# "Too Posh to Push"



## FitMama (Jul 20, 2003)

LA Times Article today. Increasing acceptance of elective Cesarean births.









Link:

When 'natural' seems too risky


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## Snowdrift (Oct 15, 2005)

I can hardly wait. This person is projecting that c-sec's will not peak until they reach 60%. Freakish.

Personally though, if I was planning a birth with half a dozen people standing in a circle screaming at me to push harder and not to breathe while staring at my genitalia, I'd probably also want a c-sec.


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## sapphire_chan (May 2, 2005)

Huh, a good portion of that article, all the stuff about incontinence, seems to actually be an argument against episiotomies.


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## philomom (Sep 12, 2004)

Ick. I so-o could not wrap my head around this.


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## Undercover Hippie (Sep 7, 2004)

Hmm. Well, the article as a whole seemed to portray both sides fairly well. They did cite most of the newest research I've read (both pro and con). I am irritated that there's no recognition that many of the problems after vaginal births aren't due to the method of birth, but to the way vaginal births are handled by a typical OB. I'm also floored by this:

Quote:

Dr. Patrick Culligan, an obstetrician at the University of Louisville Health Sciences Center, did a statistical analysis of risks and costs, published in the International Urogynecology Journal online in July 2004. He estimated that if 100,000 hypothetical women chose planned surgery over vaginal delivery, the result would be 16.6 fewer permanent nerve injuries to babies' shoulders, a rare side effect of complicated vaginal delivery. He also predicted that there would be 185.7 fewer cases of anal incontinence in women as they aged, and an overall cost savings of $3.2 million.
How can that monetary value be right? C-sections cost so much more, how can doing them on everyone save money?

For me, even though I can never in a million years imagine choosing an elective c/s, I feel like I've got to support that choice. I don't want to but I can't rationalize supporting one woman's choice over another. So really, I think every woman should have a choice to birth however she wants, from planned c/s to planned UC and everything in between. I'd like to see a lot more education and a lot more fairness though--if someone can choose a c/s and get their insurance to cover it, then I shouldn't have to fight and fight and fight to get my HB covered.


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## Undercover Hippie (Sep 7, 2004)

Quote:


Originally Posted by *sapphire_chan*
Huh, a good portion of that article, all the stuff about incontinence, seems to actually be an argument against episiotomies.


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## minkajane (Jun 5, 2005)

Quote:


Originally Posted by *tie-dyed*
Personally though, if I was planning a birth with half a dozen people standing in a circle screaming at me to push harder and not to breathe while staring at my genitalia, I'd probably also want a c-sec.











I agree!


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## huggerwocky (Jun 21, 2004)

I can't read the article because it wants me to log in.

Anyway, I am one of those women who will elect to have a c-section. I believe everyone should have the right the brith as she wants to, but then I'm just one of those "too posh to push" .


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## NYCVeg (Jan 31, 2005)

What I don't understand about the "too posh to push" mentality is...

What's posh about being catheterized and peeing in a bag?
What's posh about a longer and often far more painful recovery?
What's posh about scarring?
And why is being cut across your abdomen so much more pleasant than POSSIBLY having a small tear elsewhere?

I just cannot for the life of me fathom why people think a c-section is somehow easier and more dignified than a vaginal delivery (although I do think "standard" vaginal delivery in a hospital is pretty undignified most of the time!).


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## Peppamint (Oct 19, 2002)

Quote:


Originally Posted by *sapphire_chan*
Huh, a good portion of that article, all the stuff about incontinence, seems to actually be an argument against episiotomies.

I've noticed that. These studies and doctors automatically assume that I won't eat well and exercise, that I'll allow someone to make me labor in bed, push in the lithotomy position, give me an nice deep episiotomy and chant push push push while I push at full dialation until I burst blood vessels- with or without the urge to push.









<shudder>


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *NYCVeg*
What I don't understand about the "too posh to push" mentality is...

What's posh about being catheterized and peeing in a bag for three days?
What's posh about a longer and often far more painful recovery?
What's posh about scarring?
And why is being cut across your abdomen so much more pleasant than POSSIBLY having a small tear elsewhere?

I just cannot for the life of me fathom why people think a c-section is somehow easier and more dignified than a vaginal delivery (although I do think "standard" vaginal delivery in a hospital is pretty undignified most of the time!).

Not sure where you derive your information from but women who have csections are not cathed for three days. Some who have complications after surgery possibly, but the cath is usually out in 12-24 hours. Also, you assume that its a far more painful recovery -- my last two csections were a breeze to recover from. Far better than many vaginal births, even some homebirths, I know of. My friend who had a emergency csection ten weeks ago said it was far easier than her vaginal birth and that had she been able to elect if for her first birth, she would have. (note she had a natural birth for the first)
While I do have a scar, its pretty faint now and I would rather have my six inch cut there then a third or fourth degree tear in my vagina.

Don't get me wrong, I am all for people having the right to choose the birth they want. And I believe in natural childbirth and homebirth, but also support a woman's right to choose a csectoin if that is what she wants and feels is best for her. Its about freedom of choice, for everyone, even when they don't agree with you.

Kim


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## NYCVeg (Jan 31, 2005)

Quote:


Originally Posted by *OnTheFence*
Not sure where you derive your information from but women who have csections are not cathed for three days. Some who have complications after surgery possibly, but the cath is usually out in 12-24 hours. Also, you assume that its a far more painful recovery -- my last two csections were a breeze to recover from. Far better than many vaginal births, even some homebirths, I know of. My friend who had a emergency csection ten weeks ago said it was far easier than her vaginal birth and that had she been able to elect if for her first birth, she would have. (note she had a natural birth for the first)
While I do have a scar, its pretty faint now and I would rather have my six inch cut there then a third or fourth degree tear in my vagina.

Don't get me wrong, I am all for people having the right to choose the birth they want. And I believe in natural childbirth and homebirth, but also support a woman's right to choose a csectoin if that is what she wants and feels is best for her. Its about freedom of choice, for everyone, even when they don't agree with you.

Kim

Okay...I changed the "three days" thing. I was sort of speaking hyperbolically.

Fourth degree tears (and most third degree tears) to the vagina are caused almost exclusively by episiotomies, not normal vaginal deliveries.

I don't "assume" it's a more painful recovery. Statistically, it is. All of the studies that I've come across of on c-sec vs. vaginal delivery say that sections lead to more painful and longer recovery times, on average. That doesn't mean that EVERY woman will have a worse recovery with a section, but that she women are statistically likely to. In one study, for instance:
25% of women reported pain 2 weeks after their c/s
15% reported pain at 8 weeks, including difficulty with normal activities, such as bending, getting out of bed and caring for their babies
(This particular study is cited in Henci Goer's Thinking Woman's Guide to a Better Birth.) I'm perhaps more sensitive to this now b/c a friend of mine was bullied into an unnecessary c/s by her OB and ended up with a horrible and long recovery. She was basically unable to care for her child for weeks and had to hire outside help and she is in deep mourning about the bonding she lost immediately after the birth and in the weeks that followed.

The risks of complications are also much higher with a c/s. Sections have higher maternal mortality rates (numbers I've read, from different sources, are that moms are anywhere from 500-700% more likely to die as a result of an elective c/s). Problems associated with the surgery--hemmorage, blood clots, infection, etc.--are also far less likely with a vaginal birth. C/s babies are more likely to have lower Apgar scores and have difficulty breathing and 1-6% of babies are cut in the surgery itself (the risk is higher for breech babies). Having a c/s also increases the risk of uterine rupture and hemmorage in future pregnancies and deliveries, and the risk of ectopic pregnancies.

To me this is less about choice than about practicing responsible medicine. Personally, I believe that performing an elective c/s, in the absence of medical complications warranting surgery and particularly for first-time mothers, borders on malpractice. For a healthy mother and baby, the risks are more serious and more likely. Healthy bodies were designed to give birth vaginally, and I don't just think that there is a good argument that it is safer or more convenient to have major surgery to remove your baby (which is not to say that I don't think that c/s are a blessing for moms or babies with serious complications). Can you imagine if I walked into an ER with kidney stones and demanded that a doctor perform surgery on me to remove the stones because I didn't want to endure the pain of passing them? No responsible doctor would do this.

