# c-section safer?



## justice'smom (Jun 5, 2007)

Please forgive me if this is not in the correct place. I just talked to my sil the other day who is pregnant and due in about a month. She and I are due just a few days apart. Anyway, she is having a hospital birth and I am having a homebirth. Let me say, that I am very encouraging with whatever decision she has made. Anyway, we talked about c-sections and how they are done so much more now in America than before and she said it's because it's safer. First of all, I know that is not true, but she also said she doesn't get why people think a dr. would do a c-section just for the money because the dr. doesn't make any more money on a c-section than the dr. makes on a vaginal birth. She said it is her understanding the dr. makes a salary. Is she right about that? Also how can I find info for myself that c-sections are not safer and that we are losing more babies in America than other countries where the norm is vaginal birth? Again, this is for me and not for her. She and I agreed to disagree, but I just want to make sure I'm right about the info I gave her. It makes sense to me that a vaginal birth is safer since that is how God created it to be, but I have been known to be wrong before. Thanks ladies.


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## AllyRae (Dec 10, 2003)

Of course a c-section is not safer than an uncomplicated vaginal birth (that does not use instruments). A c-section is a major surgery and with it comes the complications of major surgery. There is also increased respiratory distress that comes from a baby being born prior to it's own chosen birth date and not going through the birth canal.

However, I personally believe (yet don't have research to back it up...







: ) that a non-emergency c-section might be safer than today's hospitalized vaginal births (meaning births with the combination of pitocin, epidurals, and vacuum extractions). At least safer for the baby...I can't imagine having your head yanked by vacuum suction that can pop off and have to be redone several times, after being squeezed by unnaturally strong contractions is good for the baby. And of course, for some people, a c-section is safer than a vaginal birth (but that's rare of course).

I am coming at this from the angle of someone that had 2 vaginal births that resulted in the pit/epi/vacuum combo, the second of which lead to the death of the baby. My third baby was born via c-section due to another medical issue, plus CPD (confirmed after the first two births--my baby's heads are always bigger than my pelvic opening, and they only come out via vacuum). My little girl had respiratory distress syndrome, but besides a UTI in me a week later, there were no other complications and we both came home a couple days after the birth. However, my abdomen was open, my uterus removed, sewn, and put back in, and the baby was born before she would have otherwise chose to. I can not imagine that is safer than a medication/intervention free birth for a person without pre-existing (or newly existing I guess) reasons for it...

There will always be bad outcomes no matter what you choose to do, but *unnecessary* interventions are typically more dangerous than letting nature take it's course (and of course, I do believe that sometimes the interventions can be safer than not taking the interventions of course...but I also think that should not be the norm)


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *justice'smom* 
she doesn't get why people think a dr. would do a c-section just for the money because the dr. doesn't make any more money on a c-section than the dr. makes on a vaginal birth. She said it is her understanding the dr. makes a salary. Is she right about that?

I'm honestly not sure if she's right or not about the salary & same money for CS vs. vaginal. _However,_ the CS takes less of the doc's time! No waiting around. Nurses & anaesthiologist come in to prep mom, doc does the surgery & it's all said & done. Less time investment. Also, if they're scheduled in advance, no need to wait around during nights & weekends!

She needs to see the movie "The Business of Being Born" if she doesn't believe many CS are done today for reasons other than medical necessity.

There have been some great studies. Unfortunately, I don't have them off hand, but I'm sure you'll get some replies here with good links.


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## The4OfUs (May 23, 2005)

At the hospitals I've worked at, the doctors are salaried, so I don't necessarily buy the "more money" argument (although I guess if sections generate more revenue for the hospital, more sections would mean they would have more revenue to offer higher salaries to doctors)......but I do entirely buy the less time and being able to schedule it, not having to wait around. Sigh.


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## 2+twins (Apr 20, 2004)

A really big reason that the docs do more c-sections (and in a sense, save money) is b/c of liability concerns. Doing a c-section equates in a court of law to having done "everything" possible to save the mother and/or baby. So if you're looking at this from the sue-happy standpoint of the American way, a doctor will save more money by erring on the side of caution (so to speak) and doing a c-section. That way if the outcome is bad, the doc will not be held liable and will therefore save a bundle on malpractice insurance and payouts. Does that make sense? I'd recommend reading the book Pushed - I don't know how to word these things very well myself but that book really spells it all out for you. Everyone giving birth should read that book first.

Vaginal birth *is* safer than surgical birth for most women and babies. That is indeed true.


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## Full Heart (Apr 27, 2004)

Def not safer. No intervention is without risks. We have a 10 fold increase in accreta because of the sky rocketing c/s rates. With the "once a section, always a section." comes complications that increase with each surgery.

While a dr might not get more money for each c/s the insurance he or the hospital carries is going to look at how many c/s he is doing. If hes not doing enough, they can drop him or increase his rates. They are also done from convenience more than out of necessity. Which is why most c/s happen during the day during the week. Money and time is always a consideration. If not directly, indirectly.


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## majormajor (Nov 3, 2006)

a c/s (after 39-40 weeks) is probably the safest way for a baby to be born, but the risks to mom and the risks to subsequent pregnancies make it overall the less safe choice. the risks to mom are very serious and IMO, tend to be glossed over.

also, while infant mortality is bad in this country, that measures deaths in the first year. our perinatal and neonatal mortality are good. the US has a lot of premature births, so i don't think c/s are a problem there.

unfortunately, i can't point you to any good resources discussing the problem. most web sites i find terribly biased, most of the data is inaccessible, and the issues are so varied... perhaps one day i'll write my own book on the subject! (i'm a science writer, as qualified as henci goer, but birth is an interest, not a specialty, so i doubt i ever will.... still, who knows).


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## barefootpoetry (Jul 19, 2007)

Having your abdomen and colon surgically opened to manually extract your feces and then sewn shut again is not safer than pooping.

There are VERY few RARE cases where it would be safer to have a C-section. Transverse baby, placenta previa, IUGR, to think of a few. But in general, for the vast majority of women, a normal natural bodily function is safer than major surgery.


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## lisa_nc (Jul 25, 2008)

For a lot of women, that first cesarean IS somewhat safe (I won't say "safer" because it's not). It's that that first cesarean sets her up for a LONG path of fighting for a VBAC or having a ERCS. With each ERCS and subsequent pregnancy, it becomes dramatically more dangerous. It becomes a question of what you want your reproductive future to be.


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## SublimeBirthGirl (Sep 9, 2005)

12+ hours of labor with an uncertain birth time and possibly having to go to the hospital at 3 am, or 20 minutes in surgery at 3 in the afternoon. Even if they get paid the same amount, it's for a lot less work. It's not just that OBs are cold and evil and don't care about safety; they're brainwashed in medical school. They probably mostly believe that a c-section is as safe as a vaginal birth, even though it most definitely is *not*. An OB in the Business of Being Born talked about how one study showed times for c-sections peaked at 4 pm and 10 pm - time to go home, time to go to bed. And there are far fewer c-sections on the weekend. Convenience is a huge factor.

Doctors do not always do what's best for patients. Look at how they experiment on people, using drugs they don't know are safe, for example. They're just people like anyone else. They're not benevolent gods who only do what's right.


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## majormajor (Nov 3, 2006)

also, there are consequences of sections that woudn't even occur to most people. one of my closest friends had 2 sections in the 70s and 80s (and a VBAC in the 90s. she had classical incisions, too. and her VBAC baby was almost 9 lbs, face up. just had to throw that in there!). anyway, she needs some abdominal surgery now, that most people have laproscopically, but she might not be able to because of the scar tissue. who would have thought about that? not me! so now, she's going to have ANOTHER major abdominal surgery in her 50s. so yeah, there are consequences for mom for the rest of your life. definitely NOT something anyone should take lightly!


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## AlexisT (May 6, 2007)

Just to answer on the money issue - most insurers have gone to global payments. Single payment for pregnancy and delivery, regardless of how it happens. Insurers don't want to give doctors an incentive to perform extra procedures (which they then have to pay for). This doesn't mean your OB is on salary, though. Private-practice OBs do usually get paid according to the number of deliveries they do, but it doesn't matter which way the baby comes out. In some HMOs doctors are salaried (I believe Kaiser works this way) and some hospitals employ laborists.

While CS are sometimes performed for convenience it is worth noting that an "elective" section (which might be medically necessary) will always be scheduled for a convenient time so we would always expect CS rates to be lower on the weekends.

The real reason is more liability than anything else. Since we have made CS pretty darned safe (we're only seeing problems now from so many repeated sections--they accumulate, and if the mother doesn't have more than 2 children we're unlikely to see them at all) it's much easier for patients to claim that CS was the safer call and a doc should have done it. So they would rather just do the section and not get sued.

In some cases they do really believe it's safer, like routine CS for frank breech, even though the trial might have had problems.

A CS is not safer than an uncomplicated vaginal delivery. The problem is that we don't know which deliveries will be uncomplicated--so CS is like taking off most of the risk from the baby and putting it onto the mother, plus adding some as well. Sometimes this is the right call. But if you do it all the time, you're just making women undergo major surgery for no reason.


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *AlexisT* 

A CS is not safer than an uncomplicated vaginal delivery.

ok i have to be nit-picky here, then i'll stop. i hate this line of thinking, because you could just as easily say an uncomplicated c/s is just as safe as a v-birth. you can always pick out the group that come through just fine in retrospect, but that's pointless. i know you know that, you just happened on a pet peeve of mine!


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## chandasz (Apr 13, 2005)

As a definition-- uncomplicated major surgery is still not safer than a bodily function in the presence of normalcy.

There are a million articles out there that talk about this issue. I really like the mothering article about childbirth in a culture of fear. Perhaps search this and give it to her.

The OB may not make more $$ on a c-section (I don't know) but it is a quicker thing than waiting around for a natural birth to happen and if time = money... then maybe it is cheaper. Also there are many others that get paid in the case of a c-section plus all the additional meds. C-sections are a BIG source of income for hospitals if not OBs.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *majormajor* 
a c/s (after 39-40 weeks) is probably the safest way for a baby to be born, but the risks to mom and the risks to subsequent pregnancies make it overall the less safe choice.

No, I read of a large study that compared elective CS to vaginal birth & the CS babies had much higher rates of breathing problems.

Found the article:

Quote:

This study suggests that elective Caesarean section compared with intended vaginal delivery leads to a twofold to fourfold increased risk of overall neonatal respiratory morbidity and even higher relative risks of serious respiratory morbidity in term newborns.


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## Kelly1101 (Oct 9, 2008)

Quote:


Originally Posted by *MegBoz* 
No, I read of a large study that compared elective CS to vaginal birth & the CS babies had much higher rates of breathing problems.

Found the article:

Those results are likely because of a tendency to take the babies out too early, rather than letting them go term.


