# A bit of a spinoff: When is a C-sec essential?



## pumpkinhead (Sep 15, 2003)

How do you all feel about C-sec's? I'm no expert, that's for sure, but here are my answers:

-prolapsed cord
-extreme maternal distress (i.e. BP, etc)
-maternal injury (spinal nerves, paralysis etc)
-extreme fetal distress (i.e. heart rate etc.)
-Extenuating fetal circumstances (very permature babe, emphalocele, cojoined twins)
-placenta previa
-placental abruption

Correct me (as I'm sure you will







) if any of these are inncorret assumptions.

That's all I could come up with. I agree that lots of these issues could be 'treatment' related in how labour and delivery are managed esp during a hospital birth.

I'd love to hear all of your insights.

P.S. I feel that C-sec's have their place and are a wonderful tool *IF* (big if) they are absolutely essential!!


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## Pynki (Aug 19, 2002)

i think if YOU feel you needed a c/s.. Then YOU as a person probably did.. Whether it was technically medically neccesary who knows..

My 1st ds was breech.. We had him c/s.. Could i have delivered him vaginally.. Maybe.. I doubt it with the way the other 2 were... (HIgh forcepts and vaccuum extractions) but it's possible.. I would still have a c/s for breech position, but that is MY personal comfort level.. I am very glad, however, to have a VERY pro vback OB.. Who said, "So are we having this baby the right way?" when i cam in pg with our 2nd.. I was scared, but did have the vbac, and am sooo glad i did...

I don't think all the bashing of c/s after the fact that we see alot around here is very useful.. It's done.. You can learn about ways to avoid a c/s again, but NOTHING is a given...

Just my .02..

Warm Squishy Feelings..

Dyan


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## pumpkinhead (Sep 15, 2003)

Whoa! My intent was NOT to bash c/s in the LEAST!

I do think a lot of the whole 'fear factor' and 'comfort level' can be largely accredited to the care and information a Mama recieves, either way (i.e. fear of a vag birth or fear of a c/s).


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## OnTheFence (Feb 15, 2003)

Quote:

_Originally posted by pumpkinhead_
*How do you all feel about C-sec's? I'm no expert, that's for sure, but here are my answers:

-prolapsed cord
-extreme maternal distress (i.e. BP, etc)
-maternal injury (spinal nerves, paralysis etc)
-extreme fetal distress (i.e. heart rate etc.)
-Extenuating fetal circumstances (very permature babe, emphalocele, cojoined twins)
-placenta previa
-placental abruption

Correct me (as I'm sure you will







) if any of these are inncorret assumptions.

That's all I could come up with. I agree that lots of these issues could be 'treatment' related in how labour and delivery are managed esp during a hospital birth.

I'd love to hear all of your insights.

P.S. I feel that C-sec's have their place and are a wonderful tool *IF* (big if) they are absolutely essential!!*
Transverse Breech, Uterine Anomaly, True CPD, Some type of injury that might prevent vaginal birth, eclampsia


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## Greaseball (Feb 1, 2002)

The reasons you listed are pretty standard, but there are exceptions.

At my midwife appointment yesterday, she mentioned that a few days ago she had delivered a baby at home with a prolapsed cord. The birth was ready to happen and then the cord dropped, so she had the mom get into the knee-chest position, reached all the way up and got the baby out.

If I were in that situation I might have let her try it. But if it dropped well before the birth, I'd transfer. We are a 3-minute drive from the hospital, and that's how long it took her to get the baby out. If we had a big car I probably would have wanted to be on the way there, and let her try the delivery during the drive.

Transverse babies that refuse to turn are another reason, but there have been exceptions there too, where the midwife has reached into the uterus and turned the baby. Footling breeches have been born vaginally though, some in unassisted home births by MDC members.

About maternal distress/injury/deformity, I don't know. Mothers with high bp, herpes, fibroids, a few previous classical incisions, muscular dystrophy, paralysis, diabetes, and partial placental abruptions have birthed vaginally, and some of them were home VBACs.

Fetal distress is tricky; so many babies delivered surgically for this reason were born with high apgars, suggesting no distress had been present. All they have to go on are heart tones, which may or may not be true indicators of distress. Still though, I would transfer if I got those low tones during a home birth.

There is some controversy as to whether premature babies fare better when delivered vaginally or surgically. My sister was born by c/s at 29 weeks, and I think it was necessary. Babies delivered vaginally at 34 weeks have been just fine, but it probably depends on what is wrong with the baby. Contractions help strengthen the lungs and force out excess fluid.

True CPD can only be verified after the 2nd stage of labor begins, so an ultrasound or pelvic x-ray isn't really valid when done before labor starts.

I'm lucky enough not to have anything majorly wrong with me physically, so I can't imagine having a deformity or disease and then being faced with risky decisions. I would transfer during a home birth only for fetal distress, non-turnable transverse, prolapsed cord when birth is not expected to happen right away, or placenta previa/abruption.


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## pumpkinhead (Sep 15, 2003)

Greaseball,

Yeah, that's pretty interesting. I guess it just proves what most of us already know: every one of us is unique and every labour and delivery are pretty unique as well. Circumstances alter cases and nothing is ever cut and dried until the fat lady sings (or gives birth as it were







). Whew, enough coloquilisms already?!

Onthefence,

What is CPD?


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## OnTheFence (Feb 15, 2003)

Quote:

_Originally posted by pumpkinhead_
*Greaseball,

Yeah, that's pretty interesting. I guess it just proves what most of us already know: every one of us is unique and every labour and delivery are pretty unique as well. Circumstances alter cases and nothing is ever cut and dried until the fat lady sings (or gives birth as it were







). Whew, enough coloquilisms already?!

Onthefence,

What is CPD?*
When the pelvis is too small to pass a baby.


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## Pynki (Aug 19, 2002)

.. I was totally NOT saying YOU were c/s bashing Pumpkin..

Sorry.. maybe I wasn't clear enough on that.. But i have seen a lot of c/s bashing on these here boards.. The whole.. Well you didn't NEED a c/s you know.. KILLS me.. Perhaps it wasn't medically neccesary but what does it do for the mom after the fact..

Just to clarify...

Sorry about that PH..

Warm Squishy Feelings..

Dyan


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## pumpkinhead (Sep 15, 2003)

Pynki,

No worries, Mama!







. I wasn't offended, just wanting to clarify!








back atcha

OnTheFence,

Cool, thanks, but what do the letters stand for?


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## Gemini (Apr 9, 2003)

I had an emergency c-section at 31 weeks with my 4 year old due to her heart rate dropping when I had my Braxton Hicks. Try going on mag and thought I was gonna have 9 weeks of bedrest in the hospital, but a couple hours later my doc wanted the baby to come out. (this is the short version)

I felt okay with the whole thing. I was able to have a successful VBAC in 2002 with out medication.









Just my experience.


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## Viola (Feb 1, 2002)

Quote:

_Originally posted by Greaseball_
*
Transverse babies that refuse to turn are another reason, but there have been exceptions there too, where the midwife has reached into the uterus and turned the baby. Footling breeches have been born vaginally though, some in unassisted home births by MDC members.*
The midwife who did my homebirth delivered the footling breech of one of my friends. And I had another friend whose baby was presenting her shoulder and ultimately had a vaginal delivery. But I honestly think I would have had a c-section in that situation because her labor sounded horrible. I would have had a c-section if either of my babies had been breech because I really wouldn't have had a choice other than unassisted. I have a friend who was able to have a breech at the hospital, but the hospitals in this area are pretty conservative and she was lucky. The doctors wanted to do a c-section, but there was one who was willing to deliver vaginally.


