# no shock in elective c-section declaration from ACOG



## Marlena (Jul 19, 2002)

http://www.washingtonpost.com/ac2/wp...nguage=printer

Quote:

It is ethical for doctors to deliver a baby by Caesarean section even if the mother faces no known risks from conventional labor, the nation's largest group of pregnancy specialists has decided.

The American College of Obstetricians and Gynecologists' ethics committee is issuing a statement today that for the first time addresses the increasingly popular elective Caesarean sections -- those performed when there is no medical necessity.

...

The new statement could help accelerate a rapid increase in Caesarean sections by making doctors more willing to perform the procedure on an elective basis, some experts said.
I suppose it will help make up some of the revenues lost to rising medical malpractice premiums, and will also relieve docs of some of those inconveniently timed deliveries. Pregnant medical consumers can sleep soundly tonight.







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## stayinghome (Jul 4, 2002)

Unbelievable. I don't even know what to say.


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## spero (Apr 22, 2003)

Grrrrrrrr...just think of all those women who will buy right into this concept...I can't tell you how many women I have encountered who "would just love a schedulled c-section, so I don't have to go through labor!"


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## Mere (Oct 1, 2002)

Geez, the way it's going in a 100 years people won't even remember that babies can be born naturally...how sad.


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## Tigerchild (Dec 2, 2001)

Before jumping headfirst into the pileup here, in support of the mamas here who have had cesarean births I'd like to point out one thing...

I wonder how many mamas would qualify as 'elective' based on that criteria?

I would. *Labor* posed no great risk to my health. Keeping the guys inside did. So, I elected to have the cesarean after we knew their lungs were mature.

But I'll still punch anyone who dares to call me lazy, ignorant, or thoughtless as to the well being of my children right in the mouth. At least in regards to the kids' method of birth.


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## Marlena (Jul 19, 2002)

I also ended up with a c after hours of allegedly significant decellerations whenever my contractions would start to speed up. I guess dd liked it in there.







At the time, it was billed as a necessary c, but I suspect that, in the care of a good midwife who was not affiliated with a group of OB/Gyns (mine was), I probably would've delivered safely and naturally, vaginally.

That being said, I don't have any genuine regrets about the section. The point was to end up with a healthy child, and that's what I ended up with. So I'm happy.









The point being: it is not my intent by having started the thread to bash women who have or had c-sections. Rather, it is merely to point out another step in the direction of further medicalizing and controlling childbirth, after a number of years in which the use of midwives increased, as did other practices in hospital births such as rooming in, allowing family members to be present in the room at birth, etc. etc.


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## Greaseball (Feb 1, 2002)

If any woman has the right to request a section, any woman should have the right to request a vaginal delivery as well. And I mean ANY woman - footling breech, VBAC with classical incision, triplets, 14-lb baby, 3-day labor, under 5 feet tall, 4 weeks overdue, membranes broken for 24 hours, herpes, or even a woman with all of these conditions!


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## Marlena (Jul 19, 2002)

Um...not really. No. I don't think you'll even find many midwives who'd agree with that position.

Rather, it's sorta like saying (though somewhat more extreme) that you can wait for the kidney stone to pass, or we can take it out surgically. The former may have less morbidity, and is certainly more "natural," but both are reasonable medical choices. I think you'd have a hard time finding anyone, however, who'd think it's ok to deliver an 11 lb breech baby vaginally where the mother is tiny with a small pelvis and who had a broken coccyx and who also has active herpes.


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## Greaseball (Feb 1, 2002)

Well I think it's OK! Too bad I'm not a birth attendant, moms would seek me out!

I read of a woman who was able to deliver at home with a midwife in spite of: age over 40, twins, breech, 2 weeks overdue, and VBAC for past CPD. (Open Season) Women have also delivered vaginally in each of the situations I listed in my last post; sometimes more than one.

Open Season lists several extreme circumstances under which women have been able to VBAC, such as herpes, more than 5 cesareans, muscular dystrophy, classical incision (one woman had a homebirth after 3 classical incisions), and triplets. It's a fascinating read!


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## kama'aina mama (Nov 19, 2001)

Quote:

_Originally posted by Tigerchild_
*But I'll still punch anyone who dares to call me lazy, ignorant, or thoughtless as to the well being of my children right in the mouth. At least in regards to the kids' method of birth.*
As well you should! I suppose it might be possible that an induction might have had a good outcome for you (as good a C birth, I mean) but that is not for other people to decide. You were in the situation, you made the best choice for your family. I am never comfortable when general conversations of this nature become specific. No one has a right to judge anyone else.. but I think it is still okay to say "Gee, there are probably way too many C's in this country, and this new statement is clearly not going to do anything to change that."


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## Marlena (Jul 19, 2002)

Quote:

but I think it is still okay to say "Gee, there are probably way too many C's in this country, and this new statement is clearly not going to do anything to change that."
Absolutely!


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## detergentdiva (Oct 16, 2002)

I've had 3 sections now
Number 1 heart decels failure to progress

Number 2 planned vbac 24 hour labor severe pain, no progress, dr thought I was rupturing from #1, turned out I had adhesions from #1

Number 3 planned section, started having issues at 8 weeks, large amount of adhesions from #1 and #2 had problems keeping baby in, had more issues during surgery, baby premature

Spent next year on pain meds, July 2002 hysterectomy, continued problems from adhesions

Why do I say all this because thank God for the medical advancement that saved my children and myself, without it I would not have them.

BUT I do NOT think sections should be elective. Too many people think it is a minor surgery with no complications let alone death. Women are made to have children vaginally and although there are a small number of us who for one reason or another can't that doesn't mean that every other person should say het I want baby on this date so I can "Plan" my borth. Please get over yourself and start thinking about the child you are about to give birth to and the consequences of your elected major surgery!!


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## gurumama (Oct 6, 2002)

Quote:

_Originally posted by Greaseball_
*Open Season lists several extreme circumstances under which women have been able to VBAC, such as herpes*
ACOG has actively promoted vaginal delivery in cases of herpes (since the early '90s) unless the mother has active lesions or is going through her primary (first ever) outbreak.

Otherwise mothers with herpes can have safe vaginal deliveries--it's NOT a medical condition that automatically qualifies one for a c/s, and not a condition that HMOs will automatically consider a valid reason for a c/s.

I think the ACOG's policy on elective c/s is an attempt to normalize ELECTIVE c/s and to give women more "choices". Sadly, it'll be touted as a progressive thing among certain sectors of women (like that urologist, Jennifer whatever, one of the sex sisters).


