# What IF C-Section Was Proven Safer Than Natural Birth?



## demeter888 (Jan 18, 2013)

This is just a hypothetical question. I'm interested in the motivations behind how we judge information.

If you happened to see strong supporting evidence that proved to you that giving birth via scheduled c-section at 39 weeks is now safer/better for mom and baby than giving or even attempting birth vaginally at 40+ weeks in an uncomplicated scenario, would you still go ahead and attempt vaginal birth?

Why or why not? (Assuming you lived in an area and had access to care that had been included in the studies proving the safety of the procedure).


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## cileag (Aug 16, 2008)

I think it would depend on how big the difference was in safety. Is it dramatically safer for mom and baby or is it slightly (statistically even, but a small percentage) safer? I would choose the way I make all my decisions---what is reasonably safe, what is my preference, what can I afford. I am comfortable with people choosing VBAC and out of hospital birth because while you can arguably see that there are situations where mom or baby might benefit from a different setting, it is a reasonably safe choice. I would also consider the long term consequences---future risk of pregnancy complications, newborn gut health, recovery time, cost increase. I do not have a strong feeling that I have to do things "naturally" for them to be safest or best.


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## fruitfulmomma (Jun 8, 2002)

In terms of absolutes I would still want to know how much safer a c-section was vs vag birth. If it were a matter of 1 in a 1000 vs. 2 in a 1000 baby deaths, for instance, then no, I am no getting cut open for that. If it were 1 in 1000 vs 1 in 100, then maybe, probably.

In terms of relativety and me/my child, I am absolutely going to take the risks of c-section to me for a transverse baby, a prolapsed cord, or other child in serious danger. Very likely for other less emergent things.

But I stumbled across a book awhile back and they seemed to be arguing that sections are absolutely safer for all women due to risk of pelvic floor damage. And while I don't want to dismiss women's real concerns about that, I find it really disingenuous and slightly infuriating that these men are telling all women to base their decision on that.


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## fruitfulmomma (Jun 8, 2002)

Oh, on the why... for the same reason that I am unlikely to have a g-tube put in, if the studies showed that it was slightly, but absolutely, safer to receive nutrients that way. It isn't the way my body was designed to eat. I may be less likely to choke, but I'd be missing all the benefits that come with actually eating my food.


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## mamaofthree (Jun 5, 2002)

knowing this is hypothetical, but still... i can't imagine there would be any info that would make me think that a new surgical procedure would be better for mom and baby than millions of years of nature having us have babies a certain way. i would think the piece was a bunch of garbage. seriously. it isn't even logical.

that doesn't mean if something came up and i felt that a c-section was the safest way for my baby to be born i would go and have a vaginal birth anyway. i think each birth needs to be looked at individually. that is why any paper that says 1 way of doing things is 100% better than another, i don't believe it. i mean YES vaginal birth in most cases is the best way for a baby to be born, but even it isn't 100% safe in all cases.


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## hippy mum (Aug 12, 2006)

Nope. Unless it was necessary, like someone mentioned-a prolapsed cord, rupture, previa etc, I'd go with vaginal birth. There are too many benefits to baby via natural birth. Natural labor triggers hormones for breastfeeding, helps with infant gut flora to name just two things. A csec isn't going to help with that.

mamaofthree-you said it-we've got thousands of years of natural birth, and only recent surgery for babies to be born.


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## AlexisT (May 6, 2007)

But the thought experiment IS that it's safer, so "I don't believe it is" isn't much of an answer. Presumably, in the thought experiment, all the issues you mention have been thought of. That's why it's a thought experiment, not reality.

It's a question about how you prioritize statistical safety.

The idea that it must be better because it's natural is a logical fallacy. Nature doesn't require perfection; all that counts is a low enough failure rate. Historically, with no intervention, birth has not been a safe process, and nature has been satisfied with that. Modern birth is not truly natural at all. We've made it safe by not having everyone do it "naturally." The question here is, what if the risks of C-section were made so low that the odds were that it was always the safer birth for you? We're already at the point where NICE in the UK has said that the risks of C-section are now sufficiently low that if a woman wants a CDMR, it may be considered.

It's slightly irrelevant for me--a C-section is personally safer for me, so this wouldn't really add anything to my decision making process.


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## rebeccainva (Sep 21, 2012)

Quote:


> Originally Posted by *demeter888*
> 
> This is just a hypothetical question. I'm interested in the motivations behind how we judge information.
> 
> ...


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## Katie8681 (Dec 29, 2010)

Quote:


> Originally Posted by *rebeccainva*


Interesting question. I'm struggling with the premise though







every other "procedure" in medicine is going for more and more minimal and small incisions, if possible through the vagina even! This is because cosmetically, recovery time, and post op complications almost across the board are better that way.

I wish we had safer, more effective methods of induction myself. While I wouldn't go for an elective c/s at 39 weeks, induction between 39 and 40 weeks if that were proven to be safer for both me and baby than waiting until after 41 weeks, I would go for it.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *fruitfulmomma*
> 
> But I stumbled across a book awhile back and they seemed to be arguing that sections are absolutely safer for all women due to risk of pelvic floor damage. And while I don't want to dismiss women's real concerns about that, I find it really disingenuous and slightly infuriating that these men are telling all women to base their decision on that.


I'm not sure which book you are referring to, but I did recently read Choosing Cesarean, which I believe is cowritten with a female OB and a journalist, each of whom advocate c-section being safer in developed countries. Their reasons were many, and pelvic floor damage is a good enough reason for me; but there are still risks for major surgery and I don't like the idea of it.

However, the reason I started this thread was to understand why there is so much resistance to the idea despite the presence of data. I expected most women, especially here, to still prefer natural. I am trying to figure out how much of this is ideological for women because it was for me, initially. Now I HAVE pelvic floor damage and it SUX and it's FOR LIFE.

There is such a huge public outcry against the inappropriate interventions and c-sections and it means that we aren't seeing all the data because the data that goes against popular sentiments rarely ever sees the light. I am trying to understand it better, basically. For example, why are there so many warnings about c-sections, but virtually none about natural birth? There is an ideological force at work here that spans all religions and affects how we make our decisions.

I am not arguing that c-sections are safer, BTW. Nobody wants to hear that even if I did have the time and inclination to make such an argument.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *AlexisT*
> 
> But the thought experiment IS that it's safer, so "I don't believe it is" isn't much of an answer. Presumably, in the thought experiment, all the issues you mention have been thought of. That's why it's a thought experiment, not reality.
> 
> ...


This is why I stressed in my question if it proves it for you. That whatever data you require to be present is available. If people are saying that no amount of studies or data convince them, then I would like to know if they hold this policy in general or only when it applies to something they prefer to not have to contemplate? I know some people strongly prefer to make decisions based on anecdotal information, and I certainly can see why when there is almost always a political, ideological, or financial motivation behind the studies presented to the public. Almost.

For me personally, if I put myself in the shoes I was in before I had the birth experience that I had, I know without a doubt that I would have had trouble even putting myself in such a scenario to answer such a question; my brain would have simply revolted against the idea of accepting such data. I wouldn't WANT it to be true. The question is, why?

There is something about the idea of science and medicine having that big of a leg up on mother nature that I just don't think I would like to fully accept. ESPECIALLY in light of all the questionable things modern medicine is taking part in where childbirth is concerned. I would like to think that I was born to give birth and get into my spirit trip and powow in a cave with other earth mamas.

I think a lot of women want this right of passage. Yeah, the bottom line is, nature is not "nice". Not one bit.


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## dinahx (Sep 17, 2005)

Surgery has inherent risks, always has, always will. So I can't even imagine a scenario in which surgery would be inherently safer.


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## AlexisT (May 6, 2007)

Well, speaking for me personally--after having been through a CS twice, while i feel some regret that I will never experience vaginal birth, it's not enough to trump my surety about CS being safer for me. So in the end, I'm data driven. But after having been through the process of deciding between VBAC and RCS, I have a certain amount of comfort with uncertainty. I'm okay with the concept of choosing my odds and balancing my preferences.

But I wouldn't have that perspective had I not had the CS to begin with. And now that I've had 2, and I've had 2 children in the way that was safest for me--none of the regret over a rite of passage is enough to trump feeling that I made the best decision given the data available to me.

Getting really sick (with severe preeclampsia) was also enough to disabuse me of the notion that Mother Nature is a kindly old lady. She really isn't. It's one thing for me to say, "I don't need to do anything unless something goes wrong," but I'm no longer capable of a priori valuing something because it's "natural." Left entirely to Nature, things wouldn't have gone too pleasantly.


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## monkeyscience (Feb 5, 2008)

I agree that it would depend on the degree of improved safety. It would have to be what I would consider a significant improvement in safety before I would consider it. I am also one who would find it hard to believe that a study could be done that would provide adequate measures to prove to me that c/s was safer for every mother and every baby, because I don't believe we fully understand all the ways that birth method impacts the future health of the mother and baby. Also, I plan to have more children, and the evidence is very clear that each c-section you have increases the risks for both mother and child in all subsequent pregnancies. I would not be interested in risking myself and future children for the current child unless the current child and/or I were at very serious risk of harm. Frankly, I would not want to deal with the discomfort of being post-op while also caring for a newborn, if the odds were relatively the same, safety-wise.

I agree that the idea that it's "natural" for all pregnancies, labors, and deliveries to end well for mothers and babies is a fantasy. The natural system works well enough for enough (I would even argue, the majority of) babies and mothers to survive, thus propagating the species. But the idea that ALL mothers and ALL babies are best served by letting nature take its course is just as dangerous as the idea that ALL mothers and ALL babies are best served by having the most high-tech interventions available.

Quote:


> Originally Posted by *demeter888*
> There is such a huge public outcry against the inappropriate interventions and c-sections and it means that we aren't seeing all the data because the data that goes against popular sentiments rarely ever sees the light. I am trying to understand it better, basically. For example, why are there so many warnings about c-sections, but virtually none about natural birth? There is an ideological force at work here that spans all religions and affects how we make our decisions.


I'm curious where you go for news besides Mothering. Because frankly, I'm not seeing this outcry and suppression of data at all. I see plenty of articles on why medical interventions are better. And there are scores of stories of mothers who were told by their doctors that waiting for spontaneous labor would/could kill or maim their baby, but were not told of any of the risks of induction and/or c-section.


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## fruitfulmomma (Jun 8, 2002)

I appreciate what you are trying to ask here, but after some consideration I don't think I can adequately express my full thoughts on the issue without offending some people and/or turning it into a religious discussion. I do think Monkey brought up a good point about future children. As we are open to as many future children as we are given, I absolutely have to keep that in mind when making these decisions.

I have not experienced a c-section but two of my planned homebirths ended in transfers to the hospital and my last child, who was my first planned hospital birth, ended with a pit induction after she failed her bpp/nst and became very sluggish in her movements. At the time I was very concerned about her health and safety and needed her out. I was given the option of pit or cytotec. I knew enough about both, that it was absolutely no question to me about which one to go with. I would have also gladly submitted to a c-section right then if they had told me that she needed it.

Lastly, I have been in the ncb and hb community for about 15 years. I don't always like what I see, but there have only been a handful of times where I felt that the mother or midwife in question was being completely dismissive of all sound evidence and trusting "nature" despite the obvious issues right in front of their faces.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> Surgery has inherent risks, always has, always will. So I can't even imagine a scenario in which surgery would be inherently safer.


Well, your point that surgery has inherent risks and always will is a valid point. Natural birth also has inherent risks. I can see a lot of people have a hard time imagining surgery being safer, so I'm trying to understand why.


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## LLQ1011 (Mar 28, 2012)

I think over the years lots of stuff is deemed safe and unsafe and resafe and then black boxed. I would not trust that statement at all.


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## monkeyscience (Feb 5, 2008)

Quote:


> Originally Posted by *demeter888*
> 
> Quote:
> 
> ...


I think that is because, whether you are scientifically or religiously minded, we were evolved/created to give birth through our vaginas. That is how the system is set up to work. Like all systems, it doesn't have a 100% success rate, and it can go catastrophically wrong. We are not at all evolved/created to undergo c-sections. How well we withstand that is entirely dependent on how good the technology is. I think a lot of us have a hard time believing that just a few hundred years of surgical experimentation could surpass the millions of years of evolution and/or the work of an all-knowing God in terms of outcomes.


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## dinahx (Sep 17, 2005)

I am scientific AND religiously minded. <3 I believe deeply in the safety of 'expectant management' in most areas of human health so elective management is less safe always IMO. Obviously you can't totally elect for either method of birth (you might have PTL even with a scheduled C), so then it is just a question of more or less aggressive management.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *monkeyscience*
> 
> I'm curious where you go for news besides Mothering. Because frankly, I'm not seeing this outcry and suppression of data at all. I see plenty of articles on why medical interventions are better. And there are scores of stories of mothers who were told by their doctors that waiting for spontaneous labor would/could kill or maim their baby, but were not told of any of the risks of induction and/or c-section.


I understand and agree with all your points until this very last paragraph. Obviously my exposure to information on c-sections is quite different from yours. If I google c-section, the first ten articles coming up mostly do outline the risks of the surgery. Maybe they aren't ideal, but it's a start. Women who educate themselves find this information quite easily in comparison to the risks of natural birth. I have heard numerous reports in major news broadcasts that hospitals are being accused of performing too many c-sections. I know several mothers who underwent the procedure and have expressed doubts as to the necessity of it. Anyone who digs in the very least will have been exposed to the natural childbirth movement. NBC is major one news source that has reported on it extensively over the years. http://www.nbcnews.com/health/c-section-rate-stable-third-year-new-report-shows-6C10459239

I see a lot of supression of data. My mom worked for the CDC and the reports published on this kind of topic seem entirely politically motivated. And often inaccurate. The questions we have on this topic rarely even get asked in the first place. I am asking why. All the great points you brought up in your first paragraph and the many unknowns, are knowable and publishable. The public just generally doesn't want to hear it right now.

As to not being told the risks of c-section, in my state we have to sign a waiver to consent to a c-section in which we are informed of the risks of c-section. No such information is provided for in the consideration of a natural birth or the vast number of interventions and injuries that might take place during one. More to the point: google natural childbirth and compare the number of times the word "risk" appears in the headings. It doesn't come up for me even once.

It's my own impression that there is a bias at work which implies that something is OK if it's natural and less than ideal if medicalized. Birth is inherently dangerous and many women like myself often start out very naive as to its risks either way. This creates a missing piece of the puzzle in educating women about childbirth.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *LLQ1011*
> 
> I think over the years lots of stuff is deemed safe and unsafe and resafe and then black boxed. I would not trust that statement at all.


I'm not sure which statement you are referring to?


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *monkeyscience*
> 
> I think that is because, whether you are scientifically or religiously minded, we were evolved/created to give birth through our vaginas. That is how the system is set up to work. Like all systems, it doesn't have a 100% success rate, and it can go catastrophically wrong. We are not at all evolved/created to undergo c-sections. How well we withstand that is entirely dependent on how good the technology is. I think a lot of us have a hard time believing that just a few hundred years of surgical experimentation could surpass the millions of years of evolution and/or the work of an all-knowing God in terms of outcomes.


I agree that it is hard to believe that a few hundred years of medical/surgical experimentation can surpass hundreds of millions of years of evolution-or even better-intelligent design. But it very clearly has in many cases. Otherwise the vast majority of people wouldn't go to the doctor when their health is at risk and there wouldn't be life saving surgeries that we use when mother nature fails to keep us alive and feeling good. I don't think that means life should be created in petri dishes going forward, but hopefully I am making some sense.

It again goes back to what seems like an ideological argument.


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## dinahx (Sep 17, 2005)

How about an economic argument? Expectant management of birth AND miscarriage saves me money in the short AND long term. Which improves my quality of life. In a country with the highest medical costs in the world without the corresponding best outcomes, that is worth considering. Especially because I value & want to preserve my fertility, my uterine integrity, my hormonal function, keep my abdominal cavity adhesion free, etc.

At the base of the Section vs. Vaginal debate is a maternal safety vs. fetal safety debate. That is @ the very origin of Cesarean (before that they used to do a D&X in obstructed labor). Now it is deeply preferable to have a Cesarean & a live baby vs. a D&X, obviously. But I do NOT accept that in a country where I can end my pregnancy for any or a gender/diasability reason, to viability & beyond, that I have to patently increase my health costs & risks in a non-emergent situation for a statistical calculation of intrapartum safety!

Any difference on a population level would be super tiny. Even choosing a HomeBirth with any type of Midwife only increases intrapartum mortality from 0.07/100 to 0.243/100. And those are Dr. Amy's numbers. So any increase NEONATAL safety would be totally WAY too fractional for 39 weeks to ever become public health policy in any universe.

Dr. Amy has a great post on the concept of 'diminishing returns' that is worth reading on this topic.

As far as the idea that Pelvic Floor injuries would ever compete with actual abdominal intrusion, no. And I find the notion that vaginal birth irreprably damages the Yoni to be very unfeminist & less than accurate. My second birth IMPROVED my Yoni.

Just like you can't get a true rate of 'necessary Circ' in a culture that forcibly retracts & refuses to understand the foreskin, you can't get a true rate of injury in expectantly managed birth in an active management culture.


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## sillysapling (Mar 24, 2013)

Quote:


> Originally Posted by *demeter888*
> 
> I agree that it is hard to believe that a few hundred years of medical/surgical experimentation can surpass hundreds of millions of years of evolution-or even better-intelligent design. But it very clearly has in many cases. Otherwise the vast majority of people wouldn't go to the doctor when their health is at risk and there wouldn't be life saving surgeries that we use when mother nature fails to keep us alive and feeling good. I don't think that means life should be created in petri dishes going forward, but hopefully I am making some sense.
> 
> It again goes back to what seems like an ideological argument.


I go to the doctor when something's wrong. I go to the doctor to make sure nothing's wrong, and if something's wrong enough- I get medical treatment to fix it. But you do not get major surgery when everything's hunky dory!

By this argument- shouldn't we be hooking everyone up to feeding tubes? We could ensure proper nutrition, eliminate unhealthy things, eliminate allergy concerns, etc. Given the rate of things like diabetes and people dying from allergic reactions- eating is horribly dangerous! But we don't. I've never even see anyone suggest that I should go to the doctor because they know better than me how to eat to the degree that I can't be trusted to eat myself.