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## IslandMamma (Jun 12, 2003)

Quote:

_Originally posted by pumpkinhead_
*Cool, thanks, but what do the letters stand for?*
Don't quote me, but I believe CPD stands for "cephalo pelvic disproportion"-- or "head won't fit through pelvis".

HTH...


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## Greaseball (Feb 1, 2002)

I don't understand why some midwives won't deliver breeches, even frank breeches. What's the point of having a midwife if they are just going to have the same rules doctors do?


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## veganmamma (Sep 10, 2002)

Yes cephalopelvic disproportion. Fetal overlap isa sign of CPD that can be diagnosed before labor begins, but even with fetal overlap, there is a chance it is relative CPD, meaning if the baby changes position, the baby's head may fit through the pelvis. All women with suspected CPD should be allowed to labor on their own terms, it is still possible for the baby to be born vaginally in some cases of fetal overlap.

Quote:

When the pelvis is too small to pass a baby.
CPD isn't really when the pelvis is too small to pass the baby. The wording tends to further the "women's bodies are suspect" mentality. This is detrimental to women who have been rightfully or wrongfully diagnosed with CPD. The truth is, CPD is when the baby's head presents in a way that it will not fit through the pelvis. It may be that the head is too large to pass through the pelvis, that the type of pelvis won't allow for the baby's position/size, etc., but it really isn't that the pelvis is too small. It may mean there was a bad match in head







elvis sizes, but the "too small" wording isn't really accurate and can be hurtful to mothers who have had a CPD diagnosis.

It is my understanding that Laura Shanley, author/activist and MDC member had at least one footling breech at home.

Transverse babies have been turned in labor; there are techniques less drastic than reaching into the uterus to turn the baby, but this is also an option.

I'm not saying that some cases may necessitate c/s, but it shouldn't be the first remedy by any means.

Herpes lesions in the birth canal at onset of labor is a reason for c/s.

Hydrocephaly causing CPD.

I just want to say that with my dd chances are I would have been diagnosed CPD, but it was relative CPD due to bad positioning and once she was moved she was able to descend and was born very quickly. I only wish my MW had taken me seriously enough to come over and move her BEFORE I was in labor for 69 hours!

Anyway, CPD is never a permanent diagnosis. The amount of CPD that is diagnosed and the amount that is true is dramatically different. IMO, one of the biggest factors in a woman overcoming CPD diagnosis, or being told before birth she is at risk, is confidence.


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## veganmamma (Sep 10, 2002)

Quote:

_Originally posted by Greaseball_
*I don't understand why some midwives won't deliver breeches, even frank breeches. What's the point of having a midwife if they are just going to have the same rules doctors do?*
I agree. Under my state's law breech delivery is verbotten by MWs though. A MW who does breech delivery can lose her backup and even be prosecuted. In CA, if someone dies during a felony (practicing medicine without a license) the person who did the felony is prosecuted for first degree murder. There was a MW here before midwifery was legal who was prosecuted for this and even the judge said it was a travesty, but the law was/is still the law.


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## Irishmommy (Nov 19, 2001)

Moving this to Birth and Beyond...


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## Viola (Feb 1, 2002)

Quote:

_Originally posted by Greaseball_
*I don't understand why some midwives won't deliver breeches, even frank breeches. What's the point of having a midwife if they are just going to have the same rules doctors do?*
Not sure about other situations in this thread, but my midwife will deliver breeches in general. However, she told me that she would not deliver me if I was breech. I didn't switch to her until I was almost 40 weeks, so that is probably why. I was a little surprised to find that out, however.

Oh, here is a story that mentions the footling breech homebirth: http://www.newsreview.com/issues/ren...5-09/cover.asp


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## Greaseball (Feb 1, 2002)

Quote:

Anyway, CPD is never a permanent diagnosis. The amount of CPD that is diagnosed and the amount that is true is dramatically different. IMO, one of the biggest factors in a woman overcoming CPD diagnosis, or being told before birth she is at risk, is confidence.
Many women who are sectioned for CPD go on to vaginally birth a baby that is larger, sometimes by 2 lbs or more.

My midwife will deliver breeches and twins, as will most of those I have interviewed. I interviewed one who said "No breeches, twins, VBACs, diabetics" and on and on. Might as well see an obstetrician.


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## veganmamma (Sep 10, 2002)

Quote:

_Originally posted by Greaseball_
*Many women who are sectioned for CPD go on to vaginally birth a baby that is larger, sometimes by 2 lbs or more.*
Yep, it's true.


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## lisamarie (Nov 19, 2001)

HELLP Syndrome is another reason for a c-section to try to save both mom and babe. A dear friend of mine just went through an emergency c-section last week (she was put under general) and she was 33 wks. along. Her dd was 3 lbs. 5.9 oz and 15 3/4 inches long and is doing well.

Warmly~

Lisa:bf


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## veganmamma (Sep 10, 2002)

Yes, also MDC member gossamer had an emergency c/s for HELLP syndrome


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## lisamarie (Nov 19, 2001)

Yes, i remembered her story about HELLP and her dd. She was heavy on my thoughts last week when my friend had her baby.

warmly~

Lisa:bf


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## Elphaba (Nov 19, 2001)

Well, I know this example is really really rare, but Heather Mills (Paul McCartney's wife) had a cesarean at 37 weeks, and I thought she was just another idiot celebrity who wanted to schedule her birth and be done with it. I didn't realize she had metal plates and pins in her pelvis, and she had to have reconstructive surgery a few months after the birth.

I felt like an a$$ for assuming the worst about her.


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## crazy_eights (Nov 22, 2001)

I know that paralysis is not an absolute indication for a c/sec. I know a woman that had a vaginal birth after she was paralysed, ironically enough, from an epidural in labor (she had a undiagnosed bleeding disorder and developed a clot at the site which caused nerve damage). She went on to deliver her next child vaginally despite being paralysed from the waist down.


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## tabitha (Sep 10, 2002)

because for some time i suspected i might have herpes, (i dont... i had an allergic reaction to iodine used in a rape kit in the ER...long story) i can tell you the herpes is usually not a good reason for a cesarean. If you have your average OB, he or she will likely push a cesarean whether you have lesions or not







Some practitioners will push acyclovir (antiviral med) on you in the last weeks if you want to deliver vaginally.

However herpes is most fearsome when it is your *very first* outbreak while you are in labor, something that cannot be predicted and is quite rare in monogamous pregnancies, as you can imagine. Subsequent outbreaks do not present the same danger, and babies can be born vaginally in most cases as herpes doesnt always occur inside the vagina or on the cervix, it is often external.

in addition, there is some research showing that many babies born to women with recurring outbreaks (not the mother's first) have immunity to this disease! there is a weath of alternative treatments to prevent outbreaks, and so on and so forth.

I am quite glad it is no longer a concern for me (no on to bigger scarier worries :LOL) but I dont think herpes belongs on a list of "definite" reasons for cesarean.

tabitha


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## Greaseball (Feb 1, 2002)

T
When a c-sec is planned, why is it so often planned for 38 weeks? Why can't they let the mother go 40 weeks, and just have her come in earlier if labor starts before then?


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## veganmamma (Sep 10, 2002)

Tabitha, if a MW in CA who is licensed and has backup doesn't refer a client with herpes to an OB who will ultimately want to do a c/s, she will lose her backup if the baby gets sick. I agree it may not be a definite reason for c/s depending on the location and state of the lesions, but it is a big indicator. I think many practitioners are also doing the liquid banddaid stuff now where it is sealed off. I agree, it is definitely not an absolute, I should have said that in my post, thanks for correcting me.