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## daylily (Dec 1, 2001)

Quote:

I suppose it will help make up some of the revenues lost to rising medical malpractice premiums
Exactly. Doctors charge a lot more for a c/s. Maybe this will help the economy--







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## DaryLLL (Aug 12, 2002)

See the correlation between this and the rise of popularity of artificial feeding? Doctors say, Species specific milk? Nah, too much trouble and besides, your nipples might be sore for a couple weeks.

Vaginal birth? Nah, too much trouble, and labor might hurt for a few hours. (Don't tell moms they will have pain, severe pain, from the c-sec site for weeks or months and numbness for a year. Shhh...)

What. A. Scam.


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## InfoisPower (Nov 21, 2001)

IMO this is just another example of following the $$$$.

Doctors cannot stand by and do nothing even when it's the best thing to do. Doctors cannot resist using toys (reminded of the Monty Python skit and the machine that goes boooooing) to back up taking inappropriate action.

That and they like to disempower women and *deliver* them.

I 'm totally disgusted and want to uke

rant off.


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## Greaseball (Feb 1, 2002)

The countries with the lowest c/s rates do not give dr's bonuses for them the way we do here. Doctors are paid a flat fee for every delivery.

What if we gave them bonuses for vaginal births here?

About herpes - I have spoken with some midwives who will deliver a woman with an active outbreak. They put plastic over the lesions. Some midwives have a policy of doing nothing at all, even if lesions are present in the vagina, and have never seen a baby get herpes.

I just got Open Season out, and here are some more VBACs that occured under special circumstances - bone spurs, placental abruption, meconium, severe obesity, type 1 diabetes, previous fibrioid removal, and one with fibroids currently in the uterus. Before c/s was invented even mothers with complete placenta previa were delivered vaginally and in about half the cases the babies lived. (Of course, if I were in that situation I'd opt for surgery.)

My point is, if women with normal pregnancies are able to decide for themselves they will have surgery, than women with pregnancies that are variations of normal should be able to decide they will not have surgery.


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## kama'aina mama (Nov 19, 2001)

Quote:

_Originally posted by InfoisPower_
*(reminded of the Monty Python skit and the machine that goes boooooing)*
The machine goes _PING!_


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## InfoisPower (Nov 21, 2001)

Ah well details,details...I was remembering the sound it made as I heard it. Not what the characters called it. Therefore your Ping = my Booooing! :LOL


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## Meiri (Aug 31, 2002)

Quote:

"I do think it's a step forward in that the college has grudgingly agreed that it might be a reasonable thing to do. That's new," Walters said. "They should have said that in the absence of compelling evidence to support the superiority of either vaginal birth or Caesarean section that either one is a reasonable alternative for delivery and should be considered equally."
If the stat is accurate, wouldn't a 4 times higher death rate for caesarean be rather compelling evidence that vaginal is safer?







:

Let's see possible incontinence issues vs. adhesions or death? hmmm difficult choice!:LOL

And this from a mom who has had 2 emergency caesarians after hours of pushing each time because the sprouts were flat out Stuck: one with head cocked to the side a bit, the other facing my leg.


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## Marlena (Jul 19, 2002)

Quote:

If the stat is accurate, wouldn't a 4 times higher death rate for caesarean be rather compelling evidence that vaginal is safer?

It probably would. But first a few questions: Maternal or fetal mortality, or both? And, of course, sources?


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## Greaseball (Feb 1, 2002)

I believe it's maternal mortality, which is probably why ACOG doesn't think it's that bad. After all, they were only women...


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## DaryLLL (Aug 12, 2002)

Quote:

_Originally posted by Marlena_
*It probably would. But first a few questions: Maternal or fetal mortality, or both? And, of course, sources?*
Are you kidding? The risks are well known. Here are a few. There are others. Read *Silent Knife*, for starters.

http://www.childbirth.org/section/risks.html

Quote:

Cesarean birth is major surgery--, risks are involved.
1) The estimated risk of a woman dying after a cesarean birth is less than one in 2,500 (the risk of death after a vaginal birth is less than one in 10,000).
2) Infection. The uterus or nearby pelvic organs such as the bladder or kidneys can become infected.
3) Increased blood loss. .. twice as much with cesarean birth as with vaginal birth.
4) Decreased bowel function. The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.
5) Respiratory complications. General anesthesia can sometimes lead to pneumonia.
6) Longer hospital stay and recovery time. Three to five days in the hospital [and hospitals are dangerous, germ ridden places]
7) Reactions to anesthesia. The mother's health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
8) Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.

risks to the baby :

1) Premature birth. If the due date was not accurately calculated, the baby could be delivered too early.
2) Breathing problems. ...more likely to develop breathing problems such as transient tachyapnea (abnormally fast breathing during the first few days after birth).
3) Low Apgar scores. ...can be an effect of the anesthesia and cesarean birth, or the baby may have been in distress to begin with. ... baby was not stimulated as he or she would have been by vaginal birth.
4) Fetal injury...the surgeon can accidentally nick the baby while making the uterine incision.
Other risks include higher incidence of post partum depression, and less success with breastfeeding.

And:

http://www.mercola.com/2003/sep/27/cesarean_section.htm

Quote:

Unfortunately, the growing fanfare surrounding cesarean sections is another health care "illusion." The rising rate of C-sections is not due to an increase in the complications mentioned above, but rather to an increase in elective cesareans for reasons such as patient or practitioner convenience, pain-free labor or provider liability fears, none of which constitute a valid reason for C-section.

. Babies born by C-section do not receive the natural stimulation that comes from moving down the birth canal, and therefore must often be given oxygen or a rub down to help them breathe. They also miss out on the natural hormones that are released during vaginal birth to help the baby during his first moments of life.
One of the complications of a C-section that is hardly ever addressed is the problem that the resulting surgical scar has on the mother. It frequently blocks the proper flow of energy through the autonomic nervous system and seriously impairs her ability to stay healthy.
Cesareans also have a psychological effect on women. Most women who have cesarean sections reported that the experience was traumatic. Women are also less able to care for the newborn immediately after childbirth and therefore may miss out on bonding opportunities.


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## SpiralWoman (Jul 2, 2002)

Quote:

Too many people think it is a minor surgery with no complications let alone death.
that is the problem here. The statement made by ACOG merely reflects what is already happening within a culture that disempowers women in so many ways that it is constantly unmining our birth choices. Unless women chose to educate themselves, they will continue to chose disempwered birthing methods *as their 1st choice!*

What action can we take to promote education & empowerment of women??? Only women taking their power to chose what happens to them will change anything.

blessings, Maria


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## smittenmom (Mar 2, 2003)

From the article:

Quote:

Even if their babies are not in a feet-downward "breech" position, or they do not face other possible complications, some women are choosing to forego natural labor and instead schedule a surgical delivery, either for convenience, because they fear the pain of childbirth, or because of concerns about possible long-term complications from the physical trauma of labor and delivery.
The physical trauma of labor and delivery?! What about the physical trauma of major surgery?!!!