"When their health is at risk" is not "When your body is functioning as it should and everything is going fine"- most births are the latter. Some births are the former, which is why we have c-sections and medical interventions. The problem is, we've gotten it into our head that- to go back to the food metaphor- healthy people with healthy bodies can't be trusted to eat dinner on their own just because some people have problems that prevent them from doing so without severe risk (and, yes, sometimes healthy people choke or get food poisoning or whatever else- so there's wisdom in having a medical professional around when giving birth, but having a medical professional around doesn't mean getting sliced open).

If there's a sign that natural birth will seriously put myself and/or my baby at risk- hell yeah I'm getting a c-section. I don't know a rational, responsible person who would refuse to get a c-section even when it's clear But simply being pregnant is not a sign that my baby or me is at serious risk!


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## hippy mum (Aug 12, 2006)

dinahx-do you have Dr Amy link? I'd like to read her stuff.

This is turning into an interesting conversation. I may have missed some things. What about mortality rate and csec? I'm sure the numbers could be wrong, but in states with increased csec, mortality went up. So how is that safer? Finding a breakdown on how many of those were inductions, not elective, may be hard. Maybe comparing US cesarean/mortality rates with a country with low cesarean/mortality rates would give some clear information. Or even just high % vs low % among states.

The US has a big problem with not education women on childbirth practices. (on a lot of things imo) No one ever told me csec risks. Nor breastfeeding info, or vaginal birth info. The birthing class went over labor stages. Not much else.

Going back to natural, someone brought up bp problems-wouldn't the higher percent be nutritional problems and perhaps stress related, not genetic? When did eclapmsia/preclampsia start becoming a common problem? Information tell us the higher percent is in many first time moms. First time moms are stressed out and afraid-they have no idea what to expect. And the diet in the US is horrible, for the most part.

My thoughts on birth, are that perhaps former delivery problems can be overcome, though not for everyone. With guidance/counselling etc. My 2 births were very different. I had a lot of fear the second time of a repeat of the first, and the women surrounding me were very strong and helpful. I read some empowering books on trusting the body during birth. It was a different outlook than the first time.


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## monkeyscience (Feb 5, 2008)

Quote:


> Originally Posted by *demeter888*
> 
> Quote:
> 
> ...


Talking about medical treatment/surgery for an illness or abnormality isn't what you referred to in your original post, though. I thoroughly agree that a c-section is a much better option than a natural delivery for a mother with a complete previa, for example. What you appear to be saying is that because c-section is better in that case, it's better in all cases. That doesn't make sense. Dialysis is also an awesome modern medical innovation. But it's only for people with kidney problems. There is no reason for someone with healthy kidneys to opt to have their kidneys removed and be on dialysis for the rest of their life. I absolutely agree that modern medicine does wonderful things. But I have a hard time believing that modern medical intervention in a process that would otherwise occur naturally is a good idea, absent of specific problems or indications of risk.


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## monkeyscience (Feb 5, 2008)

Quote:


> Originally Posted by *demeter888*
> 
> I understand and agree with all your points until this very last paragraph. Obviously my exposure to information on c-sections is quite different from yours. If I google c-section, the first ten articles coming up mostly do outline the risks of the surgery. Maybe they aren't ideal, but it's a start. Women who educate themselves find this information quite easily in comparison to the risks of natural birth. I have heard numerous reports in major news broadcasts that hospitals are being accused of performing too many c-sections. I know several mothers who underwent the procedure and have expressed doubts as to the necessity of it. Anyone who digs in the very least will have been exposed to the natural childbirth movement. NBC is major one news source that has reported on it extensively over the years. http://www.nbcnews.com/health/c-section-rate-stable-third-year-new-report-shows-6C10459239
> 
> ...


Being made to sign a consent form and actually having the risks thoroughly explained to you, in an unhurried manner, where you feel comfortable asking questions, are two completely different things. You don't have to sign a consent form for a natural birth for the same reason you don't have to sign a consent form for eating a meal or having a bowel movement. It's not a medical event. That doesn't mean there are no risks, or that you can't injure yourself.

I would also argue that if doctors felt natural birth were particularly risky, they would tell mothers about it. And some doctors do, in fact, tell mothers what they perceive as the negatives of a vaginal birth. (I think we're muddling 'natural' vs 'vaginal' birth in this thread, but that's a different point.) The fact that many doctors do not, to me, is a testimony that they do not consider it to be particularly risky.

I do agree that some NCB educators and advocates gloss over the risks of some birth choices, and that does bother me. However, (and I may be way off base here), it seems from your posts that you had a particularly physically traumatizing vaginal birth, and are generalizing your experience to all vaginal births, as if most mothers have the same outcome as you did, which I don't think is true. I would be interested to see some actual numbers as far as what you perceive the risks of vaginal birth to be, and what your sources are for those perceptions. And I mean that with respect. I feel like we are having a somewhat vague conversation that could be helped by being more concrete.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *monkeyscience*
> 
> Being made to sign a consent form and actually having the risks thoroughly explained to you, in an unhurried manner, where you feel comfortable asking questions, are two completely different things. You don't have to sign a consent form for a natural birth for the same reason you don't have to sign a consent form for eating a meal or having a bowel movement. It's not a medical event. That doesn't mean there are no risks, or that you can't injure yourself.
> 
> ...


I didn't say the consent form was ideal, but it does outline some major risks. Whether or not doctors should be held responsible for more is a matter of debate I won't argue; they should on all levels infomr us more and they should on some levels be far more informed themselves.

However, giving birth is much different than eating a meal or having a bowel movement and this is my point: for many women and babies birth is dangerous and that is why they need medical intervention. The way that births take place in hospitals is a HIGHLY medical event but we all seem to still want to remain in denial of that fact or hope it won't happen to us when the fact is *birth is a medical event for the majority of women. *Whether it should be is beside the point.

You are not making any sense whatsoever by saying doctors don't consider vaginal birth particularly risky. If they didn't, there would be vast numbers of them approving home births and supporting it as a whole. The vast majority of doctors perceive birth as a medical event with inherent risks.

My intention with the thread is not to argue over statistics and sources nor have my personal experience and how I perceive it to be analyzed. The goal is to understand why so many people are disiniterested in or uncomfortable with the ideas presented on a deeper level. And in turn, I mean that with all due respect and appreciate your replies


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *monkeyscience*
> 
> Talking about medical treatment/surgery for an illness or abnormality isn't what you referred to in your original post, though. I thoroughly agree that a c-section is a much better option than a natural delivery for a mother with a complete previa, for example. What you appear to be saying is that because c-section is better in that case, it's better in all cases. That doesn't make sense. Dialysis is also an awesome modern medical innovation. But it's only for people with kidney problems. There is no reason for someone with healthy kidneys to opt to have their kidneys removed and be on dialysis for the rest of their life. I absolutely agree that modern medicine does wonderful things. But I have a hard time believing that modern medical intervention in a process that would otherwise occur naturally is a good idea, absent of specific problems or indications of risk.


You haven't explained why, though. A process that occurs naturally is not always the best process for the people involved. It seems like this argument is not really based on something concrete, because you and others keep talking about belief.

The bottom line is science and medicine step in where mother nature fails. As there are inherent risks in human beings giving birth, to suppose that medicine has or could in fact become advanced enough to do a better job is not even remotely far-fetched. I was using the point of other medical interventions that have shown effective; whether or not the original issue was intended for one of disease or perfectly natural occurence is really beside the point. Maybe you don't think it should, but that is quite different from acknowledging that it could or maybe even does in some instances. And all I wanted was to ask but what if it did?


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## dinahx (Sep 17, 2005)

You can't practice medicine on a 'best for everyone' basis. Isn't that your beef with Natural Birth ideology?

Birth also has benefits for a woman's body, we can't just write off those. Cesarean is a LOT closer to safe for every baby than it is to being safe or without seqelae for every mother. And that simply can never be enough justification for a policy of routine cesarean @ 39 weeks. It would have to be safer in the short AND long term for the *mother* & it would also have to be low in morbidity.

It all again comes down to 'a good mama throws her body under the bus for any microscopic increase in neonatal safety!' I don't accept I can't have both. Statistics show that setting & provider is a larger predictor of Cesaean rate than any single health indication. With the reveloution in microbiological understanding & cesaean's inevitable need for antibiotics (not to mention opiates!) the microbiome has to be considered too.


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## sillysapling (Mar 24, 2013)

Quote:


> Originally Posted by *demeter888*
> 
> You haven't explained why, though. A process that occurs naturally is *not always* the best process for the people involved. It seems like this argument is not really based on something concrete, because you and others keep talking about belief.
> 
> The bottom line is science and medicine step in where mother nature fails. As there are inherent risks in human beings giving birth, to suppose that medicine has or could in fact become advanced enough to do a better job is not even remotely far-fetched. I was using the point of other medical interventions that have shown effective; whether or not the original issue was intended for one of disease or perfectly natural occurence is really beside the point. Maybe you don't think it should, but that is quite different from acknowledging that it could or maybe even does in some instances. And all I wanted was to ask but what if it did?


"Not always" is not "never" or even "under most circumstances", and we're talking about major surgery that has serious health risks and lifelong repercussions (including risks to future pregnancies) as well.

List one circumstance- with references- where invasive medical intervention is, the MAJORITY of the time, better than letting nature take it's course when your body is functioning as it is designed to. The only thing I could possibly think is vaccinations- and even then, vaccinations can do harm and there are people who have never gotten them and been fine.

As I said- medicine has found a better way to get humans nutrients. There are inherent risks in eating, some people have medical conditions that make eating without medical intervention impossible, some people have died from eating (choking, allergies, etc). Yet we still don't hook up feeding tubes to healthy humans.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> How about an economic argument? Expectant management of birth AND miscarriage saves me money in the short AND long term. Which improves my quality of life. In a country with the highest medical costs in the world without the corresponding best outcomes, that is worth considering. Especially because I value & want to preserve my fertility, my uterine integrity, my hormonal function, keep my abdominal cavity adhesion free, etc.
> 
> ...


I think you are veering off the topic and making several points about your value system vs the values of others. First of all, elective cesarians are not necessarily more expensive. In fact, they would be cheaper than the system we currently have, which is roughly 30% of women in emergency surgeries. There are risks with vaginal surgery that others might value just as much as you value your fertility, uterine integrity, hormonal function, abdominal cavity adhesion free, etc.

All valid points for concern, just not exactly what I was asking about. It would be more accurate to say that the risks of natural birth are more acceptable to you. Despite the point of my question.

Furthermore, I care what is in my best interest, not what is cheaper for taxpayers. Last time I checked we paid taxes too. This is really getting into another ideological debate.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *sillysapling*
> 
> I go to the doctor when something's wrong. I go to the doctor to make sure nothing's wrong, and if something's wrong enough- I get medical treatment to fix it. But you do not get major surgery when everything's hunky dory!


I see your point and it's an ideological one. I have already replied to one of your other posts.


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## dinahx (Sep 17, 2005)

Your POV expressed here is fundamentally idealogical. Are you asserting that you are alone in pursuing this question logically? I pay my own medical bills, so a cesarean is more expensive to me. Like enough to buy a used minivan more expensive. Everyone can now just 'charge it' to the taxpayer? Is there no responsibility as a society to act reasonably to minimize costs & steward resources?

Plus an increase in my lifetime medical costs, up to & including hysterectomy, which is more likely post several cesarean. That is a real risk & the prospect of diminished hormonal functioning in my wisdom years is a real & relevant risk.

I can't bet on being insured now or in the future, so I would be unwise to complicate my future medical care.

Are you asserting if we did it to everyone the price would magically come down? Via goodwill of surgeons & hospitals?

http://www.skepticalob.com/2009/12/cesarean-mortality-and-law-of.html


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## fruitfulmomma (Jun 8, 2002)

Honestly, I am more confused now as to what you are trying to get at. Assuming a totally hypothetical study proved beyond a reasonable doubt that caesarian birth was absolutely safer for all mothers/babies, would some of us still birth naturally and why? That was the question you asked, right? And many of us are saying no we would not necessarily have surgery, based on our beliefs about who/how we were created/evolved, etc. Why is it wrong to make decisions based on our beliefs? Science can't have all the answers and we don't make decisions in vacuums where our beliefs don't color those decisions.


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## Alenushka (Jul 27, 2002)

There not absolutes. Context matters. A good doctor is treating the patient and not a disease. Yes, sometime c-section is the safest choice.


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## myra1 (Jan 20, 2013)

Quote:


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


It is true that the information on c-section risk is available to women to make an effort to educate themselves. However, unlike in the Mothering community, the vast majority of women make no efffort to educate themselves. If they do it is anecdotal advice from other women who had managed births, pop culture, Parenting magazine, What to Expect When You're Expecting, babycenter.com, or other outlets that simply parrot the medical worlds propoganda, and mainly they take the advice of their doctor, with very little questioning.

If these women do learn about the risk of csections and routinely managed birth, they may still dismiss it as not applicable in their particular case since it does not match what they were told by their doctor. So for most women, the risks of c-sections/interventions ARE downplayed. Doctors still give very biased information.

Consent is not needed for a natural birth in a hospital because by chosing to be there, you are acknowledging it is not without risk. The consent given for csections and other interventions in most facilities is laughable at best. Informed in no way describes it. For my hospital births, everything I declined was met with shocked lecturing and dire warnings, but interventions were done without ANY explanation, and when a consent form was required, it was presented during hard contractions during which I had no capability of reading the pages of warnings. In fact, I was told it was all 'just standard' and I would not be treated if I did not sign it without reading.

I would dare say most women I talk to who are not part of the natural birth community can barely even tell me why their C-section or induction was needed, other than generally that the baby 'would have died!' Each person is convinced that they were a special case. Which is not to say thay they made the wrong choice or are somehow at fault, just that there was obviously no education and informed consent provided to them.


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## AlexisT (May 6, 2007)

The question was about safety, not cost. And in a hypothetical medical system that's made surgery as safe or safer than vaginal birth, perhaps it's also made it less expensive than it is now. It's a thought experiment, not grounded in the reality of our current medical system.

It seems to me fairly clear that the question is whether or not our choices are purely statistic-based or if we have an a priori bias towards non-intervention or in favor of natural birth, and if so, how far? It isn't always wrong to be biased in favor of expectant management, but it's a bias that has to be recognized as much as any bias in favor of surgery. As a thought experiment, arguments about the reality of medical care today don't seem very relevant. Yes, _now_ there is a lifetime risk to repeated surgery; we can't say this will always be true or to what extent, because we do not know what advances in surgical technique will be made.

As for information sources, my experience--over 2 high risk pregnancies--is that while OBs may minimize risks, a large percentage of consumer level literature, childbirth education, etc does not come from OBs: it is written by groups or people trained by groups involved in natural childbirth. The prevalence of natural childbirth ideas in the literature is disproportionately large compared to the number of American women who actually have or plan one. (Even the hospital childbirth education that many people complain is geared towards getting you to have an epidural is often provided by Lamaze-trained CBEs.) I did not have antenatal education in the US--my first was in the UK--but I can tell you, the sources I was given were not biased in favor of interventive birth and in fact I was left unprepared for my emergency C. The reason many women are ignorant of risk isn't that they did not have access to the information, or in some cases even that they were not told by their OB: many never cared enough to read it.


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## monkeyscience (Feb 5, 2008)

Quote:


> Originally Posted by *demeter888*
> 
> Quote:
> 
> ...


How is this an ideological point? I see "if it ain't broke, don't fix it" as a logical point, not an ideological one.


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## AlexisT (May 6, 2007)

(That said, I still dislike the image that women who do not seek out information are uninformed, uncaring sheeple. Many do not seek out information, or care, because they place no intrinsic value on the outcome other than getting out of it in a reasonable state. They place no value on process. If it is of no matter to you whether you have surgery or a vaginal birth, and you regard it as a simple medical question, the odds are you're going to say, "The OB can answer this better than I can, so I'll let him/her tell me what to do." There is another bias at work here: that an actively made, informed decision is always better. It frequently is--if you get the outcome you wanted less, but you were an active participant in making it, you're likelier to be accepting of it. But if you place no intrinsic value on the choices at hand, it's very hard to make that kind of active, patient-directed decision-making that's being pushed here. I cared about the decision making process for my 2nd CS because I felt I had been deprived of a participatory voice during my first, but beyond valuing certain trade-offs involved with each choice, I placed very little intrinsic value on the options. I didn't consider a VBAC because I felt it was inherently worthwhile to have a vaginal birth.)


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## AlexisT (May 6, 2007)

Quote:


> Originally Posted by *monkeyscience*
> 
> How is this an ideological point? I see "if it ain't broke, don't fix it" as a logical point, not an ideological one.


No, it is. It's a bias in favor of non-intervention. Ideology or bias isn't a value judgment; it's a philosophical question. It's about your starting point. Some people have a bias in favor of action. If the odds are equally weighted, they will choose to act because they are philosophically inclined to be more satisfied having done something. Other people are the reverse; they are inclined to not act unless the evidence suggests they should.

It's not about one being inherently better than the other; it's just the lens through which we view our decisions.


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## JenVose (Jun 17, 2013)

If studies showed that CS was the safest way to give birth for myself and my baby (and it was my first birth), I would take the time to research all aspects of CS and make a determination on whether I felt the increase in safety was of significant benefit given the drawbacks that will always be present, as it is a surgery and there would still be the issue of recovery/etc. that would still make it more inconvenient in terms of CS vs. a natural, uncomplicated birth.

In my current situation, having once given natural birth in a birthing center with excellent outcome for both me and my little girl, I would likely disregard any study that indicated CS might be the safer option, as my previous experience would indicate that there was no reason to believe that an elective CS could provide any better outcome (as baby was 10 of 10 on 1- and 5-min Apgar, never any jaundice, and in 16 months has only had two illnesses that resulted in fever; my recovery was faster than I have seen with any mothers who have had hospital births with drugs).

That being said, I would not hesitate to accept a medically recommended CS (although you can bet I'd be extremely nervous!) if my health or the baby's health or positioning indicated that in our particular instance, it was the safer decision individually.