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## Piglet68 (Apr 5, 2002)

I had a c-section due to genital herpes. I actually had to beg my OB's (I had two, since I moved halfway through my PG) to let me have a c-section. IME, most of them say it isn't usually necessary.

The reason I asked for one is b/c I had a history of asymptomatic outbreaks, a drastic increase in outbreak frequency during pregnancy, and I refused to go on acyclovir while pregnant (there's more but this is the short version, lol). I researched the issue for weeks on end and was very comfortable with my decision.

I had a wonderful birth and recovered very fast. Of course, I'll be having another one this time. However, I don't consider myself to be an "advocate" of CS and, in fact, I am definitely of the opinion that prenatal care and birthing needs to be taken out of the hospital/medical setting as the "norm". I could go on about that but I'm preaching to the choir here, lol.

Oh, and greaseball, the reason they schedule the sections a week early (for me, at least, it was 39 weeks, not 38) is because they prefer it if you don't go into labour first. First and foremost, because if for some reason you went through labour fast and/or weren't able to get to the hospital in time you risk an emergency c-section (general anaesthesia) which is something nobody wants! Also, it is much easier to recover from a section if you haven't laboured for long beforehand, not to mention I can't imagine dealing with getting the spinal/epidural and dealing with labour pains at the same time! Finally, a small reason but..you risk having a "partner" perform the C/S rather than the OB whose been your primary care person throughout your PG. However, I'm pretty sure that if I asked to wait until I started labour that they would be okay with that (I live 1.5 blocks from the hospital, lol).


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## OnTheFence (Feb 15, 2003)

Quote:

_Originally posted by Greaseball_
*







T
When a c-sec is planned, why is it so often planned for 38 weeks? Why can't they let the mother go 40 weeks, and just have her come in earlier if labor starts before then?*
Ny OBs malpractice insurance would not let her due a csection prior to 39 weeks unless it was an emergency or their was a documented health concern, like pre-eclampsia or GD. In fact she actually gave me an article from the ACOG that recommends waiting until the 39th week. I read where a lot of people are having csections at 38 weeks, and I figure their doctors are lying on paper or dont give a rats behind.
I had a csection at 38 weeks, it was planned, and had medical reasons however my doctor made sure all her i's were dotted and I had to sign something knowing the risks.


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## pamamidwife (May 7, 2003)

I don't know that a thread like this, asking this question, is educational or helpful at all. Each woman's situation is so very different - and there are so many variances to so many different complications that arise in labor and birth.

I just think that it will do nothing but create a huge division and arguments.

Just my opinion, though.


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by pamamidwife_
*I don't know that a thread like this, asking this question, is educational or helpful at all. Each woman's situation is so very different - and there are so many variances to so many different complications that arise in labor and birth.

I just think that it will do nothing but create a huge division and arguments.

Just my opinion, though.







*
I disagree...for now. I think so far it has been very civilized and some healthy non-judgemental (on either side) is a good thing. I think there are a lot of things that are assumed. I've had 2 c/bs and I didn't know "all" the reasons for a c/b. I've only known my own. And for the record most of us feel there is a division (not sure about huge) and that we are not heard.

This issue is so close to the heart it is bound to get ppl riled up but that doesn't mean it should be taboo. Life is about educating ourselves. I find this type of conversation helpful as long as it stays helpful and not judgmental. I also believe that if you know you are the type of person to be that way and to start "arguments" then you should avoid "conversations" like this. Not because you aren't to be heard but it is the "nice" thing to do.

About scheduling a c/b prior to 40 weeks or before labor starts... I'm not sure about statistical info but in my opinion if it is scheduled as a repeat I see no problem with waiting unless there are reasons not to. But if it were to be for footling breech where prolapsed cord is a concern then I agree having it before labor is good idea.

I had one c/b at 38 weeks after a failed indcution (a super long failed induction) and the recovery was long and hard. But baby was super fine. I had my second c/b planned (I planned it at 39 weeks so it was at 40 weeks...long story but most of you were here for it







) without labor. It was a much easier recovery and a much better experience. Bryce was in special care for 30 hours but that was due to low O2 sat levels. If I were to ever have another babe (which we arne't planning on) I'd see how I felt about everything again and if we did decide to go the way of a repeat we would again wait till 40 weeks unless there was a reason not to.


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

T sorta
Has anyone read Ina May's new book? She talks about a midwife in the Netherlands who practiced from 1693-1745 named Schrader. Of the just over 3000 births she attended 10 were placenta previa and in 8 of those cases she was able to deliver a live baby to a live mother. It's astonishing really!

I am not advocating attempting vaginal birth with a previa, just noting this amazing accomplishment.


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## its_our_family (Sep 8, 2002)

T ?? In Schrader's time were they able to diagnose many "problems" or potential ones?? It IS amazing the things they CAN do


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

Well, if I am reading it correctly the diagnosis occured at the onset of labor when the woman would start bleeding profusely. The first time it happened to a woman she was tending she had no idea what was happening and the woman died. But she thought about it a lot and realised the only hope was to deliver as fast as possible. So she would watch closely and as soon as it was possible she would deliver the placenta, swiftly perform an internal version and pull the baby out by his/her feet. I have no doubt it was highly unpleasant for the mother but still, better than dying.


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## stafl (Jul 1, 2002)

Quote:

_Originally posted by pamamidwife_
*I don't know that a thread like this, asking this question, is educational or helpful at all. Each woman's situation is so very different - and there are so many variances to so many different complications that arise in labor and birth.

I just think that it will do nothing but create a huge division and arguments.

Just my opinion, though.







*
I totally agree. This thread kept me up all night thinking about it.

I think what bothers me the most is the language used.
Saying that a c-section, in retrospect, was or was not necessary does absolutely no good. What I think we should be discussing is whether or not c-sections are _avoidable_ instead.

I honestly believe that for most women who have had a c-section, it was indeed necessary, given the particular situation, the particular circumstances, at that particular place and time.
Whether it could have been avoided is an entirely different sort of discussion, and one I think would be quite informative and beneficial for everyone.


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## tabitha (Sep 10, 2002)

i find it very helpful to discuss situations that warrant the need for cesarean birth. i have, of course, my own list (comfort level) and it will differ from anyone elses. but sharing our thoughts and info is never a bad thing.

i think, if i were made uncomfortable by this civil sharing of information, i would ask first what i was projecting into it? no harsh words have been shared here, but a lot of very useful info has beeen shared.

mamas need to know the what and why of cesarean necessity. they need to tools and info to find their own comfort level- for instance, i wouldnt have a cesarean for herpes, but others would. the important thing is that people are empowered to make a choice for themselves, not just told by someone they "have to". that is what i like about these sort of discussions. they challenge us to really dig into our hearts and discover where we stand. there is no judgement here. there is no wrong answer.

by discussing what would and would not guide me to choose a surgical birth, i am not judging a mother who has other reasons. there are some here, i know, who would choose sooner, some who would choose later than i.

