Uneccesary C-section immoral?

[SusanneT]

Surely the worst aspect of the over use of c-sections which are not strictly medically necessary is that they often inhibit women’s ability to bear a larger than average family because of the danger faced in third or forth pregnancy.

 

[Cat]

This article talks about this subject Why Most Brazilian Women Get C-Sections

Thank you. Interesting and disturbing.

The same type of thing happened here in the United States with breastfeeding. My mother came from a family of 11 children, and they were dirt poor white trash. Mainly for economic reasons, my grandmother breast-fed all eleven of my aunts and uncles, and of course, my mother, who was the oldest daughter and therefore saw first hand her younger siblings breastfed.

When she had me, she wanted to breastfeed, just like her mother had breastfed. But I was born in 1957, and the common attitude in society was that breastfeeding was old fashioned, something that only poor, ignorant people did. Modern mothers fed their babies formula, which was full of nutrients and much healthier than breast milk.

My mother had no support for breastfeeding from the doctors and nurses who touted the wonders of modern formula. Her mother lived across the country, and was still much too poor to come and help take care of her daughter and the new granddaughter.

So I got formula, and so did my brother, who was born with some foot deformities and spent the first 18 months of his life in the hospital having several complex surgeries.

Isn’t that awful? Thankfully breastfeeding has come around full circle and now most mothers at least give it a try, although I believe that many mothers give up once they return to work full time. It’s a lot of work to pump and often, the babies seem to get confused and prefer the easy-to-feed purchased nipples on bottles rather than mother’s.

My mother encouraged me to breastfeed, BTW, and so did my mother-in-law. I was very blessed.

So now it sounds like C-sections in Brazil are being denigrated in the same way that breastfeeding was denigrated in the U.S. 60 years ago.

 

[Cat]

Im not a Brazilian man…

What difference would that make anyway. right now, c-section rates in the States has been rising and is now at 35%. The World Health Organization has shown that this number should be between 10 and 15%. This is based on the pecent of births which encounter problems with risks that outweigh the risk of a major surgery.

I really wish you would provide some medical evidence to support your statements.

Your statistic about C-sections in the U.S. is inaccurate.

The C-section rate varies depending on where you are in the U.S. In our area, it’s around 15-18%. I see a heavy emphasis on good pre-natal care, preparing for a natural delivery with pain medication as an option for those who want it, and breastfeeding.

I work in a hospital lab. The most blood I have ever seen given for anything is 200 units (most of you would say “pints”) for a C-section that went horribly wrong. Even gunshots don’t usually use get that much blood. We must never get the idea that a C-section is taking an easy way out of labor and delivery.

And yes, I agree that a pregnancy is not a pathology, and that a pregnant woman is not a “patient” like a heart patient or a gall bladder patient. BUT…a pregnant woman can become a patient in an instant when something goes wrong. One of my friends actually coded on the delivery table during the birth of her first child. She was only in her mid-20s, and there was absolutely no warning of this, no indication that it could happen. But it did, and had there not been a team of medical professionals right there with all the modern equipment ready to go, in all likelihood, she would have died.

Just last week, we had a set of cultures in our lab of a uterus that had become infected after a delivery, and we were told to look for the bacteria that cause gangrene. The patient was a young woman, not someone at high risk. Who knows what cause the infection? (So far, no gangrene-causing bacteria.)

I am personally incredibly grateful for the C-section. Even though I look like a big, healthy, raw-boned woman, I have a funnel-shaped pelvis (probably one of the reasons for my osteoarthritis of the knees), and my first baby spent 21 hours trying to get her head through a tiny opening that wouldn’t even be big enough to birth a Barbie doll. Finally the doctor said, “This isn’t going to happen vaginally.” And I was very glad that she was born by C-section. If the technology had not been available, I would have continued to labor until my baby died of the stress, and then I would have died a screaming horrible death due to carrying a corpse inside of my body. Lots of women died just like this before C-sections were developed. Thank God for helping scientists to discover the technology of the C-section that has enable millions of mothers to give birth to millions of babies. It’s a pro-life surgery.

 

[rcwitness]

Your statistic about C-sections in the U.S. is inaccurate.

i will look into my source again. If you have source for a different number according to all areas, i’d appreciate being corrected

It’s a pro-life surgery.

When there is a threat to the health despite a natural birth attempted. Yes

 

[Xantippe]

i will look into my source again. If you have source for a different number according to all areas, i’d appreciate being corrected

**I suspect the reason for the discrepancy is that Cat may be talking about PRIMARY c-sections, whereas the 33% number is overall. Primary c-sections often precede later c-sections, whereas a woman who starts with a first vaginal birth may never have a c-section at all.