Ooooh, this just gets me so...


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## Meiri (Aug 31, 2002)

Thank-you DaryLLL. I'd only read that stat from secondhand sources, hence my "if".

The stuff about babies having breathing difficulties only applies to c-births without any labor though. In my cases, a sample of 2 admittedly, there'd been a good day of labor and both of mine came out nicely pink from the start. {DH peeked over the curtain at DS's birth, saw pink fist flying before the rest of him was out! Then he sat back down and wished he hadn't done that.:LOL }

Still wasn't my first choice for their births, but...that's life.


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## DaryLLL (Aug 12, 2002)

Ah, Meiri, this isn't a thread about whether those who really need em should have em. It's about whether drs should give them out for "convenience" sake. As I see it.

IMO, *Silent Knife* and *Open Season* should be required reading in high school, and esp in med school!


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## KKmama (Dec 6, 2001)

As I understand this statement, what they're basically saying is that women should be allowed to opt for cesareans. And yeah, I strongly disagree with that. C birth definitely has it's place as a *medical* procedure to ensure the health and safety of the mother and the baby. And *medical professionals* should be the ones determining when *major surgery* should be done. It's not like cosmetic dentistry or something...

I had a brain wave a while back, and I'm not sure I shared it here. I thought that maybe it could actually be good to get insurance companies involved in all of this. Shouldn't they be pushing for VBACs, because they're so much cheaper? Shouldn't they be harassing drs. about unnecessary Cs?


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## Marlena (Jul 19, 2002)

No, DaryLLL, I was not kidding. I'm certainly opposed to elective c-sections. But I'm also opposed to throwing out rhetoric and "information" that can't be factually supported. Rhetoric and hyperbole do not help any cause (unless you happen to be able to bombard a wimpy, spinless media and go by the name of the Bush Administration, but that's another matter).

I tried to post last night, but dd is sick and i wasn't able to finish it. If I have more time tomorrow, I'll try to get the most recent US Census data re these issues. My understanding is that maternal mortality is increased, maternal morbidity issues are different (not comparable, ie, though likely also significantly increased in all cases other than cases of 3rd and 4th degree tears in vaginal birth and so forth), and that fetal mortality and morbidity are decreased with c-sections. But I'll see what the data show.


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## SpiralWoman (Jul 2, 2002)

Quote:

And *medical professionals* should be the ones determining when *major surgery* should be done
If I lived in a perfect world full of ethical surgeons willing to take a backseat to birthing women & a hospital system that values the positive results of natural birth for mother *and* baby, (like maybe Holland?) I would be more likely to agree with this statement.

Unfortunately, our medical professionals are the ones who have been determining & giving "necessary" Csecs among the truly neccessary ones. I really really believe in a model where *I* am always the decision maker about my care. If a major surgery is to be performed on me, it goes like this: I hire a trained professional to give me his/her best opinion. Maybe I hire 2, or 3. They work for me, they are paid consultants, I am the decision maker. Period.

So, really, I think all options should be open to birthing women, from an elective C to an unassisted home birth to whatever feels right for that woman. I just want to put my energy into creating a culture where women are truly informed about birth & where unassisted home births are just as "endorsed" by our culture as Csecs.


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## applejuice (Oct 8, 2002)

What do I think?

As a person born at home in the 1950's and the mother of four homeborn children...I think that:

...vaginal birth as practiced by the medical profession is very dangerous and that Caesarean Sections are probably safer...

...that said, any woman who is stupid enough to fall for that dictum deserves what the consequences are. I am very sorry, but any woman, after all of the work that has been done to get midwives licensed and into hospitals, fathers in the delivery rooms, freestanding birth center, water births, ABC centers, child birth information classes and all of the studies and information out there, well, they just have to be dumb!

YOu have to make the decision you can live with. I know women who shop for hairdressers more intensively than they investigate the OB who will deliver their child.

You will live a lifetime with this child - and celebrate that child's birthday every year for the REST OF YOUR LIFE! YOu will never forget it! You will relive it constantly. REALLY you will.

Having that BABY will transform you. Do not be dumb - be informed!

The stories I read about unnecessary Caesarean Sections are old and repetitious. Unnecessary drugs and interventions that stalled a perfectly healthy woman's labor after a perfectly healthy pregnancy...

Women who would not even drink a cup of coffee during pregnancy open their veins and duras to potent drugs that slow their babies heart rates and cause fetal distress to justify surgical interventions.

HOw SAD!

Get smart

- do not be a victim!

- do not become a statistic!

Be a hero for your child and yourself!

You will not regret that!


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## Meiri (Aug 31, 2002)

DaryLLL, I get what this thread is about, and I agree with what's been said here, 100%.

I was only refining what you'd posted. A baby who has been through labor only to need an emergency caesarian at the end will not have the same issues as one who is born from a scheduled labor-free caesarian. To not state that is to not tell the whole truth.

I think women who end up with necessary surgeries shouldn't have that extra fear in the mix if they have labored and their baby has gotten that stimulation before the surgery started.

That's all I was getting at.

I had all the feelings of "failure" and grieving for how their births went, even though I hadn't had any of the standard interventions, so I understand those effects of surgical birth quite well. FWIW breastfeeding went so well both times that that success did much to help heal those injured emotions.

But I think ACOG is being extremely irresponsible with this issue. And then they have the nerve to complain, or rather doctors have the nerve to complain, about the malpractice insurance rates. And several states are in crisis over obstetric care because ob's won't practice in some states with very high rates. But as a profession they've done everything, and I'm quite literal about that "everything", bass ackwards as regards normal scientific medical procedure. They made certain practices standard without doing safety and efficacy studies. Then when studies are done and show harm and ineffectiveness, they keep those practices anyway due to "defensive medicine".

Their entire system is whacked, nuts, crazy, insane, obscene...and yet there are good ones out there who don't cut unless truly necessary, who do support maternal mobility, who do stay for the entire labor rather than arriving in time to play "catch"...._sigh_


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## KKmama (Dec 6, 2001)

SpiralWoman, in my mind, midwives are medically professionals, too, who have a say in whether a woman gets referred to a ob/gyn for a C. And yeah, drs. are definitely doing too many Cs, but should patients ever be allowed to make the decision to have a totally elective C (as is implied by the orig. FACOG stmt)? That just seems to be going from bad to worse.