Lauren, i think i was speaking about whether it should be a reason a Mama should feel cesarean was absolutely neccesary, not whether her practitioner would force her to have a surgical birth. It is true, many things will risk you out of normal attended birth... you just wont be able to find an OB or midwife, yk? (unless you travel, and a lot of mamas do...) In my case,though, if i felt educated and very strongly about my situation and did not feel it warranted a cesarean, i would birth unassisted if need be. of course, if i felt a strong need for a cesarean i would choose one. ( i havent given much thought to a situation where i wanted a cesarean but couldnt get one ... i imagine i could find an OB here easily who would give me one. who knows?)

i agree, stafl, that a discussion about avoiding cesarean is a great one. but if no one talks about the medical situations that lead to cesarean, who will know how to make their choice? if mamas are not talking about it, that leaves the OBs and midwives. i dont want to just listen to their recommendation and comply- i want to be informed and to have given it a good soul search in advance, so that i can fashion my own choice out of a wealth of knowledge. i am simply not comfortable with the thought that my midwife would tell me something, and i not give it any thought, as much as i trust her. frankly, i dont think she would be comfortable with that either. she makes sure when we talk that i am active and aware in the conversation... she doesnt make decisions for me, she is just my companion. she wants to know my comfort level, and she lets me know her emotional and legal comfort level. we have discussed all manner of situations... and the reason i am babbling on and on is that i think this thread and ones like it are useful, at least to me, because i plan to discuss all of these things with her.

tabitha


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## pumpkinhead (Sep 15, 2003)

'Necessary' or 'Avoidable' are just words. In this discussion I think they mean essentially the same thing. It's not nomenclature or terminology that is the point of the discussion. That said, it *IS* important that we choose our words carefully esp when discussing a subject that so many find so provoking, and so a very valid point.

I have to say that I feel this has been an eye opening discussion for me and everyone has been respectful and polite.









Above all, as Mama's, we are responsible for informing ourselves and then making the best descisions for ourselves and our children based on this info. As Tabitha said, how will we be able to make informed choices if no one is willing to discuss these situations?

I've found the responses here to be VERY informative! I've even discovered that I don't really feel as 'afraid' of cesarean birth as I once was having read some of the Mama's stories here.

It's nice to know that we have the *choice* to have a c/s if we or our birth care providers deem it is unavoidable and/or necessary. It's also nice to know that there are alternative choices or alternative pathways to avoidance of a surgical birth, if you will.

I think this is a valuable and civil discussion and I want to thank everyone who has contributed stories or information! I'm learning LOTS!


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## OnTheFence (Feb 15, 2003)

tabitha [/B][/QUOTE] _but if no one talks about the medical situations that lead to cesarean, who will know how to make their choice? if mamas are not talking about it, that leaves the OBs and midwives. i dont want to just listen to their recommendation and comply- i want to be informed and to have given it a good soul search in advance, so that i can fashion my own choice out of a wealth of knowledge._








AWESOME that you say this tabitha, I so AGREE! (no one pass out)

Before I had my daughter I never entertained the thought of a csection. I wasnt going to be one of "those" women. Even if my baby was breech I was going to have a vaginal delivery -- and my OB would have done it. The thing is my baby was a in a transverse breech position due to a uternine deformity -- something I didnt know I had. If I knew then what I know now about first time mothers and breeches, ECV, etc. I would have never done all the things I did to turn my baby or the ECV and would have planned a csection. As you said, each person is going to have their own comfort level -- and this would be mine, now. However I really didnt know enough and just was of the belief, it will not happen to me. Of course, no one ever discussed it either. None of my homebirthing friends, my doctor really didnt, the books I read barely touched on the subject and focussed on why not to have one, the dangers of it, etc.


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## Carmel (Jan 31, 2003)

Quote:

I don't understand why some midwives won't deliver breeches, even frank breeches. What's the point of having a midwife if they are just going to have the same rules doctors do?
I have read and re-read this and I feel like I have to reply. I want to point out a few of the reasons why a midwife may choose not to attend breeches.

1)Honoring your abilites. In my trainingas a midwife I attended 1 breech birth. It was a wonderful experince from which I learned a lot. Does that make me qualified to attend breeches? I would attend a woman at home for a planned breech (depending on the woman) and certainly with help from more experinced hands. Not all midwives have the training or experience to attend breeches- which is unfortunate- however, I feel it would be a disservice to a family to do something I don't know how to do.

2) The legal situation. While it is extremely frustrating to both midwives and parents when midwives are limited by legal rules/standards, most midwives cannot completely remove the law as a variable when she makes a decision. I could give so any examples; it comes down to each midwife weighing the choice in front of her. If it meant for me that I would not be able to practice if I attended a breech birth I don't think I could do it (I keep thinking of all the other families who I could attend if htat happened).

And finally, what is the point o fhaving a midwife? To have the opportunity to be a part of decsions that are made about you and your baby and to be cared for in a personal, loving way. I could list more reasons, but I think I think this is the heart of midwifery.

Again, I would love it if all midwives feltl they could and legally could attend breeches. Hopefully that day is coming.


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by Carmel_
*

And finally, what is the point o fhaving a midwife? To have the opportunity to be a part of decsions that are made about you and your baby and to be cared for in a personal, loving way.*
I WISH the mws I went to were like this!! The ob I switched to was but my mws were far from what you describe. This is the reason I looked for a mw though


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## The Lucky One (Oct 31, 2002)

Quote:

Well, if I am reading it correctly the diagnosis occured at the onset of labor when the woman would start bleeding profusely. The first time it happened to a woman she was tending she had no idea what was happening and the woman died. But she thought about it a lot and realised the only hope was to deliver as fast as possible. So she would watch closely and as soon as it was possible she would deliver the placenta, swiftly perform an internal version and pull the baby out by his/her feet. I have no doubt it was highly unpleasant for the mother but still, better than dying.
Yeah, but what if the mother were only, say, 2 or 3 cm dilated when the profuse bleeding occured? Then what?

Sorry to stray off topic, but as someone who is dealing with previa, I found that to be interesting.

lisa


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## Greaseball (Feb 1, 2002)

There's no way I'd take the risk today. I'm glad there was a chance at survival back when there was no surgery, but I would not even consider trying a vaginal birth with full previa today!

Of course, many times the placenta will move upward as the pregnancy progresses, so no need to resign yourself to surgery in the first few months.


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## crazy_eights (Nov 22, 2001)

This thread brings up a couple thoughts in my mind. Part of the reason that many people think "well, there might be other unnecessary c/sec's, but mine was necessary" is.... THEY ARE RIGHT. The problem is that many, many of the c/sec's that we have today are caused by inappropriate use of interventions. Elective inductions, induction b/c mom is 41 weeks (or 40), induction b/c baby is "too big", "too small", "too much fluid", "too little fluid", routine amniotomy, admitting mom when not in active labor, early epidurals.... the list goes on and on and on. The problem is that many of these interventions (esp. in a first time mom) can lead down a slippery slope to where a c/sec actually DOES become necessary! And this is by no means a condemnation of people that had the above interventions. Only the routine use of them by practitioners *who should know better*!!!!

As for why c/sec's are often scheduled for 38 weeks, it's b/c OB's like to do them before the head gets engaged in the pelvis as it makes the surgery easier.


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## veganmamma (Sep 10, 2002)

Thank you Chava, I feel like I say that in so many other threads-- I guess I forgot to say it this time. You are right.


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## stafl (Jul 1, 2002)

Quote:

_Originally posted by pumpkinhead_
*'Necessary' or 'Avoidable' are just words. In this discussion I think they mean essentially the same thing. It's not nomenclature or terminology that is the point of the discussion. That said, it *IS* important that we choose our words carefully esp when discussing a subject that so many find so provoking, and so a very valid point.

I think this is a valuable and civil discussion and I want to thank everyone who has contributed stories or information! I'm learning LOTS!







*
I think the point I'm trying to make is the difference between being _*re*active_ and _*pro*active_.
I know that my c-section was totally necessary. I've said it before and I'll say it a hundred more times. BUT it was also probably _avoidable_, had I not had the intervention avalanche that led to the surgery that perhaps saved my daughter's life.