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## chandasz (Apr 13, 2005)

majormajor said:


> a c/s (after 39-40 weeks) is probably the safest way for a baby to be born, QUOTE]
> 
> Why do you believe this to be true when the vast majority of the research out there shows otherwise?
> 
> Please let me know what brings you to this conclusion. I find this to be a VERY alarming statement.


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## Drummer's Wife (Jun 5, 2005)

Quote:


Originally Posted by *majormajor* 
*a c/s (after 39-40 weeks) is probably the safest way for a baby to be born*, but the risks to mom and the risks to subsequent pregnancies make it overall the less safe choice. the risks to mom are very serious and IMO, tend to be glossed over.

where did you find that info?








:


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Kelly1101* 
Those results are likely because of a tendency to take the babies out too early, rather than letting them go term.

Nope. They evaluated that:

Quote:

It was found that 2.8 per cent of infants delivered normally at 37 weeks had respiratory problems compared with 10 per cent of those delivered by elective Caesarean. At 38 weeks the proportion was 1.7 per cent compared with 5.1 per cent, and at 39 weeks 1.1 per cent compared with 2.1 per cent.


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *MegBoz* 
No, I read of a large study that compared elective CS to vaginal birth & the CS babies had much higher rates of breathing problems.

Found the article:

sorry, i should be more specific! when i say safe, i'm thinking only of major morbidity or mortality. so, for babies, that's permanent brain damage, paralysis, and death. for mothers, pretty much only death (just personal parameters).

re: that elective c/s study, the morbidity they discuss there are transient breathing problems, not death. i don't recall whether that study looked at mortality. but certainly, yes, transient breathing problems are higher in c/s babies. interestingly, i recall that that study showed that babies who were c/s'ed after labor had the same rates of breathing problems as vaginally born babies. would be quite interesting if it's labor, not the squeeze through the birth canal, that does whatever it does to the lungs!

finally, i will have to get back to you on why i believe what i do. a quick answer is that i'm not a big believer in much of the published research... i think there are so many flaws, and a lot of the research just doesn't do a good job of answering the question it's trying to answer. it's not that i think science doesn't work, it's just that i'm not sure how i feel about epidemiology. i think it might truly suck, but i'm still working out my feelings on that.







but you can't do a randomized, double-blind, controlled trial on c/s vs. vaginal birth, so you have to do what you can with what you have. and anyway, there are few studies looking at just c/s mortality. anyway, my ideas come from reading the VBAC scientific literature. when i was preparing to VBAC, i read every paper i could get my hands on. IMO, VBAC vs. ERCS is a pretty good proxy for vaginal vs. c/s, cuz you can just subtract the mortality attributable to the previous c/s. and i didn't want to acknowledge it at first because it didn't go along with what i believed, but the studies showed a really small neonatal mortality in c/s babies.

however, i'd love for someone to bust through with a flaw in that logic! my opinions are never set in stone.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *majormajor* 
sorry, i should be more specific! when i say safe, i'm thinking only of major morbidity or mortality. so, for babies, that's permanent brain damage, paralysis, and death. for mothers, pretty much only death (just personal parameters).

That's one of my biggest problems with this whole issue. Doctors get to define what parameters define "safe", then they get to decide which procedure is "safer". (Incidentally, why does paralysis count for a baby, but not for a mother?)

I had an "uncomplicated" c-section the first time. A close friend had an uncomplicated vaginal delivery about a year before that. The day after her baby was born, she was walking around the house. A week after my baby arrived, I got stuck on my couch, unable to even stand up to pick up my baby, who needed to eat. Fortunately, it was "only" about half an hour, before I managed to stand up, and fortunately, there was no emergency (only urgency). That surgery was not safer than, or even as safe as, an uncomplicated vaginal birth.

Frankly, until doctors actually document _all_ the consequences of c-sections (they don't), and accept that it's up to the _patient_ to decide if those consequences have a negative impact on their lives, I don't care what they say, or what their studies say.

My records don't show the permanent numbness in my abdomen and pelvis (and I don't care if you or the medical profession consider that a safety issue or not - _I'm_ the one living with it, and all the ramifications of it). My records didn't show the, admittedly minor, infection in my incision in 2005...the one that kept the incision from closing for almost _two months_. My records don't show when one my kids hurts themselves, because I'm physically incapable of moving quickly enough to prevent an accident that I can see is about to happen. My records don't show the emotional and psychological impact of being unable to have a baby for _ten years_ and wondering that whole time if it was because of my primary c-section. In other words...my records (aside from the errors and lies) are worthless.

The only recovery I've had that would be considered at all complicated by the medical profession was my last one, and a _large_ part of that was because my son was stillborn. Yes - it was a HBAmC attempt, but my uterus didn't rupture, and nobody has any idea why he died. The c-section didn't stop his death...and I'll never know if the previous three contributed to it.


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## Storm Bride (Mar 2, 2005)

I also wanted to add that I don't believe the increase in respiratory problems is solely because of prematurity or low birthweight. DD was my only (so far) scheduled, labour-free section. She's also the only one of my children who had breathing issues at birth. However, she wasn't premature. She was taken at 39w, 2d, and my dates are firm. She also weighed 10lb. 2oz. She simply wasn't ready to be born. That's all.


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## L&K'smommie (Aug 23, 2007)

I don't know statistics of the other things but when I worked at an OB/GYN office a few years ago c/s did indeed cost more than a normal vaginal delivery(by at least $5000) and that was just the office charges. Now did each particular doctor see that extra money probably not but the doctor who owned the practice did. Plus, a c/s pays a lot more to the hospital than does a vaginal delivery so I can see how money could be an incentive but probably not as big of an incentive as convenience.


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## barefootpoetry (Jul 19, 2007)

Quote:


Originally Posted by *majormajor* 
sorry, i should be more specific! when i say safe, i'm thinking only of major morbidity or mortality. so, for babies, that's permanent brain damage, paralysis, and death. for mothers, pretty much only death (just personal parameters).

The risk of death, both to mother AND baby according to every study I've found, is roughly three times greater with a C-section than a vaginal birth. There is the hole you asked for.

Also, what about all the other risks SHORT of death? If you don't die, does that mean everything else doesn't matter? What about placenta problems in future pregnancies? What about long-term lack of sensation at the scar site? What about incision infections? What about internal infections? What about PTSD and other birth-related trauma? What about the emotional affects of "giving birth" without the proper cocktail of hormones, a great recipe for PPD? What about the negative affect on the BFing relationship? What about baby developing asthma or allergies later in life, which some people suggest could be tied to Cesareans? What about the negligible, but worth mentioning, risk of baby being cut during the surgery? What about one of momy's organs accidentally being nicked? What about negative reactions to the anesthesia? What about hemorrage? I came a breath away from dying during a catastrophic hemorrage that would NOT have happened if I hadn't had an unnecessary Cesarean. The world went black, I couldn't speak or move, and my body was ice cold. But I guess since I didn't actually die and my baby isn't brain-damaged, it's all good.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *L&K'smommie* 
I don't know statistics of the other things but when I worked at an OB/GYN office a few years ago c/s did indeed cost more than a normal vaginal delivery(by at least $5000) and that was just the office charges. Now did each particular doctor see that extra money probably not but the doctor who owned the practice did. Plus, a c/s pays a lot more to the hospital than does a vaginal delivery so I can see how money could be an incentive but probably not as big of an incentive as convenience.

I used to haunt the OB forums (had to stop because it was bad for my blood pressure, yk?), and I recall a time when they were discussing how great it would be to work at a 100% c-section hospital. Several of them treated the idea as a "died and gone to heaven" kind of scenario. They definitely like the convenience.


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## murphysaangel (Feb 8, 2008)

"The Home Birth Advantage" by Mayer Einstein is great for statistics in this country. You could also send her info from ICAN and I am sure that Mothering.com has it's own list of great articles. I'm a firm believer in the fact that major abdominal surgery is ALWAYS going to be far complicated and pose more real and long-term risks for baby and mom. I'll try to find it but I know there's a study done by chiropractors that showed the baby's cranium is not properly shaped during c-sec's and will be more likely to have immune system problems due to the increase in pressure on the atlas and occiput (that would otherwise have been released during vag. birth). Not to mention increased risk for mom and baby of infection, major bloos loss, baby being nicked by scalpel, etc. I can attest to infection - after my son was born via unplanned cesarean I had 3 infections in as many weeks - with a high fever of over 104, the last one landing me back in the hospital and unable to breastfeed for 3 days. Luckily we were all fine after that and my ds took back to the breast no problem. But it's just one more non-immediate risk to the baby: less chance for bonding to mom and increase in the likelyhood of problems breastfeeding.


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## phrogger (Oct 16, 2006)

C-sections are safer, then they were 50 years ago, but that is probably the extent of them being "safer". In general, they are not safer then a vaginal birth. There is something extremely important with the baby going through labor and then being squeezed through the birth canal.

C-sections CAN and DO save lives, I wont discount that at all. I have had one medically nessicary c-section that I have no doubt without there could have been some major complications (premature high order multiples) but really, how often does that happen? Not often at all.

My OB also makes the same no matter how the baby gets here, but it does make it easier on him. He is the only Dr. in the practice so unless he plans to have someone on call for him, he is usually the on call guy.


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## leila1213 (Sep 15, 2006)

Also, even if the doc is paid the same for a C/S vs. v-birth, scheduling the C/S (or induction) will guarantee they are credited with the revenue. Whereas, if labor is allowed to start on its own, they may not be on call at the time and therefore revenue goes to another dr.


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *barefootpoetry* 
The risk of death, both to mother AND baby according to every study I've found, is roughly three times greater with a C-section than a vaginal birth. There is the hole you asked for.

Also, what about all the other risks SHORT of death? If you don't die, does that mean everything else doesn't matter? What about placenta problems in future pregnancies? What about long-term lack of sensation at the scar site? What about incision infections? What about internal infections? What about PTSD and other birth-related trauma? What about the emotional affects of "giving birth" without the proper cocktail of hormones, a great recipe for PPD? What about the negative affect on the BFing relationship? What about baby developing asthma or allergies later in life, which some people suggest could be tied to Cesareans? What about the negligible, but worth mentioning, risk of baby being cut during the surgery? What about one of momy's organs accidentally being nicked? What about negative reactions to the anesthesia? What about hemorrage? I came a breath away from dying during a catastrophic hemorrage that would NOT have happened if I hadn't had an unnecessary Cesarean. The world went black, I couldn't speak or move, and my body was ice cold. But I guess since I didn't actually die and my baby isn't brain-damaged, it's all good.









perhaps i'm not being clear enough: c/s is, as far as the research has shown to this point, certainly more dangerous for the mother. that's, IMO, the number one reason we need to try to lower the c/s rate.

also, your absolutely right that there are quite a few more minor and major morbidities associated with c/s. when i was trying to make a choice between VBAC and ERCS, i decided to ignore those. like i said, personal preferences... but how do you weigh the odds a baby will be nicked by a scapel against the odds that it could die? to me, you can't have enough nicks to make a preventable death worth it.

so no, i'm absolutely not saying i think elective c/s is a great idea. however, i am saying that a first c/s is safer for a baby than a vaginal deliery, in terms of major morbidity and death. i know that's not a popular opinion on this website, which is probably why i usually stay out of these discussions!

and like i said before, i know what the research shows. there's only very scant, very flawed research that pits c/s against v-birth. like that worthless macdorman study. so, like i said, i have used VBAC as a proxy for vaginal birth vs. c/s. when you subtract the morbidity and mortality due to the c/s, i think you get a pretty good comparison of the two. and actually, there is a flaw with this method. i'd like to see how c/s affects mortality in the first year. more SIDS? more infections?

i also didn't mean to imply that experiences like your hemmorhage don't matter. i was trying to say that when i was looking at the data for myself, i decided that maternal mortality was the only parameter that i really cared about for myself. of course i would never want that for me or anyone, i didn't factor but the odds of it happening into my decision making, just because i didn't want to make myself crazy. i know c/s is more dangerous for mom.

baby, got to go!