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## Greaseball (Feb 1, 2002)

Of course women and babies who need c/s should have it, just like women and babies who need a vaginal birth (the vast majority) should have that option supported as well.

Cesareans are not risk-free for the baby, even with some labor. They come out of the vagina for a reason. It's what is supposed to happen. Some can't, but those are rare - nowhere near 20 or 25% of all births!


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## CanOBeans (Apr 7, 2002)

Re: risks to babies and mothers from elective cesarean --

Here is an excerpt from my article on VBAC which can be read in full here: http://mothering.com/11-0-0/html/11-4-0/vbac-lash.shtml References for all the footnotes cited here can be found at the above link.

You should note that I was extremely conservative in which studies I cited -- I limited it as much as possible to ELECTIVE cesarean risks. Emergency cesareans carry much higher risks than are detailed here.

An important thing to note is that ACOG's position is based on a comparison of cesareans to *typical* vaginal birth -- which usually involves one or more serious interventions such as induction, electronic fetal monitoring, restricted nourishment, restriction of movement, epidurals and/or other drugs, episiotomy, forceps and vacuum extractions. Were they to compare the risks of cesarean to those of natural vaginal birth with little to no intervention, the balance would tip heavily in favor of vaginal birth as the safest for both mothers and babies. But I'm pretty sure everyone here already recognizes that!

Anyway -- Risks of elective cesarean section --

Risks to the Baby
"Neonatal respiratory distress syndrome (RDS) is an important complication of elective repeat cesarean section."29 Respiratory distress syndrome is seen in 0.2 to 1.7 percent of term babies born by elective cesarean;30,31,32 incidences are higher among neonates of less than 37 weeks gestation. RDS is a serious, life-threatening condition for the baby, often necessitating time in the NICU (an average of 11.2 days) and possible mechanical ventilation and drug therapy.33 When combined with rates of transient tachypnoea of the newborn, a self-limiting condition that is nevertheless worrying to parents and also may result in NICU time, Morrison et al. found that the risk was 3.55 percent among babies born at estimated gestational age of 37 weeks or later.34 This was a threefold increase over cesarean during labor and a sevenfold increase over vaginal birth. Hales et al. found a 12.4 percent incidence of respiratory morbidity in term neonates delivered by elective cesarean section.35 In another study, Levine et al. found a similar 0.37 percent risk of persistent pulmonary hypertension (PPH) in neonates delivered by elective cesarean section, a fivefold increase over those born vaginally.36

Even higher incidences of RDS are found among preterm neonates. Iatrogenic (physician-caused) prematurity is a known risk of elective cesarean section, usually related to failure to conform to protocols for determining gestational age prior to delivery or errors in estimating weeks of gestation even with the use of clinical data.37 Although most studies have examined risks for very premature infants, there are also significant risks for babies born from 32 to 36 weeks. One recent study demonstrated that rates of infant death (from birth to one year) are increased threefold in the US (four and one-halffold for Canada) for babies born between 34 and 36 weeks gestation, and sixfold in the US and 15-fold in Canada for babies born between 32 and 36 weeks gestation. Substantial increases were noted for deaths due to asphyxia, infection, sudden infant death syndrome, and external causes.38

Less serious but still disturbing, the baby delivered by cesarean section is at increased risk of being cut by the surgeon during delivery. The incidence of surgical wound is 2 percent overall, and as high as 6 percent for breeches.39 Researchers believe these risks to be underreported.

Risks to the Mother
Almost no one will argue that mothers still face higher risks from elective cesarean as compared to vaginal birth, although the overuse of medical interventions such as forceps, vacuum extraction, and episiotomy may soon close the gap. Infections are the most common maternal complication after cesarean section and account for substantial postnatal morbidity and prolonged hospital stay.40,41 Other risks include massive hemorrhage in 7.3 percent of cesareans,42 transfusions in 6.4 percent,43 ureter injury in 0.03 to 0.1 percent,44 injury to bowels in 0.05 percent,45 and incisional endometriosis in 0.1 to 1.0 percent.46,47 This list is by no means exhaustive.

In a 2000 study reported in the Journal of the American Medical Association, Lydon-Rochelle et al. noted that women undergoing cesarean section had twice the risk of women who had given birth vaginally of being rehospitalized for reasons such as uterine infection (2.0 relative risk), gallbladder disease (1.5 RR), urinary tract infections (1.5 RR), surgical wound complications (30.0RR), cardiopulmonary conditions (2.4 RR), thromboembolic conditions (2.5 RR), and appendicitis (1.8 RR). 48 They noted in their discussion that rehospitalization has a negative social and financial effect on the family, yet another risk of cesarean section. Several studies were unanimous in finding that women who delivered by cesarean were less satisfied with their experience than were women who gave birth vaginally.49-52 Elective cesarean section also increases a woman's risk of hysterectomy in both the current and future pregnancies53, 54 and more than doubles her risk of death compared to vaginal birth.55

Increased Complications in Subsequent Pregnancies
A history of cesarean section dramatically increases the risks of severe subsequent pregnancy complications that are normally quite rare. Placenta previa, which has an incidence of 0.25 percent among women with unscarred uteri, rises to 1.87 percent after one prior cesarean.56 There exists a dose-response pattern; with one prior cesarean, there is a 4.5x risk for previa; after two prior cesareans, the risk rises to 7.4x; after three, the risk is 6.5x. With four or more cesareans, the risk rises to nearly 45x the risk of previa in an unscarred uterus.57

A low-lying placenta is also more likely to lead to placenta accreta. According to a 1997 study, the presence of a uterine scar independently increases the risk of placenta accreta from 0.01 percent in unscarred uteri to 0.25 percent when there is at least one prior cesarean section. 58 Again, the number of prior cesareans has been shown to increase the risk of accreta.59 Placenta accreta may lead to severe hemorrhage, with subsequent hysterectomy being required in 50 to 82 percent of cases.60 It can also lead to maternal death.