Language is a very powerful tool. When we say a c-section was not necessary, we are reacting to something that happened in the past that cannot be changed.
When we say a c-section may have been avoided, and discuss the ways this could be accomplished, we are being proactive and might just help prevent a future c-section from happening.

And I have to echo everyone else in congratulating us all on remaining civil and keeping this discussion from heating up! It is such an emotionally-charged topic, and I'm impressed with the entire tone of this thread.


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## Piglet68 (Apr 5, 2002)

I wanted to add my voice to those congratulating us all for a civil and informative discussion.









I usually stay away from these threads because I'm a very happy C/S mama and I feel "out of place" on a board of natural birthing advocates, even though I share the same views as so many of you regarding the overmedicalization of birthing.

So many good posts here, but I like tabithas alot - we really do need to empower ourselves. And, of course, we all have our individual thresholds. I'm sure that if I were more set on having a vaginal birth, and didn't have such a fear of pain, I might not have chosen the C/S route. I made my decision not just with facts and statistics, but knowing myself as a woman and a person and how different outcomes might affect me and my birthing experience (including the emotional ramifications of passing on what is, at best, an embarassing social disease, to my baby). For some, having a C/S is a heartbreaking loss of a dream, for others it's a lifesaving and even enjoyable outcome.

Regardless of our choices, they should all be based on sound knowledge and facts, and an awareness of the cascade-of-interventions effect that so plagues birthing in this society.


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

Quote:

_Originally posted by The Lucky One_
*Yeah, but what if the mother were only, say, 2 or 3 cm dilated when the profuse bleeding occured? Then what?

Sorry to stray off topic, but as someone who is dealing with previa, I found that to be interesting.

lisa*
More







T

There aren't a ton of details in the account Ina May gives. All I know is Schrader managed to save 8 out of 10 which is astonishing. There is some "common wisdom" if you will, that in cases of previa labor tends to go REALLY fast... as though your body knows what is up and is doing it's best to make it work.


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## pumpkinhead (Sep 15, 2003)

Quote:

_Originally posted by stafl_
*I think the point I'm trying to make is the difference between being reactive and proactive.
I know that my c-section was totally necessary. I've said it before and I'll say it a hundred more times. BUT it was also probably avoidable, had I not had the intervention avalanche that led to the surgery that perhaps saved my daughter's life.

Language is a very powerful tool. When we say a c-section was not necessary, we are reacting to something that happened in the past that cannot be changed.
When we say a c-section may have been avoided, and discuss the ways this could be accomplished, we are being proactive and might just help prevent a future c-section from happening.
*
I totally see your point and totally agree! Well put Mama!









Yes, C/S can be BOTH at the same time, necessary *AND* avoidable.


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## crazy_eights (Nov 22, 2001)

Quote:

_Originally posted by kama'aina mama_
*There is some "common wisdom" if you will, that in cases of previa labor tends to go REALLY fast... as though your body knows what is up and is doing it's best to make it work.*
I think it is more than "common wisdom". Blood is a uterine irritant and apparently in the '40's was even looked into as an induction agent. When we have a woman who comes in with uterine "hyperstimulation" (contracting 'too long and too hard') one of the first things we think of is abruption - which of course causes blood in the uterus.


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

I love learning new things! Thanks mom2six!

More on topic: This issue of how to address sections with questionable genesis is one a struggle with a great deal. Tow of my sisters had sections within a few months of each other in the 70's for CPD. One of them is somewhat open to discussing it and giving some thought to the possibility that it could have been avoided, one is totally closed on the subject. Why do I care? Well, the one who is unable to talk about it at all has two daughters in their twenties and I worry a lot about the message they have gotten about their own bodies abilities. I would hate to see them have avoidable sections because of that.


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by Mom2six_
*uterine "hyperstimulation" (contracting 'too long and too hard')*
I didn't know there was a term for it!! This is why I had my first c/b. I was pitocin induced/enhanced and I ended up becoming supersaturated. My last contraction was between 60-90 minutes with no break in between and like a 102 on the monitor. My ob refused to turn of the pit to see what would happen. When they would turn it down the contractions would normalize. But he refused to turn it off. Tracy's hb was fine and he was doing great. But they were afriad I was going to rupture because of the stress that the pit put on my system.

So, I guess my c/b fell under avoidable and necessary. I guess we'll never know if my son would have been born vaginally without the induction.


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## lollaleeloo (Jan 29, 2003)

Quote:

_Originally posted by its_our_family_
*My ob refused to turn of the pit to see what would happen. When they would turn it down the contractions would normalize. But he refused to turn it off. Tracy's hb was fine and he was doing great. But they were afriad I was going to rupture because of the stress that the pit put on my system.*
Ho. Lee. Crap.








I got chills reading this because you describe my dd2's birth like you were there for it. I was also stuck in an endless contraction and I *begged* them to turn down the pit, which had been going full blast for God knows how long, but they were adamant. They said that if I wanted to to have any chance at a vbac, they needed to get the baby out sooner not later, so the pit must stay on. I came *this close* to having a section for the same reason as you, but for 2 lucky breaks. One: my daughter had a heart like a metronome, tolerating labor exceptionally well. I'm told that if the the strip had shown so much as a _hiccup_, I would have *absolutely* been sectioned again. After 2 days of hard pit labor, it's a miracle she never appeared to register distress.

But my biggest stroke of luck happened when the pump eventually ran dry. Without the pitocin onslaught, the contractions normalized very quickly into manageable peaks and valleys again (instead of remaining plateaued at the peak). While they sent someone out to get another pump, I tested pushing gently with the contractions again, and lo and behold, the baby started moving down. 25 minutes later I had my baby.

I'm convinced that the monster contraction artificially frozen mid-peak ultimately served as an obstruction to birth, because as soon as my uterus was allowed to fully unclench, the baby resumed her descent. Until then, I could have pushed till my eyes popped out, but against a muscle siezed into rigidity by pitocin, I never stood a chance. This is all 20/20 hindsight of course, but it's hard not to see the irony of my hospital induction consisting largely of the very elements that put me at greatest risk for the very rare rupture I was seeking to avoid, and the repeat c-section I narrowly escaped.







Live and learn.

I look back on the whole episode and really only have one lingering question: Why were the doctors so reluctant to turn the pit off, even after they already acknowledge that it may have been doing more harm than good by that point? How could they be so worried about the risk of imminent rupture that they suggest c-section, yet refuse to turn off the most likely cause?

Sort of on a related note, but does anyone know the rationale behind their fear of labor slowing down or stopping for a bit at the end, even though I was engaged and fully dialated? I don't get it. I thought it was normal to have a lull just after transition.

----
Edited to remove the following paragraph because I felt it implied that I think they tricked me (something which I don't believe). The mistaken assumption was on me for projecting my wishful thinking that I could opt out at any time.
The reason I'm asking is, prior to induction, I was told that if the pitocin didn't take, they would turn it off and send me home. I certainly didn't take that to mean that if the pitocin *did* establish contractions, it had to stay on, and dosages can only go up. In fact, I only agreed to the induction under the mistaken impression that I could opt out at any time.


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## veganmamma (Sep 10, 2002)

I just wanted to say a metronome heartbeat isn't good, to my knowledge, you want variations in heart tones, but not certain types of decels.







My guess is that if she had metronome heartbeats she might have been a repeat c. Still learning about FHTs and responses though. Chava knows, Chava knows!

Good for you for growing such a strong baby, btw.