Now, if one is REALLY well-informed and knows all the risks and still elects to have the c/s, then I can see your point about choice, although I'm not sure I totally agree with it. But very few women take the time to truly research and take responsibility for decisions about their health--MDC is a very abnormal community in this way. In my experience, talking with OBs, doctors systematically downplay the risks of c/s and overplay the risks of vaginal births (same with episiotomies--a family friend who is an OB is STILL trying to convince me that episiotomies are safer and lead to less tearing, even though every single study on them AND the ACOG disagrees with him; he also says that he "would do a c/s every time if he could, b/c they're so much safer").


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## Peppamint (Oct 19, 2002)

I agree Amanda... "in general" the recovery from a c/s is harder. Granted, I have an acquaintance who had a c/s, then vaginal and another c/s. She said the vaginal was the hardest- BUT she also had a hospital birth with the standard interventions including unfortunately an episiotomy <shudder>.


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## NYCVeg (Jan 31, 2005)

Quote:


Originally Posted by *busybusymomma*
I agree Amanda... "in general" the recovery from a c/s is harder. Granted, I have an acquaintance who had a c/s, then vaginal and another c/s. She said the vaginal was the hardest- BUT she also had a hospital birth with the standard interventions including unfortunately an episiotomy <shudder>.

As with all things, you can find plenty of anecdotal evidence on both sides. I'm much more convinced by large-scale studies. I also think the statistics would skew much more in favor of vaginal birth if (medicalized, hospital) vaginal birth in this country was not designed in a way that inhibits virtually all of your body's natural coping mechanisms (e.g., epidurals that suppress the natural release of oxytocin, pitocin that makes contractions harder and longer than they would be, monitors and IVs that restrict movement, lying a position that decreases the amount of oxygen the baby can get, pushing against gravity, episiotomies, bright lights and unfamiliar surroundings, etc.).


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## goodcents (Dec 19, 2002)

HOLY MOLY!!!!

Are there people right here on this very thread advocating for _elective_ C-birth??

I thought this was a *natural* family living site?


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## tinyshoes (Mar 6, 2002)

Hey now.... even bloodletting had it's fans back in the day.

The next vogue will be colostomy bags...do you *really* think megastars like Britany Spears actually poop _the same way_ you do?!?!?!?!?


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## OnTheFence (Feb 15, 2003)

I am going to try and do this point by point.

"Fourth degree tears (and most third degree tears) to the vagina are caused almost exclusively by episiotomies, not normal vaginal deliveries. "

Really? I have read numerous homebirth forums including the one here where 3rd and fourth degree tears took place. Of the 4th degree tears I personally know people having, none of them resulted from an episiotomies.

"I don't "assume" it's a more painful recovery. Statistically, it is. All of the studies that I've come across of on c-sec vs. vaginal delivery say that sections lead to more painful and longer recovery times, on average. That doesn't mean that EVERY woman will have a worse recovery with a section, but that she women are statistically likely to. In one study, for instance:
25% of women reported pain 2 weeks after their c/s
15% reported pain at 8 weeks, including difficulty with normal activities, such as bending, getting out of bed and caring for their babies
(This particular study is cited in Henci Goer's Thinking Woman's Guide to a Better Birth.) I'm perhaps more sensitive to this now b/c a friend of mine was bullied into an unnecessary c/s by her OB and ended up with a horrible and long recovery. She was basically unable to care for her child for weeks and had to hire outside help and she is in deep mourning about the bonding she lost immediately after the birth and in the weeks that followed."

I think recovery is subjective myself. Anyway, I will say that while statisticly (and they are skewed often to fit the bias of whomever is interpreting them) may show that csection are more difficult to recover from, I think on this forum it is highly exagerated. The biggest problem with cesarean recoveries is the lack of information given to patients in boosting their recovery. While I would be interested in reading the EXACT study quoted above, I wonder how many who have vaginal births experience pain at 2 weeks. Most I know of.

"The risks of complications are also much higher with a c/s. Sections have higher maternal mortality rates (numbers I've read, from different sources, are that moms are anywhere from 500-700% more likely to die as a result of an elective c/s). Problems associated with the surgery--hemmorage, blood clots, infection, etc.--are also far less likely with a vaginal birth. C/s babies are more likely to have lower Apgar scores and have difficulty breathing and 1-6% of babies are cut in the surgery itself (the risk is higher for breech babies). Having a c/s also increases the risk of uterine rupture and hemmorage in future pregnancies and deliveries, and the risk of ectopic pregnancies."

I think you find that cesareans are fairly safe. While they may not be as safe as vaginal births, they are for the most part safe for mom and baby. Also I would LOVE to see the sources that a mom who has an elective csectoin has an increased rate of death of 5-700%. Thats complete rubbish and exageration if I ever read one. Of course natural vaginal birth is ideal and safer, but when dealing with individuals and their own health the ideal can easily change. I can clearly tell you that I had two wonderful cesareans which were pretty painless with excellent recoveries. Also had healthy, nursing babies that were not damaged at all by the surgery. Also, I think its unfair to really say that csection babies fair worse -- often csection babies are being delivered by csection because they are having problems during birth which would result in them having problems breathing and lower apgar scores. Its all a matter of perspective.

"To me this is less about choice than about practicing responsible medicine. Personally, I believe that performing an elective c/s, in the absence of medical complications warranting surgery and particularly for first-time mothers, borders on malpractice. For a healthy mother and baby, the risks are more serious and more likely. Healthy bodies were designed to give birth vaginally, and I don't just think that there is a good argument that it is safer or more convenient to have major surgery to remove your baby (which is not to say that I don't think that c/s are a blessing for moms or babies with serious complications). Can you imagine if I walked into an ER with kidney stones and demanded that a doctor perform surgery on me to remove the stones because I didn't want to endure the pain of passing them? No responsible doctor would do this."

Actually they do, especially for children. You should read up on the new therapies they are performing to break up stones so people can't pass them. Just because you believe its irresponsible doesnt make it so. Women should have the right to choose how they give birth, whether that be in their living room, back yard or the OR. Csections are safe. Safer is in the eye of the beholder. I don't want anyone telling me I have to carry a baby to term, much less if I do how to birth it. Its no one elses business.

Kim, supporter of choice
Now, if one is REALLY well-informed and knows all the risks and still elects to have the c/s, then I can see your point about choice, although I'm not sure I totally agree with it. But very few women take the time to truly research and take responsibility for decisions about their health--MDC is a very abnormal community in this way. In my experience, talking with OBs, doctors systematically downplay the risks of c/s and overplay the risks of vaginal births (same with episiotomies--a family friend who is an OB is STILL trying to convince me that episiotomies are safer and lead to less tearing, even though every single study on them AND the ACOG disagrees with him; he also says that he "would do a c/s every time if he could, b/c they're so much safer").[/QUOTE]


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *busybusymomma*
I agree Amanda... "in general" the recovery from a c/s is harder. Granted, I have an acquaintance who had a c/s, then vaginal and another c/s. She said the vaginal was the hardest- BUT she also had a hospital birth with the standard interventions including unfortunately an episiotomy <shudder>.

Most women are not educated on how to help their recoveries from csections or any surgery for that matter. If women were informed, and allowed to make educated choices about their recoveries they would be better. Also keep in mind that many csections take place after long labors, difficult labors, or other complications which can compound a recovery. With my two elective csections I was better prepared to facilitate a healthy recovery.


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *goodcents*
HOLY MOLY!!!!

Are there people right here on this very thread advocating for _elective_ C-birth??

I thought this was a *natural* family living site?

Yes, I am. Just like I am prohombirth, I am procsection. Its about choice. The right to choose to do what you want with your body. Its a fundamental right.

Kim


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## boobybunny (Jun 28, 2005)

I have to chime in here.

I have had three vaginal births and one hysterectomy.

I never needed narcotic pain relievers after a vaginal birth.


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## FitMama (Jul 20, 2003)

Sorry about not quoting the article in my OP. I totally forgot that the article would go to a login type situation after the first 24 hours. How much can I quote and get away with?

"Too posh to push" is what some OBs call their high income, executive type patients who prefer to schedule their cesarean sections instead of waiting for labor to begin on its own.