Placental abruption is also significantly increased in women with a prior cesarean section compared to women with no scar. The rate of abruption in Finland was found by Hemminki et al. to be 0.17 percent for women without prior cesarean and 0.49 percent for women with a prior scar.61 According to the National Center for Health Statistics, the rate of abruption in the US from 1989 to 1990 was 0.6 percent overall; infant death occurred in 10 percent of these cases. In 2001, Ananth et al. found an abruption rate of 0.65 percent, with a perinatal mortality rate of 11.5 percent. Although 55 percent of these were due to early delivery, the rate of death for full-term infants in the group with lowest mortality was still 25-fold higher in cases of abruption.62 Compare the risk of these complications to the rate of rupture for women attempting VBAC found by Lydon-Rochelle et al. (0.6 percent) and the rate of fetal death associated with rupture (5 percent). Although not usually life threatening, there are other complications to consider for subsequent pregnancies. Increased rates of secondary infertility have been reported after prior cesarean, as well as higher rates of miscarriage and ectopic pregnancy.63


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## Els' 3 Ones (Nov 19, 2001)

Just got the new issue of Mothering. Peggy O' does her editorial on c's................very good piece. I will link it when it comes online.

FTR, I had a an "elective" c after 43 hrs of labor, 7 on pit with no meds, to find she was OP with a brow presenting. Given a 10% - 15% chance of her turning I elected to move it along. So I had a spinal that did not take (I'm highly drug resistant), a surgeon that did not believe I was in pain, and went home with a cathater due to a nick on my bladder from surgery. This was supposed to be a home birth!! I did go on to have a VBAC and a HBAC.

Screw the ACOG and their opinions!









El


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## DaryLLL (Aug 12, 2002)

Thanks you so much for those stats, CanOBeans!

So drs who say the risks for vag and c-sec births are equal are just terribly ignorant, foolish or immoral.

As a bfing counselor, I would like to add that antibiotics given to the c-sec mother to prevent infections of her abdominal organs often leads to thrush, which puts the bfing relationship at risk. Not bfing is harmful to the baby's and the mother's health in many many ways.

Not enough studies have been done, still! on how the use of an epidural affects the newborn's nervous system. Preliminary studies indicate it can upset the baby's ability to suck, swallow and breathe in concert, and this also puts the bfing relationship at risk. These effects can last up to once month.

Babies are more likely to be separated from their mothers for several hours after a surgical birth. Mothers and babies who miss out on the early bonding are less likely to bf as long as those who bf in the first hour. They are also more likely to abuse their child.

Again, I am not pointing fingers at anyone here. These are general trends.

Meiri-

Quote:

I had all the feelings of "failure" and grieving for how their births went, even though I hadn't had any of the standard interventions, so I understand those effects of surgical birth quite well. FWIW breastfeeding went so well both times that that success did much to help heal those injured emotions
I can relate. My first labor was 36 hours in a hospital. I am sure (in retrospect) my nervousness to be there (strange people, strange smells, bright lights, monitors) upped my adrenaline, leading to a 36 hour labor, after my water broke. When I finally dilated to 9 1/2 cms, they "let" me push. I pushed for an hour, she wouldn't come out in that time, I got the c-sec.

Of course I was determined to bf and I did. A nurse there tho told me, "I can't believe you are going to bf after all you've been through!"

My next 2 births were HBAC.


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## Marlena (Jul 19, 2002)

Thanks, Jill, for the information!!









I recently did an article on the regulation of direct-entry midwifery in the US that compares various stats for midwives versus physicians, but it didn't specifically focus on c-sections in any great detail, other than to discuss relative c-section rates between physicians, CNMs, and DNMs. If anyone wants the article, please feel free to PM me.


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## Greaseball (Feb 1, 2002)

In A Woman in Residence I read of a c/s baby whose arm was fractured during the surgery. The doctors say they "don't know how it happened." One would think a doctor would know something like that.


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## CanOBeans (Apr 7, 2002)

Quote:

_Originally posted by DaryLLL_
*As a bfing counselor, I would like to add that antibiotics given to the c-sec mother to prevent infections of her abdominal organs often leads to thrush, which puts the bfing relationship at risk. Not bfing is harmful to the baby's and the mother's health in many many ways.

Not enough studies have been done, still! on how the use of an epidural affects the newborn's nervous system. Preliminary studies indicate it can upset the baby's ability to suck, swallow and breathe in concert, and this also puts the bfing relationship at risk. These effects can last up to once month.

Babies are more likely to be separated from their mothers for several hours after a surgical birth. Mothers and babies who miss out on the early bonding are less likely to bf as long as those who bf in the first hour. They are also more likely to abuse their child.*
Yes, yes, yes. Thank you for bringing these up, DaryLLL. All of these points are ones I would have liked to make in my article, but because there was not any solid research, I left them out. It was important to me that any assertions I made in that particular article be completely and totally supported by that which passes as "evidence" under the scientific model. Thus, the extremely conservative position I took in whether to include a risk or not. There are certainly many other risks that could be discussed, but they are not measured or are only studied in another domain (lactation, mental health, sociology/psychology, etc.) -- therefore, in the mind of the birth researcher or the med pro, *they do not exist.* Going beyond this, even those who attempt to practice "evidence based medicine" are working from a highly flawed set of data -- data which assumes certain givens (for example, nearly all obstetric research assumes that hospital birth is safe -- this idea is so ingrained that the researchers don't even realize they are making this assumption) and data which is based on only a narrow set of measured outcomes. Anyone who studies the data long enough -- and I mean the whole body of literature, not just the narrow spectrum that most doctors are semi-familiar with -- must come to the conclusion that the research is self-limiting and in the end cannot be used as a reliable basis for forming any generalized "rules" or "recommendations" as ACOG insists on trying to do. (Tangent -- let's not forget, as Marsden Wagner so brilliantly pointed out -- ACOG is a *trade union* representing first and foremost the best interests of its members -- not women, not babies, but the doctors whose livelihoods rely on a constant supply of pregnant women whom they can categorize, measure, manage, deliver, and ultimately bill).

Your examples are prime ones for demonstrating this huge blind spot in the vision of ACOG et al. One reason why doctors are able to equate the safety of cesarean to vaginal birth with a straight face is because they do not include breastfeeding success or duration as a consequence of mode of delivery. Why? Because they *do not know* that failure to breastfeed is a RISK to both the baby and mother's health and well-being. They are ignorant of that fact and so give it no weight in the argument.

But the main log in ACOG's eye is in their use of typical vaginal birth, as I mentioned, as their standard against which they measure the safety of cesareans. Or, to put it another way as in my article, by saying that cesareans are as safe as vaginal birth, they are really admitting that _they have managed to make vaginal birth as risky as major surgery._

Greaseball said:

Quote:

*In A Woman in Residence I read of a c/s baby whose arm was fractured during the surgery. The doctors say they "don't know how it happened." One would think a doctor would know something like that.*
Most people do not know that a cesarean can be quite rough. Sometimes forceps or vacuum are needed to get the baby out, and brachial plexus injuries, fractured clavicles, etc. can happen just as easily as when they try to yank babies out vaginally.