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## lollaleeloo (Jan 29, 2003)

Whoops, sorry. Didn't realize 'metronome' heartbeat was a medical term. I only meant that her heartbeat stayed strong throughout the whole ordeal. She's such a little peanut, too. You'd never suspect such a warrior.


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## veganmamma (Sep 10, 2002)

:LOL It's not really, there is a name for it, metronome is a good description. I remember what heart ones are bad and what are good, but I forget all their names. Lesse, early decels, late decels... :LOL

I get you about warrior girl in a peanut's body. My dd had a long labor to deal with and she came thru like a champ with no decels until her cord was a bit compressed. She then proceeded to be the most adorable, alert little angel i've ever met.


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by lollaleeloo_
*I'm convinced that the monster contraction artificially frozen mid-peak ultimately served as an obstruction to birth, because as soon as my uterus was allowed to fully unclench, the baby resumed her descent.

I look back on the whole episode and really only have one lingering question: Why were the doctors so reluctant to turn the pit off, even after they already acknowledge that it may have been doing more harm than good by that point? How could they be so worried about the risk of imminent rupture that they suggest c-section, yet refuse to turn off the most likely cause?
*
As for the first part of the quote..... i completely agree!! My son was pretty high up (posterior also). The ob and the nurse got into a verbal argument IN MY PRESENCE about how he was handling the pit. In fact she turned it down several times without him in the room just to give me a break. I wish I had known more and pushed him more to turn the pit off.

As for the second part..... I was told that there was no going back. That once they started the pit if they turned it off then there was a chance labor would stop and that is what they didn't want.

What infuriates me is that my ob arrived 6 hours AFTER he said he would. He barely assessed me, broke my water, and turned up the pit. He came back about 2 hours later







The pit had already started to "not like me" when he broke my water. He never mentioned that we should stop and perhaps try and induction (or wait for labor) another day. He went right ahead and broke my water giving us no way to turn back. The next thing I know my contractions are lasting for forever and I only get relief when the pit is turned off. I then had my c/b (which I was fine with by the time it happened because of the pit)

I also ranked high on that scale they have. You know, the one that says if you are a good candidate for induction. I was already 3cm and over 75% plus I was already contracting. I never got passed that 3cm and 75% once they started the pit.

Like you said, Live and learn.... I wish I knew then what I know now...


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## lollaleeloo (Jan 29, 2003)

{{{megan}}}








I'm inclined to think that pushing the doctor wouldn't have done any good. I was only spared because they ran out of pit; they were never going to turn it off.







:

If anyone out there knows the rationale behind the No Turning Back The Pit No Matter What Even If It Means Surgery rule, clue me in.


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## KKmama (Dec 6, 2001)

Wow. I never got to the labor or pitocin phase (I had an emergency C due to fetal distress that was happening without there even being any contrax... long story). Anyway, I've kind of felt like the silver lining to a VBAC (the way my drs. and I have agreed, anyway) is that there will be *no* pitocin...

I'm sorry for what you both went through.


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## crazy_eights (Nov 22, 2001)

Quote:

_Originally posted by veganmamma_
*:LOL It's not really, there is a name for it, metronome is a good description. I remember what heart ones are bad and what are good, but I forget all their names. Lesse, early decels, late decels... :LOL
*
I think what you mean is lack of short term variability. It means that the beat to beat rate doesn't vary. The presence of short term variability is one of the most reliable indicators of fetal well being (more so than decels being an indiction of a fetus in distress).

And if what you ladies describe as happening during your inductions was what was going on - well, somebody wasn't doing their job. One of the things you are supposed to check for is that the uterus is soft between contractions. (Not that I doubt what you are saying, but sometime perception of what is going on can be different than what the medical types are looking at - that's another tangent. But suffice it to say I wish I had a dime for every woman that told me "My contractions were peaking OFF THE MONITOR!!!!" If it's external monitoring, doesn't mean a thing. It doesn't read contraction intensity)


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## crazy_eights (Nov 22, 2001)

Quote:

_Originally posted by lollaleeloo_
[BIf anyone out there knows the rationale behind the No Turning Back The Pit No Matter What Even If It Means Surgery rule, clue me in.







[/B]
Um, stupid medical mentality? :LOL Truth is, not all places do this. Some places they acheive adequate contraction pattern and then once you reach 5 cms turn the pit down at the rate they were turning it up (the assumption being that your body will kick in by then). However, the problem is with the prevalance of epidurals, this equation doesn't always work. The epidural is busy supressing contractions and usually the woman needs more pitocin to overcome that effect. So it's a vicious cycle. And since many drs. and nurses are used to seeing most women with epidurals, it never occurs to them that they could actually turn the pit down/off. It sounds like your OB subscribes of the "more is better" route to induction - which has been disproven time and again by research. Another name for this philosophy is "pit to distress" - keep turning it up until the baby shows signs of distress.


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## veganmamma (Sep 10, 2002)

thanks Chava!


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## its_our_family (Sep 8, 2002)

Quote:

_Originally posted by Mom2six_
*
And if what you ladies describe as happening during your inductions was what was going on - well, somebody wasn't doing their job. One of the things you are supposed to check for is that the uterus is soft between contractions.*
Right, this is what the ob and nurse fought over. My uterus was not relaxing at all. it remained hard (the same intensity) for 60-90 minutes (somewhere in between). This is why I had the c/b. They had decided that my uterus had been under too much constant stress that uterine rupture was a "real concern"

Like I said, I wish I wouldn't have been so naive with my first babe


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## Greaseball (Feb 1, 2002)

Quote:

If anyone out there knows the rationale behind the No Turning Back The Pit No Matter What Even If It Means Surgery rule, clue me in.
In the hospital childbirth classes we were told that if pit was to be used, the mother would immediately be given the maximum amount. I asked "Why can't she just have a little bit and then see what happens?" The instructor said "I don't know, that's just not our policy."







:

If they turned it off then they might actually have to WAIT for the woman's body to work on its own time!

Isn't it true that once the pit is started, a mother should never be left alone? Do they really stay with you?


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## crazy_eights (Nov 22, 2001)

Quote:

_Originally posted by Greaseball_
*Isn't it true that once the pit is started, a mother should never be left alone? Do they really stay with you?*
It is not true where I work. Our policy require continuous monitoring and we have central monitors. We periodically check that the uterus is soft between contractions, esp. before considering increasing the amount of pitocin. This might have been true in a place without EFM or central monitoring, but I don't think it necessary any more than it is necessary with any other birth.


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## crazy_eights (Nov 22, 2001)

Quote:

_Originally posted by Greaseball_
*In the hospital childbirth classes we were told that if pit was to be used, the mother would immediately be given the maximum amount. I asked "Why can't she just have a little bit and then see what happens?" The instructor said "I don't know, that's just not our policy."







:
*
This make no sense. I think there must have been a communication problem here b/c I've had women hyperstimulate their uterus (contractions too long and close together) with a resulting huge decel on small amounts of pitocin and woman that won't contract at all (esp. if they are preterm and being induced for other complications) on huge amounts. To manage a pitocin induction effectively you have to "titrate to response" - in other words it's an art, not a science. You turn it up slowly until you get the desired result- a regular contraction pattern that causes cervical dilation. Maybe what she meant was that they have an amount they start with (where I work it's 2 milliunits, but I've worked elsewhere where they start with .5 milliunits) and that is the "maximum" amount you get, no less - until they turn it up?







:


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## Greaseball (Feb 1, 2002)

She actually said "I don't know" in response to a lot of the questions I asked. She knew the rules of the hospital, but not the reasoning behind them.


