

[Stilldreamn]

Was there a reason to utilise epidural at all, or was it the mother’s election (pre-planned, or at the time). Do such treatments mess up the natural course of childbirth?

From my pre-labor conversations with my daughters, they intended natural childbirth but were surprised at the pain they felt and both readily agreed to epidural at the suggestions of their doctors. Their contractions immediately became weaker and slowed down - although they were much more comfortable. Since their contractions had slowed down, they were given oxytocin to make their labor more effective, but after hours of this they were not making progress quickly enough for their doctors. So, they ended up with their first babies born by c-section, and their subsequent children were also c-sections because of an increased risk.

Everyone is different, but labor went much faster for me if I could move around, change position, etc - not something you can do when you have the epidural in.

Slow labor leads to more c-sections, whether the patient asks for it, or the doctor does. My eldest daughter was told “no more” after her 3rd one.

 

[KellyPalmer]

Good post until this point. The vast majority of maternal deaths were caused by a lack of BASIC medical treatment, not the super advanced stuff. In the third world, just the presence of a midwife with basic training reduces maternal death rates dramatically.

IIRC I have read that the AMA is concerned at the high incidences of C-section in this country. As I recall, it’s suspected to be driven more by liability insurance concerns than direct profit motive (insurance companies LOSE money on C-sections vs natural births). Lawyers can always win lawsuits by painting a picture of a suffering woman in labor and a greedy doctor bullied by his HMO into cutting back on needed C-sections…

 

[manualman]

Was there a reason to utilise epidural at all, or was it the mother’s election (pre-planned, or at the time). Do such treatments mess up the natural course of childbirth?

We found some medical advice that suggested that epidural doses that totally deaden the pain tend to disconnect the woman too much from PUSH urges. Our doctor readily agreed to use a smaller than usual dose so that she could still feel the onset of contractions. The price was that it still HURT too! Easy for me to say!

 

[Xantippe]

Epidurals don’t slow labor or do not slow it substantially, at least according to the latest research findings.

Here are some blog posts from a Canadian anesthesiologist, talking about the issues.

theadequatemother.wordpress.com/2013/02/04/2-cm-810/

theadequatemother.wordpress.com/2012/02/15/epidurals-and-progression-of-labour/

Previous research showed that early epidurals slow labor. However, an explanation for those old findings was that women who are in especially difficult labors will experience more pain and ask for an epidural earlier, while women who are having easy labors may only ask for the epidural later. In this case, difficult labor causes both the slower labor and the epidural request, rather than the epidural causing the slower labor.

In the second blog post, the anesthesiologist mentions that in some women, epidurals are associated with a speed-up in labor.

 

[pensmama87]

From my pre-labor conversations with my daughters, they intended natural childbirth but were surprised at the pain they felt and both readily agreed to epidural at the suggestions of their doctors. Their contractions immediately became weaker and slowed down - although they were much more comfortable. Since their contractions had slowed down, they were given oxytocin to make their labor more effective, but after hours of this they were not making progress quickly enough for their doctors. So, they ended up with their first babies born by c-section, and their subsequent children were also c-sections because of an increased risk.

Everyone is different, but labor went much faster for me if I could move around, change position, etc - not something you can do when you have the epidural in.

Slow labor leads to more c-sections, whether the patient asks for it, or the doctor does. My eldest daughter was told “no more” after her 3rd one.

I had planned an all-natural with my first, but due to a nuchal hand progress was very slow. After over two days of intense labor my midwife suggested a hospital transfer. I got Pitocin so I could contract harder, and then an epidural to handle the contractions. I dilated from 2cm to 10cm in two hours, sleeping through all of that plus transition, and woke up refreshed and ready to push for two hours. It was hard, but I really, really, really did not want that C-section. And baby #1 was born with no issues, and caught by my midwife. I think if I had had a more “traditional” provider my son would have been born via C-section at least a day earlier.