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## mamato3cherubs (Nov 30, 2004)

I just want to say that this thread is crazy







and a bit disturbing really. hmmmmm


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## tinyshoes (Mar 6, 2002)

"To Posh to Push" is also the title of an article from Time magazine, the April 19, 2004 issue. At that time, almost 2 years ago now, the c-sec rate in the US was at the highest ever, 26%, up 150% from 1975.


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## Thmom (May 4, 2004)

I too am all for a woman choosing, however the problem is that OB's do not give a an accurate picture of what a cesection entails, nor do they give an accurate picture of how it can affect a woman's future choices. This article doesn't even do that.. "less likely to have anal incontinece" ??? vaginal birth doesn't cause anal incontinece, lost of things can and the mis-handling of a vaginal birth can certainly contribute but so can the slip of a scalpel during a c-section... actualy bladder lacerations are quite common during a c-section.

The point is that for women to truly have a choice they need all the facts, including how a section can limit thier future birthing choices, that a managed vaginal delivery increases thier risk for pelvic damage, that any medication used during labor/birth transfers to the baby and may have long term effects including issues with breastfeeding and the bonding experience of mothers... etc etc... there are so many things that the average woman isn't aware of
and if she's not aware of them how can she truly make a choice?

and it's 5-700% more likely to die, doesn't mean that 5-700% die just that the risk factor is higher. It's like saying 5-7 times more likely.

according to this study, it's 4x's more likely

Quote:

Perinatal mortality rate - babies that die:
3 per 1000 for planned vbac
4 per 1000 for elective cesarean

Maternal mortality rate - moms that die:
2.8 per 10,000 with a trial of labor
2.4 per 10,000 with an elective cesarean

The risk of a mother dying from a cesarean is small but is still considerably higher than with a vaginal birth:
Maternal death with cesarean: 4 in 10,000
Maternal death with all vaginal births 1 in 10,000
Maternal death with elective cesareans 2 in 10,000
Maternal death with all normal vaginal births 0.5 in 10,000

Countries with some of the lowest perinatal mortality rates in the world have cesarean rates under 10%. The World Health Organization says, "Clearly there is no justification in any specific region to have more than 10-15% cesarean section births."

The infant mortality rate in the US is currently 6.9/1,000. This report states "The United States continues to rank poorly in international comparisons of infant morality."

The maternal mortality rate in 1996 (the last year statistics were available) was 12 per 100,000 births. There has been no decrease in maternal mortality in the US for 20 years according to a Mortality and Morbidity Weekly Report.

Sources:
Trends in Cesarean Birth and Vaginal Birth After Previous Cesarean, 1991-1999
National Vital Statistics Reports, Volume 49, Number 13, December 27, 2001
A Guide to Effective Care in Pregnancy and Childbirth, Chapter 38, Labor and birth after previous cesarean, M. Enkin, M.J.N.C. Keirse, J. Nielson, C. Crowther, L. Duley, E. Hodnett, and J. Hofmeyr. Oxford University Press, 2000
Annual Summary of Vital Statistics: 2000, Hoyert DL, Freedman MA, Strobino DM, Guyer B. Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA


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## gentlebirthmothr (Jul 13, 2005)

fitmama,

Thank you for the link to the article. Personally, think this a bad option for the moms and the doctors who do it.


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## NYCVeg (Jan 31, 2005)

Quote:


Originally Posted by *OnTheFence*
I am going to try and do this point by point.

"Fourth degree tears (and most third degree tears) to the vagina are caused almost exclusively by episiotomies, not normal vaginal deliveries. "

Really? I have read numerous homebirth forums including the one here where 3rd and fourth degree tears took place. Of the 4th degree tears I personally know people having, none of them resulted from an episiotomies.

Yes, really. You can go to the ACOG website or search PubMed for one of the many studies done on episiotomies in the last 20 years. The reason ACOG now recommends against routine episiotomy is because they found that they were more likely to cause the very problem that they were supposed to prevent. As I said before, you can always find anecdotal evidence on both sides of issue. But statistically, your risk of a 3rd or 4th degree tear is FAR higher with an episiotomy--and most of the women in these studies were having hospital births, where the position of the mother makes her far more likely to tear. Does this mean that women who have homebirths or vaginal births NEVER have 3rd or 4th degree tears? Of course not.


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## Rainbow (Nov 19, 2001)

I really believe elective c-sections to be a step in the process of women reclaiming the birth process. Typically substantial change in history tends to go to an extreme, peak, and setlle back down.

Wealthy women went from hiring wet nurses [breastfeeding being only for the poor], then later to feeding their babies themselves without the breast [bottles], to a peak in formula usage, to it settling back down and women now having individual control over their option of feeding. Breastfeeding, I would guess now being on the slow rise.

While I prefered not to have a csection, I can support that women are taking contol over their births as a step in change.

We can all agree that it is important for women to have full


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## NYCVeg (Jan 31, 2005)

Quote:


Originally Posted by *OnTheFence*
I think you find that cesareans are fairly safe. While they may not be as safe as vaginal births, they are for the most part safe for mom and baby. Also I would LOVE to see the sources that a mom who has an elective csectoin has an increased rate of death of 5-700%. Thats complete rubbish and exageration if I ever read one.

Okay...try:
1) Rochat R W et al. Maternal mortality in the United States: report from the maternal mortality collaborative. Obstet Gynecol 1988; 103(5): 459-63
2) Schuitemake N et al. Maternal mortality after cesarean in The Netherlands. Acta Obstet Gynecol Scand 1997; 76(4): 332-34
3) vam Ham M A, van Dongen P W, Mulder J. Maternal consequences of cesarean section. A retrospective study of intra-operative and post operative maternal complications of cesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74(1): 1-6
4) Hall M. H. Commentary: confidential inquiry into maternal death. Br J Obstet Gynaecol 1990; 97:752-3

There's tons of research on the increased risk of c/s. If you go to PubMed and investigate, the preponderance of evidence is overwhelming. Even many of the perceived benefits of c/s (that c/s mothers are less likely to have urinary incontinence later in life, for instance) have been shown to be false.

You keep citing your personal experience, but I protest once again that anecdotal evidence is NOT statistically valid and should not be used by doctors/women in making most surgical decisions. That's like saying, "Well, I was spanked and I turned out fine, so spanking is okay." Or, "My kids did great on formula, so formula is just as good as breastmilk." Or put another way: Most infants who ride in cars without car seats will not be killed or seriously injured in accidents (because most of them will not be in accidents), but because the risk is HIGHER without a car sear, it is legally mandated that all infants be put in them.

Quote:

Safer is in the eye of the beholder.
Actually, it's more than that. I agree 100% that a woman may FEEL safer in a hospital than at a homebirth, for instance. But to me "safer" is what has been shown, over time, statistically, by an overwhelming number of reproducable studies and an aggregate of outcomes to be safe. Out-of-hospital birth, for example, has been proven in study after study to be as safe as hospital birth for the majority of low-risk women. C/s has never been proven to be as safe as vaginal birth, but has been proven to have more and more serious risks.

Quote:

Can you imagine if I walked into an ER with kidney stones and demanded that a doctor perform surgery on me to remove the stones because I didn't want to endure the pain of passing them? No responsible doctor would do this."

Actually they do, especially for children. You should read up on the new therapies they are performing to break up stones so people can't pass them. Just because you believe its irresponsible doesnt make it so.
I hardly want to get into this (as a person with recurring kidney stones, I do in fact know quite a bit about them), but I actually think it's relevant. For most people, the technology to break up stones is non-invasive (sound waves are used; it's an outpatient procedure). For some people with very severe stones that cannot be passed or broken up, surgery is the best option--this correlates to women who, for medical reasons, will likely fare better with a c-section (placenta previa, toxemia, etc.). For people who have smaller stones that can be easily passed, however, surgery is not performed, particularly because pain medications are effective treatments. It's beyond irresponsible--it's malpractice, plain and simple. My dad has a patient who has chronic, debilitating kidney stones (several times a year)--bad enough that she needs morphine to get through them. But because they are small and can be passed, no doctor in her many years of treatment has suggested surgery. It would simply cause more damage, pain, and difficult recovery, when the stones are passed in a relatively short amount of time.