In other words, I would consider the idea in full if I had not had any prior experience to indicate that a less invasive option could be as safe for me and my baby. But given my experience, I feel that I have enough knowledge to accept that it is possible to have the best possible outcome without the risk of surgery, therefore would not consider CS as a first option given my experience, but am still willing to accept that there could be extenuating circumstances which might make another choice better.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> Your POV expressed here is fundamentally idealogical.


My POV? Which point have I made that is ideological? do let me know.

I'm sorry but I am not interested in debating the cost of a cesarean or factoring that in to the scenario as a valid reason to prefer a vaginal birth, especially when a large number of attempted vaginal births wind up in an emergency cesarean anyways, which is significantly most expensive of all.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *hippy mum*
> 
> dinahx-do you have Dr Amy link? I'd like to read her stuff.
> 
> This is turning into an interesting conversation. I may have missed some things. What about mortality rate and csec? I'm sure the numbers could be wrong, but in states with increased csec, mortality went up. So how is that safer?


Let me clarify that this is a hypothetical scenario for all intents and purposes. Sometimes people have a hard time putting themselves in such a scenario even hypothetically that my point is that the data might not matter anyways.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *fruitfulmomma*
> 
> Honestly, I am more confused now as to what you are trying to get at. Assuming a totally hypothetical study proved beyond a reasonable doubt that caesarian birth was absolutely safer for all mothers/babies, would some of us still birth naturally and why? That was the question you asked, right? And many of us are saying no we would not necessarily have surgery, based on our beliefs about who/how we were created/evolved, etc. Why is it wrong to make decisions based on our beliefs? Science can't have all the answers and we don't make decisions in vacuums where our beliefs don't color those decisions.


All we have to go on in life is beliefs. What are our beliefs based on? Feelings? Data? Personal experiences? All of the above? Which basis for beliefs will have the best outcome? I believe we should all very carefully be aware of and understand the beliefs we have and their consequences. I do believe dogma is wrong, since you asked, and yes, I'm a big proponent of critical thinking. That is an ideology just like any other, and my point is not to criticize one way of believing vs. another, just to understand the differences. I apologize if this offends anyone in any way. I believe our hearts have a place in our beliefs as much as our minds.

I asked the question because I wanted to see how readily accepting people might be to the scenario in the first place. There seems to be a general rejection or hesitation toward the scenario. There seems to be a need to find a reason to reject it. What is it in our ideologies that causes this? That is my question.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *monkeyscience*
> 
> Talking about medical treatment/surgery for an illness or abnormality isn't what you referred to in your original post, though. I thoroughly agree that a c-section is a much better option than a natural delivery for a mother with a complete previa, for example. What you appear to be saying is that because c-section is better in that case, it's better in all cases. That doesn't make sense. Dialysis is also an awesome modern medical innovation. But it's only for people with kidney problems. There is no reason for someone with healthy kidneys to opt to have their kidneys removed and be on dialysis for the rest of their life. I absolutely agree that modern medicine does wonderful things. But I have a hard time believing that modern medical intervention in a process that would otherwise occur naturally is a good idea, absent of specific problems or indications of risk.


I am not saying that c-section is better in all cases in reality, so there is nothing to debate there. My scenario is what I am debating. I got to create the scenario and I don't understand why we keep arguing about a scenario when it's hypothetical. And once again you are closing your point in regards to what you believe


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## dinahx (Sep 17, 2005)

Your POV is made clear through your posts even though it has not been overtly stated. The very notion that cost is an absolute non-factor & that a 'large number' of intended vaginal births end in emergency cesareans is evidence of that POV. Can you cite a number of planned vaginal births that end in truly emergent cesareans & break out which of those are failed inductions vs. expectantly managed? Can you explain why some institutions/regions have been able to produce dramatically lower numbers of' cesareans than other comparable institutions/regions?

In your hypothetical scenario, you are not saying safer for who. Mother & baby are seperate entities & the safety of one is not necessarily a function of the safety of the other. So is your hypothetical that it is safer for the *baby*?

As Cesearean inherently displaces some neonatal risk onto the mother. Not eliminating it, rather shifting the risk equation.

Proposing a hypothetical in which risk is somehow magically eliminated for BOTH parties is first, the stuff of unicorns & fairy tales, sure I would love it of the baby could fly from my abdomen in a puff of glitter, but we are in the real world, where surgery involves cutting & MRSA risk.

Also, the unspoken implication is that women either don't have the right to think about their own safety & long term health (they DO have this right) or routinely attempt to avoid cesareans strictly for some guru cult ideology that has absolutely nothing to do with health (present AND future), maternal risk, recovery time or costs (present AND future).


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *myra1*
> 
> I would dare say most women I talk to who are not part of the natural birth community can barely even tell me why their C-section or induction was needed, other than generally that the baby 'would have died!' Each person is convinced that they were a special case. Which is not to say thay they made the wrong choice or are somehow at fault, just that there was obviously no education and informed consent provided to them.


 I agree that doctors and hospitals do a very poor job of informing women about the facts. I understand why, but that doesn't make it right. I also feel that women are uninformed in general about some of the realities of childbirth, and often willingly so.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *AlexisT*
> 
> (That said, I still dislike the image that women who do not seek out information are uninformed, uncaring sheeple. Many do not seek out information, or care, because they place no intrinsic value on the outcome other than getting out of it in a reasonable state. They place no value on process. If it is of no matter to you whether you have surgery or a vaginal birth, and you regard it as a simple medical question, the odds are you're going to say, "The OB can answer this better than I can, so I'll let him/her tell me what to do." There is another bias at work here: that an actively made, informed decision is always better. It frequently is--if you get the outcome you wanted less, but you were an active participant in making it, you're likelier to be accepting of it. But if you place no intrinsic value on the choices at hand, it's very hard to make that kind of active, patient-directed decision-making that's being pushed here. I cared about the decision making process for my 2nd CS because I felt I had been deprived of a participatory voice during my first, but beyond valuing certain trade-offs involved with each choice, I placed very little intrinsic value on the options. I didn't consider a VBAC because I felt it was inherently worthwhile to have a vaginal birth.)


My doula told me I was the most prepared and informed she had ever seen any first-time pregnant woman (for childbirth). That obviously does not guarantee anyone will enjoy their birth experience nor have a safe one. But I have no shame in my feelings about that experience, and no regrets that I didn't seek out information. I am very, very blessed to have a son safely delivered.

But in the end I became the victim of my midwife's ideology. She thought that I wanted a vaginal birth if at all possible. This was an assumption made on her part because of other portions of my birth plan that fit in with her ideology of what I ought to prefer. She did not ask me during the labor what I wanted because she saw through the lens an ideology that prevented her from even asking the question. I had developed a birth ideology through a similar lens because of the sources I selected to obtain my information from and failed to realize that until much later. Now I am trying to understand the decision making process, how women think about birth, and correlate it to the present state of things in medicine.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> Your POV is made clear through your posts even though it has not been overtly stated. The very notion that cost is an absolute non-factor & that a 'large number' of intended vaginal births end in emergency cesareans is evidence of that POV. Can you cite a number of planned vaginal births that end in truly emergent cesareans & break out which of those are failed inductions vs. expectantly managed? Can you explain why some institutions/regions have been able to produce dramatically lower numbers of' cesareans than other comparable institutions/regions?
> 
> ...


I'm not sure you read my question clearly so I am pasting it here for you:

If you happened to see strong supporting evidence that proved to you that giving birth via scheduled c-section at 39 weeks is now *safer/better for mom and baby t*han giving or even attempting birth vaginally at 40+ weeks in an uncomplicated scenario, would you still go ahead and attempt vaginal birth?

If you aren't interested in answering it or don't like it, you don't have to and that's OK.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *JenVose*
> 
> If studies showed that CS was the safest way to give birth for myself and my baby (and it was my first birth), I would take the time to research all aspects of CS and make a determination on whether I felt the increase in safety was of significant benefit given the drawbacks that will always be present, as it is a surgery and there would still be the issue of recovery/etc. that would still make it more inconvenient in terms of CS vs. a natural, uncomplicated birth.
> 
> ...


First off, congratulations on your positive drug free birth and healthy bebe. In a situation that can get scary like childbirth, women need your positive experiences like yours in their minds to know that it's possible. It seems that you, like me, tend to make decisions based mostly on personal experiences and, in absence of that, on objective information where you can find it.


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## dalia (Sep 3, 2007)

Well, if I had a choice, I would not choose a section. Because I dislike surgery very much, and because the recovery time was awful for me and caused PPD. I just had such a bad experience the first time. I'm working on a VBAC this time. We'll see.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *sillysapling*
> 
> "Not always" is not "never" or even "under most circumstances", and we're talking about major surgery that has serious health risks and lifelong repercussions (including risks to future pregnancies) as well.
> 
> ...


There are an abundance of medical practices and procedures-and ever increasing-which are used and highly popular and considered better than letting nature take its course despite their being elective. I had my wisdom teeth extracted, my SIL had ablation for heavy bleeding Etc. You want to have an ideological argument. There is no need to make it something else.

I'm well aware of the risks of cesareans. You are missing the point of my scenario. Furthermore, the risks of vaginal birth haven't been mentioned once, by anyone.


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## dinahx (Sep 17, 2005)

FYI: Routine Wisdom tooth extraction is on the way out. I only had one removed for this reason. Many dentists are now thinking that in the absence of symptoms, aggressive WT management is less preferable than expectant management & potentially avoids issues like TMJ, etc.

I think your question avoids realities of Cesaean, like that it isn't a method for unilaterally lowering risk to both parties, it is a method for displacing risk from the baby to the mother. Granted, since intrapartum mortality is measured per 1000 & maternal mortality is measured per 100,000, most mothers have some risk to spare. However maternal mortality is a growing issue in the US & Cesaeans are the primary cause of this.

One could argue that intrapartum mortality is also a maternal health risk (psychologically) & I would accept that to an extent.

However your question misses (maybe on purpose) the whole *reason* for expectant management of birth. It is safer & less medically complex for the Mother, in most cases.

If a mother values something like avoiding a potential Pelvic Floor issue more than avoiding abdominal adhesions & potential infections & an indisputably longer recovery time, then that is fine & most practices in the US are more than happy to accomadate that. However just like breast sagging is not *caused* by Breastfeeding but by aging, the pelvic floor can have issues only caused by pregnancy & hormonal changes (MOST Hysterecomy patients report pelvic floor issues, for example & Cesaeans increase the risk of Hysterctomy).

Maybe you can show us some data on risks you believe to be unique to vaginal delivery vs. pregnancy generally. I don't consider my Pelvic Floor to be in grave danger from a vaginal birth, certainly not from an expectantly managed one (just as you are drawing a distinction between scheduled & emergency C, a distinction can be drawn between expectant & active management of vaginal birth). I had a second - third degree tear with my first birth, with my second I just loosened up a stitch that was too tight & opted for no stitching @ all. The end result was a love life that was *better* than before vaginal childbirth. Any pelvic floor issues beyond that are from carrying my children, not delivering them.

I just think in our culture, we cannot get an accurate picture of vaginal birth's real effects (positive & negative) because of persistent sexist inaccurate myths like 'hot dog & a hallway' surrounding vaginal birth . . .


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## AlexisT (May 6, 2007)

But that's the point: The question is asking us to ignore current medical reality and base our decisions on a hypothetical situation. The decisions I make today, and the decisions I would make under hypothetical conditions, aren't the same. It's asking us to ignore the current state of data and examine our preexisting biases.


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## dinahx (Sep 17, 2005)

Asking us to ignore the reality of birthing a baby by operating on the baby's mother & pretend it is safer for both parties is idealogical in nature because it posits a future where that could & will become reality. I am saying, based on the nature of what we are discussing & all existing data that medical science will never make universal, elective Cesearean a safer choice for mothers generally. Statistically it is quite far from being so now. So I am asking OP to examine the biases that lead her to believe that either Ceseareans are just about to become or could ever become the safer choice for the mother OR that the mother's safety is not important.


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## AlexisT (May 6, 2007)

How can you be sure?

None of us is capable of making definitive statements about the relative safety of surgery at some unspecified future point with unknown-to-us developments. Whether or not I think it's likely doesn't matter--I can't know the future. OP never said she believed it was the case--she asked us to imagine a situation where it was.

We have already improved upon nature substantially. We have already made it safer for many women to give birth surgically, and the risks of surgery have been progressively lowered to the point where for more and more women, surgery is now the safer option. With the current state of surgical technique, anesthesia, and so on, it's not currently wise to recommend it for all women (though we have lowered it to the point where CDMR, if you are only planning 1-2 children, may be a reasonable choice). But you cannot claim to know that this will always be so.

By the way, there's a debate over just how much maternal mortality actually has increased and how much was due to changes in CDC reporting.


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## IdentityCrisisMama (May 12, 2003)

I think I answered this question on another thread of yours, Demeter. I know you are doing a lot of soul searching on this subject and that you were let down by our MW and Hypnobabies as well. I want you to know that I support the choice to elective cesarean because I do not believe any of us can decide for another woman what amounts to "elective". I think extreme discomfort with vaginal birth is a "need" for cesarean. As are all kinds of other reasons. I want to put that out there since you are discussing your experiences on this thread.

For the hypothetical...

For me, I suppose it comes first down to a sustainability and equality question, which I know a lot of people have already discussed. One of the reasons I like that we have a homebirth movement in this country (the US) and the world is because of this underlying fear of lost knowledge. That would be a worry for me if we moved entirely away from unmedicated childbirth.

For me there is also the issues of "what we don't know". Anyone worth their weight knows that science is just what we know now. Even if everything we know is correct (which it isn't) there is so much we don't know.

I do think it has been demonstrated through evolution that vaginal birth works pretty well. If we were to move over to birthing mainly through cesarean, I would worry about the outcomes of that. Honestly, it feels a little sci-fi even. On your other thread I think I also talked about this... What if it were proven that it is safer to eat some weird nutritional concoction out of a feeding tube? It probably would be. Right? We could ensure optimal nutrition, everyone would have the same experience, things could be controlled. It think it would be kinda weird and would not be worth the few people who would die choking on a hot dog. Sorry to be crass.

I know this is kind of hyperbolic but if this is a though experiment as someone called it, it seems like fair game. ;-)


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## dinahx (Sep 17, 2005)

I think until our culture fully awknowledges the sequelae from operative birth even later in life & the huge importance of uterine/ovarian retention through the lifespan, then we can't & don't yet fully understand the risks of elective Cesearean. I don't relate to some vague philisophical statement that 'someday maaaaaan will improve upon naaaaaature' because that has been the rallying cry of technology, since I suppose the first tools were invented. Man has destroyed nature just as often, if not more often than S/He has improved upon it, medicine being no exception here. In any case, the idea that we will SOME bright day invent another, better method of delivering babies than SVD for *everyone* has an idealogical basis.

Don't forget that Hysterectomy is widely & I mean widely performed in the US, IMO it is something all women need to engage in an active avoidance campaign if they intend to retain their Uterus over the lifespan. Expectantly managing L&D is one way to preserve & protect the uterus.


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## Ratchet (Mar 24, 2011)

I think it is an interesting question and I get your point-- I wouldn't avoid a c/s "at all costs" but would like to try reasonably-- and I think your premise is a hard one to wrap our brains around because it is fundamentally against the state is science and healthcare currently. For people who are healthy and free from illness, medical care is harmful ( med side effects, getting infections in the hospital, and unnecessary costs, which do matter for safety because they affects accessibility and affordability of care for people). I think medical professionals are in agreement with that. The best initial treatment for hypertension is eating better, the best treatment for a sprained ankle is if-it-hurts-don't-do-it. Other medical things are based on our current lifestyle choices-- if we weren't choosing to avoid pregnancy all the time and breast fed more, we would rarely menstruate and thus not need ablations, and if we didn't have modern dental care probably a spare tooth coming in would help. But medical care for its own sake doesn't do better than our own natural state. BUT iF IT DID, I would want a vaginal birth for the sake of experiencing it (the same way I choose to hike up mountains or take on a challenge at work or run a race etc) but would feel ethically obligated to choose a c/s if it was proven better. Luckily I am sure that will NEVER be the case across the board.


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## hippy mum (Aug 12, 2006)

Dinahx, very true.

Even if we were to take the surgery risks away and say it was safer, what about consecutive pregnancy risks, assuming the mom would choose to have another "safer" cesearean? What about health of mother and baby after birth? Recovery? Breastfeeding? Hormone release that comes with vaginal birth? We would have to ignore all of those things in the scenario that surgery was safer for birth for the general populace and pretend there are no problems.

Regarding cost of elective/emergency, the US is a country of inductions and "failure to progress" which results in those emergency surgeries. Not saying there aren't some real emergency ceseareans but those would be a small percent compared to the others.

There are risks to vaginal birth. I don't think anyone has said that there aren't any. The summary I've found (from reading/talking to women) is that many of the bad vaginal outcomes comes from women not being educated about birth and the medical practice pushing for labors to be quick and using practices not needed. We're no longer a culture where birth is normal and not medical, so we have these problems.


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## IdentityCrisisMama (May 12, 2003)

Quote:


> Originally Posted by *AlexisT*
> 
> It seems to me fairly clear that the question is whether or not our choices are purely statistic-based or if we have an a priori bias towards non-intervention or in favor of natural birth, and if so, how far?


Yes, I imagine that's the main point of the hypothetical, right, Demeter? You want to talk about whether our choices are driven by safety (if we're throwing out access, expense and religious objection) and to what extent. The exercise is to to see how far general ideological attachment to unmedicated birth is a factor when not choosing elective cesarean?

Ok, so scratch my last post.

To answer that question, I'd have to say, "I don't know". Safety gets weighed in for birth choices, sure, but then it gets mixed up with all kinds of other things. I chose to birth at home for both of my kids (my first was a non-emergent transfer). My choice was not entirely about safety. So, no, I would say that I would not choose elective cesarean even if it were proven safer. By extension, I relate to and support other choices that are made based on similar decision making processes.

But, of course it also comes down mostly by what we mean by "safer". If there was some tragic mutation where 10% of children died as a result of vaginal birth I'm sure I would choose cesarean - of course. But, when we are talking "safer" currently when it comes to birth choices the numbers are too small for me to not let all kinds of other factors in, yk?