Baby #2 was also a long labor (he was “sunny side up”), but not nearly as long and no meds at all. It was intense, but I’m glad I did it. I think overall it was easier - I wasn’t hooked up to anything, could move as much as I wanted, eat what I wanted - they actually had me go for walks with hubby outside to help baby descend. I was able to push more effectively being able to “feel everything”, and I recovered so much faster.

Planning all-natural births for any future kids, as well.

 

[Cat]

Personally I think C-Sections are a financial scam by our insurance companies. America leads the world in the number of C-Sections preformed per year. Now if the mother or baby is sick or if the mother is older than I’m all for it.

Doctors can schedule the birth of your child down to the exact second. That is not natural. What bothers me is that when you arrive at the hospital in labor wanting a natural birth they immediately start I.V.s fluids “in case” of an emergency. They do not allow the birthing mother to eat or drink for during labor which goes on for hours. How is a mother supposed to push out a baby with no nutrients??? Then the mother is just too wiped out to push they do a c-section. I think it is a way of stealing legally.

Women are made to birth children NATURALLY as Mary birthed Jesus. It should not be a "surgical procedure’. Our bodies are designed for it. A mother can have the baby at home home or a birthing center with a Midwife for under $1000. A C-Section costs on average $18,000 and the co-pay and/or out of pocket charges are about $3000. And we wonder why out insurance premiums are so high?

Just my humble opinion.

Not all women were made to birth children naturally.

Have you ever spent some time walking around graveyards with older headstones? Take a careful look. You’ll see quite a few tombstones with young women, and next to the young woman’s stone you’ll see a small stone with a baby who was born and died on the same day that mom died.

These women died in childbirth. Before C-sections, many women died in childbirth. Some of these deaths were due to various infections, and others were due to mothers who are “NOT made to birth children naturally.”

I’m a big woman, and you might think I would be a great baby-birther. Not so. My pelvis is shaped like a funnel. Without the miracle of C-section technology, I would have died bathed in my own blood and screaming in agony trying deserately to push a baby out of a two-inch opening, and IF baby had survived (which she wouldn’t have), she would have been profoundly brain-damaged.

Financial scam by insurance companies? Definitely not.

I advise all women to be very careful about condemning life-saving technology in such a cavalier way.

As for the OPs query, I’m wondering if the OP is referring to C-sections that are planned specifically because a woman is “built” like me, unable to give birth naturally, OR C-sections that are planned because the couple wants to take a cruise at a certain time, and baby needs to be born first. To me, the first reason is good, but the second reason–I’m not so sure about scheduling a birth for a couple’s convenience. OTOH, I know couples who wanted the C-section scheduled because Daddy is being deployed overseas and would like to be present for his child’s birth–again, I’m not so sure about this.

But I’m fairly certain that the Church has not pronounced any ruling on the issue yet.

 

[KellyPalmer]

Epidurals don’t slow labor or do not slow it substantially, at least according to the latest research findings.

Here are some blog posts from a Canadian anesthesiologist, talking about the issues.

theadequatemother.wordpress.com/2013/02/04/2-cm-810/

theadequatemother.wordpress.com/2012/02/15/epidurals-and-progression-of-labour/

Previous research showed that early epidurals slow labor. However, an explanation for those old findings was that women who are in especially difficult labors will experience more pain and ask for an epidural earlier, while women who are having easy labors may only ask for the epidural later. In this case, difficult labor causes both the slower labor and the epidural request, rather than the epidural causing the slower labor.

In the second blog post, the anesthesiologist mentions that in some women, epidurals are associated with a speed-up in labor.

Actually, this is incorrect. If you read the actual studies, you will see that they compared women receiving epidurals to women receive IV narcotics. Women with natural med-free labors were not included. What does this really show? It shows that epidurals don’t slow labor more than IV narcotics. Based on the research I have done, there is reason to believe that both epidurals and IV narcotics have the potential to slow down labor. However, there will never be a randomized controlled trial to check because it is considered unethical to randomize someone to no pain medication.