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *majormajor* 
sorry, i should be more specific! when i say safe, i'm thinking only of major morbidity or mortality.










Um, ok. I find that confusing, considering you first wrote:

Quote:


Originally Posted by *majormajor* 
a c/s (after 39-40 weeks) is probably the safest way for a baby to be born,

So "safest" means "safer than vaginal birth," correct?

If you say that CS is "safest way" (i.e. meaning "SAFER than vaginal birth") then why would you not include *all risks?* Even if the CS has only slightly higher risks, or risks that aren't life-threatening, such as transient breathing problems?

I don't understand why anyone would even bother to say, *"IF you compare only death rates, CS is safest. (Yes, there are other risks to CS, but let us disregard those.)"*







Why? Why would you disregard all the other factors? What is the point of such a comparison?

Quote:

i'm not a big believer in much of the published research... i think there are so many flaws, and a lot of the research just doesn't do a good job of answering the question it's trying to answer. it's not that i think science doesn't work, it's just that i'm not sure how i feel about epidemiology. i think it might truly suck, but i'm still working out my feelings on that.
You are absolutely correct that there are many lousy studies. Fortunately, there are some scientists out there who do know how to conduct good studies. If you read "Born in the USA" by Dr. Marsden Wagner, he talks extensively about bad research & why it is bad.

But finally, I think quantity is important. With large enough sample sizes and enough studies, the truth will emerge... like it or not.

Quote:

you can't do a randomized, double-blind, controlled trial on c/s vs. vaginal birth, so you have to do what you can with what you have.
Yes, the randomized double-blind study is the absolute ideal format for conducting research. Yes, one can't be done on CS vs. vaginal. (Actually... I'm fairly certain some docs have tried!! I'm pretty sure I read that in either the book "Pushed" or "Born in the USA" but they didn't get women interesting in participating.

Anyway, there are many things you can't do a randomized, double-blind study on. That doesn't mean the scientific community collectively throws their hands up in the air and says, "Humph, we just don't know." Yes, you're right you do the best with what you have. When you get large enough sample sizes so that you can match similar cases, you CAN get good data without the randomized double-blind.

Quote:

and anyway, there are few studies looking at just c/s mortality.....
IMO, VBAC vs. ERCS is a pretty good proxy for vaginal vs. c/s, cuz you can just subtract the mortality attributable to the previous c/s.
Again, I have to wonder why you'd even consider this. Frankly, I'm shocked. Can you imagine if you went to your dentist and he said, "You have gum disease. I want to give you a treatment that may have nasty side-effects. BUT, it won't kill you - your rate of dying from this medical treatment procedure is not any higher than if we didn't do the procedure. Sure, there are other harmful, negative, and painful side effects. But the mortality rate is not higher. So you are fine with that, Right?


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## barefootpoetry (Jul 19, 2007)

Quote:


Originally Posted by *majormajor* 

so no, i'm absolutely not saying i think elective c/s is a great idea. however, i am saying that a first c/s is safer for a baby than a vaginal deliery, in terms of major morbidity and death.

I am still







as to how you came to this conclusion. Your method of reasoning on this topic is making absolutely no sense to me.

Even IF - and that's a really big IF - C-section is safer for babies, and I don't believe it is, how is that completely exclusive from the harm it does to the mother? Do babies not deserve a happy, healthy mom? Not one who is struggling to recover from major surgery? Don't they deserve a good breastfeeding relationship? Not one that is hampered by anesthesia that affects both parties and pain-killing drugs taken afterwards? Don't they deserve a mom who isn't much more likely to suffer from PPD and PPP and possibly harm her baby? A healthy baby and a healthy mom have to go hand in hand. Or wait, don't tell me, risk to the mother doesn't matter, since A) she didn't die, and B) her baby is okay. Gee, I wonder why this is such an unpopular thing for you to say, especially here.

A quick Google search shows me that infants have a three times higher death rate after/during C-section. If those studies may be "flawed" or "scant" then show me something else to go on. Show me what makes you believe that babies are honest-to-God safer being surgically extracted than born. I'm not talking about comparing scalpel nicks to death, and I'm not talking about the one-in-whatever-thousand chance a baby is incompatible with vaginal birth, like transverse lie or placenta previa, etc. Show me why C-section is a "safe" rule of thumb in general, and show me why vaginal birth is more dangerous. Because I am honestly not following yuo here. I would also like to see you explain your VBAC vs. ERCS thing a little more because that is confusing to me also.


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *MegBoz* 

Quote:

So "safest" means "safer than vaginal birth," correct?

If you say that CS is "safest way" (i.e. meaning "SAFER than vaginal birth") then why would you not include *all risks?* Even if the CS has only slightly higher risks, or risks that aren't life-threatening, such as transient breathing problems?

I don't understand why anyone would even bother to say, *"IF you compare only death rates, CS is safest. (Yes, there are other risks to CS, but let us disregard those.)"*







Why? Why would you disregard all the other factors? What is the point of such a comparison?
this is a good question. to me, it's because death and permanent brain damage are so much bigger than transient breathing problems that transient breathing problems are almost disappear from the equation. think about if you were to really try to quantify the risks of birth. imagine a point system, if you will. were one to tally the risks of each method of birth, one would have to assign beforehand that death is worth x points, HIE y points, TTTS z points. in my worldview, x = 1,000,000, HIE = 500,000, and TTTS = 1,000.

i would never for a second suggest that ANYONE ELSE adopt my point system. however, i have assumed that most people find death and HIE to be so much worse than any transient problem that they totally dwarf the transitory problems.

you're right, though. i should have written that a baby is less likely to die or suffer permanent brain damage or paralysis after a first c/s. my post continued to make that point that this is not the be all and end all of the decision regarding how to deliver, but it is one key factor.

Quote:

Anyway, there are many things you can't do a randomized, double-blind study on. That doesn't mean the scientific community collectively throws their hands up in the air and says, "Humph, we just don't know." Yes, you're right you do the best with what you have. When you get large enough sample sizes so that you can match similar cases, you CAN get good data without the randomized double-blind.
i absolutely agree.

Quote:

Again, I have to wonder why you'd even consider this. Frankly, I'm shocked. Can you imagine if you went to your dentist and he said, "You have gum disease. I want to give you a treatment that may have nasty side-effects. BUT, it won't kill you - your rate of dying from this medical treatment procedure is not any higher than if we didn't do the procedure. Sure, there are other harmful, negative, and painful side effects. But the mortality rate is not higher. So you are fine with that, Right?


but that's not a proper analogy. the way i see the data is that:
1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.

until that equation changes, i will advocate vaginal birth. however, i am not going to deny that one part of the puzzle comes out in favor of c/s. it doesn't change the fact that the picture that emerges when you consider all of the pieces favors vaginal birth.

the only thing we're disagreeing about is point number 1. it's a really tough question to answer because the increase in risk is so slight and so confounded by other variables that it's extraordinarily hard to measure. honestly, i don't think anyone knows yet. i said "probably" safer, but if you were to ask me my confidence in that.... maybe 65%? there's so much missing data that i think it's impossible to be sure.


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## Drummer's Wife (Jun 5, 2005)

I am still lost on the first c-section being safer for baby. I've honestly never, in all my research, came to that conclusion.

Of course there are situations where a c-section is the safest method of getting baby out for both mother and baby, but your average laboring mom? That is a really odd statement to me.

eta: I was posting at the same time you were responding, major. Reading it now


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *barefootpoetry* 
Even IF - and that's a really big IF - C-section is safer for babies, and I don't believe it is, how is that completely exclusive from the harm it does to the mother? Do babies not deserve a happy, healthy mom?

Excellent post. I second all of that.

Scientific studies aside... I don't think our process of human evolution is so flawed that CS is better for the baby than vaginal birth - across the board. That just seems nuts to me.


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## barefootpoetry (Jul 19, 2007)

Quote:


Originally Posted by *majormajor* 
but that's not a proper analogy. the way i see the data is that:
1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.

until that equation changes, i will advocate vaginal birth. however, i am not going to deny that one part of the puzzle comes out in favor of c/s. it doesn't change the fact that the picture that emerges when you consider all of the pieces favors vaginal birth.

OK. I can kinda sorta agree with this, although I would still like to see evidence that vaginal birth is more dangerous for baby.

HOWEVER, if this is true, don't 2 and 3 therefore negate 1? I am being sincere here. If there is a slightly lowered risk, whatever it may be, of the first C-section, don't the subsequent risks of future C-sections, as well as the risk to mom, cancel out that lower risk to baby?


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## jennyfah (Jul 20, 2006)

Quote:


Originally Posted by *majormajor* 
but that's not a proper analogy. the way i see the data is that:
1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.

until that equation changes, i will advocate vaginal birth.


So are you hoping that the equation *will* change, and that C-birth will someday be 'safer' than normal physiological birth? I don't think that I am alone in confusion here.







I do want to understand what you are saying, and I hope that you can expand/clarify this. I think it is a valuable and interesting conversation, but I am not completely tracking with what you are saying.

Thanks,
Jen


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## Lisa1970 (Jan 18, 2009)

The doctor does not make a salary. Who would pay his salary? He is a private business and he gets paid by the business he has. This is not socialized medicine in this country.

The extra money for a csect is not small. Basically, I know a couple years ago it was $2500 for all prenatal care and birth and postnatal care. It was an extra $2500 for making it a csect. Plus, they do not have to be on call for csects, they just schedule them.

Csects come with far more danger than a regular delivery. Women die all the time from csects.


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## Lisa1970 (Jan 18, 2009)

majormajor said:


> but that's not a proper analogy. the way i see the data is that:
> 1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
> 2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
> 3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.
> ...


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## Kelly1101 (Oct 9, 2008)

Quote:


Originally Posted by *barefootpoetry* 
OK. I can kinda sorta agree with this, although I would still like to see evidence that vaginal birth is more dangerous for baby.