To illustrate the difference, I personally have had three babies and have a 0% c-section rate, because I had a first vaginal birth and then a second vaginal birth and then a third vaginal birth. (And believe me, it’s not the end-all-be-all of motherly accomplishments.) Cat, on the other hand, has a 100% c-section rate, due to having had a first and then a second c-section. So I have a 0% rate, she has a 100% rate, and between the two of us, we have a 40% c-section rate.**

When there is a threat to the health despite a natural birth attempted. Yes

 

[Allegra]

Ive asked people to discuss unnecesary c-sections and their opinion on the morality of them. Why should I assume someone is talking about something different, when they dont specify.

Becuase you also introduced the subject of pain relief. You’ve repeatedly stated that you also find any form of pain relief in child birth to be spiritually unhealthy and that you are proud that you wife isn’t having any of that.

 

[Xantippe]

The WHO 10-15% c-section rate is a bit of a zombie fact–it continues to wander the internet long after WHO no longer has withdrawn the number as a target.

sciencebasedmedicine.org/whats-the-right-c-section-rate-higher-than-you-think/

From the current WHO handbook:

“Earlier editions of this handbook set a minimum (5%) and a maximum (15%) acceptable level for caesarean section. Although WHO has recommended since 1985 that the rate not exceed 10–15%, there is no empirical evidence for an optimum percentage or range of percentages …”

From the Science Based Medicine blog:

“…[T]he majority of countries with high mortality rates have CS rates well below the recommended range of 10–15%, and in these countries there appears to be a strong ecological association between increasing CS rates and decreasing mortality.”

“The data show that low maternal mortality and low neonatal mortality are associated almost exclusively with high and very high C-section rates.”

“The data themselves are quite clear. There are only 2 countries in the world that have C-section rates of less than 15% AND low rates of maternal and neonatal mortality. Those countries are Croatia (14%) and Kuwait (12%). Neither country is noted for the accuracy of its health statistics. In contrast, EVERY other country in the world with a C-section rate of less than 15% has higher than acceptable levels of maternal and neonatal mortality. There nothing ambiguous about that.”

“The average C-section rate for countries with low maternal and neonatal mortality is 22%, although rates as high as 36% are consistent with low rates of maternal and neonatal mortality.”

 

[thewanderer]

The WHO 10-15% c-section rate is a bit of a zombie fact–it continues to wander the internet long after WHO no longer has withdrawn the number as a target.

sciencebasedmedicine.org/whats-the-right-c-section-rate-higher-than-you-think/

From the current WHO handbook:

“Earlier editions of this handbook set a minimum (5%) and a maximum (15%) acceptable level for caesarean section. Although WHO has recommended since 1985 that the rate not exceed 10–15%, there is no empirical evidence for an optimum percentage or range of percentages …”

From the Science Based Medicine blog:

“…[T]he majority of countries with high mortality rates have CS rates well below the recommended range of 10–15%, and in these countries there appears to be a strong ecological association between increasing CS rates and decreasing mortality.”

“The data show that low maternal mortality and low neonatal mortality are associated almost exclusively with high and very high C-section rates.”

“The data themselves are quite clear. There are only 2 countries in the world that have C-section rates of less than 15% AND low rates of maternal and neonatal mortality. Those countries are Croatia (14%) and Kuwait (12%). Neither country is noted for the accuracy of its health statistics. In contrast, EVERY other country in the world with a C-section rate of less than 15% has higher than acceptable levels of maternal and neonatal mortality. There nothing ambiguous about that.”

“The average C-section rate for countries with low maternal and neonatal mortality is 22%, although rates as high as 36% are consistent with low rates of maternal and neonatal mortality.”

Thank you! I was just about to say the same thing but you found all the links for me.

 

[Xantippe]

Your attempt at putting fear into a labor on the sole premice of pain in order to justify a c-section is immoral, and the very thing that I find ugly and disrespectfull to a sacred birth.

**If a c-section is a woman’s only shot at a relatively painless delivery, I think a c-section is totally defensible.

Let’s forget the woman’s side of it–why would it be moral or ethical for a husband or medical providers to stand by and allow a woman to experience hours or days of needless agony? Good people relieve the pain and discomfort of others–we don’t just stand by and allow others to suffer when we can relieve their pain.

As I mentioned earlier, I’ve had three epidurals. The second one came late enough that I experienced probably 75-85% of labor totally unmedicated. The whole labor was only 4 hours, so it didn’t last long enough to cause PTSD, but I can easily imagine that if the same exact experience had gone on any longer, I might have experienced very serious psychological results.

Being in totally uncontrollable pain that feels like the body is being ripped apart is quite the experience. In that sort of state, the mind is only conscious of pain–there is almost no room at all for any other emotions or thoughts. I was much more “present” when I had working epidurals and was able to talk cheerfully to my husband and the nurses and be excited about having a baby. When I didn’t have an epidural, I didn’t have any thoughts to spare for the baby or anybody else at all. (I did have a doula, thank goodness, which probably kept me from being terrified by the situation.)