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## salr (Apr 14, 2008)

First I should state that I dislike thought experiments because I think a lot of the time they are an attempt to lead people to a certain way of thinking rather than their stated goal of just seeing what people think. And thought experiments are often harsh or filled with things that are horrific to think about. I don't think it's a sign of lesser intelligence or anything to not like them.

Anyway, this is an interesting conversation so I'll join. If a c-section were magically safer for me, my baby, and all women then I would, like many others here, look at how MUCH safer. There would be a point at which I would have surgery instead based on that. I am also assuming that this safety magically continues for all health outcomes for mother and baby.

I'm still making this hypothetical decision for myself so from my perspective I will take into account what value I see in natural birth. It can be a positive, bonding, transformative event and I wouldn't choose to miss that possibility. I would feel connected to a traditional way of doing things and I value that. Most importantly, I would feel human. Birth is a mammalian human thing to do and I would want to join with the other humans in experiencing that (and like someone said previously, keeping that knowledge alive).

The thought experiment I would posit in response to this is what if there were a catastrophe and it was safer for people to move to a new planet in a big shiny space ship and live in a bio-dome on a semi-friendly alternate planet? Would you go there, or would you stay on Earth with the remaining humans in a world that has no modern conveniences?


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> Maybe you can show us some data on risks you believe to be unique to vaginal delivery vs. pregnancy generally. I don't consider my Pelvic Floor to be in grave danger from a vaginal birth, certainly not from an expectantly managed one (just as you are drawing a distinction between scheduled & emergency C, a distinction can be drawn between expectant & active management of vaginal birth). I had a second - third degree tear with my first birth, with my second I just loosened up a stitch that was too tight & opted for no stitching @ all. The end result was a love life that was *better* than before vaginal childbirth. Any pelvic floor issues beyond that are from carrying my children, not delivering them.
> 
> I just think in our culture, we cannot get an accurate picture of vaginal birth's real effects (positive & negative) because of persistent sexist inaccurate myths like 'hot dog & a hallway' surrounding vaginal birth . . .


 You keep asking for my "sources" that having nothing to do with the thread, and you keep going way off topic on stuff that while interesting is just screaming bias. I"m going to give you some sources and then I want this matter to be closed. I didn't come here to educate people I came here to educate myself.

I find it comical for women to call their vaginas yonis. My Indian MIL who does yoga 1.5 hours per day in fact has a YONI (and speaks HINDI) and had an undiagnosed fistula as a result of her YONI birth in which she like many other women had her concerns over tearing dismissed as being "normal". Not all women have good fortune in childbirth, and most who do know better than to think what works for them should be applied to everybody else and dismiss everything to the contrary.

And while you might not consider your pelvic floor in grave danger from an expectantly managed birth, a great number of women have pelvic floor damage as a result of giving vaginal birth. There is a reason a great number and majority of urogynecologists themselves would opt for elective cesareans. You keep throwing in additional information as if you can somehow change my hypothetical scenario; just let it go as you clearly aren't interested in the thread as it is.

I am really tired of being asked for sources. I will post several recent studies demonstrate how several assertions/beliefs are very possibly wrong in this thread particularly about pelvic floor damage which you ask for. The point is, if you wanted this data all you have to do is look for it yourself.

http://www.jogc.com/abstracts/full/200909_Obstetrics_2.pdf
summary:

"An elective pre-labour Caesarean section in a nulliparous
woman at term has a lower risk of life-threatening neonatal
morbidity than spontaneous labour with an anticipated vaginal delivery. However, the increased risk of life-threatening
neonatal morbidity in the spontaneous labour group was
associated with an operative vaginal delivery or emergency
intrapartum Caesarean section and not a spontaneous vaginal delivery. Further research is needed to better identify
women with an increased likelihood of an operative vaginal
delivery or intrapartum Caesarean section, as this may assist
pregnancy caregivers in decision-making about childbirth."

http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937809022157.pdf
"...cesarean was consistently associated with reduced odds of birth trauma across all birth weight subgroups whether or not fetal distress was present"

http://www.ncbi.nlm.nih.gov/pubmed/17011400
"...overall, the frequency of significant fetal injury is significantly greater with vaginal delivery, especially operative vaginal delivery, than with cesarian section, at 39 weeks."

http://bjp.rcpsych.org/content/176/1/83.full.pdf+html
"...demonstrates the need to include, assess, and balance the risk of psychological outcomes in different birth plans"

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)91176-9/fulltext
"survey of obstetricians in London, in which 31% of female doctors said they would choose a planned cesarean in an uncomplicated pregnancy, compared with 8% of male doctors"

http://www.ajog.org/article/S0002-9378(10)01037-9/abstract
"Having only vaginal childbirths was associated with a significantly increased risk of stress urinary incontinence and pelvic organ prolapse surgery later in life compared with only having cesarean deliveries. ...each successive vaginal delivery increases the risk for prolapse and incontinence; it was not just the first delivery that had the most impact"

http://onlinelibrary.wiley.com/doi/10.1111/j.1479-828X.2005.00363.x/abstract 
On reviewing the available evidence, it appears that there are sufficient grounds to assume that vaginal delivery (or even the attempt at vaginal delivery) can cause damage to the pudendal nerve, the caudal aspects of the levator ani muscle, fascial pelvic organ supports and the external and internal anal sphincter. Risk factors for such damage have been defined and variously include operative vaginal delivery, a long second stage, and macrosomia. It is much less clear, however, whether such trauma is clinically relevant, and how important it is in the aetiology of pelvic floor morbidity later in life.

http://www.ncbi.nlm.nih.gov/pubmed/20177295
"The occurrence of UI and anal incontinence during the postpartum period is related to the presence of incontinence in pregnancy, and vaginal delivery increases the risk of persistent incontinence."

http://www.nejm.org/doi/full/10.1056/NEJMoa021788
The risk of urinary incontinence is higher among women who have had cesarean sections than among nulliparous women and is even higher among women who have had vaginal deliveries.

"women who choose a planned cesarean have a lower death rate"
http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> Asking us to ignore the reality of birthing a baby by operating on the baby's mother & pretend it is safer for both parties is idealogical in nature because it posits a future where that could & will become reality. I am saying, based on the nature of what we are discussing & all existing data that medical science will never make universal, elective Cesearean a safer choice for mothers generally. Statistically it is quite far from being so now. So I am asking OP to examine the biases that lead her to believe that either Ceseareans are just about to become or could ever become the safer choice for the mother OR that the mother's safety is not important.


I am going to try to break this down one more time. First of all, asking a hypothetical question doesn't convey an ideology. I HAVE my own ideology, but that had nothing to do with the question. And in case you need more sources, here is one:

http://www.merriam-webster.com/dictionary/ideology

You seem to repeatedly ignore te actual question and draw something from it that has nothing to do with what I asked.


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## TCMoulton (Oct 30, 2003)

Hypothetically speaking, if there was concrete evidence that a c/s birth would be safer for both mom and baby I would have no problem making that choice. My two births were completely different (one vaginal, one c/s) and each resulted in some post birth challenges but in the end, for me, a safely delivered child was most important.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *IdentityCrisisMama*
> 
> I do think it has been demonstrated through evolution that vaginal birth works pretty well. If we were to move over to birthing mainly through cesarean, I would worry about the outcomes of that. Honestly, it feels a little sci-fi even. On your other thread I think I also talked about this... What if it were proven that it is safer to eat some weird nutritional concoction out of a feeding tube? It probably would be. Right? We could ensure optimal nutrition, everyone would have the same experience, things could be controlled. It think it would be kinda weird and would not be worth the few people who would die choking on a hot dog. Sorry to be crass.
> 
> I know this is kind of hyperbolic but if this is a though experiment as someone called it, it seems like fair game. ;-)


Hi, nice to see you again

I don't think vaginal birth "works pretty well", but that's my own opinion. I think for human beings in particular, vaginal birth is a very complex and often risky event and one in which changes to a woman's body are not good for her often enough that it warrants consideration of medical intervention.

That said, I also like and support home birthing for low risk women. I just wish there was more data on home birthing AND elective c-sections, and that more research was put into understanding it to make it either safer. I find it bizarre how the denial process both women and doctors end up in causes birth to be even more medicalized as a result.

It is a thought experiment; I don't want to be cornered about my sources or have somebody tell me I think the way I do because I was "traumatized". I very obviously would not have taken the time to ask the questions I do if I had ended up with a blossoming power yoni of sexual delight thanks to my birth experience.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *IdentityCrisisMama*
> 
> Yes, I imagine that's the main point of the hypothetical, right, Demeter? You want to talk about whether our choices are driven by safety (if we're throwing out access, expense and religious objection) and to what extent. The exercise is to to see how far general ideological attachment to unmedicated birth is a factor when not choosing elective cesarean?
> 
> ...


Yes, to the first question, except that we aren't throwing out the access; access to it is assumed. Religious objection and cost stand as valid reasons to say no to c-section in my scenario. The question was basically to what extent our ideologies interfere with the best/safest outcome for mother/baby. Period. I think the emerging answer for a lot of women is an emotional one and for some it's one about identity/relationship to the world.

Another missing piece of the puzzle is the lack of studies and academic research available into the safety of home births, which very well might be safer over all than any hospital birth for a large number of women. If only more people asked! That is yet another example of how one's (my own, in this case) personal experience and ideology shapes the direction of where I educate or don't educate myself, and how thew same data could get published in order to answer one public questions vs. another.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *salr*
> 
> The thought experiment I would posit in response to this is what if there were a catastrophe and it was safer for people to move to a new planet in a big shiny space ship and live in a bio-dome on a semi-friendly alternate planet? Would you go there, or would you stay on Earth with the remaining humans in a world that has no modern conveniences?


LOL. I like this question. I have done remote solitairy hiking and enjoyed it. I'm pretty hardcore about to being close to the earth: when it doesn't put my life or family in obvious risk. But if day to day living were as risky as birth, then I would move to the big shiny planet.

However, the point that you are making is that in the way you chose to answer the scenario, the safety is not significantly more, so you would choose your own personal values to tip the scales.


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## IdentityCrisisMama (May 12, 2003)

Quote:


> Originally Posted by *demeter888*
> 
> I find it bizarre how the denial process both women and doctors end up in causes birth to be even more medicalized as a result.


It is hard to discuss hypotheticals because so often there is a personal motivation behind the question (I think that's what some people are talking about when they say this is an ideological question).

When I said that vaginal birth worked pretty well I meant it got us through many millions of years. My mind went to cesarean section being WAY safer and removing financial obstacles it went to birthing entirely by cesarean as a species (not an individual)...and then I wondered how long we could go with that method of giving birth. I'd be weird, wouldn't it?

My mind skipped right over the current birth debate because if we were going there I do think I'd have similar trouble that others are having with separating out all the issues that we know are related and it wouldn't be a hypothetical.

Anyway, I hope you find the answers you're looking for and I wish you well for your birth.


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## IdentityCrisisMama (May 12, 2003)

Quote:


> Originally Posted by *demeter888*
> 
> The question was basically to what extent our ideologies interfere with the best/safest outcome for mother/baby. Period.


To that question I would say that I object to the term "interfere". If we substitute "influence", I think they play a HUGE role (if talking about basically the current state of what we know if just slightly tweaked in favor of cesarean). I think we all do it. Some, probably, more than others.

If this is the question another way to ask would be to ask parents to list their top ten reasons for choosing birth interventions in order of most to least important. I'd be telling to see where safety falls for people and how they phrase that, wouldn't it?


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## dinahx (Sep 17, 2005)

The mother/baby in a birth scenario are not interchangeable and never ever will be. Their safety is measured individually. I maintain that there will never be a scenario where an elective surgical birth is safer for BOTH the baby and the mother, it is sorta close, if OB was practiced correctly (ie always waiting for 39 actual IRL weeks vs. 39 LMP weeks) to being safer for the baby. That's it. But you don't get a I'm a Better Mama award for choosing one. Just as you said, there is risk inherent in birth, and past a certain point it can only be shifted around, not completely eliminated. Tradeoffs.

I don't get how someone would be NOT idealogical and not eager to link to data. There is really a very clear motivation behind this hypothetical.

I wholeheartedly believe that Homebirth is NOT quite exactly as safe for the baby, but women still get to choose one. And they aren't bad mamas for choosing the option that is safer for themselves & acceptably safe for their baby. Medical care in birth is totally wonderful, and expectant management with trained professionals in the developed world does NOT frequently entail Fistulas. Trying to imply that that is a real & common risk of expectant management & SVD in a medical setting would be like someone attacking Cesareans to post women who had to have limbs amputated or ended up in comas after their surgical births.


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## salr (Apr 14, 2008)

I also object to the term 'interfere' and it gets back to my dislike of hypotheticals. I'm pretty sure everyone can see this is not just a hypothetical but something the OP actually believes to be true.

As far as using ideology or whatever to tip the scales of my hypothetical choice, you might be surprised how much weight I would give my own ideology compared to other people. I'm assuming other people would be in line for the c-section before me. But that doesn't make me a bad mom. That doesn't mean I don't care about the safety of my hypothetical baby.


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## IdentityCrisisMama (May 12, 2003)

Quote:


> Originally Posted by *salr*
> 
> I also object to the term 'interfere' and it gets back to my dislike of hypotheticals. I'm pretty sure everyone can see this is not just a hypothetical but something the OP actually believes to be true.
> 
> I really don't think so. Sometimes members are on this journey as they are having a tough change or some reaction to birth (or whatever topic) and Mothering can be a great place to process that. It can seem funny because for a variety of reasons we are not comfortable asking a direct question - or often don't quite know what the direct question is until we've had a chance to discuss the issue. I've been a member since Demeter's first thread here and admire her process and soul searching!


Quote:


> Originally Posted by *demeter888*
> 
> That is yet another example of how one's (my own, in this case) personal experience and ideology shapes the direction of where I educate or don't educate myself, and how thew same data could get published in order to answer one public questions vs. another.


Yes! I think this is a cool thing to dwell on, really. To me, it's the path to really being self-aware. It's one thing to be educated on a variety of subjects and to let our passion settle on a few things...it's another to really get deep on the process that we use to get there.

One of my observations about myself and others is the tendency to decide what we want to be true first...and then apply research after. Right?

Another funky little pitfall is that once something is on our radar we naturally start to "see it". It's like getting a new model of car - have you noticed that you suddenly see that car everywhere?

Then, of course whatever confirms what we want to be true is great & valid and whatever contradicts it deserving a deeper look or we decide is trivial or worth it. Or, more likely, we don't even see it because it's not what we're looking for. Funny how we can understand it for ourselves (on some level...? or maybe we don't?) but have so much trouble understanding when someone else does it, right?

If this is what you mean by ideologies interfering, I can see where you're coming from.

What I guess I would say to that is that I think it better to work on our own stuff in that department - work on where our own ideologies may be leading us astray. It's *really hard* to discuss other people's ideologies and where that's interfering with rational choices without them feeling defensive or tricked. If that's part of the question, I think maybe a really clear, direct question about that would be a good way to go. However, I do think that being really self-aware of our own choices and process may make us less invested in the choices others make.

The reality of all of this is that if any of us were really clear we would probably be focusing on something like access to medical care, ending heart disease, or education, or global warming or whatever. Even what we choose to talk about or think about reflects our own ideologies.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *salr*
> 
> I also object to the term 'interfere' and it gets back to my dislike of hypotheticals. I'm pretty sure everyone can see this is not just a hypothetical but something the OP actually believes to be true.


That's a very indirect way of making an accusation. I AM a human being here part-taking in this thread, so if you have something to challenge in my viewpoints, go ahead. I made very clear what my motive was in the thread. Latter posts of mine no doubt indicate I do have ideological bias, but the purpose of the question was to see if people even answered it. FOr the most part, they had trouble with it. I wanted to understand why. Indirectly suggesting I have an ulterior motive or am not being honest is really just more scapegoating.


----------



## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> I don't get how someone would be NOT idealogical and not eager to link to data. There is really a very clear motivation behind this hypothetical.


Yes, there is! And if you actually read and understood one single thing I said, instead of constantly veering off-topic or demanding "sources", you'd have no reason to even make this statement.

I've been clear from the start.

For the most part, people who reject the hypothesis do so without trying to "defend" their reasoning with arguments that had nothing to do with the scenario in the first place. IT's purely hypothetical. What evidence there is to support the possibility that cesarean IS definitely safer for some women has no bearing on what I wish to understand. There is plenty of evidence, sources, Etc. None of them prove a hypothetical. That's ridiculous. If you were sincerely interested in sharing information, learning, or otherwise contributing something beyond your own ideological agenda I think by now you would have done so.


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## IdentityCrisisMama (May 12, 2003)

Quote:


> Originally Posted by *demeter888*
> 
> That's a very indirect way of making an accusation. I AM a human being here part-taking in this thread, so if you have something to challenge in my viewpoints, go ahead. I made very clear what my motive was in the thread. Latter posts of mine no doubt indicate I do have ideological bias, but the purpose of the question was to see if people even answered it. FOr the most part, they had trouble with it. I wanted to understand why. Indirectly suggesting I have an ulterior motive or am not being honest is really just more scapegoating.


In that case a better use of everyone's time would be to ask, "If asked, 'If C-section were proven safer than vaginal birth', would you answer the question. And, if you would have trouble answering, why do you think that may be."









I can tell you why I thought the question was troubling. It's because I don't know what you want to know and in clarifying, you've given several different explanations. I suggest getting deep on what the question is and try again. Ulterior motive, no, but an unclear one for sure. Hugs and support for the work you're trying to do!


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *IdentityCrisisMama*
> 
> To that question I would say that I object to the term "interfere". If we substitute "influence", I think they play a HUGE role (if talking about basically the current state of what we know if just slightly tweaked in favor of cesarean). I think we all do it. Some, probably, more than others.
> 
> If this is the question another way to ask would be to ask parents to list their top ten reasons for choosing birth interventions in order of most to least important. I'd be telling to see where safety falls for people and how they phrase that, wouldn't it?


I agree, the use of 'interfere' was a poor choice, and skewed the hypothetical with my own ideological bias. That's why I've tried not to append too much to the question because I think it was pretty clear to begin with.