Hmmm, didn't mean to write so much. I do want to say one last thing -- some cesareans are necessary. Some are unnecessary but become inevitable given the interventions and other crap women are subjected to in typical labor management (I had one of these). And some are just completely, utterly, moronically unnecessary. Saying that doesn't imply judgment of any woman's experiences -- even, IMNSHO, a woman who actively chooses an unecessary cesarean -- it is a judgment on those who control birth in our society.


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## Marlena (Jul 19, 2002)

You go, Jill!

Quote:

(Tangent -- let's not forget, as Marsden Wagner so brilliantly pointed out -- ACOG is a trade union representing first and foremost the best interests of its members -- not women, not babies, but the doctors whose livelihoods rely on a constant supply of pregnant women whom they can categorize, measure, manage, deliver, and ultimately bill).
Bingo.


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## Quirky (Jun 18, 2002)

Marlena, I'm on my sister's Mac, and I can't for the life of me figure out how to make this thing open a second browser window, or I'd link you to the page - but there was a study linked from ACOG's homepage (press releases) in the last few months that showed that c-section is associated with a 4x greater risk of maternal mortality (if I recall correctly, controlled for high risk pregnancies, etc. but I may be wrong on that). We had a thread about it - it was a huge study done in North Carolina, I think. Maybe someone else knows what I'm talking about and can post the link?

ETA: bingo! found the link

How on Goddess' green earth it can be "ethical" for OBs to do elective C-sections when the risk of death is 4x greater is beyond me....


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## Marlena (Jul 19, 2002)

The link doesn't work.

It was on ACOG's site? I'll search for it...

Let's see...I found "Sex is better for some women after sterilization" (September 1, 2002), and "Home births double risk of newborn death" (July 31, 2002), but not the c-section study (funny, that...).

Ah, here we are. You might be looking for this?: http://www.acog.org/from_home/public...ng14505fla.htm

While the abstract there doesn't have the vaginal birth info, this summary does:

http://www.acog.org/from_home/public...erFriendly=yes

Quote:

Mortality Risks -- Another study examined the association between pregnancy-related death and health care services, including maternity care coordination, nutritional services, sources of prenatal care (public vs private), the number of prenatal visits, and method of delivery. It found that a cesarean delivery significantly increased a woman's risk of experiencing a pregnancy-related death (35.9 deaths per 100,000 deliveries with a live-birth outcome) compared to a woman who delivered vaginally (9.2 deaths per 100,000). Pregnancy-related mortality rates were higher among women with cesarean delivery when all causes of death were analyzed. This study also found that women who received regular prenatal care significantly decreased their risk of death.


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## Marlena (Jul 19, 2002)

Incidentally, the study cited IS just one study, using limited information from North Carolina. Then again, if I remember correctly, the home birth study is also just one study, using birth certificate info from Washington state (I'd have to go back and check that, though...it's been a few months since I looked at it). Interesting how the one is relatively quietly mentioned, while the other was trumpeted all over not merely on ACOG's site, but in numerous press releases that made the national newspapers.


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## sohj (Jan 14, 2003)

Quote:

_Originally posted by applejuice_
*...that said, any woman who is stupid enough to fall for that dictum deserves what the consequences are. I am very sorry, but any woman, after all of the work that has been done to get midwives licensed and into hospitals, fathers in the delivery rooms, freestanding birth center, water births, ABC centers, child birth information classes and all of the studies and information out there, well, they just have to be dumb!

YOu have to make the decision you can live with. I know women who shop for hairdressers more intensively than they investigate the OB who will deliver their child.*
The problem is that despite "all the work" that you mention, it is far from consistently available.

I did NOT have a c-section. But, I did have a totally hijacked birth which you can read about starting here, at this post on a thread in Birth and Beyond

The gist of it that pertains to your post is:

Quote:

I am enraged by people who "choose" to have births at hospitals because they are creating the "market" for interventionist births and they, out of fear, created the hospital birth as a mainstream birth. If there were no obstetricians, we would have a large supply of midwives. And I could have had a bigger selection to make a choice from.
and, from a later post on the same thread:

Quote:

Alison74: knowing there are "choices" isn't enough. The reason I ended up with the midwife I did is because there are only 7 (SEVEN!!!!!) homebirth midwives in New York City. We have 16 million people in the greater metro area and, how many was it again?, SEVEN homebirth midwives.
And the largest birthing center here, Elizabeth Seaton, closed its doors in the beginning of September because of insurance problems.

And, otherwise, if you are in a normal L&D at any of the hospitals here, you cannot have a water birth. You can labor in a tub, but you have to get out to give birth. That makes no sense to me from the point of view of a mother, but there you have it. It's the policy.

In the hospital where I ended up, there WAS a midwife in the room with me, but it was the doctor who was "in at the kill" so to speak. It was the doctor, who I had never met before (yet more to the story...not my decision and I'm not going into it here and, yes, I thought I had everything covered), who cut me open and ruined my health for a very long time.


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## CanOBeans (Apr 7, 2002)

Here is a more concise statement on risks to mothers and babies which includes references. To access the original statement, go to http://www.ican-online.org/resources/wp_electivecs2.htm -- this is posted here with permission -- please feel free to pass along, taking care to include the copyright info on the bottom.

Position Statement: Elective Cesarean Sections Riskier than Vaginal Birth for Babies and Mothers
by Jill MacCorkle, ICAN Clarion Editor

Recently, a few physicians have claimed that elective primary cesareans and elective repeat cesareans are safer for babies, and even for mothers, than vaginal birth.1,2 While selective use of the medical literature might seem to back up this claim, a review of the studies which consider short- and long-term risks of cesareans does not. Elective cesareans put babies and mothers at risk, use valuable and limited healthcare resources, have negative psychological and financial consequences for families, and substantially increase serious risks in subsequent pregnancies. The high rate of cesarean in the United States has not resulted in improved outcomes for babies or mothers. Additionally, vaginal birth after cesarean (VBAC) is still less risky for mothers and babies than cesarean section, despite recent claims to the contrary. ICAN is opposed to cesarean sections performed without true medical indication.

Risks to the baby from elective cesarean section

Babies delivered by elective cesarean have an increased risk of neonatal respiratory distress syndrome (RDS), a life-threatening condition,3-7 and other respiratory problems that may require NICU care.
Babies delivered by elective cesarean have a five-fold increase in persistent pulmonary hypertension (PPH) over those born vaginally.6
Babies delivered by elective cesarean are at increased risk of iatrogenic (physician-caused) prematurity, usually related to failure to conform to protocols for determining gestational age prior to delivery, or errors in estimating weeks of gestation even with the use of clinical data.7,8 Prematurity can have life-long effects on health and well-being, and even mild to moderate preterm births have serious health consequences.9
Babies delivered by elective cesarean are cut by the surgeon's scalpel from two to six percent of the time.10 Researchers believe these risks to be underreported.