In general, I agree with Thmom. While I personally believe that primary elective c/s borders on malpractice, I'm not saying they should be made illegal or anything. But it's more than "just a choice." Doctors have a responsibility to REALLY educate their patients on risks of elective surgery, both to themselves and their babies and not paint c/s as an "easier" solution to childbirth (which is what the "too posh to push" idea promotes). This is not likely to happen in a medical system where doctors have all the incentive in the world to perform c/s (it brings in more money, it can be "conveniently" scheduled, it takes less time, hospitals have c/s quotas, it gives doctors more control over births, it's a way of sidestepping malpractice suits, etc.). And women, of course, have a responsibility to REALLY educate themselves. But outside of this board, I rarely see that. When most women I know hear something from their doctors, they believe it. One (admittedly) anecdotal example to make this point: my VERY well educated sister (Ivy League college, business school, runs her own company) was told by her pediatrictian that "there are no real benefits to bfing after 3 months, so if you're having difficulty, you can just stop." So she stopped. Zero research. Zero investigation. Sadly, I think this is pretty typical.


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## liseux (Jul 3, 2004)

I read the article and I have also had a c/s & 2 vaginal births. The woman in the beginning of the article that chooses a section has a very valid reason to have a section IMO. The writer could have chosen a woman who chose a section just for convenience or because she was worried about stretching her vagina. Both seem like silly reasons for major surgery. The woman quoted had 2 miscarriages and a stillbirth. She obviously couldn`t trust pregnancy so why is it surprising if she couldn`t trust birth? I don`t blame her at all, and I`m sure not many of us here have walked in her shoes, so why judge?

On the other hand, scheduling a section for no good reason is scary because it can take us all further from what is normal and healthy. Yet, deciding whose section is necessary can be awkward and a waste of energy. I remember wondering why a friend had to have 3 sections while I was planning my 2nd home birth. I was like, doesn`t she know about VBAC? Later I learned that she had one emergency c/s transfer during a birth center birth, one baby die during a VBAC due to severe shoulder dystocia and the last one was planned at her request. Fellow natural minded mamas still asked her why in the world she was scheduling that third section. Like they had any clue what she went through.

When a similar situation happened to me, I was amazed at the judgemental attitudes in the natural community surrounding elective sections. All I can say is, I was the same way & if I hadn`t been unlucky enough to have all my well laid plans thwarted, I would still be that way. Those of you who have had everything go the right way, you are very fortunate, it could have been different. Everybody seems to agree that a small percentage of women really need a section, the tricky part is respecting people`s choices without picking them apart. Having a section for emotional reasons can be valid too.


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## aprilushka (Aug 28, 2005)

I don't care if women choose c/s (though I do care that so many women are coerced into c/s and I do care that the consequences to subsequent pregnancies are not typically discussed thoroughly by doctors with anyone having a c/s, planned or not). But what irritates me with these articles about choice, is WHERE THE HELL IS MY CHOICE FOR VBAC? That's being written about too, but less and some of the restrictions are getting close to being nonconstitutional, IMHO. The majority of docs won't attend them, a large number of hospitals (probably the majority of hospitals if not the majority of hospital beds, when you balance out small vs. large facilities) don't permit them and due to the bottom line of one insurance co., I couldn't have a VBAC pretty much with an OB in a hospital in the entire state of Oklahoma if I wanted to. A lot, if not most, birth centers can no longer get insurance coverage on VBAC. In some states midwives can't attend them at home (like NJ, where the c/s rate is the highest in the nation) legally, in many others required physician consent for mw-attended homebirths pretty much causes the same result. In most others the legal situation is grey as to HBAC and HBACers live in fear of CPS in case (God forbid) they do rupture at home or anything else goes wrong. I know why this is, I know the doctors are often put in a tough situation because of liability and insurance (which is one reason I'm not asking one to attend my VBAC), but the fact is, whereas a first time mom in my area could easily find someone to do her nonmedical c/s, my choices for VBAC are much more limited, esp if I want to maximize my chances of success rather just ending up with a c/s that's planned later rather than sooner (which is where many VBAC plans go ultimately once the doctor starts getting third trimester jitters).

As for what recovery is worse and the dangers of surgery vs. vaginal birth for a particular birth itself, there are arguments on both sides (although I would argue for the vast majority of babies and mothers vaginal birth produces overall better results), so in that case I say--- whatever works best for you. However, if a woman thinks there is a possibility she wants 3+ kids, then the odds tip much more heavily in favor of vaginal birth. After 2 c/s the numbers get worse for placenta accreta and after 3 c/s and esp after 4 c/s they are a lot scarier (why many doctors in addition to refusing to attend VBAC, will not take on a patient AT ALL in pregnancy (even for ERCS) who has had 3 or 4 c/s). There aren't a lot of studies on uterine rupture after multiple c/s, but it does go up and would include the risk of rupture prior to labor (ie, prior to one's scheduled surgery). Scar tissue also tends to get worse with each surgery which makes the surgery more complicated. So whereas I think one can balance the risks in a reasonable way to go either way up to 2 kids, after that I think it's pretty hard to argue that c/s is a safe alternative to vaginal birth. Of course, most women who choose c/s for no medical reason probably aren't planning on more than 2 kids. But what about those women who are and ended up with a primary c/s often b/c of their doctor's liability fears and find it almost impossible to find a VBAC attendant? Why do they not get to balance the risks and benefits and make the choice that's best for them? There was an article published (the abstract is on pubmed) that had a "decision tree" for VBAC based on the various risks of c/s vs TOL after c/s that made it clear that if a woman desired 3+ kids VBAC should be encouraged, yet instead doctors push the tubal at the second c/s, and many women who wanted more kids and wanted vaginal births but for whatever reason did not have them the first two times, tired of fighting, tired of the pain and emotional heartache they may have suffered from the surgeies they've had, give up their dream for a bigger family and give in and their doctor has essentially made their reproductive choices for them....last I heard, it's unconstitutional to make a reproductive choice for a woman.

So I support the choice to have a totally elective primary c/s, I just wish those electing it and the doctors supporting it would support VBAC too, but almost always they don't.


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## liseux (Jul 3, 2004)

"WHERE THE HELL IS MY CHOICE FOR VBAC?" Aprilushka

This is a good point & it should be equal. I would love to have a VBAC this time, but it is a slim possibility & so the rest of your post just scared the pants off me. I know those are real risks though & they need to be made clear to all pregnant women. How do people in Brazil and other places with super high section rates deal with these rising risks?

I see you are in No. Va, Aprilushka and planning an Hbac. Not for you, but other moms you might know, I know of a proVBAC female OB who delivers at Alex. hospital. Pm me if you ever want her info.


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## aprilushka (Aug 28, 2005)

Quote:


Originally Posted by *liseux*
"WHERE THE HELL IS MY CHOICE FOR VBAC?" Aprilushka

This is a good point & it should be equal. I would love to have a VBAC this time, but it is a slim possibility & so the rest of your post just scared the pants off me. I know those are real risks though & they need to be made clear to all pregnant women. How do people in Brazil and other places with super high section rates deal with these rising risks?

I see you are in No. Va, Aprilushka and planning an Hbac. Not for you, but other moms you might know, I know of a proVBAC female OB who delivers at Alex. hospital. Pm me if you ever want her info.

Thanks liseux, see your pm. I know your story and understand why you might make different choices from me.

As for Brazil (and some other Latin American countries), I imagine the doctors push the tubal after 2 or 3 c/s, although I haven't studied this question. The huge c/s rate is more among the middle and upper class in the cities, where people I think have fewer kids. Rural poor people are still more likely to have vaginal births (and more kids) in Brazil I think, so it's not the same issue for them (though they have all the issue of poverty and birth obviously). At any rate, I'd be interested in knowing what their national previa/accreta rate is compared to countries with low c/s rates and no restrictions on childbearing. China is the other big c/s place, and we all know about how many kids you are legally supposed to have there, so health wise it's a much smaller problem.


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## goodcents (Dec 19, 2002)

OntheFence....just curious

do you include shooting drugs as someone's right to do with their bodies what they like?

How about shooting while pregnant?


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## goodcents (Dec 19, 2002)

OntheFence....just curious

do you include shooting drugs as someone's right to do with their bodies what they like?

How about shooting while pregnant?


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *boobybunny*
I have to chime in here.

I have had three vaginal births and one hysterectomy.

I never needed narcotic pain relievers after a vaginal birth.