We all have an ideology and I don't want mine to interfere with the way the question is understood and I think for the most part that has been accomplished. In fact, trying to understand information without prejudice is a part of my ideology; but it's fallible because I'm human. However, my agenda has been very clearly explained.

I think the reason I posed my question the way I did is because most people are not even aware of their own biases and that is what I wanted to get to the heart of. This is too vast a topic to contain in one thread so my efforts to keep it simple started with a simple hypothetical.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *IdentityCrisisMama*
> 
> In that case a better use of everyone's time would be to ask, "If asked, 'If C-section were proven safer than vaginal birth', would you answer the question. And, if you would have trouble answering, why do you think that may be."
> 
> ...


I am going to have to disagree with you here My motive has been explained in detail throughout the thread and is really quite simple. I wanted to know if people could answer a hypothetical and very straight question when the scenario is one they are not comfortable with.

People often have trouble with answering the question simply and directly because they are uncomfortable with the scenario right off the bat. People are not even willing to answer the question without digressing. The question was very clear. If it is proven best/safest for mother AND baby. If it was available to you where you are. Still, people seemed to gloss right over these details.

If people are not even willing to consider the question without digressing, it illustrates how their personal feelings/biases can potentially prevent them from being receptive to information. That might be arguable, but it's my own experience and conclusion.

My impression so far is that this is one topic people feel very strongly about and the end result is an insidious amount of misinformation and deficit in proper education for women like myself. I've been very privileged to make the birthing choices I made, despite the errors I made due to my own biases at the time. I made some fear-based decisions, and in MY ideology, that is now recognized to be a very grave mistake. I have no agenda to convince anyone of this, just to revisit where my head was before I took on a different way of seeing things.

One thing I like about the moms in this forum however is the large number of them who understand that each woman deserves to make her own choice.


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## hippy mum (Aug 12, 2006)

It looks like the reasons why most here are having trouble with choosing the hypothetical, is the safety and all that goes with it, is hard to ignore. A few posters mentioned personal motivation behind our ideals, when you get to the root of it. I think that's partly right. We would have to completely remove emotion (religion etc) out of the equation, and that's difficult to do, no matter how much we deny it.

A friend of mine once said that we can find any information to back our beliefs-another example- it was just put out last year if I remember right, that vbacs should be explained to all women with prior csec and attempted if the woman is a candidate for it, due to the safety/birth benefits. I'm sure there are many that would dispute that fact or moms having fear of a vbac, just like many would be in favor of it.

Demeter, it seems that you are having a hard time with this decision? Or looking for more support in ceseareans over vaginal birth, given the hypothetical question? Momma, this is your/family birth choice. If you feel that it is right for you, then that's what you do. I'm sure if you were to make an elective cesearean thread, those having one or had one would pop in 

I think one thing to remember, is to not be judgemental toward each other. Especially with birthing choices, it can be a hard decision, especially if our prior birth experience was not ideal for us. How many of us had not great experiences with birth the first time so looked for a different way the second? How many of us had to fight for our decision that second time, especially if it was very different? How many of us changed our ideals to support that choice?


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## IdentityCrisisMama (May 12, 2003)

Quote:


> Originally Posted by *demeter888*
> 
> I am going to have to disagree with you here My motive has been explained in detail throughout the thread and is really quite simple.


No, it really wasn't - at least not to me. Communication is part asking, part listening and part being understood. I'm trying to listen to the question...and it is feeling more like an a discussion of other people's biases than anything else.

Have you ever heard the saying, "90% of drivers think they are a better than average driver"? Most us to think we are aware of our own biases.

I do not think this is a simple question or that the question is clear or that it has been clarified well. If there is something to be gained in learning that people are having trouble with this question, I struggle with understanding what that is. You seem resistant to the possibility that it is just a poorly constructed question, which I think is a pretty good example of one form of bias.


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## CI Mama (Apr 8, 2010)

Demeter, I've been skimming through this thread and I admit, I am not always following the conversation. But what does stand out for me is that you're trying to process an unexpected and difficult experience with birth, and that's something I can relate to, having had an unplanned c-section after a long & difficult labor.

You also seem to be asking about how we use information, specifically, statistics, to make decisions.

I'd like to offer a few thoughts, which may or may not be in line with what you're aiming for. I present all thoughts as my opinions.

No statistic, whether real or "experimental" will ever be 100% true for all births. Some of them might be vanishingly close to 100%, but there is nothing in birth that will apply to absolutely everyone. My experience with looking at stats is that I wanted to know not only "what are my chances of having a good outcome" but I wanted to know "will a bad outcome happen to me?" I think it is easy to confuse wanting to know your statistical risk of having something happen with being able to predict what will actually happen to you during birth. As rational as I hope my mind is, I was hoping that having the stats on my side would mean that nothing bad would happen.

I think there's a difference between how we look at information when we're preparing for the unknown, and how we look at it as we're processing after the fact.

Now that I'm on the other side of birth, having had a difficult experience that I had felt was not very likely, I have found myself tending towards two different ways of processing it:

A) Deciding that my bundle of "birth beliefs" was a load of crap and feeling duped by what I did not know or anticipate.

B) Blaming myself for doing something wrong (because birth can't be flawed, but I can be).

I think these are very common responses to difficult experiences. I'm sure I'm not the only one who does this. The internet makes this pretty clear. No matter what bundle of birth beliefs one holds, there's a website out there devoted to poking holes in those beliefs, trotting out examples of where those beliefs have served women poorly, and rallying a community that wants to counteract that set of beliefs, etc. And the same holds true for option B. I'm pretty good at self-blame on my own, but if needed reinforcement, I can find ample voices on the internet that would join me in picking apart every detail of my birth experience and pointing out every mis-step that I made.

I don't want to gloss over the fact that some bundles of birth beliefs truly are dangerous and detrimental to women. Care providers can do things that harm women, and women themselves can undermine their birth experiences by being poorly informed or making poor choices. I know that can happen, and when it does, I think it's important to call out the bad beliefs or the bad care providers, and it's important for women to decide for themselves what ownership they want and need to take in their own experiences in order to move forward. And the internet is also a great place to see all of that in action.

I find it harder to get support for what I think of as the 3rd path, which is the path that I have been trying to walk for the past 4+ years. And that is the path where birth doesn't get blamed, care providers don't get blamed, and women don't get blamed, because there is a mystery at the heart of birth, and the mystery is that some births are really difficult, and there isn't always a simple, clear reason why. That's what feels most true in my experience, and that's the place I try to stay, though there is very little support for it.

I don't know if that addresses what you're getting at, but I just wanted to share in case you find any of this helpful. If not, feel free to ignore all of this!

I wish you peace on your journey.


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## salr (Apr 14, 2008)

Demeter, I'm sorry for talking about you without talking directly to you. I was confused by some of the side conversation that was about people's current knowledge of safety, as opposed to the hypothetical. I was purposely ignoring your situation and journey because that wasn't what the question was about. I don't mean to be cold about that though. You're definitely a human and I'm glad you're here talking about all this.

One thing that maybe a pp just touched on is that when I look at statistics I try to decide how they apply to me. In the thought experiment that is not part of it because it is assumed that they just DO apply to me, or it is assumed they are not statistics but rather a crystal ball knowledge of the future. That might be where some of the side conversation stems from.


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## salr (Apr 14, 2008)

Demeter, are you expecting there to be a common number representing safety that everyone will agree on? By that I mean, if c-section were 80% safe but vaginal birth was 60% safe do you think all moms would/should choose c-section? I'm wondering if your question is about what the numbers are for each person, or if your question is about (given the numbers) what would influence a person to choose the less safe path.

I guess I'm curious if we can or should add more details to the thought experiment in order to get more specific responses. Like, hypothetical numbers.


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## monkeyscience (Feb 5, 2008)

I've been reading along to see what others have had to add to this conversation, and it's been interesting. I've decided there are a few things I would like to say.

There's been a few mentions of us making decisions emotionally, and then backing them up afterward with the "facts"/statistics/etc. that most conform to our pre-made decision. There's actually a really awesome book about this topic that I highly recommend called The Righteous Mind by Jonathan Haidt. It's way too long to get into his theories in detail here, but it basically boils down to the fact that deciding and THEN reasoning is what humans do. It's far more interesting than that, though.

I also agree with the statement that no, honestly, the hypothetical situation presented at the beginning of the thread is NOT clear, and that's part of the reason people have been struggling to answer it. Just to quote it one more time:

Quote:


> If you happened to see strong supporting evidence that proved to you that giving birth via scheduled c-section at 39 weeks is now safer/better for mom and baby than giving or even attempting birth vaginally at 40+ weeks in an uncomplicated scenario, would you still go ahead and attempt vaginal birth?
> 
> Why or why not? (Assuming you lived in an area and had access to care that had been included in the studies proving the safety of the procedure).


The biggest thing that is unclear to me about this is whether or not the scheduled c-section is safer for mom and baby only in the short term (i.e., no/fewer injuries to mother & baby, no/fewer perinatal infections, no/fewer respiratory issues for baby, etc.), or if it is the short AND long term - i.e., 20 years later, moms/babies who went the section route were physically healthier than moms/babies who attempted vaginal delivery. The word "better" on its own is totally meaningless, IMO. I do not understand if the OP means "better" physically (which I would think would be covered by "safer") or better emotionally (which is an entirely subjective and personal thing, and there will never be a one-size-fits-all "best" in that area), or in some other way. It is also entirely unclear from this scenario (as has been brought up several times) whether in this hypothetical world, the risks of repeat cesareans to future babies still exist. Perhaps the lack of future risks is, in the OP's mind, implied by "safer", but again, this is not directly stated. As has also been brought up, all surgery requires a recovery period, even if there are zero complications from the surgery and recovery proceeds flawlessly. If this hypothetical is meant to be about a future where abdominal surgery magically no longer requires any recovery time, that should be stated directly. There is also the question many have brought up about breastfeeding - having a c-section is known to increase the risk of breastfeeding issues. If, in this hypothetical scenario, that risk has been eliminated, it should be stated. Again, perhaps the OP thinks that is implied in the "better/safer" portion of the hypothetical, but that is very unclear.

I have already answered the question quite directly, but I will answer it again just to be clear: If the evidence proved to me that a scheduled c-section was safer than attempting vaginal delivery, I would want to know how much safer. If it were significantly safer (reducing risks from, say, 1 in 10 to 1 in 1000), I would probably do it, even if there were risks to subsequent pregnancies. If the risk reduction was less pronounced (say reducing risks from 1 in 1000 to 1 in 10,000), I would probably not do it, due to the risks to subsequent pregnancies and the necessary recovery time. I understand (and have experienced) that vaginal deliveries also have recovery times to some greater or lesser extent. However, there is at least a chance with a vaginal delivery that that recovery time will be minimal, and there is not really a chance of that with c-sections.

If I were rewriting the hypothetical as I am guessing (perhaps incorrectly) that the OP intended, it would look like this:



> If you saw evidence that proved to you that giving birth via scheduled c-section at 39 weeks is now always much safer* for mom and baby, in all measures of short- and long-term physical and emotional health, than giving or even attempting birth vaginally at 40+ weeks in an uncomplicated scenario, would you still go ahead and attempt vaginal birth? Assume that there is no recovery time from the c-section (you're up and moving normally the next day, no pain or risk of injury to the incision site), and that breastfeeding is in no way hindered by your surgery.
> 
> Why or why not? (Assuming you lived in an area and had access to care that had been included in the studies proving the safety of the procedure).
> 
> *Assume, too that the evidence meets your definition of "much safer", whatever that may be.


The answer to this question is yes, of course I would. Do I find it incredibly unfathomable that such a scenario could ever exist? Yes. But if it did? I have no reason to have a vaginal birth if it isn't better in any way, shape, or form for anyone involved.

I think the biggest reason people are struggling with even contemplating this scenario is because it posits a world in which we KNOW, absolutely and beyond any doubt, that a complex intervention that affects a myriad of things in two different, complex human beings, potentially for the rest of their lives, will be better in all measures than the alternative. Science simply doesn't offer that kind of certainty about anything. All science can do is offer odds. It is not entirely unfathomable to me that scheduled c-section could someday be a better option for a large percentage of women. (Unlikely, to my mind, but not unfathomable.) But absolutes are always difficult to contemplate, because we do not live in a world of absolutes.


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## LLQ1011 (Mar 28, 2012)

What I meant was that it is very common in our medical world for them to decide and present strong evidence for something (Like formula feeding is better decades ago) and then take it back only a few years later. Just like circumsision. Before they said to not do it, now they are saying to do it. In the end this cycle is common and if they did come out saying csection at 39 weeks is better (which we know will not happen as studies continue to come out to show this is not the case at all) I would not trust it as it is pretty normal for these things to bounce back and forth. In my ecperience the natural way almost always wins out in the end (not saying there are not exceptions as I myself am one) but for the most part it seems as much as we fight the natural processes the more it ends up that it was the best way all along.


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## CI Mama (Apr 8, 2010)

Quote:


> Originally Posted by *monkeyscience*
> 
> I've been reading along to see what others have had to add to this conversation, and it's been interesting. I've decided there are a few things I would like to say.
> 
> There's been a few mentions of us making decisions emotionally, and then backing them up afterward with the "facts"/statistics/etc. that most conform to our pre-made decision. There's actually a really awesome book about this topic that I highly recommend called The Righteous Mind by Jonathan Haidt. It's way too long to get into his theories in detail here, but it basically boils down to the fact that deciding and THEN reasoning is what humans do. It's far more interesting than that, though.


Thanks for the book recommendation. Sounds like a very interesting read.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *hippy mum*
> 
> Demeter, it seems that you are having a hard time with this decision?


You are referring to my decision to have an elective cesarean? Not in the slightest. I know what is best and safest for me and my baby. I have no problems with people not seeing it that wa because I understand where it comes from. I have read more than one side of the reports and done my homework. There is an ideological bias for the majority of people. What I posted this thread for was to revisit my own thinking back when I thought along similar lines. Now I do.

You are very right in that people can find "data" to support whatever ideas they want to, and in the natural childbirth industry, there is no shortage of bias and miseducation either. "Nobody is saying vaginal birth doesn't have risks", is a far cry from educating women about what the risks are. "Our bodies are designed to give birth" is clearly not applicable to all women and grossly dismissive, insensitive, and ignorant of the realities. We who hold steadfast to the dogma do so for a reason. It is just the flip side of the coin for those who dismiss what they consider less important.

I take no pride in the idea of a "natural" birth because I don't believe it is inherently better than any other type birth. Safer? Sometimes. More enjoyable? Sometimes. Better if you plan to have more than 2 or 3 babies? Absolutely. But most women don't. Nothing is perfect but so few people are willing to talk about the imperfections of nature. Mother nature is imperfect and quite cruel and that is based on the data. That is the crux of where the denial seems to lay.

I have seen too many times women who have put pressure on themselves to be whatever the ideal is in terms of having a natural childbirth. Until we remove the judgmental attitudes we carry towards ourselves and women who choose differently for themselves, we are all wrong.

My question was very clear. My motive was very clear. Those who wanted to understand better asked rather than assumed. Those who were scared jumped to conclusions or tried to invalidate my question (or motive).

All in all a good and interesting discussion. I will take my time to learn all there is to learn from this as I come to understand my OWN biases and refine my own ideology.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *IdentityCrisisMama*
> 
> No, it really wasn't - at least not to me. Communication is part asking, part listening and part being understood. I'm trying to listen to the question...and it is feeling more like an a discussion of other people's biases than anything else.


It is not a discussion of other people's biases, it is a discussion of everyone's biases. Implying that this is somehow one-sided is just not representative of the thread or what I have said personally. The question itself, while it definitely raised other questions, really raises all the valid questions I wish more people would ask in the first place:

1. What are the true potential complications of vaginal birth compared to c-section for me, really?

2. Is safety what I value most about giving birth?

3. Why does the idea of mother nature being inferior to scienctific (or created) intervention bother me?

There are a lot of assumptions and dogma. These are all questions I wish I had asked myself sooner. My motive is to understand why I didn't. It's still a bit of a mystery.


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## dinahx (Sep 17, 2005)

I think actually experiencing a Cesarean is the only thing that can disrupt the current set of ideas that you are espousing. I actually developed my passion for expectant management of childbirth after seeing my mother go though four classical Sections (the first of which saved my life) and then 5 years later, a Hysterectomy for adenomyosis, etc. Classical sections are definitely on a higher order of impact, it makes the tradeoff a lot more clear, but there is still a tradeoff today.

There are a lot of assumptions being made in this thread about those who interpret the available evidence on birth safety differently.

That we are scared of medicine, that we are under the spell of dogma, that we think just because something is natural it is always better in a very rube like simplistic fashion, that we are basically starry-eyed pawns of the natural childbirth 'industry'. Those assumptions are not correct, but I suspect that until you experience the other method of resolving birth, you won't see where we are coming from. I hope dearly that when this is all done, that you have such a wonderful and problem free experience that you can hold on to your assumptions, but the reality is that just as getting a low-impact vaginal birth is a combination of skill (in preparing, in selecting a setting and provider), health, and luck, getting a low-impact cesarean is dependent on the same factors.

I have seen women who WANTED cesareans howling @ the moon afterwards and feeling totally trapped by the recovery time and the pain. And I have seen women who didn't want them do awesome! I have also seen women who thought it would go fine get horrible post-op infections and women who had health conditions that should have made recovery complicated back to work & love @ 3 weeks . . . So it just isn't 100% predictable or even close . . .


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *CI Mama*
> 
> You also seem to be asking about how we use information, specifically, statistics, to make decisions.
> 
> ...


Statistics was only a small part of the hypothetical scenario. The way I raised the question, the idea of a set whatever data (be that reports, studies, trial, stats) somebody needed to prove for themselves that c-section was safer. One point I made early on was that, understandably, not everybody makes decisions like this. Not everybody believes these things are absolsutely knowable. I'm still a proponent of natural childbirth for some women, wish we knew more about it, wish home birthing was supported and objectively studied far more than it is, and have added some additional tools to my childbirth knowledge and philosophy, as well. I don't feel like I was duped and I don't think blame is good for anyone. I haven't accepted something as an unknowable mystery, though. I am tirelessly analytical to the point that it can make some people uncomfortable.