HOWEVER, if this is true, don't 2 and 3 therefore negate 1? I am being sincere here. If there is a slightly lowered risk, whatever it may be, of the first C-section, don't the subsequent risks of future C-sections, as well as the risk to mom, cancel out that lower risk to baby?

I think that's where the family plan comes into it-- if you're planning on having more children in the future, you DEFINITELY want to avoid the c/s. It's not quite so bad if it's going to be your only child, I think.


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## Lisa1970 (Jan 18, 2009)

http://www.associatedcontent.com/art...ny.html?cat=52


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## kltroy (Sep 30, 2006)

She's right that a CS is safer THAN IT USED to be. Also safer than vag birth in some select situations (like previa, and even breech if nobody has a clue how to do a vag. breech). And the salary thing for docs is true too, BUT docs feel a lot of pressure to "bill for procedures". Ultimately a practice gets most money through insurance billing, so if you go in for an ultrasound, for example, your doctor's office will bill for an office visit + 1 u/s (2 procedures). Docs who bill a lot bring lots of $ to the practice. This can manifest as a raise, bonus, or offer for partnership in the future. Ethically, I know no doctors who would perform major surgery for this reason, but billing is frequently at the back of their minds, at a subconscious level.


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## barefootpoetry (Jul 19, 2007)

Quote:


Originally Posted by *kltroy* 
She's right that a CS is safer THAN IT USED to be.

Well, in that case, vag birth is a lot safer than it used to be, too.







So is pretty much everything else, as science and knowledge continue to progress.


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## majormajor (Nov 3, 2006)

So are you hoping that the equation *will* change, and that C-birth will someday be 'safer' than normal physiological birth? I don't think that I am alone in confusion here.







I do want to understand what you are saying, and I hope that you can expand/clarify this. I think it is a valuable and interesting conversation, but I am not completely tracking with what you are saying.

well if i could have any wish, they'd both be 100% safe!

i think vaginal birth should always be the default, with a c/s when necessary. i have no idea what the c/s rate "should" be, but i'm pretty sure it should be a whole lot lower than it is. 10 or 15%?? i doubt c/s will ever be safer, because i don't see how you can eliminate the risk to moms. it's not like they can be done laporscopically!

i am not anti-c/s though. i don't like the way it's kind of demonized as a second-rate birth. i know it is for some people, but everyone's different.

it's a strange topic, because while it's kind of theoretical for me, there are women like stormbride for whom it's absolutley not theoretical. my heart breaks for them. i just want to be able to do one small part, and that's have an honest discussion about risks, even if 100% of the discussion doesn't jive with the rest of my beliefs. i think that we all owe that to women like stormbride.

and stormbride, i'm so sorry to hear that you never got any answers about your baby. that must be so hard. i was just reading an article on yahoo that said in more than 25,000 babies in the US are stillborn each year, and more than 30% of the time no one can figure out what happened. i didn't realize the numbers were so high.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *majormajor* 
i am not anti-c/s though. i don't like the way it's kind of demonized as a second-rate birth. i know it is for some people, but everyone's different.

I know there are women who don't see it as second-rate birth. I'm truly happy for them. I have to admit that I don't exactly see it as second-rate birth, either. I don't see it as birth at all. Whenever I hear the phrase "cesarean birth", I kind of want to throw up.

Quote:

it's a strange topic, because while it's kind of theoretical for me, there are women like stormbride for whom it's absolutley not theoretical. my heart breaks for them. i just want to be able to do one small part, and that's have an honest discussion about risks, even if 100% of the discussion doesn't jive with the rest of my beliefs. i think that we all owe that to women like stormbride.

and stormbride, i'm so sorry to hear that you never got any answers about your baby. that must be so hard. i was just reading an article on yahoo that said in more than 25,000 babies in the US are stillborn each year, and more than 30% of the time no one can figure out what happened. i didn't realize the numbers were so high.
I actually have a pretty good idea what happened (maternal infection), and it's possible that the autopsy report will tell me. Unfortunately, when I asked for it, I didn't get it...apparently, they don't release the results to parents, unless you go see your doctor so he/she can "interpret" it for you. I'm not up to that yet. However, it wasn't anything really clear cut, as nobody at the hospital had any idea what had happened.

Honestly...I've reached a point where I'm just looking forward to getting _this_ baby out (even thought the "how" of that gives me insomnia and nightmares) and getting my tubes tied. Except for my wonderful kids, my reproductive life has been one long nightmare, and waking up is sounding really, really good. (Kind of a funny sentiment from somebody who regularly got "I hate you" in jest from other moms when pregnant with my first, because pregnancy is a walk in the park on a lovely spring day.)


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## Ldavis24 (Feb 19, 2009)

Quote:


Originally Posted by *majormajor* 
also, there are consequences of sections that woudn't even occur to most people. one of my closest friends had 2 sections in the 70s and 80s (and a VBAC in the 90s. she had classical incisions, too. and her VBAC baby was almost 9 lbs, face up. just had to throw that in there!). anyway, she needs some abdominal surgery now, that most people have laproscopically, but she might not be able to because of the scar tissue. who would have thought about that? not me! so now, she's going to have ANOTHER major abdominal surgery in her 50s. so yeah, there are consequences for mom for the rest of your life. definitely NOT something anyone should take lightly!

agreed my mother had my younger brother via c-section this is in 1987 and now she has had 3 resulting surgeries to repair the damage done by that c-section. The last being they had sew her bladder to her stomach wall to keep it from collapsing, that after having her uterus removed in the second surgery...While this is not typical of the post c-section mother, I just wanted to highlight that unless you educate yourself there is a good chance your doctor won't.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *Ldavis24* 
agreed my mother had my younger brother via c-section this is in 1987 and now she has had 3 resulting surgeries to repair the damage done by that c-section. The last being they had sew her bladder to her stomach wall to keep it from collapsing, that after having her uterus removed in the second surgery...While this is not typical of the post c-section mother, I just wanted to highlight that unless you educate yourself there is a good chance your doctor won't.

...or can't. I have no faith that doctors are even aware of the risks, in many cases. They see surgery as a perfect tool that solves all the problems inherent in the flawed way a woman's body works...and they don't see what doesn't fit the picture.


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## jeliphish (Jul 18, 2007)

Did she mean that c/s are safer in general than they used to be??? She would be right then....I mean any surgical technique has become safer over the years. That still doesn't mean that they are safer than an uncomplicated vaginal birth though. But C/S themselves have of course gotten safer over the year....so has gall bladder surgery, and open heart surgery.


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## Ldavis24 (Feb 19, 2009)

Quote:


Originally Posted by *majormajor* 
but that's not a proper analogy. the way i see the data is that:
1. a FIRST c/s carries a smaller risk of death and permanent injury to baby than a first vaginal deliery.
2. a first c/s carries higher risks of death, permanent, and non-permanent injury to a mother.
3 all subsequent c/s increase risks of major and minor morbidity and mortality for both mother and baby.

until that equation changes, i will advocate vaginal birth. however, i am not going to deny that one part of the puzzle comes out in favor of c/s. it doesn't change the fact that the picture that emerges when you consider all of the pieces favors vaginal birth.

the only thing we're disagreeing about is point number 1. it's a really tough question to answer because the increase in risk is so slight and so confounded by other variables that it's extraordinarily hard to measure. honestly, i don't think anyone knows yet. i said "probably" safer, but if you were to ask me my confidence in that.... maybe 65%? there's so much missing data that i think it's impossible to be sure.

If this was true, that a first time mother having a c-section is safer for the baby than vaginal birth then why do women such as Ina May Gaskin routinely have C-section rates below 4% in first time mothers and have far lower infant mortality rates than most anyone?
Clearly she is doing something right here with her work on the farm and you have no logic to back up your statement other than your feeling which is factually incorrect.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *Ldavis24* 
If this was true, that a first time mother having a c-section is safer for the baby than vaginal birth then why do women such as Ina May Gaskin routinely have C-section rates below 4% in first time mothers and have far lower infant mortality rates than most anyone?
Clearly she is doing something right here with her work on the farm and you have no logic to back up your statement other than your feeling which is factually incorrect.

I'd have to look at the stats again. I don't recall finding anything that suggested primary c/s is safer than a first vaginal birth...but maybe it is, if we're talking about a typical intervention-laden hospital birth...


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *barefootpoetry* 
OK. I can kinda sorta agree with this, although I would still like to see evidence that vaginal birth is more dangerous for baby.

HOWEVER, if this is true, don't 2 and 3 therefore negate 1? I am being sincere here. If there is a slightly lowered risk, whatever it may be, of the first C-section, don't the subsequent risks of future C-sections, as well as the risk to mom, cancel out that lower risk to baby?

absolutely. i mean, my opinion again, but the future sections are SO much risker for mom and the future babies. also, there are so many consequences for moms i'll bet we're not even seeing yet. i wonder what kind of complications we're going to see when our generation with the 30-40% c/s rate hits old age.

i've also been thinking about my use of the term "safer." i haven't spent much time thinking about what a subjective word that really is in this case. i think in the future i'll stay away from the subjective terms. i mean, what if 1 in 10,000 fewer babies die because of c/s, but 1 in 50 have TTTS, 1 in 10 have asthma, 1 in 25 have diabetes... i'm not sure "safer" is appropriate in comparing the two, just "different."

hm, i'll think about this more.

oh, and i'm not going to be able to even justify my "safer" claim, because i didn't do anything like keep a spreadsheet of results. that'd be like doing my own cochrane review! the thought, at the bottom of it, is based on the idea that we know vaginal birth can go wrong, so we know about the mortality associated with vaginal birth. and we know if we c/s'ed every baby at 39 weeks, we'd save all of the unexplained stillbirth from happening. so when i used the #s from the VBAC studies, i was trying to figure out why babies die after a c/s. it would have been helpful for me if they discussed all of the c/s deaths, but they didn't.

anyway, i'm most certainly NOT advocating c/s for everyone at 39 weeks!

my friends IRL would be most entertained by this thread. i'm the one who's trying to make a VBA2C happen in maine (i think i have some good leads too).


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## Ldavis24 (Feb 19, 2009)

Quote:


Originally Posted by *Storm Bride* 
...or can't. I have no faith that doctors are even aware of the risks, in many cases. They see surgery as a perfect tool that solves all the problems inherent in the flawed way a woman's body works...and they don't see what doesn't fit the picture.

true I found with my OB before I switched to a midwife I felt like I had to justify that my body is capable of birthing. That in fact my body was designed for this and in fact on a physical level if my dog can give birth to 10 puppies because that is what her body was made for then my body can do it to. Well not the 10 puppies but you know what I mean.
Pregnancy is not a disease and I don't appreciate being made to feel like it is by any doctor. I just wish my mother had been able to know that she had options which she says she felt like she didn't have at the time.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *majormajor* 
absolutely. i mean, my opinion again, but the future sections are SO much risker for mom and the future babies. also, there are so many consequences for moms i'll bet we're not even seeing yet. i wonder what kind of complications we're going to see when our generation with the 30-40% c/s rate hits old age.