You didnt but some have.
Also, some homebirthers, not saying anyone here drink alcohol, smoke dope and do other drugs/herbs to help with pain relief during labor. I really don't see a difference.


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *goodcents*
OntheFence....just curious

do you include shooting drugs as someone's right to do with their bodies what they like?

How about shooting while pregnant?

They have the right to do it, buts its illegal and they should go to jail and their kids taken from them, especially if their child is born addicted.

This has nothing to do with elective csections.

The thing is, all the statistics pointing to greater risks during a csection are for ALL csections. Not elective ones. Many women who have csections have them due to problems during birth -- which is going to skew the actual risks associated with having a cesarean birth. My decision to have a planned csection has far different risks than a woman with HELLP syndrome or a woman who is having problems in birth.

While you can post risks and articles pointing out the risks of csections, until there are actual and completed studies strictly on planned, elective cesarean births those risks are not going to truly apply.

Kim


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## aprilushka (Aug 28, 2005)

Quote:


Originally Posted by *OnTheFence*
They have the right to do it, buts its illegal and they should go to jail and their kids taken from them, especially if their child is born addicted.

This has nothing to do with elective csections.

The thing is, all the statistics pointing to greater risks during a csection are for ALL csections. Not elective ones. Many women who have csections have them due to problems during birth -- which is going to skew the actual risks associated with having a cesarean birth. My decision to have a planned csection has far different risks than a woman with HELLP syndrome or a woman who is having problems in birth.

While you can post risks and articles pointing out the risks of csections, until there are actual and completed studies strictly on planned, elective cesarean births those risks are not going to truly apply.

Kim

I won't get into that (Maternity Center Association says it all in their document based only on the best studies), but all c/s elective or not produce greater risks of placental problems for subsequent pregnancies. It's a function of the scar and messing with the uterus, not how the surgery is done or circumstances or controlled and it's these risks that are usually the most dangerous consequence of c/s. So yes, if you only want one kid you can make your argument, but for 2 it gets tenuous and for 3+ you pretty much can't make it.


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## ~*~MamaJava~*~ (Mar 7, 2004)

This is kind of crazy, that we are even discussing this on MDC. It's a natural family living site...hence...natural birth. I'm just surprised, but I guess dialogue is always good so we're not just in our little bubble









I just want to say that in the SPECIFIC instance where someone chooses a csec because of cosmetic/convenience reasons, I think they are bananas. I get why some people have them - the ones who have lost babies during birth, or had stillborn babies. In their shoes I would seriously consider it. And I have two IRL friends who don't seem able to birth babies on their own - actually have the huge baby/small pelvis mismatch. What I dont get is those above reasons, and the ones I've met who are just too scared to give birth vaginally - the ones who also argue for the universal epidural because 'it's just so horrifically painful'. Okay, yes, sometimes the pain for some people is unbearable. But get over it, ok, lots of people can handle it and birth babies just fine without all that crap. And honestly, if you're too busy to have a baby when it wants to come, then maybe you should question the whole parenting thing. Kids are so darned inconvenient, aren't they?


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *aprilushka*
I won't get into that (Maternity Center Association says it all in their document based only on the best studies), but all c/s elective or not produce greater risks of placental problems for subsequent pregnancies. It's a function of the scar and messing with the uterus, not how the surgery is done or circumstances or controlled and it's these risks that are usually the most dangerous consequence of c/s. So yes, if you only want one kid you can make your argument, but for 2 it gets tenuous and for 3+ you pretty much can't make it.

The risks are still low. Its all about cost/benefit. The same measuring stick should be used for all statistics used in this venue, however it isn't. I have had three successful pregnancies without placental issues in a deformed uterus. My chance of having placental problems is greater than average, yet I was more than willing to take the risk, considering it was very very small.


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## morning glory (Dec 8, 2005)

I haven't read the article or all of the posts yet but this just strikes me as another situation where Dr.s think they know better and then 20 years down the road we all find out no, they didn't. But there is never any admission of a mistake. Its all the same story with different characters...formula is better than breastfeeding, babies should cry all on their own so they don't "manipulate" you, you should absolutely circumcise your son...its for his health (and don't worry babies don't feel pain), you should be strapped flat on your back for birth because the Dr's know how to control the situation, your baby should sleep on their stomach, no wait...side...hang on a sec...back. Thats right, back., you should only eat margarine its far better for your heart, sugar replacements are much better for you than sugar and 100% safe (okay so mainstream medicine hasn't back peddled on that one yet but its coming).







Do you think we ever reach the point where we see whats coming and just head it off at the pass?









Anyway...I think it will just be a matter of time til the dangers of extreme intervetions in birth (especially elective interventions) are another thing added to the list of medical "ooopsies".

And with all of that being said...I think it was OnTheFence who originally posted somthing along these lines...I have to agree with every woman's right to choose the birth experience she wants for herself. If you are against elective c-sections then you are also against elective homebirth, or water birth since those aren't the norm either...the beauty of a free society is that everyone gets to decide for themselves. Even if what they chose looks pretty stupid to the rest of us. And if we rule out elective c-sections then where do we draw the line? Is a woman who has had five failed vaginal births forced to attempt a sixth because we don't allow elective c-sections?

Enough rambling from me







...I'll go actually read the article now

Casey


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## mamato3cherubs (Nov 30, 2004)

Quote:


Originally Posted by *~*~MamaJava~*~*
But get over it, ok, lots of people can handle it and birth babies just fine without all that crap. And honestly, if you're too busy to have a baby when it wants to come, then maybe you should question the whole parenting thing. Kids are so darned inconvenient, aren't they?

















:







I also agree with a womens free choices and completely respect those who choose to have a c/s due to previous problems, such as a case I know of where mom lost her baby to group B strep despite routine IV antibiotic treatment during labor. She subsequently schedualed a c/s for the delivery of her next baby due to fear of a repeat loss. I have to say I would have made the same choice.

I also feel tha tmY issues with this are the fact that as I have taked to drs and listened to how many inform a patient of the risks associated with various procedures, many just rattle it off and make light of everything that is covered. I feel that women shouls be better educated about what is happening, or going to happen to them and there baby before they make or agree to a decision. I wish more women would be like those of us in this community and do there research.


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## MommytoTwo (Jun 20, 2004)

Fine - let them get cut. I dont care. But for every doctor saying its ok to choose a c/s there better be one saying its ok to choose VBAC. (And meaning it)


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## Jilian (Jun 16, 2003)

I find it ironic that hospitals are performing elective c-sections and the cost of c-sections are WAY higher than vaginal births. I wonder if money is partly to blame here.

I do agree that every pregnant woman should have the right to choose, ONLY after she has been given all the facts on each of her options. There is a reason why c-sections have not been allowed to be elective up until recently, because they carry far more risks than vaginal birth. Most OBs will openly admit this.

It just makes me sad that some moms elect to have an unnecessary c-section then later regret it after knowing all the facts. It happened to my good friend







Breaks my heart.


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## LoveChild421 (Sep 10, 2004)

Quote:


Originally Posted by *tie-dyed*
Personally though, if I was planning a birth with half a dozen people standing in a circle screaming at me to push harder and not to breathe while staring at my genitalia, I'd probably also want a c-sec.

I agree. I think of the elective C-section movement as being a reaction to the degrading and totally unappealing way typical hospital births go. When I became pregnant with my son I was 20 and really had no knowledge of birth other than "A Baby Story" and the horror stories my friends and my mom had told me about being cut and things like that. All I knew was that I had to find a better way, that I couldn't go through that- my reaction was very visceral- I was sick to my stomach and felt like if I went through that I would feel totally violated. At first I thought "I could have a C-section and avoid all that, keep my perinium intact, etc" but thankfully as I researched it more I found mothering and information on birth centers and midwives and homebirth. I chose a homebirth. Strangely I feel that I have something in common with those who chose an elective C-section because we both reject traditional birth practices as barbaric. I heard a woman who chose an elective C-section talking about her choice on "A Baby Story" and she said "I just wanted a sense of control over the birth" and I feel that is so telling- don't we all want to have control over our own bodies and not have Dr.s and nurses telling us what we are "allowed to do" and what we have to have done to us? I wish more women who chose an elective C-section had information about and the chance to see a homebirth. I think some of them would be swayed over to the homebirth/ birth center side.