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## crazy_eights (Nov 22, 2001)

I wasn't thinking about answering the question of "why can't you give a little bit and see what happens?", but I realized re-reading that "titrate to response" answers that question. You increase the amount until you get the desired response. However, this by definition doesn't produce a "natural" labor pattern. The pitocin, from my understanding, overrides the body's natural feedback mechanism (and hence the need if you are going to back off on it to back off at the same rate taht you increased) to release it's own oxytocin. That and we make you contract every few minutes right from the start - no slow build up, they want you contracting every few minutes right from the start.


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## merpk (Dec 19, 2001)

Had an experience similar to what Greaseball's referring to.

1st baby, they gave me pitocin, and it was like going from zero to 60 in 5 seconds. From these gentle little happy contraction-like-thingies to these several-minute-long-seeming monsters that just barely had a break between them. Vroom.







Horrific experience.

Changed OBs after that. (Do you wonder why?







: )

Next baby, different hospital, different OB ... they did what Mom2Six posted, like a fine art, very slight, then slightly more, then slightly more, till the contractions became just a little stronger, and stronger, and then at some point just stopped the pitocin, and I continued on my own.

Don't know, maybe it's different OB's policies as opposed to the hospital itself ...


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## Justice2 (Mar 18, 2003)

I delivered a 32 week preemie. It was never mentioned that a c/s would be needed or even recommended. I did have an episiotomy though. They said something about head trama during birth...forgive the lapse in memory, 144 of labor and labor stopping drugs will make you a bit incoherent. It's amazing really(considering ALL of the drugs that they pumped into me (mag sulfate, nubain and others), my daughter was born that early at 3lbs, 13 0z, 1min APGAR was 8, 5 min was 9 and at 20 min it was 10 (without needing any oxygen)...she was a real trooper.

Now, I do have a friend. Her first was a c-sec due to FTP (debatable, as we all have discussed before). Her second is a really sad story. It was discovered the day they found out she was pregnant (5 months and I still don't understand how she reached 5 months without a symptom







) that their baby had developed a diaphramatic hernia. At the birth, there was only 1/8 of one lung developed. The abdominal organs were inside of the thoracic cavity, causeing the underdevelopment of his lungs and displacing his heart up and to the right. The doctor told them that it was HIGHLY UNLIKELY that the baby would survive a vaginal birth. So, they agreed to the repeat c/s. It was funny really. They were told to expect a 2lb baby at term. Daddy said NO WAY, fed his wife as much protien (among other things) that she could tolerate, made sure that her diet was ABOVE the norm....they delivered a 6lb 8 oz baby. This baby was incredibly sick...as a baby would be without his lungs....but so very healthy. He actually set records in the hospital where he was born (in Flordia, a hospital and a doctor that specialize in this type of abnomality). He is home now, will be a year old in June. Truely a wonderful ending, when everyone was clearly expecting the worst.

Sorry I got so very







T I am reading the nutritional section in Holistic Midwifery....and in comparing the text with this situation, I can completely understand where Ms. Frye states how nutrition can make such a difference in the outcome in a pregnancy and baby.

With my second birth, getting in the jaccuzi slowed down my contractions....I was lying in the bed and a nurse came to my IV machine with a needle. I asked her what it was. She said that the doc had ordered pit...my contractions went from 1 min apart to 3 min apart...talk about a doc rushing my birth. AND THEY WEREN'T EVEN GOING TO TELL ME THEY WERE GIVING IT TO ME...Luckily, (and somewhat strangely, if you ask me....) at that very instant, my contractions picked back up...and no pit. was administered.


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## pumpkinhead (Sep 15, 2003)

T sorta

Greaseball,

Quote:

In the hospital childbirth classes we were told that if pit was to be used, the mother would immediately be given the maximum amount. I asked "Why can't she just have a little bit and then see what happens?" The instructor said "I don't know, that's just not our policy."
Thats SO weird! I had a pit induction as well with my son and their policy was to start at a very low dose and then increase it by half every 20-30 minutes. When they'd got you into a *good* contraction pattern, they leveled off the dose there. In my case, I too experienced some 'unending' contractions. They first scaled the dose back a bit, and when the contractions didn't appreciably let up, they turned off the whole thing!

I wonder if each hospital has it's own different policy regard this stuff?


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## Greaseball (Feb 1, 2002)

Just from reading threads, I get the idea that every hospital has a different policy, which to me says they are not truly concerned about babies. How can something that is good for babies in one state - or city - be bad for them in another?


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## candiland (Jan 27, 2002)

I'm sure different doctors hold different philosophies about how pit. is administered. Some get really impatient and pump it up for that "Wham, bam, thank ya, ma'am!" birth effect.... maybe others are less rushed at that point, more patient, in a better mood, whatever, so they give the woman a much longer time frame in which to dilate.


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## Greaseball (Feb 1, 2002)

Of course, if they really are patient, they won't use pit!


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## pumpkinhead (Sep 15, 2003)

Quote:

_Originally posted by Greaseball_
*Of course, if they really are patient, they won't use pit!*
So true







.

Altho, I think some of us ladies need to be patient as well...or at least be told it IS okay (GOD FORBID) to go more than 10 days past the almighty due date. Or to at least educate ourselves as to this, and have it supported by medical care givers. I didn't know this, myself, at the time. They were telling me how with every day I was overdue, how much the risk of c/s went up. Scared the CRAP outta me. Of course, I did have a responsibility to educate myself as well....

I have an aquaintance who absolutely *REFUSES* to go beyond her due date. She goes to the hospital and begs to be induced and refuses to leave until they do. Make me wanna







uke.

She's due with the latest babe the beginning of July and she says to me, "You know, I think this is gong to be an 'end-of-June' baby", meaning, she intends to be induced at the end of June. I CANNOT believe that self respecting Doc's would give in to this! Then again, maybe I can







:


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## Piglet68 (Apr 5, 2002)

Quote:

_Originally posted by Greaseball_
*Just from reading threads, I get the idea that every hospital has a different policy, which to me says they are not truly concerned about babies. How can something that is good for babies in one state - or city - be bad for them in another?*
They're concerned about their bottom line. Plus you have to take into account regional attitudes. For example...

There is a "Breastfeeding Friendly" initiative that hospitals have to fulfill a number of criteria to get this certification for. I delivered in such a hospital and it was a wonderful experience. EVERY nurse receives extensive BF training and advocates for BFing. There are lactation consultants available to you if you need one. There was a "shopping cart" that came by everyday with BFing supplies, like breast pads, lanolin, etc. Babies were actively encouraged to room in with their mamas. All mamas were allowed time with their baby following the birth (including C/S mamas) for at least 2 hours before the baby was taken for it's exam. During that time all mamas were encouraged to get the baby to latch. In fact, the one and only negative formula-pushing experience I had was with an OB who was visiting and not affiliated with the hospital.

So, this was Boston where people are pretty enlightened and where competition for your health care dollars is fierce b/c there are many hospitals there.

Compare this to a rural hospital where nobody in the region really BFs and the hospital sees no reason to spend the money changing policies. The nurses are all for formula and "giving mama her rest" by putting babes in the nursery all night with paci's and bottled water. There's no incentive for them to be certified as BFing Friendly b/c the mamas don't know any better and don't really have a choice of where to birth anyways.

So, that's my long answer to a simple question, lol.