Risks to the mother from elective cesarean section

Up to 30% of women who have a cesarean acquire a postpartum infection. Infections are the most common maternal complication after cesarean section and account for substantial postnatal morbidity and prolonged hospital stay.11
Other serious complications for women undergoing cesarean include massive hemorrhage,12 transfusions,13 ureter injury,14 injury to bowels,15 and incisional endometriosis.16,17
Women who undergo cesarean report much lower levels of health and well-being at seven weeks postpartum than women who have vaginal births.18
Women who undergo cesarean section have twice the risk of rehospitalization for reasons such as infection, gallbladder disease, surgical wound complications, cardiopulmonary conditions, thromboembolic conditions, and appendicitis. Rehospitalization has a negative social and financial effect on the family.19
Women who undergo cesarean section report less satisfaction than women having vaginal births.20,21
Women undergoing cesarean are at increased risk of hysterectomy in both the current and future pregnancies.22,23
The maternal death rate is twice as high for elective cesarean as for vaginal birth.24
In subsequent pregnancies, women with a prior cesarean have higher rates of serious placental abnomalities which endanger the life and health of the baby and the mother.25-27 Women are rarely told that a cesarean places future babies at higher risk.
After cesarean section, women face higher rates of secondary infertility as well as higher rates of miscarriage and ectopic pregnancy.28,29

--------------------------------------------------------------------------------

1. Harer WB Jr. Patient choice cesarean. ACOG Clinical Rev 2000;5(2).
2. Greene MF. Vaginal delivery after cesarean section - Is the risk acceptable? N Engl J Med 2001; 345(1): 54-5.
3. Bowers SK, MacDonald HM, Shapiro ED. Prevention of iatrogenic neonatal respiratory distress syndrome: Elective repeat cesarean section and spontaneous labor. Am J Obstet Gynecol 1982;143(2):186-9.
4. Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: Influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995; 102:101-6.
5. Hales KA, Morgan MA, Thurnau GR. Influence of labor and route of delivery on the frequency of respiratory morbidity in term neonates. Int J Gynaecol Obstet 1993; 43(1):35-40.
6. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol 2001;97(3):439-42.
7. Parilla BV, Dooley SL, Jansen RD, and Socol ML. Iatrogenic respiratory distress syndrome following elective repeat cesarean delivery. Obstet Gynecol 1993; 81(3):392-5.
8. Hook, B et al. Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics 1997; 100(3):348-53.
9. Kramer MS, Demissie K, Yang H, Platt RW, Sauve R, Liston R. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. J Amer Med Assoc 2000; 284(7):843-9.
10. Smith JF, Hernandez C, Wax JR. Fetal laceration injury at cesarean delivery. Obstet Gynecol 1997; 90(3): 344-6.
11. Henderson EJ & Love EJ. Incidence of hospital-acquired infections associated with cesarean section. J Hosp Infect 1995; 29: 245-255.
12. van Ham MA, van Dongen PW & Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74: 1-6.
13. Naef RW III, Washburne JF, Martin RW et al. Hemorrhage associated with cesarean delivery: When is transfusion needed? J Perinatol 1995; 15: 32-35.
14. Eisenkop SM, Richman R, Platt LD & Paul RH. Urinary tract injury during cesarean section. Obstet Gynecol 1982; 60: 591-596.
15. Davis JD. Management of injuries to the urinary and gastrointestinal tract during cesarean section. Obstet Gynecol Clin North Am 1999; 26: 469-480.
16. Wolf Y, Haddad R, Werbin N, Skornick Y, Kaplan O. Endometriosis in abdominal scars: A diagnostic pitfall. Am Surg 1996; 62(12):1042-4.
17. Wolf GC, Singh KB. Cesarean scar endometriosis: A review. Obstet Gynecol Surv 1989; 44(2):89-95.
18. Lydon-Rochelle MT, Holt VL, Martin DP. Delivery method and self-reported postpartum general health status among primiparous women. Paediatr Perinat Epidemiol. 2001 Jul;15(3):241-2.
19. Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal rehospitalization. J Amer Med Assoc 2000; 283(18):2411-2416.
20. Fawcett J, Pollio N & Tully A. Women's perceptions of cesarean and vaginal delivery: Another look. Res Nurs Health 1992; 15: 439-446.
21. Waldenstroem U. Experience of labor and birth in 1111 women. J Psychosom Res 1999;47: 471-482.
22. Stanco LM, Schrimmer DB, Paul RH, Mishell DR Jr. Emergency peripartum hysterectomy and associated risk factors. Am J Obstet Gynecol 1993; 168(3 Pt 1):879-83.
23. Bakshi S, Meyer BA. Indications for and outcomes of emergency peripartum hysterectomy. A five-year review. J Reprod Med 2000; 45(9):733-7.
24. Bewley S. Maternal mortality and mode of delivery. Lancet 1999; 354: 776.
25. Zaideh, SM et al. Placenta praevia and accreta: Analysis of a two-year experience. Gynecol Obstet Invest 1998; 46(2):96-8.
26. Ananth, CV et al. The association of placenta previa with history of cesarean delivery and abortion: A meta-analysis. Am J Obstet Gynecol 1997; 177(5):1071-78.
27. ****** DA, Chollet JA & Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 1997; 177: 210-214.
28. Hemminki, E and Merilainen, J. Long-term effects of cesarean sections: Ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996; 174(5):1569-74.
29. Hall MH, Campbell DM, Fraser C & Lemon J. Mode of delivery and future fertility. Brit J Obstet Gynecol 1989; 96: 1297-1303.

This material may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All rights reserved.


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## Marlena (Jul 19, 2002)

Quote:

knowing there are "choices" isn't enough. The reason I ended up with the midwife I did is because there are only 7 (SEVEN!!!!!) homebirth midwives in New York City. We have 16 million people in the greater metro area and, how many was it again?, SEVEN homebirth midwives.
The regulation of direct-entry midwifery in New York state is largely responsible for this. It is virtually impossible for anyone other than certified nurse-midwives to practice in the state. The matter has been litigated from here to there. And the DNMs lost.