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## NYCVeg (Jan 31, 2005)

Quote:


Originally Posted by *LoveChild421*
Strangely I feel that I have something in common with those who chose an elective C-section because we both reject traditional birth practices as barbaric. I heard a woman who chose an elective C-section talking about her choice on "A Baby Story" and she said "I just wanted a sense of control over the birth" and I feel that is so telling- don't we all want to have control over our own bodies and not have Dr.s and nurses telling us what we are "allowed to do" and what we have to have done to us? I wish more women who chose an elective C-section had information about and the chance to see a homebirth.

I think you're absolutely right. Unfortunately, how one's body recovers from major surgery is SO out of one's control. Some people recover beautifully and easily. Some people have difficult, weeks or months long recoveries with serious pain. You never know how/when you'll need pain medications afterward and for how long--or how you will react to them (personally, I have never felt more OUT of control than when I was on pain meds and couldn't think straight). Not that vaginal birth is predictable. But I think the elective c/s may give many women a false sense of control.


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## rootzdawta (May 22, 2005)

Well . . . in my mind, labor is a great deal of work. I have never worked so hard physically in my whole life. And it was far from glamorous--grunting, screaming, etc . . . not the idea I had gotten from _Birthing from Within_(though I love that book). After seeing just the pictures from me giving birth, my sister swears she's having a c/s. I can see why elective c/s is the posh way to go.


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## crazy_eights (Nov 22, 2001)

Quote:


Originally Posted by *OnTheFence*
While I would be interested in reading the EXACT study quoted above, I wonder how many who have vaginal births experience pain at 2 weeks. Most I know of.


MOST? From WHAT? The episiotomy they had? B/c while many may be tired, lack sleep and other 'joys' of the post partum period, few are experiencing pain at 2 weeks post-partum. Unless of course, they had a episiotomy.

FWIW, I believe that the rate of 3rd and 4th degree tears in the absence of episiotomy are around 1%.


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## CrazyCatLady (Aug 17, 2004)

Heck, I had a natural birth (well drug free anyway). I even got a big fat episiotomy and I was walking around feeling great with in hours of giving birth. I left the hospital early ama. Was doing housework and laundry the very next day (I realize that I shouldn't have been). I can't imagine that I would have felt that great after a c/s. But I've never had one, so what do I know. I think elective c/s are tacky. There is a medical need for some c/s, of course. But how has that need gone from what it was years ago to the 30+% that it is now when we supposedly live in such great times medicaly speaking? I do know many woman that "needed" c/s and I don't think that they really did (baby was too big at 7 pounds?) I don't think a lot of woman (even on mdc) are as informed as they think they are, I just hear a lot of things that make me scratch my head. But it's not my body and even though I still don't think it's cool. I wouldn't not be someones friend or be mean to someone who had a c/s. I blame it on the doctors and the times that we live in, not the moms.


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## Thmom (May 4, 2004)

Quote:


Originally Posted by *mom2seven*
MOST? From WHAT? The episiotomy they had? B/c while many may be tired, lack sleep and other 'joys' of the post partum period, few are experiencing pain at 2 weeks post-partum. Unless of course, they had a episiotomy.

FWIW, I believe that the rate of 3rd and 4th degree tears in the absence of episiotomy are around 1%.

and certainly not pain from normal activities like bending over or picking up thier new born.


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## wifeandmom (Jun 28, 2005)

Quote:


Originally Posted by *adenlilysmama*

How can that monetary value be right? C-sections cost so much more, how can doing them on everyone save money?

For me, even though I can never in a million years imagine choosing an elective c/s, I feel like I've got to support that choice. I don't want to but I can't rationalize supporting one woman's choice over another. So really, I think every woman should have a choice to birth however she wants, from planned c/s to planned UC and everything in between. I'd like to see a lot more education and a lot more fairness though--if someone can choose a c/s and get their insurance to cover it, then I shouldn't have to fight and fight and fight to get my HB covered.


First, I think if you compare the 'typical' hospital vaginal delivery with an elective c-section, the cost difference really isn't that great. Let's begin with the length of stay, which is typically 48 hours for vaginal delivery vs. 72 hours for c-section. The thing is, the 48 hours doesn't begin until the baby is BORN, so if mom is in the hospital laboring/pushing for 24 hours, she's going to have the exact same length of stay as an elective c-section mom whose stay begins at delivery, which would be upon admission to the hospital since labor/pushing isn't a part of an elective section.

Then you have to consider how many hospitals require continuous EFM, IV's, etc as part of a routine vaginal delivery. How many women get an epidural for the typical hospital vaginal delivery?

By the time it's all said and done with a 'routine' vaginal delivery, all of those interventions that are considered 'standard' add up to more money than you'd see if the 'typical' vaginal delivery only involved a hep lock with perhaps intermittent monitoring at the most, and no routine epidurals for laboring moms.

Anyhow, on to the next part of your post.

I completely agree that a woman should have the CHOICE to birth in the way she feels is best for herself and her baby. Period. The end. If that means birthing at home unassisted, there should NOT be any fear of CPS being called if something happens. If that means checking in at 8am for an elective c-section, so be it.

I want women to have CHOICES and adequate INFORMATION to make the right choice for herself and her baby.

I also cannot comprehend why on earth insurance companies don't cover birth center births, midwife attended homebirths, etc. That seems so incredibly stupid, since without a doubt, those two birthing situations will cost much less than your average hospital birth, be it vaginal OR section. You'd think they'd want to save money??

I think it is WRONG for them to deny this coverage. If they cover a hospital birth, they have no excuse to not cover a midwife attended homebirth. I'm ok with them requiring it to be with a licensed provider, but it should be covered.


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## NYCVeg (Jan 31, 2005)

Quote:


Originally Posted by *wifeandmom*
First, I think if you compare the 'typical' hospital vaginal delivery with an elective c-section, the cost difference really isn't that great.

It actually is. I wish I had exact numbers for this at my fingertips, but even with all the interventions of a "typical" vaginal birth, c/s is MUCH more profitable for a hospital. Once you throw surgery into the mix, costs raise exponentially.


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## aprilushka (Aug 28, 2005)

Quote:


Originally Posted by *OnTheFence*
The risks are still low. Its all about cost/benefit. The same measuring stick should be used for all statistics used in this venue, however it isn't. I have had three successful pregnancies without placental issues in a deformed uterus. My chance of having placental problems is greater than average, yet I was more than willing to take the risk, considering it was very very small.

Sure, the risks are still low and one is entitled to take the risks one wants to take. With pretty much every pregnancy and birth (no matter the way it's done) the risks are low. My point is, with respect to a third child, it's pretty hard to say that 2 c/s is as safe as 2 vaginal births. With respect to a fourth child, it's even harder to say that 3 c/s is as safe as 3 vaginal births. And that's because c/s carries unique risks to subsequent pregnancies that no vaginal birth does, no matter what other complications it may bring (tears, etc) in comparison to the possible complications of the surgery in and of itself. I'm not arguing the risks of vaginal birth vs c/s arising out of those two methods of birth itself, but rather that c/s brings with it with each surgery increased risks for future pregnancies that vaginal birth just doesn't, no matter how "bad" the vaginal birth. There's no getting around the fact that the scar makes a difference in the uterine environment and the scar does not exist with vaginal birth. It is a risk unique to c/s, and no "measuring stick" or balancing test can erase the fact that c/s produces those unique risks for future pregnancies that just do not exist with vaginal birth.


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## aprilushka (Aug 28, 2005)

Quote:


Originally Posted by *NYCVeg*
It actually is. I wish I had exact numbers for this at my fingertips, but even with all the interventions of a "typical" vaginal birth, c/s is MUCH more profitable for a hospital. Once you throw surgery into the mix, costs raise exponentially.

It's generally more profitable for the hospital to have c/s. Doctors sometimes get paid the same for both but c/s in the end is better for them too because they can schedule it and better control the length of time it takes (as opposed to an induction) and time is as valuable to them as money.


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## amyjeans (Jul 27, 2004)

I am not one who likes to get into heated debates about stuff like this- because I do feel passionately about the subject of birth. But...