Why not treat labor pain the same way we’d treat any other pain of the same magnitude?
**

Just because an unnecessary c-section is immoral, does not mean im assigning sin to anyone in particular. Their could be many different reasons for woman thinking they need one, but really dont. It could be the doctors to blame, or the mother, or both, or maybe both are invincibly ignorant. Its not my desire to tell someone what they are sinning, but that I believe unnecessary c-sections are immoral. Society, the States included, is going towards more unnecessary c-sections. Is it healthy??? NOT according to the World Health Organization.

The US has a number of demographic trends going on that encourage c-sections: more and more Hispanics, older mothers, fatter mothers, more multiple births, etc.

As we’ve discussed, there genuinely are some big issues with women who want or expect a larger family and wind up with 4+ c-sections in a row, but for the average American woman having 1.88 kids, it’s really not a big deal.

 

[Allegra]

The US has a number of demographic trends going on that encourage c-sections: more and more Hispanics, .

 

[THP]

This is an interesting debate but I think a lot of the confusion comes from the use of the word “immoral”. This really is not about morals but rather ethics - specifically medical ethics. Clearly, if a hospital in Brazil has a 99% c-section rate, especially given a large Catholic population with couples presumably planning large families, there is something going on that is ethically suspect.

For rcwitness the question centers around the tension between patient autonomy and nonmaleficence (“first do no harm”). In my view, as long as the patient understands the risks involved with all of the options a primary elective c-section is neither immoral nor unethical.

In general, if a patient is planning on having more than 2 children I counsel them on trying for a vaginal delivery with baby #1 or VBAC with baby #2 depending on the situation but these are not absolute rules.

 

[Xantippe]

We’ve just been discussing the social issues with c-sections in Latin America, which has a c-section rate substantially higher than the US (around 50% in Mexico, for instance, versus 33% in the US).

If a woman comes to the US from one of those countries already having had a c-section for social reasons, that puts her on the train that will likely lead to more subsequent c-sections, as the US VBAC rate is now under 10%. This in turn pushes up the US c-section rate.

Here’s a cite for the current US VBAC rate.

en.wikipedia.org/wiki/Vaginal_birth_after_caesarean

 

[PrincessRenae]

In general, if a patient is planning on having more than 2 children I counsel them on trying for a vaginal delivery with baby #1 or VBAC with baby #2 depending on the situation but these are not absolute rules.

But I’m sure you would never advise them to have a home birth VBAC to avoid a C section just because a person doesn’t want it.

 

[THP]

But I’m sure you would never advise them to have a home birth VBAC to avoid a C section just because a person doesn’t want it.

In my opinion, no one should ever have any delivery outside of a hospital and if the local hospital refuses to offer a VBAC option then I would recommend either moving or having a repeat c/s.

 

[PrincessRenae]

In my opinion, no one should ever have any delivery outside of a hospital and if the local hospital refuses to offer a VBAC option then I would recommend either moving or having a repeat c/s.

That’s what scares me about this thread entirely. This just comes off to me as a personal justification presented as what’s medically and ethically/morally best when it’s very far from it.

 

[THP]

That’s what scares me about this thread entirely. This just comes off to me as a personal justification presented as what’s medically and ethically/morally best when it’s very far from it.

Agreed. This is why it is best not to get medical advice for potentially life and death situations from the internet or documentaries. There are so many factors involved that are unique to each situation plus anyone with a keyboard can chime in so the potential for serious mistakes is high.

 

[mommamaree]

Agreed. This is why it is best not to get medical advice for potentially life and death situations from the internet or documentaries. There are so many factors involved that are unique to each situation plus anyone with a keyboard can chime in so the potential for serious mistakes is high.

Yes. Exactly.

This is precisely why I have advised rcwitness to focus his attention on his wife and unborn child, to build up their support system and prayer network. This thread has tread right into the territory of offering medical advice, despite the fact that the OP has mentioned several times that he is asking only for opinions on unnecessary C-sections. The experience of Brazilian women is not one of informed consent. They are being railroaded into C-sections and being treated horribly by doctors. There is a grass-roots movement to change that, because women are tired of being manhandled and violated by retaliatory doctors. This is really happening to them. They are not choosing this for themselves. The only thing we can do from outside Brazil is pray for them, believe them when they share their stories with the world, and encourage them to keep working for cultural change. We cannot presume to judge their medical choices from a distance, especially when obstetrics in their country has backed them into a corner.

 

[PrincessRenae]

Agreed. This is why it is best not to get medical advice for potentially life and death situations from the internet or documentaries. There are so many factors involved that are unique to each situation plus anyone with a keyboard can chime in so the potential for serious mistakes is high.

Absolutely. I think it’s a big contributing factor for a lot of problems we’re experiencing now; people get on the internet and start siding with other people who have the same opinions and views, regardless of whether or not it is actually legitimate research or aligns with the consensus of the medical or scientific community. I have to wonder if we would be having such terrible whooping cough outbreaks today if the internet didn’t exist.