Another point of fact is that epidurals are associated with a fourfold increased risk of poor fetal positioning at the time of birth, even after adjusting for other factors. This causes epidurals to increase the risk of both c-section and vacuum assisted delivery.

 

[KellyPalmer]

This conversation is kind of all over the place but I do want to say to deskjockey – like others have mentioned, the Catholic Church takes no specific position on mode of delivery. That is an issue for the mother/father and their health care provider. There’s nothing wrong with your wife having delivered all of your children by c-section.

 

[KimberlyCat]

Actually, this is incorrect. If you read the actual studies, you will see that they compared women receiving epidurals to women receive IV narcotics. Women with natural med-free labors were not included. What does this really show? It shows that epidurals don’t slow labor more than IV narcotics. Based on the research I have done, there is reason to believe that both epidurals and IV narcotics have the potential to slow down labor. However, there will never be a randomized controlled trial to check because it is considered unethical to randomize someone to no pain medication.

Another point of fact is that epidurals are associated with a fourfold increased risk of poor fetal positioning at the time of birth, even after adjusting for other factors. This causes epidurals to increase the risk of both c-section and vacuum assisted delivery.

 

[Xantippe]

Manualman said:

“We found some medical advice that suggested that epidural doses that totally deaden the pain tend to disconnect the woman too much from PUSH urges.”

I’ve had three epidurals. With two of them, there was absolutely no problem with pushing (in fact, with the third, the urges were really TOO urgent–I was afraid we weren’t going to get a nurse in in time, let alone the doctor). However, with the second epidural, it was a speedy 4-hour delivery and took a long time to get the epidural going, so that by the time the epidural was working, it was time to push. Being so numbed up definitely hampered the pushing process–it would definitely have gone faster if I’d had some sort of physical sensation. I’ve often wondered whether that epidural was worth it, since we were almost done anyway, and the placement of the epidural was truly nightmarish (it took about half a dozen tries while I was thrashing around uncontrollably). However, I told the story to my current OB, and she pointed out that even if the epidural was late, it meant that I was nice and numb for my repairs, which is definitely a good thing.

So, if the epidural is done in a timely manner, it should be possible to turn it down in time for pushing (which is what I presume happened for my first and third deliveries).

 

[deskjockey]

This conversation is kind of all over the place but I do want to say to deskjockey – like others have mentioned, the Catholic Church takes no specific position on mode of delivery. That is an issue for the mother/father and their health care provider. There’s nothing wrong with your wife having delivered all of your children by c-section.

Thank you!

 

[Tarpeian_Rock]

Personally I think C-Sections are a financial scam by our insurance companies. America leads the world in the number of C-Sections preformed per year. Now if the mother or baby is sick or if the mother is older than I’m all for it.

Doctors can schedule the birth of your child down to the exact second. That is not natural. What bothers me is that when you arrive at the hospital in labor wanting a natural birth they immediately start I.V.s fluids “in case” of an emergency. They do not allow the birthing mother to eat or drink for during labor which goes on for hours. How is a mother supposed to push out a baby with no nutrients??? Then the mother is just too wiped out to push they do a c-section. I think it is a way of stealing legally.

Women are made to birth children NATURALLY as Mary birthed Jesus. It should not be a "surgical procedure’. Our bodies are designed for it. A mother can have the baby at home home or a birthing center with a Midwife for under $1000. A C-Section costs on average $18,000 and the co-pay and/or out of pocket charges are about $3000. And we wonder why out insurance premiums are so high?

Just my humble opinion.

Given that C-sections are more costly than natural births, and normally lead to longer hospital confinements, and have a greater risk of post-surgical complications – all of which lead to a greater payout by the insurance company – what, exactly, would be the motivation of the insurance company in promoting C-sections?

 

[Bergon]

Lutherans would be cautioned not to have a c-section if it was for connivence as it begins to limit the ability to have children.

It depends. I don’t think that it limits the ability to have children to any extent that it would be morally repugnant. It is not the same as a person having a sterilisation procedure.