I wonder about that, too. My mom had three c/s (in '63, '68 and '69 - then was told she couldn't have any more kids - she'd wanted six). As far as we can tell, she hasn't had any long-term effects (aside from a truly ugly scar), but she knows she has adhesions, and her abdomen has never been "right" since then. However, "my abdomen isn't right" isn't a medically accepted condition, yk?

I strongly suspect I'll have incontinence problems, at the very least. It's very difficult to maintain abdominal and pelvic floor strength when so much sensation has been lost.


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## majormajor (Nov 3, 2006)

i didn't realize you were preggers storm bride, congrats! i'm also really sorry you've had such terrible experiences. i keep having this fantasy that i'll go into labor and give birth so quickly with #3 (i'm not pg yet, not even sure we're going to try for a third) that i can just have the baby at home by myself. i don't have the guts to plan an unassisted birth, but it's definitely my fantasy. maybe that's just my brain's way of dealing with those feelings.


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *Storm Bride* 
I'd have to look at the stats again. I don't recall finding anything that suggested primary c/s is safer than a first vaginal birth...but maybe it is, if we're talking about a typical intervention-laden hospital birth...

yes, this. wow i'm posting today more than i ever have! DD is sound asleep on my lap, so you'll be dealing with me for another half hour.









this was the problem when i was trying to research epidural safety too. they kept comparing epidurals to things like stadol and demerol, and then saying epidural was no different. so i'd say, ok, what are the effects of stadol or whetever, where are the studies from way back when when they first started using these drugs. nowhere to be found! i read somewhere that they tried a RCT trial with epidural too but couldn't get enough women to sign up. i don't know if i believe that though, i know TONS of women that have had NCBs.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *majormajor* 
i didn't realize you were preggers storm bride, congrats! i'm also really sorry you've had such terrible experiences. i keep having this fantasy that i'll go into labor and give birth so quickly with #3 (i'm not pg yet, not even sure we're going to try for a third) that i can just have the baby at home by myself. i don't have the guts to plan an unassisted birth, but it's definitely my fantasy. maybe that's just my brain's way of dealing with those feelings.

Yup. Baby-under-construction's EDD is June 28th...probably scheduling my 5th (and last!! YAYYY!) c-section for June 29th. I, at least, have a decent OB this time...it helps. I alternate between trying not to think about it, procrastinating on ordering "Birth from Within" (many people have recommended it to me), and staying up all night tossing and turning. Oh, yeah - and _trying_ to focus on gestating in peace and enjoying my last pregnancy. That's the hardest one, but the most worthwhile, imo.


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## barefootpoetry (Jul 19, 2007)

Quote:


Originally Posted by *majormajor* 
absolutely. i mean, my opinion again, but the future sections are SO much risker for mom and the future babies. also, there are so many consequences for moms i'll bet we're not even seeing yet. i wonder what kind of complications we're going to see when our generation with the 30-40% c/s rate hits old age.


Exactly. So the idea of the primary C-section being "safe" is null and void, because 9.9 times out of 10 in this country, you are automatically signed up for a ERCS for all future births. Which would never happen if you hadn't had that "safe" first C-section to begin with.

I have been screaming this at the top of my lungs for years now. Everywhere you see docs fa-REAKING out over the idea of doing VBAC, and going on and on about how dangerous it is, etc. etc. Well, the solution is so friggin' simple: STOP DOING THOSE FIRST C-SECTIONS. Oh, but the C-sections are "safe."







:

So you see where my frustration comes from. You will rarely hear an OB lecture a patient and try to talk her down from a C-section, whether it is her first or fourth. But try to do a VBAC and the poop really hits the fan. It is so backwards. If there are all these risks from VBAC then OBVIOUSLY the C-section is the PROBLEM here.


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## Drummer's Wife (Jun 5, 2005)

Quote:


Originally Posted by *barefootpoetry* 
Exactly. So the idea of the primary C-section being "safe" is null and void, because 9.9 times out of 10 in this country, you are automatically signed up for a ERCS for all future births. Which would never happen if you hadn't had that "safe" first C-section to begin with.

I have been screaming this at the top of my lungs for years now. Everywhere you see docs fa-REAKING out over the idea of doing VBAC, and going on and on about how dangerous it is, etc. etc. Well, the solution is so friggin' simple: STOP DOING THOSE FIRST C-SECTIONS. Oh, but the C-sections are "safe."







:

So you see where my frustration comes from. You will rarely hear an OB lecture a patient and try to talk her down from a C-section, whether it is her first or fourth. But try to do a VBAC and the poop really hits the fan. It is so backwards. If there are all these risks from VBAC then OBVIOUSLY the C-section is the PROBLEM here.

Right. and to me, this is obviously a huge issue. I'd guess that most women end up having or at least wanting more than one child. SO, even if that initial c-section is 'relatively' safe, the risks go up for each subsequent cesarean.

Cause then you have people like Stormbride and myself who will likely end up with five c-sections. I have a hard time trying to understand how yet another surgery is safer than a vaginal birth, even when we are talking about a vba4c. I felt the same with #3 and #4 as well, yet finding a provider to take you on for a vbamc can be near impossible.


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## phrogger (Oct 16, 2006)

Quote:


Originally Posted by *Drummer's Wife* 
Right. and to me, this is obviously a huge issue. I'd guess that most women end up having or at least wanting more than one child. SO, even if that initial c-section is 'relatively' safe, the risks go up for each subsequent cesarean.

Cause then you have people like Stormbride and myself who will likely end up with five c-sections. I have a hard time trying to understand how yet another surgery is safer than a vaginal birth, even when we are talking about a vba4c. I felt the same with #3 and #4 as well, yet finding a provider to take you on for a vbamc can be near impossible.


I ask the same question too. Honestly if my body worked I would just stay home because in my head at least, a vaginal delivery seems safer then my 5th c-section. And I have had good surgical births.


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## barefootpoetry (Jul 19, 2007)

Quote:


Originally Posted by *Drummer's Wife* 
Cause then you have people like Stormbride and myself who will likely end up with five c-sections. I have a hard time trying to understand how yet another surgery is safer than a vaginal birth, even when we are talking about a vba4c. I felt the same with #3 and #4 as well, yet finding a provider to take you on for a vbamc can be near impossible.

Ugh. Big hugs to you guys. I can't imagine having that many C-sections. DH and I decided when I was pregnant with #2 that if I had to have another C-section, we were calling it quits in the babymaking department, because I just couldn't face being forced to do that a third or fourth time.


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## Drummer's Wife (Jun 5, 2005)

Quote:


Originally Posted by *phrogger* 
I ask the same question too. Honestly if my body worked I would just stay home because in my head at least, a vaginal delivery seems safer then my 5th c-section. And I have had good surgical births.

my surgeries went really well, too. But I am still afraid of another c-section.

I feel the same way and yet it's almost impossible to assess the risks involved with a hba4c or uba4c vs a 5th cesarean. Mostly because there are not too many women who end up having 4-5 c-sections, and there are even _less_ women who end up having vba4c --in the hospital, at home with a midwife, or at home unassisted. It's just a really rare occurrence.


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## Drummer's Wife (Jun 5, 2005)

Quote:


Originally Posted by *barefootpoetry* 
Ugh. Big hugs to you guys. I can't imagine having that many C-sections. DH and I decided when I was pregnant with #2 that if I had to have another C-section, we were calling it quits in the babymaking department, because I just couldn't face being forced to do that a third or fourth time.

see, having your family size decided for you because of unnecessary --or even necessary-- c-section(s) is just awful.

I'm glad you were able to hbac and can go on to have another baby if you choose.


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## TzippityDoulah (Jun 29, 2005)

Quote:


Originally Posted by *barefootpoetry* 
Having your abdomen and colon surgically opened to manually extract your feces and then sewn shut again is not safer than pooping.


LOL!! I just laughed so hard I snorted!


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## Juvysen (Apr 25, 2007)

:


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *barefootpoetry* 
Ugh. Big hugs to you guys. I can't imagine having that many C-sections. DH and I decided when I was pregnant with #2 that if I had to have another C-section, we were calling it quits in the babymaking department, because I just couldn't face being forced to do that a third or fourth time.

I've always wanted four children, and if I'm being perfectly honest, I'm truly not rational where my reproductive life is concerned...not anymore. DH basically didn't care that much either way if we have another baby or not. He okayed it, because he was even more afraid for my mental health if I don't have another one than he is if I have another c-section. Nice way to decide on family size, huh? "Which option is less likely to put my wife over the edge?" Woo-Hoo.


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *Storm Bride* 
I've always wanted four children, and if I'm being perfectly honest, I'm truly not rational where my reproductive life is concerned...not anymore. DH basically didn't care that much either way if we have another baby or not. He okayed it, because he was even more afraid for my mental health if I don't have another one than he is if I have another c-section. Nice way to decide on family size, huh? "Which option is less likely to put my wife over the edge?" Woo-Hoo.

i'm sorry.







have you thought about talking to a counselor? a doula friend of mine said all of her clients who have seen counselors really benefited from it.


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## dlm194 (Mar 23, 2005)

My doctor made the same amount of money whether he did a c-section or a vaginal birth. But if you break that down to earnings per hour, he made a lot more doing a c-section that hangining around all day for my labor to progress.

Hospitals make out on c-sections. My insurance paid out $27,000 for my uncomplicated c-section. They paid out just $1800 for my completely drug free VBAC (the only drugs I had were 2 motrin afterwards).

As far as safety, prematurity, etc (hopefully I got these links right!)...
*
PROBLEMS FOR THE MOTHER
*
Mother is 2.84 times more likely to die. She is also more likely to lose her uterus, suffer infections or hemorrhage. The risk of hysterectomy triples in the next pregnancy. Subsequent pregnancies are more likely to result in ectopic pregnancies. The risk of still birth doubles in subsequent pregnancies. The chance of a placenta abruption (where the placenta tears aware from the ueterine wall) and uterine rupture in subsequent pregnancies also increases (scheduling a c-section does NOT prevent uterine rupture).

20% of women develop fever after CS, most due to iatrogenic infections requiring diagnostic fever evaluation for both woman and baby.

Maternal death in the US ranks 41st in the world. We also have one of the highest c-section rates in the world. In 2004, the US maternal death rate was 13.1 per 100,000 live births. In NJ (where we have the highest c-section rate), our maternal death rate was 21 deaths per 100,000 live births in 2004.

Optional Caesareans resulted in hospital stays that were 77 percent longer and cost 76 percent more than normal deliveries. Mothers who had the optional surgery were 2.3 times as likely to return to the hospital within 30 days, usually because of wound complications or major systemic infections.