Quote:

I want women to have CHOICES and adequate INFORMATION to make the right choice for herself and her baby.
I agree with this statement. yet- most mamas don't understand that birth is not just a physical act- but a physiological one as well. The female body was made with the purpose of delivering a baby through the birth canal and out the vagina. From a physical view- sure c-sections are an option but not the natural way. A woman's body creates and dictates the ebb and flow of hormones, muscle control and overall rhythmic pattern of birth from the first contraction to the last. Her body has a program in which all satisfaction comes from it playing out the entire sequence of events in birth from the initial conception and discovery of birth- up to nursing the baby. A c-section interrupts this flow and can seriously damage the phyche of both mama and baby. HOWEVER in certain circumstances C-sections are a viable solution for the safety of the mama and baby- but all too often they are turned to for no other reason than convienence.
http://www.osteohome.com/SubPages/brthtrm.html

Quote:

C-section may seem easier on the infant, however, the child needs the stimulus of being gently "squeezed" through the birth canal to properly stimulate his body to start life. Once a child is born, he takes the all important first breath. It is the first breath that initially re-expands all the structures of the body that were "pushed together" in the descent through the birth canal. A good, deep, unencumbered, full first breath needs to be taken. This can even be difficult in a seemingly "normal" delivery without trauma, if the child is effected by anesthesia or narcotic pain medication that the mother has been given. In a c-section a deep first breath rarely happens.
http://www.icpa4kids.org/research/children/birth.htm

Quote:

This surgical procedure is becoming more common and therefore more accepted today. Mothers have been erroneously convinced that this procedure could actually be better than a natural process! Unfortunately, they are not aware of the dangers and resulting injuries associated with them.

Medical research on birth trauma tells us that, "Forceful pulling on the baby's neck particularly when combined with stretching of the spine&#8230; has been considered the most important cause of infant spinal and brain stem injury."
As with the pp quote at the top here- most mamas are not aware of the psycological effect of c-section, and that is an area that OB's stay away from either due to ignorance or disbelief.

just my 2 cents.


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## Pandora114 (Apr 21, 2005)

Ok, her's my 2 cents

I want to have a homebirth for my next child, I had a homebirth for my first.

There is no FARKING way I'm setting foot in a hospital n giving birth naturally.

Strangers + Vagina = PANIC attack for me

There is no way I'll let a stranger, and I dont give a rats ARSE if they got a degree behind them or not, touch my vagina, look at it or shove various things up it. PERIOD.

So, if I'm forced to "birth" in a hospital, C-section all the way. Sorry....It would wind up that way anyway. Stress induced FTP is what would result.

I know the risks, I know the recovery I know all that stuff. But seriously, KO me with Gen A *dont dont dont paralize me or I'll get even more panicky* gut me, sew me back up and wake me up.

I am a Sexual assult surivor. Being birth raped would put me over the edge...


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## NYCVeg (Jan 31, 2005)

Pandora...I don't think anyone's saying there's NEVER a reason for an elective c/s (and I think trauma from sexual abuse is a very good one).

As for the cost of c/s.Here are 2003 numbers from maternitywise.org:

Quote:

In 2003, U.S. hospitals charged an average of
$15,519 for a c-section with complications
$11,524 for a c-section with no complications
$8,177 for a vaginal birth with complications
$6,239 for a vaginal birth with no complications.
They have a really informative webpage, I thought: http://www.maternitywise.org/cesarean_response.html

This pamphlet seemed especially useful:
http://www.maternitywise.org/pdfs/ce...kletinsert.pdf

From childbirth.org (outdated numbers, though):

Quote:

The latest statistics indicate that 967,000 cesareans were performed in the US in 1989. The Public Health Citizen's Research Group estimates that over one-half the cesareans performed in 1987 were unnecessary and resulted in 25,00 serious infections, 1.1 million extra hospital days and a cost of over $1 billion.
See http://www.childbirth.org/section/CSFact.html


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *Thmom*
and certainly not pain from normal activities like bending over or picking up thier new born.


I didn't have this pain with my last two csections. I felt great.

Someone said that no one can know how they will recover from major surgery. Well no one knows how their birth will go and if they will have a natural vaginal birth, however people still prepare to do that. I prepared for a excellent recovery, and got it, two times. It can be done.

After my last two csections I was feeling great, doing normal activities, breastfeeding, etc. I left the hospital fairly quickly after both of them, rested and ready to go home to my family. I went shopping the day I left the hospital with my youngest. Not only that but after all my csections I was resuming sex at the three to four week mark, and wanted too! Many that choose to have csections do so for various reasons and the majority of them have very smooth recoveries. (often this has to do with the lack of labor experienced before a csection)


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## OnTheFence (Feb 15, 2003)

Quote:


Originally Posted by *NYCVeg*
It actually is. I wish I had exact numbers for this at my fingertips, but even with all the interventions of a "typical" vaginal birth, c/s is MUCH more profitable for a hospital. Once you throw surgery into the mix, costs raise exponentially.

My csection was only $1200 more than a vaginal birth.
I think people who believe csections are more profitable to a hospital are mistaken. They may cost more, but they also cost more to the hospital. They use more staff for a csection for one. Four MDs have to be present for a csection which also raises the cost. But for $1200 more, that barely seems profitable considering they had to pay someone to clean the OR, had to provide four additional nurses, an anest. assistant, and the list goes on and on.


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## orangefoot (Oct 8, 2004)

This is taken from a booklet produced by the NHS in the UK and distributed to the general public in order to explain the current guidelines on CS.

"During your pregnancy your midwife or doctor
should give you information about birth that
is based on the best available research evidence.
You should be offered this information in a
form that suits you if you have extra needs -
if, for example, you do not speak or read
English or if you have a disability. It should
include accurate information about caesarean
section, including:
• common reasons for needing a caesarean
section
• what the procedure involves
• the risks and benefits of caesarean section
compared with vaginal birth
• how having a caesarean section might affect
any future pregnancies
• how having a caesarean section might
affect your chances of having a vaginal
birth in future.
Your midwife or doctor should encourage you
to ask questions if there is anything you do not
understand, and discuss them with you."

http://www.nice.org.uk/pdf/CG013publicinfoenglish.pdf

The full guidance runs to over a hundred pages and contains huge amounts of data and references on which the guidance is based. A friend recently had a planned cs due to complications outside her control and was scared witless by the pre op discussion with the anaesthetist who laid out all the possible problems. This reinforces the guideline's message that cs is a big deal and not to be considered lightly but despite this rates are rising here too especially in private hospitals in London. Posh Spice aka Victoria Beckham wife of the footballer David is the UK's "too posh to push" ambassador and many other major or minor celebrities have also 'chosen' this route.

You can find out the cs rates for any hospital in the UK here and here

This is my local hospital, which defends its rates because it is a centre for high risk pregnancies which require more interventions. Women come from all over a wide area to have their pregnacies monitored and many of these will have planned cs.

What is shocking to me is that the national average for unassisted vaginal delivery is only 46%.

Is there any similarly easy to access data for the US?


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## PerennialMom (May 22, 2004)

I don't buy antectodal evidence. I find antectodal evidence really annoying.

I wouldn't have a problem *IF* other alternatives of birthing were embraced as wonderfully as elective and unecessary c-sections are. The ACOG and insurance companies don't embrace VBACs or homebirths. They've made sure to put good midwives out of business through bureacracy, not from legitimate studies that PROVE homebirth to be safe. A baby dies on a midwife's watch and it's an atrocity and makes headlines. A baby dies in a hospital on a doctor's watch and it's unfortunate, making only the obituaries. Where's the logic?

Why is it so much harder for a woman to choose a natural, peaceful birth and it's glorified and so much easier to walk into an OB office and say "I'd like a c-section" and pick your date all the while being patted on the back. Tell them you don't want faulty prenatal tests or an epi and you're looked at like an alien from another planet....a hassle for the nursing staff and a liabilty for not cooperating.

It's a big fat crock of poo poo.


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## aprilushka (Aug 28, 2005)

Quote:


Originally Posted by *PerennialMom*
I don't buy antectodal evidence. I find antectodal evidence really annoying.

I wouldn't have a problem *IF* other alternatives of birthing were embraced as wonderfully as elective and unecessary c-sections are. The ACOG and insurance companies don't embrace VBACs or homebirths. They've made sure to put good midwives out of business through bureacracy, not from legitimate studies that PROVE homebirth to be safe. A baby dies on a midwife's watch and it's an atrocity and makes headlines. A baby dies in a hospital on a doctor's watch and it's unfortunate, making only the obituaries. Where's the logic?