I too wish you peace on your journey


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## CI Mama (Apr 8, 2010)

Quote:


> Originally Posted by *demeter888*
> 
> I too wish you peace on your journey


Thanks.

And thanks for the interesting thread.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *salr*
> 
> Demeter, are you expecting there to be a common number representing safety that everyone will agree on? By that I mean, if c-section were 80% safe but vaginal birth was 60% safe do you think all moms would/should choose c-section? I'm wondering if your question is about what the numbers are for each person, or if your question is about (given the numbers) what would influence a person to choose the less safe path.
> 
> I guess I'm curious if we can or should add more details to the thought experiment in order to get more specific responses. Like, hypothetical numbers.


I don't think anyone will ever agree on safety, that is why I posed the question to be whatever data is needed for you. Do I think all moms would or should choose c-section? No; why would I take away what many women wish to experience and helps to kick off an amazing bond with their child, if that is what they value most? I think moms should choose with as much data and awareness as possible based on their values. How closely moms and care providers are willing to look at that data and ask the questions in the first place is what I am seeing fall short for reasons that I don't think are logical based on values I think might conflict with other values. There is a values conflict from my perspective if somebody has trouble simply stating that safety is not their only priority. This seems to come from personal past experience with birth. It's not all objective; I'm just a biased human being. That is my opinion and I know it's not a popular one, but since I got questioned about it enough times, I have felt it necessary to sidetrack the thread by sharing this and other less important details.

I would love to know more, too. I think I intentionally started off the thought experiment to be obtuse to see how people reacted to making a choice about making a choice. I didn't intend to be manipulative; it's a hard enough question for most people in it's simplest light. It would not work if I made it too complex. Perhaps my opinion on other peoples' way of answering it is really inappropriate and I should have ignored that lure to begin with. I think a new thread with a new thought experiment is a good idea. Let me know if you post one.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *monkeyscience*
> 
> I've been reading along to see what others have had to add to this conversation, and it's been interesting. I've decided there are a few things I would like to say.
> 
> ...


1. This book looks interesting, thanks for the suggestion.

2. Your being unclear about c-section scenario data revealing only short-term or long-term safety is understandable. I left this open for interpretation, it helped me to see whether a person would choose to acknowledge either possibilty or automatically look for a reason to invalidate the scenario altogether. But, the main reason I avoided this detail is because the scenario has a lot of possibilities for complication. I personally would have assumed that when a scenario says best/safest, it means over all safest and best period with all things considered.

3. I agree the word better is very subjective. I was referring to a better health outcome. That is what I expected somebody to understand from it at a minumum, since better could refer to any number of other values, but that was the minimum it was to refer to.

4. Your newly updated question really is quite good. We can always start a new thread However, I think most people would come back with "but this scenario will never happen" on MDC.

I wanted to create a scenario that is questionably possible for inquiring minds.

5. It is possible, in fact as you might already know there is evidence to support that, elective c-sections are safer for mom and baby in the short-term in some situations. Home birth is probably safer over all than attempted hospital vaginal births, too. The bias to not question one over the other is obvious to me.

Finally, the fact that people repeatedly discount the data and it has never even occured to them that it's possible is a major learning point of the experiment. If I go over to babycenter and pose a similar scenario but with home birth instead, I think it might shed some light on how our values help or hinder the way we receive and process information, but from the flip side.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *LLQ1011*
> 
> What I meant was that it is very common in our medical world for them to decide and present strong evidence for something (Like formula feeding is better decades ago) and then take it back only a few years later. Just like circumsision. Before they said to not do it, now they are saying to do it. In the end this cycle is common and if they did come out saying csection at 39 weeks is better (which we know will not happen as studies continue to come out to show this is not the case at all) I would not trust it as it is pretty normal for these things to bounce back and forth. In my ecperience the natural way almost always wins out in the end (not saying there are not exceptions as I myself am one) but for the most part it seems as much as we fight the natural processes the more it ends up that it was the best way all along.


This is all fine and well and I tend to agree with you, but the point of the scenario was that the data was present for you to be convinced. Obviously if the data was paid for by special interests it would not work for you.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> I think actually experiencing a Cesarean is the only thing that can disrupt the current set of ideas that you are espousing.


Your statement is offensive and ignorant.

You seem to ignore data altogether in favor of wild personal opinions and personal anecdotal experience to the point that I wonder if you understand that I am a different person with my own ideas and beliefs that just don't fit in with your fringe network. *Maternal satisfaction in elective cesareans happens to be extremely high in recent years. Step outside your box.*

I'd be happy to post a large number of studies or direct you to places where you can gather plenty of anecdotal evidence that contradicts your views about my personal choices, but you already ignored my last attempt to share factual information with you, so I'm going to let it be this time. In fact, I'm going to ignore you going forward. I wish you luck.


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## AlexisT (May 6, 2007)

I've had 2 Caesareans. The first was an emergency. The second was a planned repeat, and I considered VBAC. So believe me, I am well aware of the tradeoffs and consequences.

Most of the elective (ie scheduled) Caesareans I know have a high satisfaction rate, FWIW. Emergencies, especially after long labors, do not.


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## dinahx (Sep 17, 2005)

I was just reading ACOGs journal yesterday & there are large numbers of studies just in one issue that contradict the studies you have posted here.

Maternal 'satisfaction' would be very difficult to quantify. However any study citing high levels of maternal satisfaction would not discount the experience of dissatisfied mothers just as you say positive vaginal birth experiences don't discount your experience.

How is my statement any different than your statements that a preference for expectant management of birth is ideology driven & any research supporting it is biased by that ideology? You just said I should 'step outside my box' because I stated that some women are dissatisfied with their sections & have infections & long recovery time. Just true statements.

You posts seem to want to establish that your POV is more logical & analytical & more data-y than all others & that is just not accurate.


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## demeter888 (Jan 18, 2013)

Everyone:

Here is something I want to tell women who haven't given birth about the risks of c-section:

Infection, embolism, blood clot, thromembolism, hemmorhage, adhesions, abnormal placentation in future pregnancies which can lead to severe complications, subdural hematomal absess, future sterility, nerve injury, back pain, cardiac arrest, trapped epidural catheter, high block, nausea, vomiting, itching, uterine rupture, rehospitalization, headache, human error, scarring, skin overhang, chronic pain, bladder overdistention, delayed breastmilk production, poorer/delayed hormonal production, DEATH, and extended and sometimes painful recovery time, are some of the risks for the mother in having this surgery.

THE ODDS OF THE ABOVE RISKS MENTIONED ARE SIGNIFICANTLY HIGHER IN UNPLANNED CESAREANS. And births in hospital wind up with a range of interventions, about 30% of the time these are "emergency" unplanned cesareans.

Sadly, many of these risks are inherent in birth in the cases of any medical intervention at all. There are inherent risks in choosing to give birth, period. These risks are not always avoidable. Be prepared. Know the risks, don't rely on your feelings and beliefs alone: get the data you can find. Trust no one source. There are many other risks not included above that can happen with vaginal birth as well. Don't just seek out happy or natural stories: go to a variety of sources and women for your learning. The vast majority of us will tell you that, no matter what happens, it is worth having that little baby in the end and we truly mean it.

The less afraid you are to ask questions, and the more you prepare, the better you will feel about the outcome.

ETA:

I edited "don't rely on your feelings and beliefs" to , "don't rely on your feelings and beliefs alone"


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## LLQ1011 (Mar 28, 2012)

If i was convinced by the data then this question seems odd.


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## hippy mum (Aug 12, 2006)

As far as having to experience a cesearean to have a different view-how's that's any different than anything else not experienced? Actually doing/participating changes a perspective. It may affirm a belief, it may change it. We can learn about birth (vaginal/cesearean), but until we experience it, what we perceive will be different than those who've gone through it.

Alexis-that's what I was saying earlier-electives can turn out ok (I have no idea on long term/breastfeeding/health etc), but those emergency ones are going to be more traumatic. Though I know plenty of women who had electives and wished they would have gone for a vaginal instead as well, (mainly due to recovery and breastfeeding problems). I'm sure there are plenty of women who say the opposite.


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## salr (Apr 14, 2008)

I'm with LLQ1011. If we are convinced that it is significantly safer for us, whatever significantly means to each of us, then I just can't imagine someone choosing to go with the blatantly unsafe option. Especially since there are apparently no negatives at all to choosing the safe option.

This seems like the moment when we just wait for that one person to say, Me! I care more about the experience of birth than my baby!

I just feel like we'll be waiting a really long time for that answer.


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## Backroads (May 4, 2013)

I think the deciding factor for me would be not so much improved safety via c-section but significant danger if I attempted a natural birth. If the estimation was simply "c-section will be a bit safer but vaginal should be okay", I would go with the latter.

Of course, the most important thing is the baby's safe arrival so I wouldn't be demanding vaginal delivery against common sense.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *Backroads*
> 
> I think the deciding factor for me would be not so much improved safety via c-section but significant danger if I attempted a natural birth. If the estimation was simply "c-section will be a bit safer but vaginal should be okay", I would go with the latter.
> 
> Of course, the most important thing is the baby's safe arrival so I wouldn't be demanding vaginal delivery against common sense.


Obviously, what somebody considers significant danger can be subjective. I consider attempting a vaginal birth in most hospitals in the USA to present a significant danger to me personally after having done it before. That is why many of us stay home the next time. Is unplanned major surgery a significant danger? It would seem that many posters think so.

If that is the case, and you are planning a hospital birth, women already have a 30% chance (statistically) of "significant danger".

But none of this is to say that home birth can't also be a significant danger. Are women really asking the questions they need to in order to assess what is most dangerous for them personally? Those are not easy questions to ask and we are not encouraged to ask these questions for the most part.


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## demeter888 (Jan 18, 2013)

Quote:


> Originally Posted by *dinahx*
> 
> I was just reading ACOGs journal yesterday & there are large numbers of studies just in one issue that contradict the studies you have posted here.
> 
> ...


Your method is, when your argument fails, to make personal attack, lie, and go off topic and make vague assertions. You haven't got the research or data but like to talk about it subjectively because you have an agenda you can't seem to accomplish.

Maternal satisfaction isn't that difficult to quantify, you just don't like being wrong.

I never once said expectant management for birth is ideology driven. Everything is ideology driven.

You did not say SOME women are dissatisfied, you implied that most women are, that I would be, and you got rude and nasty and made a snide comment about my birth plan which is none of your business. That's really pathetic and I'm not surprised to see you being unapologetic.

I really hope that you get help for yourself because you have repeatedly read into things that simply don't exist. You are delusional. The only person I've encountered in this thread I am quite certain I have more data and logic than is you.


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## dinahx (Sep 17, 2005)

IDK where we are getting 30% risk of a emergent Cesarean for attempted vaginal birth in US hospitals. First, my local hospital has a *primary* C rate of 9% for my practice & 11% generally. That includes inductions. The rest are repeats. That primary rate only represents women having attempting vaginal births, not managing L&D expectantly. That would include all the inductions, etc. Some VBACs would not be in that group & I am on the West Coast where Section rates are better, but the Section rate nationwide has to be broken down into primary Cesaean, inductions for which indications, etc, if you want to get the rate for how many expectantly managed SVD truly end in emergent surgery.

As far as me citing or not citing data: I was told that this thread was not supposed to be about data & then accused of all sorts of things by not linking to data.


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## myra1 (Jan 20, 2013)

Quote:


> Originally Posted by *demeter888*
> 
> Quote:
> 
> ...


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## cynthia mosher (Aug 20, 1999)

I've removed a few posts to this thread that were attacking. Let's please keep the discussion about the topic and not an individual.


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## krst234 (Nov 13, 2007)

Quote:


> I asked the question because I wanted to see how readily accepting people might be to the scenario in the first place. There seems to be a general rejection or hesitation toward the scenario. There seems to be a need to find a reason to reject it. What is it in our ideologies that causes this? That is my question.


Late to the conversation - but oh-my-gosh I can't tell you how much I LOVED seeing this question.

I asked this exact same question - hypothetically speaking - to a midwife a few years ago, simply for the sake of conversation - and the response was VERY similar to the responses you are getting.

The first was straight-up denial, and a refusal to even entertain the scenario.

The next was to examine my 'motives' in asking the question. (And this conversation was with a close friend of mine). The idea that surgery could be safer - (a mere IDEA!) was so threatening, it was like blasphemy.

After a few minutes of talking, my friend felt a little bit better about ME. I had to regain her trust during the course of the conversation. But I felt like we never got to the actual issue. There was very much an emotional refusal to even entertain the idea. It's just an idea!

I just wanted to know because what I'd observed as a student midwife, clients were often reassured of their choices because they were making 'safe' choices. And I started to wonder - what if surgery became the safest option? There is no reason to believe this could not become true. Surgery in 1960 was much more risky than it is today. Would those of us called to midwifery hang up our hats and choose new careers and send everyone off to surgery? Or would we still attend women in labor - in natural childbirth - if that is what they chose - and if they made those decisions KNOWING that they were choosing a more-risky option?

It's a tough question. And there are a lot of factors. And it is hard to even get to many of the factors because many people have very emotional beliefs about natural childbirth.

When I answered the question in my own mind - I came to an answer of "probably" - I would "probably" attend the natural birth of woman who wanted to do so despite a surgical birth being safer. And the reason for this was because I felt that women had the right to make decisions based not only on statistics, but on their own thoughts, beliefs, desires. We are multidimensional creatures! But I never felt terribly resolute in that answer. It is such an unsettling question!

This question in this thread is slightly different, though, asking if as a woman to give birth, would I choose surgery over vaginal birth if the surgical option was safer.... another fascinating aspect of this conversation! What would I choose for myself? What are our beliefs about childbirth being a rite of passage that would make us choose a more risky option? What are my personal beliefs surrounding childbirth? And how do these beliefs influence my decision making?

I truly do not know the answer to the question. It is something I will have to consider over a period of time. And I would expect my answer to change over time -as I try out different scenarios in my head.

The responses to the OP's question really demonstrate the reluctance to even consider this as reality. It is a hypothetical question! Nothing more. And this question has incredible potential to open our minds and expand our understanding of ourselves and our deeply held beliefs.

This whole thread is fascinating! So sorry I'm a few months late in responding!


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## salr (Apr 14, 2008)

Krst234, When you're thinking of this scenario are you imagining a specific difference in safety? For example, c section being 10% safer? What components of safety are you imagining? Moms/babies more likely to live, moms/ babies less likely to be injured? The problem I had with this idea was that it's a given that it is "safer" but to really mean anything I think we have to imagine specifics.

I think the way it ended up being described was that it is a level of safety to you personally that would satisfy requirements needed to be "safer"... at which point it all breaks down for me because in that case each woman will be convinced that the benefits of a c section outweigh everything, leaving us with no question remaining.


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## CI Mama (Apr 8, 2010)

Personally, the risk comparison thought experiment only makes sense to me if we view birth as a strictly medical event, with purely physical repercussions. Then we might look at interventions and recovery times and side effects and have some idea of this vs. that and what leads to better outcomes.

But I don't view birth as a strictly medical event. I view it as a rite of passage with interpersonal, psychological, and spiritual dimensions as well as physical ones. In my experience, I found my pre-birth conversations with caregivers lacking in substance about these non-physical dimensions, which I realized only after my difficult birth experience was a big problem. I think my OB didn't consider my emotional, social, or spiritual health part of her job, perhaps rightly so. My doula was so focused on preparing me for a positive experience that would follow the natural birth ideal, there didn't seem to be room to have substantive conversation about what might happen if that ideal didn't come about.

In other words, the risk conversation that is focused solely on "What are the chances of unfavorable medical event x happening, and what can we do to reduce the chances of that happening?" seems very limited to me. I realize now, well after the fact, that I would have benefited from a risk conversation that also included this: "What difficulties might I face if my ideal does not manifest, and how will I cope with those difficulties?" That might have opened me to considering the non-physical risks that might arise out of my experience. For example:

--Was I at risk of losing the respect of myself, my partner, and my care team?

--Was I at risk of having recovery needs that would overwhelm my support network?

--Was I at risk of experiencing so much pain and exhaustion during recovery that I would not be able to enjoy my newborn?
--Was I at risk of losing the right to share my birth story freely and have it heard and honored?

--Was I at risk of losing confidence in my ability to be a mother?

--Was I at risk of losing the meaning of my experience as a rite of passage?

I did not spend time contemplating these questions. These risks were unthinkable. The way I would avoid them was by having a good birth experience that matched my ideal, then I wouldn't have to worry about these possible dangers to my psyche, relationships, and soul. I would make my choices based on physical risk, which was enough to think about, and certainly not insignificant.

Ah, hindsight. How I wish I could go back to my pregnant self and gently encourage this conversation. How I wish caregivers of all modalities saw this conversation as part of their work. How I wish I could have let go of some of the dogma and idealism that ended up contributing to my psychological pain rather than mitigating it. How I wish there was a care model that wasn't about natural vs. intervention, but was about assisting the whole woman through the entirety of her birth experience, taking her unique and personal story into account.

Above all, how I wish that we could all realize that the effects of birth are not the same for everyone. They are very much embedded in a cultural and personal context. How a mother experiences a particular outcome may vary a lot depending on factors that go way beyond what happens physically to her body. Our risk models aren't geared towards considering a multi-dimensional person with a complex history, a particular way of thinking, and a specific social milieu. At best, it can compare bodies and what is likely to happen to those bodies, when controlling for factors such as age, etc.


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## dinahx (Sep 17, 2005)

What I think is interesting is the refusal of most posters to entertain the notion that maternal & neonatal safety are different issues, related, but not strictly the same . . .


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## pepperedmoth (Jun 14, 2013)

Quote:


> Originally Posted by *demeter888*
> 
> This is just a hypothetical question. I'm interested in the motivations behind how we judge information.
> 
> ...


Safer for baby, better long term health effects for all, faster recover for me? Sure, of course. Why not? I mean really. I want unmedicated childbirth because I think it's even with section on the first and beats it on the latter two. So if that's what a section did, that's what I would want. I don't tend to think things are better just because they're natural. I think a lot of natural things happen to be better, but natural does not logically imply better to me.