After adjustment for potential confounders, the risk of postpartum death was 3.6 times higher after cesarean than after vaginal delivery (odds ratio 3.64 95% confidence interval 2.15-6.19). Both prepartum and intrapartum cesarean delivery were associated with a significantly increased risk. Cesarean delivery was associated with a significantly increased risk of maternal death from complications of anesthesia, puerperal infection, and venous thromboembolism.

*PROBLEMS FOR THE BABY*

Babies are more likely to die after a c-section birth. The neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births, while the rate for vaginal delivery is 0.62 deaths per 1,000. That is nearly a 3 fold increase in death rate after you correct for risk factors that would have necessitated a c-section.

2-6% of babies are cut during c-sections. On a side note, my baby was one of them. Not a serious cut, thank heavens! But the hospitals lied and said it must have happened in utero. I talked to a woman who saw a baby with a severed leg after a c-section in her hospital NICU after the birth of her own baby. Babies born by elective c-section are twice as likely to end up in the NICU and 3 times more likely to suffer from pulmonary disorders.

Babies born by c-section are 20% more likely to develop type 1 diabetes.

Babies born by elective c-section are more likely to suffer from breathing problems. At 37 weeks, they were almost four times as likely as others of the same gestational age to have respiratory problems, at 38 weeks three times as likely, and at 39 weeks almost twice as likely. The differences remained even after controlling for maternal age, smoking, alcohol intake and other variables

Premature births have been climbing since the mid-1990s and that increase has been linked to the risk in c-section rates since calculation of the baby's due date may be off or patients and doctors may elect to deliver the baby before it's ready.

Risk of cavities is higher in babies born by cesarean. Cesarean infants acquired cavity-causing Streptococcus mutans 11.7 months earlier than did those born vaginally, said investigators led by Yihong Li, Dr. PH, D.D.S., an associate professor of craniofacial biology at New York University here. They said cesarean-born infants may have weakened defenses against bacteria because of reduced bacterial exposure during delivery. By contrast, vaginally born infants receive more intense bacterial exposure from the vagina and perineum, which may help strengthen their immunity. This may help explain why cesarean babies show greater bacteria levels at an earlier age, Dr. Li said.

There might be a positive association with development of asthma--in particular, for cesarean section--that was not explained by gestational age, birth weight, ponderal index, smallness for gestational age, parity, maternal age, or occupation.

Want to find out what would happen if we followed 100,000 healthy, low-risk first-time mothers, through three pregnancies, comparing outcomes based on whether they have elective cesarean surgery for the first delivery or plan vaginal birth????
(http://www.lamaze.org/institute/adva...nsequences.pdf)

57 more women will die

999 more women will have a hysterectomy

135 more women will have a uterine rupture and 7 babies will die

63 more women will have a cesarean-scar ectopic pregnancy
45,900 more women will have dense adhesions (adhesions make subsequent pelvic or abdominal surgery more difficult, increase the likelihood of injuring organs or blood vessels during surgery, and can cause chronic pain and bowel obstruction)

13,500 more women will experience wound (abdominal vs. perineal) pain for 6 months or more

378 more babies will die in the womb (antepartum fetal demise) without explanation after 34 weeks of pregnancy

7,830 more babies will be born preterm (before 37 weeks completed gestation)

1,620 more babies will born weighing in the lowest 5% for their gestational age

4,244 more babies will have respiratory problems serious enough to require admission to intensive care

3,240 fewer women will have anal sphincter trauma (This assumes an anal sphincter injury rate of 1%, a rate achievable with optimal care [Albers 2005].) BUT 630 more women will have bladder injury
10,260 fewer women will have moderate to severe urinary incontinence
BUT

0 fewer women will have later-life urinary incontinence (MCA 2004)


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## 2+twins (Apr 20, 2004)

EXCELLENT post, dlm194. Thank you for that!


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *dlm194* 

*PROBLEMS FOR THE BABY*

Babies are more likely to die after a c-section birth. The neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births, while the rate for vaginal delivery is 0.62 deaths per 1,000. That is nearly a 3 fold increase in death rate after you correct for risk factors that would have necessitated a c-section.

this study was WIDELY criticized. and IMO, rightfully so. the authors themselves acknowledged the validity of some of the criticisms and recalculated their findings. their new number is lower, but the free abstract doesn't say how much lower (http://www.ingentaconnect.com/conten...00003/art00002). however, the criticisms about the data still remain.

besides, no one should be drawing conclusions about the safety of elective c/s based on one study. that's why, again, i prefer to look at the safety of ercs in vbac vs. ercs studies. SO much more data there, much better in terms of matched cohorts and risk.

other than that, no quibbles! i think the scientific literature leaves little doubt about the others risks of c/s to babies and mothers. actually, maternal mortality is hard to say for sure, because fortunately it's so rare, less than 500 annually in the US. but it's logical that c/s is going to be more dangerous for mom, so i'm not as critical of the scientific evidence there.

it's that macdorman study i hate so much, especially when the 1.77/1,000 is all you see quoted, when it's been revised downward.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *dlm194* 
As far as safety, prematurity, etc (hopefully I got these links right!)...
*
PROBLEMS FOR THE MOTHER
*

But, dlm, we've decided to entirely disregard the mother in this discussion & focus only on the risks to the baby, because they are 2 entirely separate entities, dontcha know??









And if you wait for labor to start before doing a CS (whether ERCS or elective primary CS) then you eliminate the risk of prematurity. Which could potentially reduce rate of breathing problems in the CS babies.

So we're back at square one ... it apparently is questionable that it could be safest for baby to be surgically removed than follow the natural path of human evolution for millions of years...


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *majormajor* 
i'm sorry.







have you thought about talking to a counselor? a doula friend of mine said all of her clients who have seen counselors really benefited from it.

Yes. I've thought about it. Unfortunately, I trust counselors, as a profession, about as much as I trust doctors. Maybe one day I'll be desperate enough, but I'm not there yet.


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## Bellabaz (Feb 27, 2008)

C-sections can be harder the babies. Babies who go through a vaginal birth get all the fluid sqeezed out of their lungs. C-section babies often have respitory issues in the beginning (i don't mean they all have problems foever). It is also major surgery for the mother with all the risks that implies.

Doctor make different amounts of money depending on the services they provide. An office visit costs $120 (obviously not all goes to doc), uncomplicated vag birth in hospital maybe $5000 range (depending where you live ect.), c-section, i would guess $12000 and up. There are also other things in those fees but yes, the doc gets more $ for a more complicated procedure.


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## ericswifey27 (Feb 12, 2005)

Quote:


Originally Posted by *The4OfUs* 
At the hospitals I've worked at, the doctors are salaried, so I don't necessarily buy the "more money" argument (although I guess if sections generate more revenue for the hospital, more sections would mean they would have more revenue to offer higher salaries to doctors)......but I do entirely buy the less time and being able to schedule it, not having to wait around. Sigh.

I KNOW this is what happened to me. I read my records, it says "technically meets AMA standards" for csection, which meant that even though I didn't want one, and that my baby aond I were totally fine, there were no heart rate issues or signs of infection or anything of that nature according to records etc (although verbally they played the 'dead baby' card to get me to sign) AND that I had gone in wanting a natural no intervention birth- they gave me a csection. Not for any reason based in evidence based medicine, but because it was close enough to 24 hours after my water broke, and/or I hadn't dilated fast enough for them to get to their New Year's parties in a timely fashion. There's more I read but that's another thread.

This may have changed but I've also heard that some doctors are paid only for the births during his/ her shift, that could definitely bias a doctor towards cutting a labor short instead of staying over time to continue assisting in the labor awaiting birth, or turning over the birth to someone else.

I wish I still had the links to the studies, as I know there is evidence showing c-section rates increase during weekends and holidays, when understandably doctors want to be with their families.. .


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## chandasz (Apr 13, 2005)

As said above--- statistics show that most babies are born during the week between 8 and 5. Somehow I don't believe that's nature....


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *chandasz* 
As said above--- statistics show that most babies are born during the week between 8 and 5. Somehow I don't believe that's nature....

You know...it seems that most women go into labour in the wee small hours. That seems to be a time when babies want to get here. I wonder if we rescheduled all c-sections and inductions for the middle of the night...would there be as many?


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## notjustmamie (Mar 7, 2007)

Quote:


Originally Posted by *AllyRae* 
However, I personally believe (yet don't have research to back it up...







: ) that a non-emergency c-section might be safer than today's hospitalized vaginal births (meaning births with the combination of pitocin, epidurals, and vacuum extractions). At least safer for the baby...I can't imagine having your head yanked by vacuum suction that can pop off and have to be redone several times, after being squeezed by unnaturally strong contractions is good for the baby. And of course, for some people, a c-section is safer than a vaginal birth (but that's rare of course).

Actually, I think that's pretty well exactly majormajor's point.

I would guess that if we were to compare outcomes (using whatever variables we wanted) we'd find that in a "normal" hospital birth (90% medicated, 60-80% chemically augmented, coached/purple pushing, medically-managed third stage, etc.) we'd find that the risks for the babe were the same or slightly more than a 39-week elective c/s.

However, comparing that same c/s with a "natural" birth (no induction/augmentation, no pain meds, no coached pushing, spontaneous delivery of the placenta, etc.) the risks would be overwhelmingly on the c/s side.


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## Dewberry (Aug 2, 2007)

Quote:


Originally Posted by *Storm Bride* 
I used to haunt the OB forums (had to stop because it was bad for my blood pressure, yk?), and I recall a time when they were discussing how great it would be to work at a 100% c-section hospital. Several of them treated the idea as a "died and gone to heaven" kind of scenario. They definitely like the convenience.

It's not legal to have a 100% C-Section hospital. So I think that person (on the OB Forums) is full of crap! LOL

EDIT: My BF had 4 c-sections, ALL 4 were medically necessary without a doubt.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *Dewberry* 
It's not legal to have a 100% C-Section hospital. So I think that person (on the OB Forums) is full of crap! LOL

He wasn't full of crap. He didn't say he worked there - he was basically enjoying a lovely, lovely daydream, along with several of his colleagues. They all thought it sounded like a perfect job.


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## dlm194 (Mar 23, 2005)

Quote:


Originally Posted by *majormajor* 
this study was WIDELY criticized. and IMO, rightfully so. the authors themselves acknowledged the validity of some of the criticisms and recalculated their findings. their new number is lower, but the free abstract doesn't say how much lower (http://www.ingentaconnect.com/conten...00003/art00002). however, the criticisms about the data still remain.


Can you link me to some of the criticisms? I looked around and couldn't find any. I liked to see criticisms of studies.