Why is it so much harder for a woman to choose a natural, peaceful birth and it's glorified and so much easier to walk into an OB office and say "I'd like a c-section" and pick your date all the while being patted on the back. Tell them you don't want faulty prenatal tests or an epi and you're looked at like an alien from another planet....a hassle for the nursing staff and a liabilty for not cooperating.

It's a big fat crock of poo poo.

And that's the part of the whole debate that bugs me too.


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## Mrs Dimples (Apr 17, 2004)

Quote:


Originally Posted by *Rainbow*
I really believe elective c-sections to be a step in the process of women reclaiming the birth process. Typically substantial change in history tends to go to an extreme, peak, and setlle back down.

Wealthy women went from hiring wet nurses [breastfeeding being only for the poor], then later to feeding their babies themselves without the breast [bottles], to a peak in formula usage, to it settling back down and women now having individual control over their option of feeding. Breastfeeding, I would guess now being on the slow rise.

While I prefered not to have a csection, I can support that women are taking contol over their births as a step in change.

You know, I am not going to get into the rest of this thread, but I wanted to thank you for this insight. I have never thought about it this way for some reason, but this really makes sense to me. Thank you for giving me some insight into the way women think that is so different from myself.


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## huggerwocky (Jun 21, 2004)

Quote:


Originally Posted by *LoveChild421*
I agree. I think of the elective C-section movement as being a reaction to the degrading and totally unappealing way typical hospital births go.

Yes, absolutely, that is such a big big point. I personally don't fancy being told ever again my life I should stop screaming since it's not like I'm the only woman on earth who's ever given birth.

Thanks, I knew that.


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## huggerwocky (Jun 21, 2004)

Quote:


Originally Posted by *NYCVeg*
Doctors have a responsibility to REALLY educate their patients on risks of elective surgery, both to themselves and their babies and not paint c/s as an "easier" solution to childbirth (which is what the "too posh to push" idea promotes).


Forget doctors, I have found them to no source of knowledge. They can't even read NFP charts and the doctor doing my ultrasound today asked in a tone that could have worried someone without the knowledge I have " are you sure about your dates?", a question that would have been unnecessary with a look on my chart.( it showed ovulation 2 weeks later than the textbookcycle)

I sometimes feel doctors just recite old wive's tales







:

Sorry for rambling, but it had to be said. I have many more examples.


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## huggerwocky (Jun 21, 2004)

Quote:


Originally Posted by *~*~MamaJava~*~*
This is kind of crazy, that we are even discussing this on MDC. It's a natural family living site...hence...natural birth. I'm just surprised, but I guess dialogue is always good so we're not just in our little bubble










Isn't mothering also about women's rights and their empowerment?


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## Wolfmeis (Nov 16, 2004)

Quote:


Originally Posted by *PerennialMom*
I don't buy antectodal evidence. I find antectodal evidence really annoying.

I wouldn't have a problem *IF* other alternatives of birthing were embraced as wonderfully as elective and unecessary c-sections are. The ACOG and insurance companies don't embrace VBACs or homebirths. They've made sure to put good midwives out of business through bureacracy, not from legitimate studies that PROVE homebirth to be safe. A baby dies on a midwife's watch and it's an atrocity and makes headlines. A baby dies in a hospital on a doctor's watch and it's unfortunate, making only the obituaries. Where's the logic?

Why is it so much harder for a woman to choose a natural, peaceful birth and it's glorified and so much easier to walk into an OB office and say "I'd like a c-section" and pick your date all the while being patted on the back. Tell them you don't want faulty prenatal tests or an epi and you're looked at like an alien from another planet....a hassle for the nursing staff and a liabilty for not cooperating.

It's a big fat crock of poo poo.


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## artgoddess (Jun 29, 2004)

I'm just shocked. How on earth can anyone look at an elective c/s as "taking control of their birth" ? Where is the control in being straped down, your body made numb from narcotics and just laying there while another person cuts your child out of your body? How is that empowering?


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## velcromom (Sep 23, 2003)

I can see how choosing a primary c/s would bring a feeling of control to a woman who cannot tolerate the sense of submission and violation that the management of a typical hospital vaginal birth can bring... and I also understand feeling that way about ERC. I think that the "empowerment" part of an ERC is simply the difference between _making a choice_ and _having no choice_. When it becomes unacceptable in a woman's mind to risk enduring again the violation of being pressured, lied to, being left uninformed, coerced and sometimes even acted on without consent at all, then having the control of making a choice that is honored can be a really big deal.

One of the most valuable things my awesome therapist told me ages ago was that regardless of the info a person is aware of, they will do what they are able to at the time. We are all at our own place on our path, and we do what we can. If psychologically we could make a different choice, we would. It's not productive to look at women who are at places on the path we may have travelled already, and rant about how wrong they are. It might be productive to simply tell our stories about how we moved from that place on the path, and let it go.

At the same time, I believe women are not getting the full picture from their care providers and that needs to change. Also, we need to resume the chain of support and information about normal birth that has been lost over the generations of medically managed birth. Preparing the next generations to claim and insist on normal birth is probably one of the most effective things we can do to bring the pendulum back to center.

My response to the "too posh to push" set is not to rail against them, but to point to the circumstances that led them to that place as the real problem. It seems to me that women choosing c/s as a way of claiming control over birth only makes glaringly, horribly clear that women have a sense of how badly their rights are trampled in the medical model of obstetrical care but don't know any other way to regain their control of the situation. Almost like a hostage who begins to side with their captors in order to be able to regain a sense of control of the impossible situation they are in.


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## Peppamint (Oct 19, 2002)

Quote:


Originally Posted by *velcromom*
My response to the "too posh to push" set is not to rail against them, but to point to the circumstances that led them to that place as the real problem. It seems to me that women choosing c/s as a way of claiming control over birth only makes glaringly, horribly clear that women have a sense of how badly their rights are trampled in the medical model of obstetrical care but don't know any other way to regain their control of the situation. Almost like a hostage who begins to side with their captors in order to be able to regain a sense of control of the impossible situation they are in.


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## JessicaS (Nov 18, 2001)

I really find downplaying the RISKS of major, unnecessary surgery to be not only foolish, but irresponsible.

http://www.childbirth.org/section/risks.html
http://www.pregnancy-info.net/repeat_cesareans.html
http://www.americanpregnancy.org/lab...reanrisks.html
http://www.maternitywise.org/mw/topi.../evidence.html

Quote:

Cesarean birth is major surgery, and, as with other surgical procedures, risks are involved. The estimated risk of a woman dying after a cesarean birth is less than one in 2,500 (the risk of death after a vaginal birth is less than one in 10,000). These are estimated risks for a large population of women. Individual medical conditions such as some heart problems may make the risk of vaginal birth higher than cesarean birth.


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## goodcents (Dec 19, 2002)

Quote:


Originally Posted by *artgoddess*
I'm just shocked. How on earth can anyone look at an elective c/s as "taking control of their birth" ? Where is the control in being straped down, your body made numb from narcotics and just laying there while another person cuts your child out of your body? How is that empowering?










THANK YOU!!! The decision isn't the only thing you should control - but the entire process!


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## annakiss (Apr 4, 2003)

I don't see how this is about choice at all. It is unethical for a health care provider to provide or promote primary elective cesarean. It may be your choice to hack yourself open for the sake of convenience at home, but to hire somone else to do it brings their responsibilities into the matter as well. And it is a doctor's responsibility to first do no harm. It is too great a risk to choose cesarean without medical indication (and not the kind where they futz the diagnosis as is so often the case).

VBAC should be standard rather than forbidden. The stats I've heard show that about 75% of moms can have a successful VBAC.


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## cynthia mosher (Aug 20, 1999)

It seems this thread, or rather the turn the thread has taken in its focus of discussion, is in need of administrational review. So that I can manage to do that without more posts being added to the discussion pot, I am closing it.

Though I have not reviewed the entire discussion, I will say this: MDC is not an online community place for advocating elective cesarean delivery. Any member who desires to post in this manner should take their posts to another forum that welcomes such advocacy. Mothering does not.


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