Now I'll go back and read six pages of argument, but it seems like a "duh" sort of question to me. Would I want a better thing? .....yes.......


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## AwaitingJuno (Nov 6, 2012)

I applaud OP for even asking the hypothetical question. I am a Cesarean by Choice mother - and the thing I've come to understand is that birth is an immensely personal and political thing. My choice was based on my understanding of the relative risks and benefits and my understanding of what a vaginal birth was and what a cesarean birth was. After considering all the information out there, I came to the conclusion that planned cesarean better met my needs and those of my child - despite some risks that were higher and other risks that were just plain different, and some risks that were lower. In the current environment - I made a choice that is understood to be less "safe" and unconventional - but it was informed and was my perogative to make. Planned cesarean birth and planned vaginal birth are apples and oranges.

So if cesarean were shown to be safer - that would put many women in the position I was in, in the current environment. I would still choose cesarean (because that is my preference even under the circumstance where it might be less safe) - but I would have to support those who would continue to choose vaginal delivery. I would support that choice as long as it was informed because I believe every woman is in the best position to make choices for herself and to weigh for herself the relative risks and advantages of those choices. Further, I strongly believe the consequence of choice - regardless of what choice is made, is easier to live with when it has been the result of one's own decision. The consequence of a choice that is imposed, is difficult to live with, because it did not arise as a result of a person's freewill. I believe imposing treatment (be it vaginal birth or cesarean birth) - is a recipe for traumatic birth, that may have long-lasting and deep psychological consequences.

Regardless, I believe a woman should be apprised of all of her choices, the risks and benefits associated with those choices, given an opportunity to ask questions, be empowered to make the choice and then expect to have that choice respected to the degree that is reasonable. There's 9 months of pregnancy - I find it abhorrent that a full discussion of risks and benefits of all choices (vaginal and cesarean) aren't discussed in full, and that many women aren't given a choice in this regard. I also find it disturbing that there's such a focus on vaginal birth versus cesarean birth - and that so much energy is directed into promoting "normal birth", perhaps even to the extent where women for whom it isn't a good choice feel bad about not being able to have a "normal birth" -that we're really missing an opportunity to empower women and improve their health (physical and emotional).

Deprivation of autonomy is a terrible thing - it is a form of violence, and where-ever adults of sound mind are forced or led to make choices different from those that they'd make freely given the information available - humanity is made worse off. It's a shame that a lot of the information currently given to pregnant women is nothing short of propaganda - and we should be angry and outraged about it.


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## OrmEmbar (Oct 25, 2012)

Quote:


> Originally Posted by *CI Mama*
> 
> In other words, the risk conversation that is focused solely on "What are the chances of unfavorable medical event x happening, and what can we do to reduce the chances of that happening?" seems very limited to me. I realize now, well after the fact, that I would have benefited from a risk conversation that also included this: "What difficulties might I face if my ideal does not manifest, and how will I cope with those difficulties?" That might have opened me to considering the non-physical risks that might arise out of my experience.


Wow. Yes. I am so very grateful that my midwife was good at making a strong connection with me AND brought up things to think about and provided a safe space for me and DH to discuss the question of "how will I cope if things do not go as I envision". There really is so much more about birth (no matter how or where your bring your child(ren) into the world) than we normally discuss. My 2nd birthing was more about me being in my own "world" of thought than the first one. The first one was very physical and my memories are about how it felt. Memories about my 2nd one are more about what I was thinking/feeling.

It is my belief that there is no one answer to this question that covers every woman/child, but it is a fascinating question to ask.

For me, personally, I would still choose a vaginal birth in my home if there were no other complicating factors but there was a statistical difference showing c-section being safer. That is because I know it is best for my baby if I am not giving birth while experiencing fear, and needles and surgery are triggers for my fears. I would have a c-section if there was an emergent situation and deal with my fears as best I could, but I would not elect to go that path if not necessary.

Thanks for the interesting discussion!


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## kaatya (Jan 2, 2014)

OK, so this thread was about a premise that C-sec was demonstrably safer than VB:

While I was always fascinated by the opportunity to explore my body's capability to birth, I do believe that if a CS was really safer for my baby and I then I would have probably gone with it.

Bottom line - while I am an advocate of all things natural, nothing as a parent could have been more important than my baby's safety/wellbeing. That's just where it sits for me.

However, back here in the real world, C-sec is NOT statistically safer than natural birth, for women experiencing normal, healthy pregnancies with normal, healthy foetuses.

I am interested in the idea that there is far more info available about the risks of C-sec than risks of VB.

Possibly that is because CS is inherently more risky - it is major abdominal surgery, after all (see above)

Also, the spiralling rates of CS in the west are so out of line with what is known about human physiology - World Health organisation recommends a CS rate of no higher than 15%, but its up around 60% in some hospitals. This means an extraordinary number of women are having births that are actually putting them at unnecessary risk. (One good reason why the risks of CS need to be kept public.)

Of course there are risks in VB. There are risks in crossing a road. That's life.

It is reasonable that women should have access to such information so that we can make informed decisions.

I do wonder though, how much we actually want to know about some of those risks

To avoid pelvic injury, for example, would you be prepared to take the riskier birth option in order to avoid the possible risk of on-going pelvic problems? How likely is it that you will have on-going issues as a result of either type of birth? How debilitating are these problems likely to be?

In other areas of medicine, you would probably be encouraged to accept some on-going discomfort as a preferable alternative to invasive surgery, assuming the surgery would not save you from mortal danger or significant debility.

Sadly, however, many women are not getting the message about the real safety of surgical options and the on-going implications of having a surgical birth. If they were, you might expect to see less of them.

I was having a rant one time about the mess that VB made of my pelvic floor (we're just talking weak muscles here, not serious injury - but still required a lot of work!) when a couple of women who had had CS said to me that a CS wouldn't have saved me from that. They also weakened pelvic floors that required rejuvenation as a result of pregnancy. So no easy answers there, unfortunately!

I wouldn't wish birth injuries of any sort on anyone, but it is always so hard to know what 'might have been'. Having experienced birth injury from a VB that took a very long time to heal, I still chose VB the next time because it was still the statistically safer option for me and my babe. Sometimes, life can be a bit sucky like that.


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## Rana Sylvestris (Nov 15, 2012)

Quote:


> Originally Posted by *kaatya*
> 
> However, back here in the real world, C-sec is NOT statistically safer than natural birth, for women experiencing normal, healthy pregnancies with normal, healthy foetuses.
> 
> ...


Well, isn't that the question? We all hear that CS is risky, but very rarely does anyone discuss the risks associated with VB. I'm not sure why exactly--because it's the default? because it's "natural"? because of historical precedent? resistance to re-examining firmly held assumptions in light of changes and new evidence?

Your post is the perfect illustration: you come on strong with the riskiness of CS--"major surgery" (sounds frightening, but how great is the risk anyway? Certainly less than many other "major abdominal surgeries") WHO recommendation (completely arbitrary and outdated, btw)--but then you brush off the risks of VB with "That's life."

Personally, that's not a satisfying analysis. I think women need better information about both methods of delivery so that they can truly make an informed choice. I have looked at the risks myself and find that there isn't a great difference in mortality or morbidity, but there are substantial qualitative differences in risk, both for the mother and the baby, that individual women may evaluate differently according to their own values and preferences.

Quote:


> Originally Posted by *kaatya*
> 
> I do wonder though, how much we actually want to know about some of those risks
> 
> ...


You may not want to know about pelvic floor disorders, but other women might. In fact, many women who suffer from PFDs as a result of VB wish that they had known beforehand and been allowed to choose a different type of delivery. It seems cruel and backward not to offer them that knowledge and choice per their own bodies and health, especially as a significant number will go on to have surgical repairs, which bring their own risks.

I'm glad your PF damage was mild, but please understand that that isn't the case for everyone. It might be a minor nuisance for one person, but for someone else it might be a significant and distressing problem with a significant impact on a number of facets of their life.


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## dinahx (Sep 17, 2005)

Statistically, we are all @ the same place PF wise @ 50, regardless of mode of delivery, so it isn't a fait accompli that CS saves your Pelvic Floor.


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## Rana Sylvestris (Nov 15, 2012)

Respectfully, I don't think that's the truth.

Age does have an effect on pelvic floor strength, but there is also discrete damage sustained during vaginal delivery. There is a difference between normal aging/loss of elasticity and the damaged and torn muscles and connective tissue, nerve damage, and direct urinary/rectal damage that some women sustain in VB. For some women VB's effects are negligible, for others a minor nuisance, and for some it is a life-altering and disabling problem. Women should know the risks involved so that they can properly weigh them and make truly informed decisions.


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## dinahx (Sep 17, 2005)

A CNM with a DNP just told me that elective Cesarean is not considered an effective means of pelvic floor preservation long term. I'm open to seeing research that states otherwise, but until then, everything else she has told me has been grounded in research so . . .

And when we say 'safer' generally we are talking about 'mortality' or 'life threatening morbidities' (like severe infection, NICU admissions, etc)


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## Rana Sylvestris (Nov 15, 2012)

Well, obviously, if you aren't specifically looking for something and systematically documenting it, you aren't going to know the whole story. If people don't view women's incontinence, pelvic floor disorders, and sexual dysfunction as problems of significance (and historically they haven't) then any analysis they offer is not going to give the full picture.

There are studies saying that it's all a wash, but they're not that convincing. If you look at the urogynecology literature you'll find information on specific problems, many of which are unique to or especially common after vaginal birth.

And speaking for relatively young women who have had these problems directly after childbirth, it's no consolation to read "we'll all be in the same boat at 50" when you're only in your 20s or 30s and you're dealing with these problems now. It's frustrating to hear claims like these when you know that your injuries (and many other women's) were directly caused by vaginal birth, but your own suffering and loss and subsequent surgeries are ignored by people who don't seem to want women to know the truth about what can happen.

I'm not suggesting that all women have CS to avoid pfd, but I think they should be given real information about possible risks of both CS and VB and allowed to make an informed choice.


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## dinahx (Sep 17, 2005)

Well I just had a C/S for fetal indication: no one told me beforehand that if I yk, try to USE my uterus again, or don't switch to a really effective BC like IUD or Vasectomy (which I find morally unacceptable) I am at a greater risk of *actual death* than I would have been after another vaginal delivery. (From Placenta Accreta, which carries an up to 7% mortality rate).

It was NBD, because I did it to reduce my child's risk of *actual death* during the birth process. But I don't think it is necessarily wrong that we Priveledge mortality over risks like lowered continence (which is not necessarily associated with lowered sexual function).

And I don't think that the problem of less than informed consent is unique to Vaginal Birth.


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## Rana Sylvestris (Nov 15, 2012)

I don't want to have a one-upmanship contest with you about risk. Frankly, nothing in pregnancy and childbirth is risk-free. Don't you think women should be well-informed about significant risks though? Is there are reason for emphasizing one set of risks and minimizing another?

I'd never dismiss the risks of CS. They are real and important to know about. So are the risks of VB, and I think unfortunately they are not often accurately and comprehensively acknowledged. Women who want to discuss the downsides and risks of VB face a great deal of hostile denial from other women, and I think that's a terrible shame.

You faced a certain set of risks with your CS and with future pregnancies, if you choose to have them. I think everyone acknowledges that. However, VB presents a separate set of risks that women have a right to know about. If you think we should only be concerned about mortality, please consider that one in five women in the US will have pelvic floor repair surgery during her lifetime. My own surgery was several hours long under general anesthesia. It will probably not be my last pelvic surgery, unfortunately. These are significant, mortality-level risks and they are usually not taken into consideration when discussing CS vs. VB.


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## dinahx (Sep 17, 2005)

I will just say that future pregnancy is not always a choice. Getting sterilized or an IUD is a choice, pregnancy is what can happen in marriage/partnership if you do not chose to use these methods. Subtle, but different.

Also even with universal Cesarean, not every pelvic floor surgery would be prevented. 1 in 5 women don't have pelvic repair surgery because of birth related injuries. Pelvic floor repair is something many women require simply from the aging process. I appreciate your point that is has a mortality rate, that is worth considering, however that mortality rate cannot be directly applied to vaginal birth.


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## AwaitingJuno (Nov 6, 2012)

How is it one poster says "women should be complete information on the risks and benefits of both VB and CS..." and another poster reads "CS for everyone!"?

Dinah is right that not every case of pelvic floor dysfunction would be prevented by cesarean - some women might still need pelvic floor surgery at some later point in time. However, there are quite a few women who deal with pelvic floor problems at a young age who would be spared from dealing with them for a long time had they had a CS instead of a VB. Many women given this information might still choose VB - and that would be their perogative, and at least they wouldn't feel as though the consequence (PFD) was a result of being kept in the dark about the risk.

There's a myriad of other risks too and the choice isn't just about pelvic floor disorders. Things like shoulder dystocias, birth asphyxia, brachial plexus injuries, cord prolapses, late term fetal demise (post 39 weeks), and just general uncertainty associated with planned vaginal delivery.

Everyone wants to be the person whose body performs "as it was meant to" - but the problem is you really don't know if you are that person or if you are just going to be completely unlucky and either yourself or your child is going to pay a very dear price. Sure, there are some things that make it more likely - but some women just don't feel like gambling with their bodies and those of their children. They'd rather take a more certain "good outcome" than a very uncertain "great outcome". That is their perogative.

It seems like the culture of natural childbirth holds many women to a standard that they cannot attain and is just as damaging to women as the magazines that portray a generally unattainable ideal of beauty.


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## Rana Sylvestris (Nov 15, 2012)

I've never claimed that every pelvic floor surgery could be avoided, or that every woman should be persuaded to choose CS even if that were possible, but certainly you can understand and acknowledge the difference between having a surgery in your 60s or 70s because of age-related changes and having it in your 20s, 30s, or 40s as the direct result of damage from vaginal birth. We're telling women to have VBs in order to avoid the surgical risks associated with CS, but failing to inform them that they may just be shifting the risk to a different kind of surgery later.

In general, in the US, women do have access to family planning methods, often as part of their maternity care. Some women will become pregnant again without explicitly making a choice, sure, but is that any justification for failing to give women a balanced view of the risks of different delivery methods?

I will not be having any more children. If I'd been able to choose a CS, I would not have incurred any risks associated with future pregnancies (placenta accrete, etc.), so those issues would not factor into the risk assessment. A woman planning more children will have to weigh things differently and might well find that VB is a better choice for her. All women are not the same.


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## fruitfulmomma (Jun 8, 2002)

Quote:


> Sure, there are some things that make it more likely - but some women just don't feel like gambling with their bodies and those of their children.


Huh? I must be reading you wrong, but it sounds like you are saying that women who choose vaginal birth are gambling with their children's lives.


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## kaatya (Jan 2, 2014)

In reply to Rana Sylvestris;

I think you have misunderstood some of the points that I made in my post.

I do not deny that there are risks to both CS and VB - but once one is pregnant, one moves into a territory where birth must occur, one way or another - and if deciding to have a demonstrably riskier CS in order to avoid potential pelvic injury, one needs to know what the likely risk of injury during either birth is, because there is risk of on-going debilitation in both scenarios.

I notice that one of the only lines of mine not quoted is where I say "It is reasonable that women should have access to such information so that we can make informed decisions." I fully agree that we have a right to information about all risks and options.

I believe, however, that because we MUST birth and because CS is still carries quantifiable risks, there may be less information available about birth injury simply because it's possibility is not a good reason to have a CS. I can fully understand how you might feel differently about this if you have experienced significant injury during a VB. I am indeed very aware of how debilitating such injury can be, as a friend of mine suffered a really significant one which had a major impact on her life and which she still finds psychologically traumatising. I also noticed that, after doing the research, she went on to deliver her subsequent babies vaginally none the less.

Also, it would be interesting to know just how much properly researched information exists about birth injury. I believe that the incidence of major, traumatic birth injury from a VB is statistically low, but if that is not the case, then we should know more about this.

We should also know more about the incidence of post-CS complication. I know from health professionals in my area, for example, that the rate of post-op infections with CS is currently very high (I stress that this is knowledge for this area, not necessarily a wide spread phenomena) However, since the infection is generally picked up by visiting nurse midwives once the women have been discharged from hospital, it is not appearing in hospital, or indeed in any, statistics.

Also, a CS does not protect you from on-going pelvic floor disorders, as I think others have pointed out. Pregnancy does much of this 'damage'

Bottom line is that having babies has an impact on your body. The idea that anyone can blossom forth into beautiful motherhood with their body substantially unchanged is a nonsense. That IS life!

The medical community consider most of what occurs during most births to fit within the parameters of normal. Yes, there is a name for most physical occurrences/outcomes of birth (especially the negative/injurious ones), but that does not make them an anomaly - they are just stuff that happens.

The general public, in many instances, prefer not to know every possible thing that can go wrong as a result of pregnancy/childbirth. When having a baby, not everyone wants to spend 9 months worrying endlessly about all the things that could happen to them during birth. (Fair enough too)

It is a version of this 'ostrich' mentality which pushes up CS rates so substantially. Many women who fear birth (for long and myriad cultural reasons that I won't go into here) think - that's OK, I'll have a CS instead. (You can bet your boots these women have not found the info on CS risk more off-putting than the info they have received on the risk of VB)

Ironically, this has helped make CS safer than it used to be, simply because so many OBs are so very well practiced in performing them.

But it doesn't eradicate the risks of surgery (simply the anaesthesia alone carries risk)

And I would love to know where you got the idea that WHO stats are 'obsolete and arbitrary'

The evidence is there to support the contention that these guidelines have plenty of 'soft' built into them, and that 15% is an overly generous allowance.

Quite simply, the incidence of CS has moved from being predominantly medical based to being predominantly cultural based.

Anyone who has a good knowledge of normal birth will hear endless stories from people who 'needed' CS on very spurious grounds (not producing a baby in the required 6 hours, for example)

More common is people 'requiring' an induction, which is well-known for causing a chain of intervention as the massive, unnatural contractions deprive baby of its oxygen....often ending in either forceps or CS

A friend of mine was recently 'augmented' in labour with this result. Ironically, if I had been under the same care as her, I would have 'needed' augmenting for 2 of my births, both of which proceeded naturally and normally, with no interference required. While we can never say what might have been, it is fair to say that she was deprived of the opportunity of attempting a VB (which she wanted) for no good reason. And it is also fair to say that she and her baby were probably put at unnecessary risk

Birth will have an impact on our bodies, no matter how we choose to birth. Until very recently in human history, VB was the only option for most women and the risks of VB were well known. Surgical birth requires someone else to step up and take responsibility for another's life - therefore the risks must be quantified and explained. This may be to prevent lawsuits, but it is also because there are risks and it would be considered unethical practice not to alert patients of this.