The link you posted simply says:

Quote:

Neonatal mortality rates were higher among infants delivered by cesarean section (1.77 per 1,000 live births) than for those delivered vaginally (0.62). The magnitude of this difference was reduced only moderately on statistical adjustment for demographic and medical factors, and when deaths due to congenital malformations and events with Apgar scores less than 4 were excluded

I did find a study looking at the risks of planned vaginal birth vs planned primary cesarean:

*What are the risks of choosing a planned primary c-section vs a planned vaginal birth?*


2.5 times more likely to be rehospitalized in the first 30 days post partum

1.8 times more likely to suffer major pueperal infection

1.9 times more likely to suffer delayed and secondary postpartum hemmorrhage

2.8 times more likey to suffer infections of the genitourinary tract

14 times more likely to suffer complications of obstetrical wounds

Cost for planned c-section was 76% higher than initial costs for planned vaginal birth
_
Source for this info:

Maternal Outcomes Associated With Planned Primary Cesarean Births Compared With Planned Vaginal Births

Eugene Declercq, PhD, Marger Barger, CNM,MPH, Howard J. Cabral, MPH, PhD, Stephen R Eavns, MPH, Milton Lotelchuck, MPH, PhD, Carol Simon, MS, PhD, Judith Weiss, ScD, and Linda J. Heffner, MD, PhD
Obstetrics & Gynecology vol109, No.3, March 2007_

Since you brought up ERCS vs VBAC, some of Landon's work is a good source for that:

*Risks of choosing a a TOL (trial of labor) over an ERCS (elective repeat c-section):*

More likely to suffer a uterine rupture - the rupture rate in the TOL group*** was 0.7%; there were no rupture in the ERCS group, however, women who presented in early labor and did not have a documented intention to labor were excluded so it is possible that women went into labor before their scheduled c-section and ruptured but were excluded from this study's data

1.4 times more like to have a uterine dehisence (typically a benign, thin area in the uterus)

1.7 times more likely to need a tranfusion

1.6 times more likely to develop endometriosis

1.3 times more like to have another adverse event such as (broad ligament hematoma, cystotomy, bowel injury, ureteral injury)

1.6 times more likely for the baby to die (doesn't sound like that big of a difference right? Remember that babies only die in about 2-10% of uterine rupture according to many studies AND babies do die after c-sections.The absolute risk of neontal death is 0.08% with a TOL vs 0.05% in an ERCS.

*Risks of choosing an ERCS over a TOL:*

1.5 times more likely to need a hysterectomy

2.5 times more likely to have a thromboembolic disease (deep venous thrombosis or pulmonary embolism)

2 times more likely for mother to die (The absolute risk of death was 0.04% with an ERCS cs 0.02% with a TOL)
*Risks of a successful VBAC delivery (remember that TOL can end in repeat c-sections) over an ERCS:*

1.2 times more likel to need a transfustion

*Risks of an ERCS over a succcessful VBAC:*

3 times more likely for mother to need a hysterectomy

5 times more likely to have a thromboembolic disease (deep venous thrombosis or pulmonary embolism)

1.5 times more likely to develop endometriosis

4 times more likely for mother to die

***Keep in mind that the TOL (trial of labor group included 17,898 women total):

Those 17,898 included women who had more than 1 previous cesarean and a variety of incision types which could put them at greater risk than most women who attempt VBAC with just 1 prior c-section and a low transverse scar.:

Breakdown of the number of previous cesareans:
• 16,915 (94.5%) had 1 prior cesarean
• 871 (4.9%) had 2 cesareans
• 84 (0.5) had 3 cesareans
• 20 (0.1%) with 4 cesareans
8 women had an unknown prior # of c-sections

Breakdown of Incision type:
• 80.9% (14,483) had a low transverse incision (this is known to be the safest incision type to VBAC with)
• 0.6% (102) had low vertical incision (2 ruptures or 2.0%)
• 17.9% (3206) had unknown type of incision (15 ruptures or 0.5%)
• 0.6% (105) had Classical, inverted T or J (2 ruptures or 1.9%)
• 0.01% (2) had unclassified (0 ruptures)

Other risk factors:
About 25% of the women in the TOL group had their labors induced (with prostoglandins or pitocin) and/or augmented with pitocin which also increases risk of uterine rupture

About 25% of the women in the TOL group were less than 2 years from their previous c-section.

_source for this info:
NEJM
Volume 351:2581-2589 December 16, 2004 Number 25

Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery

Mark B. Landon, M.D., John C. Hauth, M.D., Kenneth J. Leveno, M.D., Catherine Y. Spong, M.D., Sharon Leindecker, M.S., Michael W. Varner, M.D., Atef H. Moawad, M.D., Steve N. Caritis, M.D., Margaret Harper, M.D., Ronald J. Wapner, M.D., Yoram Sorokin, M.D., Menachem Miodovnik, M.D.,
Marshall Carpenter, M.D., Alan M. Peaceman, M.D., Mary Jo O'Sullivan, M.D., Baha Sibai, M.D., Oded Langer, M.D., John M. Thorp, M.D., Susan M. Ramin, M.D., Brian M. Mercer, M.D., Steven G. Gabbe, M.D., for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network_

ETA: I did some of these calculations rather quickly so it would be worth double checking my numbers!!!!


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## majormajor (Nov 3, 2006)

Quote:


Originally Posted by *dlm194* 
Can you link me to some of the criticisms? I looked around and couldn't find any. I liked to see criticisms of studies.

here is a letter that appeared in birth http://www3.interscience.wiley.com/c...3592/HTMLSTART

i am irked that macdorman didn't publish the revised #s in the abstract like she did with the initial #s. i can't find them.

anyway, i was reading back and realizing that i never further clarified why i like the VBAC vs. ERCS studies as a proxy for elective primary cs. vs. primary vaginal birth. basically, i focus on the studies that enroll healthy, full-term and low-risk women (because when i was doing my VBAC research, that was what i planned to be). so, the neonatal mortality and major morbidity of the ERCS group should give you some idea of the risk due to c/s in a healthy, full-term, low-risk group of women.

a second assumption is that a first c/s would not be more dangerous for babies than a second c/s (any woman in a VBAC study obviously has already had at least one c/s), which would only improve on the numbers. i doubt there's much of a difference though, if any. and, i've never seen a vbac vs. ercs study with ercs death rates of 1.77/1,000. i've seen 1/10,000 though.

so, that's my line of thinking with using the VBAC literature to get a hold on the risk of a first, elective c/s. does that clarify? however, i'm not an epidemiologist, so if anyone can tell my why i can't use the numbers from the VBAC studies to try to understand the risk from a c/s, please go ahead.


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## majormajor (Nov 3, 2006)

oh, i was looking at the maternal morbidity study you posted and saw a link to the revised macdorman numbers. it says:
_he finding that cesarean deliveries with no labor complications or procedures remained at a 69 percent higher risk of neonatal mortality than planned vaginal deliveries is important, given the rapid increase in the number of primary cesarean deliveries without a reported medical indication._

that means the macdorman #s drop to 1.05/1,000 for c/s vs. 0.62/1,000 for vaginal. the criticism that their birth certificate data is flawed still stands, though. so, the numbers are probably still pretty meaningless.


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## dlm194 (Mar 23, 2005)

That's a good point. Even Landon's study showed that the neonatal death rate was 1/2000 (0.05%) with ERCS. I thought I remembered reading that MacDorman's study went 1 month past birth. It appears to me that Landon's study just looked at babies that died right away (or never left the hospital). I'm just wondering if MacDorman's study included babies that may have died after leaving the hospital the 1st time (e.g a baby who went home and died at 3 weeks old). I'm not sure! I still believe there are too many other complications related to c-sections that would certainly not make them "safer" but I am now curious about the risk of death.


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## majormajor (Nov 3, 2006)

i wish there was more info too. interesting about macdorman and outcomes up to 1 month... i am being lazy in not looking this up, but there are different measures of mortality that can be used: neonatal mortality, perinatal mortality, intrapartum mortality (that one's during labor), but they each measure different time frames. but i don't know the definitions off the top of my head, and i'm too tired to look them up (you know it's bad when you're too tired to google something)
i am kind of wishing that i'd at least blogged about my vbac research while i did it. it was such a neat journey for me, and i put a lot of time and effort into it, it would be nice to have a record of that, both for myself and for anyone who was interested in what i read and how it changed my feelings about the kind of birth i wanted with DD2. and you know, i said the same thing to myself while i was researching vaccines... and i didn't, and i'm kicking myself for that too. but instead i subject poor mothering.com members to my half-baked, semi-coherent ramblings, because i never hashed them out in writing for myself. perhaps my siggy should just contain a pre-emptive apology.


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## Storm Bride (Mar 2, 2005)

majormajor: Thanks for the laugh. I feel the same way. I did so much digging and research over the last few years, but now I remember my conclusions, and almost none of what I used to get there! It's very frustrating.


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## majormajor (Nov 3, 2006)

i blame the kids and my lack of a good night's sleep (co-sleeping!).









i know, we can all put content advisories in our siggies. something like WARNING: the ideas contained above are the product of a mind so tired it has been known to hallucinate.

actually i think that really might have to go into my siggy. just as soon as i finish playing doo-dop (she's a puppet) for my 3 year old.


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## buko (Feb 29, 2012)

Quote:


> Originally Posted by *Dewberry*
> 
> Quote:
> 
> ...


I know this is an ANCIENT thread, but I just had to respond to this for posterity-- it is absolutely NOT illegal to have a 100% C/S hospital (in the US). Aside from the fact that it would be just as difficult to proscribe a 100% C/S rate as to proscribe all homebirths (unassisted), I have actually come across more than a couple of hospitals with a 100% C/S rate. Granted, we are generally talking about hospitals with special circumstances and a tiny number of overall births, but they do exist. For example, scroll down to the bottom of this page and you'll see two:

http://www.cesareanrates.com/florida-cesarean-rates/

Just sayin'. I have no idea why (except that it sounds outrageous) someone would think it's illegal.

Furthermore, there are hospitals with much larger numbers of births that have de facto ~75% C/S rates-- they are also on that page, just listed closer to 50-60% (they'd undoubtedly be at closer to 75% if not for people showing up pushing). Oh, and this page...

http://www.cesareanrates.com/texas-cesarean-rates/

...has several more hospitals with 50%+ rates and a hospital with over 200 births and a 100% C/S rate. So, there ya go.


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## member234098 (Aug 3, 2002)

Q


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## falafala (Sep 16, 2008)

C-sections are more dangerous for both mother and baby, yet they have become so trivialized by our society. It is major surgery and a whole host of things can go wrong. I have a dear friend who had her 3rd c-section and after a lot of complications ended up losing part of her bowel and still has trouble eating lots of things. It is major surgery!

Here is a great list about the dangers of unneeded c-sections. http://yourpregnantback.com/2012/05/whats-so-bad-about-a-c-section.html


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## member234098 (Aug 3, 2002)

Q


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## buko (Feb 29, 2012)

Actually, I don't mind that kind of doctor being in obstetrics! I say leave surgery to the surgeons, and have MWs attend normal births.