The issues Jill and others are raising about the medical research comparing vaginal births versus cesareans are highly important. However, one cannot forget the legal issues that prevent so many women who know about homebirth or birth in birthing centers with midwives and want such a birth from having one, because direct entry midwifery is either illegal in their state or is regulated such that it's either virtually impossible to practice direct entry midwifery or very legally risky, at best, to do so.


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## CerridwenLorelei (Aug 28, 2002)

will jump for joy

My Sec was legit but hers..
she asked dr to schedule for 3 weeks before due date so "I won't gain any more of that ungodly weight"
also put cereal in formula when the baby was 7 days old so she wouldn't have wrinkles or dark eyes due to lack of sleep...

Ughhhhhhh
and this makes it easier for that type of sec it sounds like ...


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## applejuice (Oct 8, 2002)

Greaseball:

A Woman In Resdience by Dr. Michelle Harrison is an excellent book. I truly advised all of my childbirth students to read this book when it first came out.

Another book is Labor and Delivery by Constance Bean in which a CCE simply writes down every thing she observes as an observer on the OB floor.

Th information is out there. My mom was no one special, but she did have four home births in the 1950's. How did someone so ordinary manuever that? In those days, mothers stayed in the hospital for a week or more and got the rest they needed. It was also more affordable. Fewer people had health insurance.

You can get anything you want . Everything is negotiable. Vote with your $$$$ and your feet.


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## kama'aina mama (Nov 19, 2001)

applejuice, I have to disagree with you. It sounds to me like your mom was very special. At the very least she was thinking way outside the cultural norms and had the guts to act on her ideas... and she raised you to do the same!


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## applejuice (Oct 8, 2002)

No, I have known the woman for fifty years and she is very ordinary.

Everyone can learn from that.

The common acts of the common person have always changed society.

Unfortunately, they do not write the history books.


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## DaryLLL (Aug 12, 2002)

They do not write the history books--

Sometimes they do! Read the







*Seven Voices, One Dream,* by one of the Founders of LLL. Just a group of 7 nice Catholic ladies, homebirthing and ebfing in the dark ages of the 1950's, the first ones to start a support group for almost anything, not to mention for doing something considered disgusting and embarrassing at the time!

Not a *his*tory book, a *her*story book.


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## Little Bear's Mama (Mar 20, 2003)

So true,DaryLLL!









On the note of homebirth,my Grandmother gave birth to seven children. All but one(her youngest,my mother) were born at home. Her first baby was 10lbs! The doctor didn't make it,and my Great Grandmother(who birthed all of her nine at home,including a almost 3 pound premie) helped deliver the baby.
My paternal Grandmother gave birth to all but one of her 4 children at the hospital. My Dad was the lone homebirth,she couldn't afford to go to the hospital.
All nursed their babies.
My mother had two breech births. My sister was a footling,myself a complete breech. She gave birth to both of us vaginally,but the doctor tore her up trying to get me out. He actually cut the inside of her vagina.







In more than one place!! As well as episiotomy and several tears!














On both births,forceps were used to pull us out! Years later,my mother had to have surgery for all the damage that was done. There was TONS of scar tissue. She would have been better off with a c-section.







Remember though,when I say this that she was bedridden,not given food or water,tied down(yes,I said tied down!!!)and made to birth flat on her back. I'm SO glad that women today have choices. I'm so glad if a woman whose baby is breech can opt for a c-section,as she probably wouldn't have any choice but to be bed ridden and made to birth flat on her back.







It just makes it too difficult to get a baby out in that position,regardless. Not to even mention a baby is folded in half!
I would rather NOT see a mom have a c-section. Yes,I think choosing a MAJOR surgery over patiently waiting for the baby come is beyond ridiculous! Yes,I think a mom should think about her health and the health of her baby and forget about convienence. BUT,I also think that there are necessary c-sections. AND I also think a mother should be able to choose the best birth for her. If she is having a breech baby,she should be able to choose a vaginal birth(with no restricted movement)or a c-section. So,basicly,it comes down to having that option available if she *needs* it,not just for cosmetic or convienence reasons.


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## Greaseball (Feb 1, 2002)

Quote:

I'm so glad if a woman whose baby is breech can opt for a c-section,as she probably wouldn't have any choice but to be bed ridden and made to birth flat on her back.
It's the intervention in breech birth that causes the problems, not the baby's position. MDC member laurashanley delivered her own footling breech with no interventions, a quick labor, no tearing, and in a standing position. And she's not the only one...

If a woman wants to have a breech baby she probably has to do it at home, unless it arrives too quick for a section. If she's not comfortable being at home, she will most likely have a section or a huge episiotomy.

If I have a breech I will most definitely stay home.

I was planning to post some quotes from A Woman in Residence, just a little at a time.

"When a patient begins to make a lot of sound, the nurses talk her into an epidural anesthetic. Then, once the anesthesia is in, they put a 'smiley face' on the blackboard next to the patient's name. The goal is to get 'smiley faces' next to every name on the board."

"...the vagina is defined as dirty...some surgeons also change their gown after touching the vagina."

"[The residents] seem to be depressed, talking mostly about work and suicide."

"What do we lose by being kind to a baby who has just been born?"

"...I learned to screw a monitor into the scalp of a baby not yet born...Was the baby smiling before I screwed the electrical lead into its head? Was the baby frightened? Is this baby curious anymore? Does this baby still want to be with us? What have we taught this new person about what life is like?"


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## Little Bear's Mama (Mar 20, 2003)

Greaseball,that was sortof the point I was making. In most hospitals,a woman wouldn't get a choice of birthing position(the doctor needs to see what he's doing,donchaknow). She would most likely be classified as "high risk" and be confined to bed throughout her labor and denied food and drink "in case she needs an emergency c-section". So,in this circumstance,no doubt that she could be better off choosing a c-section if the choice were available.
I have no doubts that a woman can birth her breech baby at home,if she chooses to do so or if that option is even available to her.


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## crazy_eights (Nov 22, 2001)

Quote:

_Originally posted by Marlena_
*My understanding is that maternal mortality is increased, maternal morbidity issues are different (not comparable, ie, though likely also significantly increased in all cases other than cases of 3rd and 4th degree tears in vaginal birth and so forth), and that fetal mortality and morbidity are decreased with c-sections. But I'll see what the data show.*
I'm not sure if the stats will give you an accurate picture. It is very, very rare to do a c/sec, even a repeat, for a known stillbirth, (even one that died before labor). So the vag. stats on mortality are artificially elevated. And I think it would depend on how you define "morbidity" to see if there is a real decrease. Lowered APGARS? Breathing difficulty (TTN)? NICU/ SCN stays? It could be quite interesting b/c there is quite a lot of room to finagle the stats.


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