Maybe these cultural phenomena help explain this idea that CS risk info is more widely available?


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## kaatya (Jan 2, 2014)

To krst234 - love your reply - lots of food for thought there!


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## Rana Sylvestris (Nov 15, 2012)

Fruitfulmomma: I think you are reading her wrong. Her next sentence is:

"They'd rather take a more certain "good outcome" than a very uncertain "great outcome"

I think her point is that some women would prefer the known and easily quantified set of risks that come with CS to those that come with vaginal birth, in which the outcome can be seen as more variable. It was an attempt to explain why CS might be a good choice for certain women, not a dig at mothers who choose vaginal birth.


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## Rana Sylvestris (Nov 15, 2012)

kaatya: Thank you for your thoughtful reply. We seem to have fundamentally different views of the situation, but I appreciate what you are saying.

It seems that to you, vaginal birth is a sort of natural default and you view CS as inherently riskier and therefore, to be avoided.

Quote:



> I do not deny that there are risks to both CS and VB - but once one is pregnant, one moves into a territory where birth must occur, one way or another - and if deciding to have a *demonstrably riskier CS* in order to avoid potential pelvic injury, one needs to know what the likely risk of injury during either birth is, because there is risk of on-going debilitation in both scenarios.


But is CS actually demonstrably riskier? I don't think you can really say that it is anymore. It's such a complex calculation, and it varies with each individual woman and each pregnancy. We've been talking about pelvic floor damage, but as AwaitingJuno pointed out, there are many other concerns, and when you look at them altogether it becomes difficult to say one method is clearly riskier than another.

Quote:


> Also, it would be interesting to know just how much properly researched information exists about birth injury. I believe that the incidence of major, traumatic birth injury from a VB is statistically low, but if that is not the case, then we should know more about this.


I agree. It's definitely something we should know more about. When women have a 20% lifetime risk of undergoing PFR surgery and VB is a major contributor to the need for them, it's time to do some more research.

Quote:


> Also, a CS does not protect you from on-going pelvic floor disorders, as I think others have pointed out. Pregnancy does much of this 'damage'


Please do not say this. It is completely untrue. Yes, you can have pelvic floor problems without having had a VB. Does that mean that VB does not cause pelvic floor problems? Absolutely not. There are studies that show a clear connection; you personally know of at least one person who sustained an injury this way; and it simply is common sense, particularly when you realize that some types of pelvic floor injury are more or less specific to VB. Normal aging is not going to cause a rectal tear, give you nerve damage, or detach your uterus from its supporting ligaments. I personally find these claims so dismissive--as if normal age-related sagging is on par with a young woman dealing with major pelvic repair surgeries, serious incontinence, sexual damage, etc.

Quote:


> The general public, in many instances, prefer not to know every possible thing that can go wrong as a result of pregnancy/childbirth.


Well, I do like to know realistically what can go wrong, especially if there are choices I can make to avoid certain outcomes or maximize others.

Quote:


> Many women who fear birth (for long and myriad cultural reasons that I won't go into here) think - that's OK, I'll have a CS instead. (You can bet your boots these women have not found the info on CS risk more off-putting than the info they have received on the risk of VB)


Why isn't that a valid choice? CS has certain risks; VB has others.

My understanding of the WHO statistic is that it was just a number that was put out without any supporting evidence, and that recent research suggests that higher c-section rates result in better outcomes. Of course, it all depends on who you are studying and what you measure, and there is a lot of room for debate there. The bottom line is that I personally wouldn't want my care being determined by someone being pressured to stay within a rigid guideline.

Quote:


> Birth will have an impact on our bodies, no matter how we choose to birth.


No denying this, but I wonder if it isn't time to allow women to choose what kind of impact they are more comfortable with?

Quote:


> Until very recently in human history, VB was the only option for most women and the risks of VB were well known. Surgical birth requires someone else to step up and take responsibility for another's life - therefore the risks must be quantified and explained. This may be to prevent lawsuits, but it is also because there are risks and it would be considered unethical practice not to alert patients of this.
> 
> Maybe these cultural phenomena help explain this idea that CS risk info is more widely available?


I think this is a really reasonable statement. I also think that times change, and sometimes it becomes necessary to adapt our practices to the current state of things. VB and CS are both pretty safe, though they offer distinct sets of risks. Maybe it's unethical not to give patients the full story.


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## dinahx (Sep 17, 2005)

CS increases the risk of Hysterectomy, Hysterectomy lowers the age of Menopause (as does female sterilization) & both are fairly major contributors to pelvic floor dysfunction.


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## Viola P (Sep 14, 2013)

I would still go for the vaginal birth. I'm under no moral obligation to take the least risky path in every situation. If I was buying a car would I pick one with a slightly better turning radius that had a correspondingly slightly smaller risk of tipping? I don't think so. Being a mother is about much more than reducing risk from 0.0001 to 0.0002 - especially during pregnancy which is generally very safe.


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## curebaby (Aug 21, 2013)

I have to wonder if evolutionary design is going to make natural birth more difficult in the next millennia. We are already so far removed from our mammalian cousins in pelvic structure, etc., combined with an increasingly sedentary lifestyle and an obesity epidemic, all of which make natural childbirth more difficult. And what about the case of the brain dead newborn in the news recently? That mother begged for a c-section due to her small frame and was refused. While I realize that may be the exception to the rule, I would agree with some of the other posters, that c-sections have their place, and while women have been birthing naturally for thousands of years, that doesn't mean fetal/maternal death rates have always been low...
Basically, I think any surgical intervention should be about benefit vs. risk and should never be about convenience.


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## Viola P (Sep 14, 2013)

I really don't see how evolutionary design could ever make women's vaginas obsolete in terms of childbearing. To me the reasons cited for the c-section epidemic of obesity and bigger babies etc... are rationalizations that blame the victim.


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## kaatya (Jan 2, 2014)

Thanks for your reply, Rana Sylvestris - this is an interesting discussion!

I would like to make it really clear that I am not in any way denying that VB can cause serious, painful, on-going pelvic dysfunction, in many different forms.

By saying that "a CS does not protect you from on-going pelvic floor disorders.... Pregnancy does much of this 'damage'" (both of which statements are true) I am in no way denying that a VB can and sometimes does cause serious injury.

I have experienced problems myself that were painful and on-going for a period, but which have ultimately resolved. I know from this experience how 'hidden' this kind of pain often is and how difficult it is to live with. I remember feeling angry and sad that this was one of the many things that no-one ever 'told' me about before I gave birth. I remember feeling like it was something that there was little support for either. My heart goes out to women in this situation and I am sorry that I have not communicated this to you earlier, because I know enough to know it can be a deeply painful and lonely space to be in.

I have spent a lot of time over many years now involved in groups which support women who are pregnant or who have young children. I have heard many birth stories and had many discussions about the myriad of ways in which birth changes peoples lives. Over all this time, stories of serious, traumatic birth injuries are rare - so rare that I can think only of the one I shared in the last post, plus one other which I read about in the media after the mother demanded disciplinary action against her caregivers. (Note: the review panel, made up of Drs, midwives and lawyers found the event to be extremely rare and unpredictable. This was not in the US so no law suit was contemplated - this panel were convened solely to examine culpability for the purpose of registration/on-going practise)

Painful and slow healing injuries like my own occasionally are voiced, but still very seldom in my experience. I have come across several incidences of pubis symphysis disorder which sometimes renders women unable to walk for a time following delivery. Tears are quite commonplace - nasty at the time, but usually not causing on-going pain or problems.

From this, I conclude two possibilities (both of which may be true) - (1) that serious injury from a vaginal birth is a relatively rare occurrence - (2) that injury following vaginal birth is something not much talked of.

I do believe that you have raised something really important in bringing this area of birth to everyone's attention. I think there needs to be more help and support for women experiencing this kind of problem, it needs to be more public and thus easier to speak of. It also seems that more research and record keeping would not go amiss. We could use some more information that is readily available.

As for where CS sits in all of this, well it may surprise you to know that I am ostensibly pro-choice on this issue! I believe that, as women, it is our duty to support one another's choices in the child-birth arena, simply because we have not walked in each other's shoes and we do not know all the reasons others make the choices they do. I have expected others to respect my choices (natural, home-births) so I should respect their choices likewise.

That said, I am always saddened when I hear of women making what I personally consider poor choices for all the wrong reasons. It saddens me when healthy women who are likely to experience a safe, normal birth are denied the opportunity to have this experience due to lack of proper support and information. To me, normal birth (with the right care-givers) is an enormously empowering experience, which optimises all the hormonal balances in our bodies for parenting a new-born, provides optimal gut flora and blood transfer for our babies and leaves us feeling like super-woman (well, for a while, anyway!) The blueprint for birth is hugely refined, despite many years of the medical profession suggesting that women were poorly designed for it. Turns out, our bodies have been very carefully programmed for this event, and much of the 'can't' has been caused by well-meant interference, rather than by biology.

For women who need CS, it is life / health saving and one of the miracles of modern medicine. If women chose CS for what I consider 'wrong' reasons, well that's only sad if they do so out of ignorance, fear and lack of support. As you say, we all need to weigh up the best evidence and make a decision that is right for us.

As for the World Health Organisation, I personally know one of their medical advisors and I can assure you that they are not the sort of people who pluck spurious numbers out of the air.

I believe that 15% will be a compromise number, balanced between what might be expected in a normal, healthy birthing population (the vast majority of us in the West) and the challenges presented to modern obstetrics by more women having first babies later in life and by the obesity epidemic, both of which have changed the risk profile in recent times. However, its been a while since I've done the reading on this, so don't quote me on this!

Also, when evaluating risk profiles, it is important to be aware of context. More and more women are being told that CS is 'safer' and believe it is so because of improvements in medical care/technology and more experienced surgeons (all of which is probably true) However, what is not being told is that, in many cases, CS is 'safer' simply because the practitioner in question is better trained in surgery that they are in normal birth. This is particularly the case with certain sorts of breech birth, where loss of skills in delivering vaginally have resulted in CS being a safer option, not because surgery is safer per se, but because the medics are untrained in handling this situation via vaginal delivery.

I believe that far too many birthing women are being subjected to unnecessary medical intervention in our hospitals precisely because their caregivers are well trained in medical intervention and not well-versed in normal, natural, un-medicated birth. The best-known example of this is electronic fetal monitoring (EFM) - practically mandatory in many hospitals for 'safety' (read litigation prevention) purposes. Extensive research has demonstrated that the primary outcome of using EFM is to cause more CS deliveries. It does not improve outcome statistics (mortality, morbidity, NICU admissions...)

Despite this evidence being widely available for some time now, many, many women are hooked up to these things for the duration of their labours for no medical reason at all. This is a real example of "care being determined by someone being pressured to stay within a rigid guideline." Frankly, I find it disgraceful.

It is medical practice such as this that fuels the 'normal birth, natural birth' fire and vilifies medicalised birth practices in the eyes of so many women.

As any woman who is conversant with genuine natural birth practice will tell you, it is hugely emotionally distressing to see a birth being changed from normal to pathological simply by ignorant (though usually well-intentioned) interference.

Having your birthing wishes (and powerful instincts) undermined in this way can be hugely psychologically damaging and is another way in which many women carry scars from their birth experience going forward. Also, consider this: I believe my own physical birth-injury may have been caused by a practitioner who insisted I adopt a certain position for delivery, despite all my instincts telling me I needed to kneel. Thus, it was not a 'normal' birth that necessarily caused the problem, so much as physiological ignorance/rigid mind-set training on the part of my care-givers. Interference, in other words.


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## curebaby (Aug 21, 2013)

name="Viola P" url="/community/t/1388046/what-if-c-section-was-proven-safer-than-natural-birth/120#post_17542021"]I really don't see how evolutionary design could ever make women's vaginas obsolete in terms of childbearing. To me the reasons cited for the c-section epidemic of obesity and bigger babies etc... are rationalizations that blame the victim.[/quote]

I wasn't inferring anyone was to blame, or that anyone was a "victim". The only persons being victimized are those women who are being bullied into a birth experience they don't want to have. I don't think c/s should be discounted as a safer birthing choice FOR SOME women and their babies. But yeah, I do think health issues can negatively impact attempting natural birth FOR SOME women, and living in an age of convenience contributes to that, because we are not obligated to use our bodies in the same way that we did even a hundred years ago, so we're a bit out of practice as a species.
I didn't mean that the vaginal canal is going to become obsolete. I was referring to pelvic design and skeletal structure as a whole, as well as muscle tone. Primates and other mammals live their whole lives practically in "ready-to-birth" positions. As we've as a species developed the
ability to stand erect and walk on two legs instead of four, we've lost some of that birth-friendly design. Here's an interesting article on the subject:
http://ngm.nationalgeographic.com/print/2006/07/bipedal-body/ackerman-text


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## Viola P (Sep 14, 2013)

Again, I really don't see how evolutionary design could make women's pelvis' ineffective for childbearing. The fact that an article in an otherwise reputable magazine would suggest otherwise speaks to the strength of our cultural notions about human female biology. Countless articles over many years have made arguments that women's ability to birth is somehow limited and nature made a mistake. This is what has always been used to justify violence against women in the obstetrics. I'm thinking here about twilight sleep and the "science" used to rationalize that. There was even a time in history where woman were manually masturbated by doctors who thought that would fix their hysteria. And only a year or two ago it came out that medical students in the US were performing pelvic exams on women who were at hospital under general anesthetic for things that had nothing to do with their genitals. All of this dogma about natures mistake with women is just one piece if a long and lengthy, and some would say biblically rooted, history of finding the female body to be broken, in need if fixing, and a subject of communal property. I do not believe that nature would design any species so it couldn't birth effectively because that makes no sense to me at all. I don't care of whatever scientific journal argues otherwise, ass pomp doctors have no doubt said stupider sh*t in the past and will continue to do so in the future.


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## Viola P (Sep 14, 2013)

Though I would hesitate to ever call myself a "choice feminist", I do think that when it comes to giving birth the woman should be able to choose what she thinks is best for her, and if that means elective c-section it should be respected. And of course c-sections save lives but unfortunately it would appear that they are also taking lives as the maternal mortality rate in the US has climbed up right alongside the c-section rate.


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## 3lilchunklins (Feb 22, 2012)

I did not read through this whole thread so forgive me if I am repeating anything.
To me, even if something in the medical world is proven safe and effective today, they're bound to change their minds tomorrow.
Just like when Dr.s recommended smoking cigarettes and even certain brands were more highly recommended among the medical field. Now we know that smoking cigarettes causes all kinds if health problems and is no longer recommended.
Point is, today's lie was yesterday's truth.


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## Rana Sylvestris (Nov 15, 2012)

I really appreciate your thoughtful and compassionate response, kaatya. Having an injury from VB can be so isolating, embarrassing, and depressing. It's rare to have anyone acknowledge it or offer support, so it's very meaningful to me that you took the time to do so. I agree that it's something people just don't talk about.

No one ever mentioned such a thing to me when I was pregnant and it certainly wasn't mentioned in any of the many books I read or the class I took in order to "educate myself" as everyone seems to advocate. Sadly, I've found that it's not that uncommon at all; most people just suffer in silence.

Thank you for supporting other women in their choices, even if they differ from what you would want. I wish you weren't saddened by their choices though. Maybe those choices are the right ones for them and thus have the potential to result in the same feelings of empowerment and energy for taking on new motherhood as natural birth does for some women. I read a lot about natural birth, but it really didn't resonate or appeal that much to me. I simply wanted to have a healthy baby in the least traumatic way possible. I think that being able to make a choice that honored my own needs and values would have been just as empowering as a natural birth would be to a woman who valued the things that go along with that. It's interesting how much people can differ.

It's funny you mention EFM. I've heard a lot of women say they dislike it, but I always found the idea of having the baby's well-being monitored throughout labor to be something that I'd find very reassuring and would absolutely want. It probably does raise the intervention rate, but it probably also helps people react quickly when there is distress too. Here is a study: http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811004807.pdf

I take your point about it being a shame when a normal healthy labor is unnecessarily interrupted and a mom ends up with a bad experience as a result. I wish every woman could have the kind of birth she would find most empowering. I just feel compelled to point out that not all women want natural birth, and that's ok too.


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## dinahx (Sep 17, 2005)

^EFM & hospital techniques for managing vaginal birth also make pelvic floor injury more likely. That was the OP's original point on this thread, that if she had to/chose to have a hospital birth, she would want it to be a section.

I had EFM in my last birth. I thought it would be reassuring, it was in fact, terrifying because I knew enough to know they wouldn't be tolerating the heart rates that kept coming up. It also totally resulted in everyone watching the monitor & not me. I had to stay in bed because they didn't like what the monitor said when I got up. They told me I 'was not in labor' even tho I was contracting regularly, which I don't ever do ahead of labor.

IDK if I paid for my need for reassurance with a Section, because in the end, the baby did have a double true knot. However it would have been impossible for me to have a tolerable labor without pain meds in that situation (forced to stay in bed). A delivery in that situation would have likely resulted in at least a tear.

My prior birth, with hardly any monitoring, total freedom of movement, etc, actually * improved* my sex life & healed some of the over zealous stitching from my first birth . . .


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## 3lilchunklins (Feb 22, 2012)

The EFM is like a coin with 2 sides. During my last birth, due to EFM they were able to detect and effectively treat babys late decels. However as labor progressed and I was attempting to find a comfortable position and not disturb the EFM proved more difficult especially since every time I had a contraction, it was instinctual to (as I'm laying on my side) draw my legs up, almost pulling myself into the fetal position. Well everytime I did that we lost babys heart beat till I released my legs. I was fearful that they would think he was "flat lining" during contractions, so I had to fight what position my instincts were telling me to get into due to the EFM...


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