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## CI Mama (Apr 8, 2010)

Quote:


> Originally Posted by *buko*
> 
> Actually, I don't mind that kind of doctor being in obstetrics! I say leave surgery to the surgeons, and have MWs attend normal births.


I agree that the world would be a better place if there were more trained, competent midwives in it, and if there were fewer barriers to women choosing a midwife for their prenatal and birth care.

But there will always be women for whom a hospital birth with an OB is the only reasonable choice, and we deserve competent care, too. I don't think it's outrageous to expect OBs to understand and support natural birth, as well as being versed in procedures such as c-section, and I think that OBs should be held to high standards of quality, compassionate care for women.


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## MeepyCat (Oct 11, 2006)

In regards to how doctors are paid and financial incentives to surgery - it should get a great big fat "It Depends."

Some doctors are on salary. I delivered both my kids at teaching hospitals, using OBs and MWs who worked in clinics at those hospitals. The doctors were on salary and were scheduled for a certain number of days per week seeing patients in clinic, and a certain number of shifts on L&D. Same for MWs. When you came in to deliver, whoever was on shift delivered your baby. This is a pretty good system, because it removes many incentives for the doctor to manipulate the method and timing of delivery - how and when you deliver affected neither their pay nor their hours (although the OB and the nursing team did stay over the end of their shifts to see me through when DS was born). Their c-section rates were still higher on weekdays, because scheduled c-sections and inductions all took place then.

The Boston Globe (sadly paywalled) did an article about c-section rates in MA hospitals last year, in which they discussed hospital staffing models and their relationship to c-section rates. The staffing model I've described is correlated with lower rates of surgical delivery. There are plenty of doctors in private practice, with admissions privileges at hospitals with different models, and without hospitalists. Those staffing models are associated with higher c-section rates, for purely practical reasons. If you have multiple OBs and dedicated anesthesiology on the L&D floor all the time, you can call a section with very little notice. That means you can afford to do a certain amount of waiting and seeing. If there's no hospitalist, and nurses have to page the patient's OB to come in for delivery, they have to be aware of the potential for surgery from a much earlier point - they should page the moment they have the slightest indication of trouble, since it can take the OB 30-60 minutes to get there. And then the OB is much more likely to go ahead and push for surgery, since his or her schedule is already in shambles, and they only get paid if they do something.

Unfortunately, the salaried staffing model is expensive, and only practical where there's a high patient load.

Doctors/Hospitals may be able to bill more for surgical delivery, but that doesn't mean that they *make* more. C-sections are far more expensive than vaginal deliveries - they involve more professionals (doctors, nurses, and a pediatric team), more equipment, more supplies, more drugs, more janitorial services. At the end of the day, vaginal delivery, even with all the waiting around, is probably more profitable. There are always more L&D rooms then there are operating rooms.

Additionally, it's totally unsurprising to me that hospital stays associated with c-sections are longer than those associated with vaginal delivery. Hospitals are legally required to let you stay twice as long after a c/s as they are after a vaginal delivery.

C-section is correlated with higher risks, but I wonder how many of those risks are related to confounding factors. I'd love to see a breakdown of indications for c-section, and the outcomes of those sections. My suspicion is that c/s performed on maternal request, or for indications without implications for maternal health (like breech positioning) have outcomes that are pretty similar to uncomplicated vaginal delivery in the long-term (after the first month or so). The short-term, of course, is going to look very different.

I've had one complicated (instrumental) vaginal delivery and one medically indicated c-section. I preferred the c-section, frankly. It was a lot easier for me to deal with the scar on my belly than it was to deal with labial and perineal tearing, both physically and psychologically. I think most people (me included) would prefer uncomplicated vaginal delivery, but sometimes there comes a point when you realize that it's not going to go that way and you need to redo your math. When DS was born, I was really grateful to the OB who "let" me push for five hours, with a failed epidural and a mounting fever. After DD's birth, I realized that some things about DS's arrival were really dumb and dangerous. I should probably have had a c-section. In the end, everything turned out fine (after the first month or so), but there were some significant risks to both of us, which I would not choose to run again. I wish I hadn't been so unreasonably frightened of surgery.

Overall, I think we women and babies would benefit from more frank, accurate, unemotional discussions of c-section. We largely can't make our decisions about how we deliver on the basis of statistics, we have to consider our own situations, and we won't necessarily even know what those situations are going to be until we're in them.


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## CI Mama (Apr 8, 2010)

Quote:


> Originally Posted by *MeepyCat*





> Overall, I think we women and babies would benefit from more frank, accurate, unemotional discussions of c-section. We largely can't make our decisions about how we deliver on the basis of statistics, we have to consider our own situations, and we won't necessarily even know what those situations are going to be until we're in them.


MeepyCat, I love your whole post, but especially this. C-sections arise out of so many different individual situations. Let's find models of care that can help all women have better births, even when really difficult decisions are inevitable and trauma is unavoidable.


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## member234098 (Aug 3, 2002)

Q


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## CI Mama (Apr 8, 2010)

Quote:


> Originally Posted by *miriam*
> 
> Why doesn't a woman who wants a home birth with a midwife deserve *competent care*? Who is putting those *barriers* up?
> 
> I had my children at home, 1970s. My mother had her children at home, 1950s. Why should any one tell a woman where to deliver and what is safer for her?


Miriam, I think I am not expressing myself clearly, or maybe you are not understanding my meaning.

I believe ALL women deserve competent care. I believe that home birth with a midwife is the best care choice for many women, but not for all. I believe that many barriers exist the prevent women from choosing a home birth or their best model of care. There are financial barriers, insurance hurdles, legal obstacles. Women can be limited because of their geographic location or their socioeconomic class or the maternity leave policies of their workplace. There is racism and homophobia and prejudice against women with disabilities. I'd like to see us work to remove those barriers.

Why should any one tell a woman where to deliver and what is safer for her? No one should. All women should have access to quality care, and should have the tools to assess for themselves what the best care is for them. I'm not arguing anything different.

I'm just trying to say that some women will birth in hospitals under the care of OBs, and some women who want to have home births or work with a midwife will be transferred because of complications. Those women shouldn't be thrown to the dogs. Good care should exist everywhere, and OBs and hospitals should be held to high standards. In my opinion, doing so doesn't undermine homebirth or midwifery in any way.


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## hildare (Jul 6, 2009)

Quote:


> Originally Posted by *CI Mama*
> 
> Miriam, I think I am not expressing myself clearly, or maybe you are not understanding my meaning.
> 
> ...










CI Mama has the wise.


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## member234098 (Aug 3, 2002)

Q


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## buko (Feb 29, 2012)

Quote:


> Originally Posted by *CI Mama*
> 
> I agree that the world would be a better place if there were more trained, competent midwives in it, and if there were fewer barriers to women choosing a midwife for their prenatal and birth care.
> 
> But there will always be women for whom a hospital birth with an OB is the only reasonable choice, and we deserve competent care, too. I don't think it's outrageous to expect OBs to understand and support natural birth, as well as being versed in procedures such as c-section, and I think that OBs should be held to high standards of quality, compassionate care for women.


True, I was being a bit glib.


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## hildare (Jul 6, 2009)

Quote:


> Originally Posted by *miriam*
> 
> (?) Have no idea what that means; it would be nice if people did not use vinaculars that are understood between them. This impedes communication.
> 
> ...


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## member234098 (Aug 3, 2002)

h


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## MeepyCat (Oct 11, 2006)

Quote:


> Originally Posted by *miriam*
> 
> I know that there are plenty of L&Ds. My point is that if a hospital has an L&D, it is rarely used.


Miriam, this statement confuses me greatly. The only hospitals I know of that do not have L&D units are those that don't do obstetrics at all (which is, I admit, a growing number, but those hospitals transfer laboring patients, the only deliveries they do are precipitous ones in the ED). Those units are in constant use, and all laboring patients are sent there. So I can only think that you mean something by L&D that the rest of us don't. Could you please explain?

Homebirth is not necessarily cost effective - it's cheaper, in monetary terms, if you consider *only* the cost of the delivery, and if the delivery goes smoothly. If things don't go well, the costs mount exponentially and instantaneously. Furthermore, home is an environment in which there is no chance of pain relief, which many women want, and which they should be able to get.

It's hard to have this conversation when you insist that women who want ceseareans, or who schedule them in advance, are deceived, misled, or frivolous, without considering the possibility that they're educated, informed, and doing the best they can to deal with the challenges of their lives.


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## Serenity Now (Mar 29, 2004)

Quote:


> Originally Posted by *MeepyCat*
> 
> Miriam, this statement confuses me greatly. The only hospitals I know of that do not have L&D units are those that don't do obstetrics at all (which is, I admit, a growing number, but those hospitals transfer laboring patients, the only deliveries they do are precipitous ones in the ED). Those units are in constant use, and all laboring patients are sent there. So I can only think that you mean something by L&D that the rest of us don't. Could you please explain?
> 
> ...


Agreed. I wonder, if one supports "birth choice" why doesn't one also support a woman's choice to birth in a hospital? To have an epidural? To have an induction? To have a C-section? If a woman makes an informed choice, should that not always be supported? Or do we only support people who make decisions identical to ours?


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## member234098 (Aug 3, 2002)

Y


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## Serenity Now (Mar 29, 2004)

Quote:


> Originally Posted by *miriam*
> 
> Your ignorance of homebirth and its practice is showing.
> 
> ...


Are you talking about me? I've been here almost as long as you have. Why on earth would you think a member that has been here for 8 years works for a hospital? I am a mother by occupation, and have been for 10 years. Perhaps I'm also an educated woman who isn't afraid to ask difficult questions.

I'm not talking about support from OB's, but from other women, which is vitally important to all mothers. So, if a woman chooses to give birth in a hospital with interventions, but otherwise she is an AP natural mother, you will not support her? I believe there is very little support for a woman like that. She's too "hippie" for other moms, and isn't "good enough" for MDC. Where does she go?

As for the second part of the paragraph where you say "you can have your choice and you are on your own. Depending on where a woman lives, that can be a daunting task, so many give up." Does that mean that you support legislation and governing bodies over midwifery? Because if not, then how is a woman to find a good midwife? Physicians have review boards and you can look up their lawsuits and any disciplinary actions, plus, if they screw up badly or often enough, their medical licenses are revoked. There are also nationwide standards with regards to their education and training. Is this what you want for midwives?

I don't think anyone is saying you have to defend homebirth, but rather saying that we should support all women who are making educated choices, and not shoving them on the fringe with insults because their choices or life experience are different from yours. Every mother has a different story. None is better than the other.


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## Kelly1101 (Oct 9, 2008)

I'm still hung up on L&Ds being rarely used in hospitals. What does this mean?


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## Serenity Now (Mar 29, 2004)

Quote:


> Originally Posted by *Kelly1101*
> 
> I'm still hung up on L&Ds being rarely used in hospitals. What does this mean?


I think this means that she hasn't had a baby in 20 years, and none of them were in a hospital.


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