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## lollaleeloo (Jan 29, 2003)

Quote:

_Originally posted by Mom2six_
*You increase the amount until you get the desired response. However, this by definition doesn't produce a "natural" labor pattern. The pitocin, from my understanding, overrides the body's natural feedback mechanism (and hence the need if you are going to back off on it to back off at the same rate taht you increased) to release it's own oxytocin.*
Maybe it's the terminology that I found to be misleading. I 'induced' labor with castor oil for my 2nd pregnancy. By that, I mean I used castor oil to kick-start a process that I hoped would continue _on its own_ when the castor oil wore off. When *they* say 'induce or augment labor' what they're actually saying is *substitute* 'natural labor' with 'artificial labor' until the baby's born one way or another? Well that would have been some valuable information to have as part of my so-called informed consent, that the way they administer pitocin meant that I would be wholesale turning the laboring process over to the pump. At the time, I had no idea I would be committing to anything that drastic (or dangerous IMO). In a way, this illustrates the reason I gave up on having a natural birth at the hospital (with no hard feelings at all toward my 1st vbac team) and had my last baby at home. I doubt that we'd have ever seen eye to eye over what exactly constitutes a "needless risk."


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## pumpkinhead (Sep 15, 2003)

Quote:

*When *they* say 'induce or augment labor' what they're actually saying is substitute 'natural labor' with 'artificial labor' until the baby's born one way or another?*

lollaleeloo,

Again, I think this is different for every woman. I had my labour started artificially, but my pitocin drip was turned off after two hours and my labour was 7 hours long. So, for 5 hours, I had no drugs and still had adequate contractions to change my cervix. I dunno if this could still be called "artificial labour". The nurse called me a 'whiffer'. She said that some women *need* to have the pit for the duration of their labours and some just needed a 'whiff'.


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## Mom4tot (Apr 18, 2003)

Forgive me for not reading all of the posts...I read the first 2 pages and the last page. I am coming to this late, but I wanted to say a couple of things.

Ben was transverse breach and there was no way he was turning. The midwife tried, but he was 9 lbs., 14oz., and my water had broke.

I wouldn't want to go through it again, but I just wanted to say that a c section doesn't have to be the end of the world. Ben was healthy and alert and he nursed within 30 minutes of being born. I had some painful moments after that, but Ben was doing fine. The nurses barely noticed him, even tho they were checking on me a lot. My pediatrician came to see us the next day and commented on how we were bonding







She found us looking at eachother in bed.

I felt really bonded with Ben, and I rose to the challenge of recovering as best I could. I'm sorry if this seems like a shameless ploy to retell my birth experience with Ben...


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## lollaleeloo (Jan 29, 2003)

pumpkinhead - What you describe as your experience, a dose of pitocin until your own labor established itself, sounds perfectly reasonable, and it's gratifying to know that they're doing it right somewhere. And no, I wouldn't call that artificial labor. It was an _induction_ of natural labor, not a replacement for natural labor. In fact, that scenario was exactly what I had in mind when I consented to my own induction. Certainly not that it would be turned on, then up to the highest setting tolerated, until the baby came. I was on pitocin for 2 days and they refused to even consider turning it off. Whenever I asked them, numerous times, to at least turn it down (to give me a break from the relentless slamming) their reply was always that turning off the pitocin would likely lead me to a repeat section, which turned out to be very effective in shutting me up btw. I told myself *this* was the labor I wanted so bad, and that in normal labor you don't get to control it with a dial, so I needed to stop being such a wimp and take it like a woman. Having never gotten the chance to labor with my first, I had no idea how fundamentally different a pitocin labor can be from natural labor. As far as I knew, contractions routinely peaking for 3 to 7 minutes was normal. I had nothing to compare it to.

It was only afterwards at one of my pp visits that I was told it was 'policy' that once the pit goes on, it stays on, end of discussion. That ran contrary to what I always thought was the standard for medically appropriate dosage: the minimum effective amount applied for no longer than is necessary. They had me convinced me that I needed it that high for the duration of my labor, when the reality was, they weren't assessing my _needs_ at all, only my tolerance. Still, at the time I just shrugged if off, even though I was annoyed at finding out that despite all my vigilance, I'd once again become subject to yet another arbitrarily administered intervention. It's mainly through these boards that I've realized just _how_ arbitrary. I'm constantly amazed at how much I took for granted that my childbirth options were dictated by my individual needs, when in fact, they had more to do with my randomly chancing upon the right (or wrong) ob/midwife practice (or pitocin pump, for that matter) than anything else.







:


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## Greaseball (Feb 1, 2002)

How is the pit connected? Can't the patient turn it off, or pull out her IV?


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## lollaleeloo (Jan 29, 2003)

Quite honestly, it never occurred to me to do either, but then, I was led to believe that the main thing standing between me and another c-section was the pitocin.


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## pumpkinhead (Sep 15, 2003)

lollaleeloo,

How awful! It irritates me how keen the medical profession is to lump every woman into the same category. AS in, what works for one, will work for ALL! We all have different body chemistries. We are ALL DIFFFERENT!!

I think if your body and your baby are *truly* ready to be in labour, it won't really matter what you use to 'kickstart' it, it will work. (Wating another while will prob work as well, but that's a dif. story )My own personal belief (based on no medical fact whatsoever







) is that those women who aren't 'ready' are the ones who end up with C/S no matter what interventions are used to induce or augment labour.

Of course, this is *not* the only reason a woman might end up having a c/s.


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

You are right, of course pumpkinhead. "Failed induction" is one of the leading contributors to C-section rates being so high. If the baby is really not ready to be born it's like an unripe fruit on the tree... shake all you want it is likely to hang on. Of course when they induce they often break the waters so then you are committed one way or another.


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## Susu (May 31, 2002)

Quote:

_Originally posted by kama'aina mama_
*Has anyone read Ina May's new book? She talks about a midwife in the Netherlands who practiced from 1693-1745 named Schrader. Of the just over 3000 births she attended 10 were placenta previa and in 8 of those cases she was able to deliver a live baby to a live mother. It's astonishing really!

I am not advocating attempting vaginal birth with a previa, just noting this amazing accomplishment.*
that is amazing. i want to read this book now. however if i was told there was a 25% chance my baby would die if i tried birthing vaginally, i'd go the surgical route.

i might also add that in so many of these types of statistics they only record who lives and who doesn't. what is difficult to count are the living babies who suffered a brain injury because of lack of oxygen on the way out.

Quote:

_Originally posted by stafl_
*I think what bothers me the most is the language used. Saying that a c-section, in retrospect, was or was not necessary does absolutely no good. What I think we should be discussing is whether or not c-sections are avoidable instead.*
i'm not sure i understand this. okay, for every instance that is listed in pumpkin's original list i'm sure that there is someone who birthed vaginally with each one and everyone turned out just fine. that's an interesting discussion too and perhaps someone can start yet another thread on this subject, however i am quite happy with the original tone and intent of this thread.


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## applejuice (Oct 8, 2002)

Quote:

CPD - cephalopelvic disproportion
or Chicago Police Department









I recall reading *somewhere* that the only true case of cephalopelvic disproportion results from a case of rickets, which is rarely seen these days, or extreme pelvic injury as from a car accident.


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## copslass (Apr 19, 2003)

That is not true, about cpd being so rare and only due to rickets, etc. I know LOTS of women whose drs have told them they'll never get a normal to large sized baby out!
And I *know I have cpd, because my doctor TOLD me I have it during my second c-section! He told (actually, screamed at) me that my babies and I would have DIED without a cesarean!

...Of course, I didn't have it with my midwives when I pushed my third, fourth, and fifth children into the world... ROFL

This is a tongue-in-cheek (but true,) post for anyone wondering...


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## lollaleeloo (Jan 29, 2003)

Copslass, it's a shame they don't have a high-five smilie.


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## pumpkinhead (Sep 15, 2003)

Quote:

_Originally posted by copslass_
*And I *know I have cpd, because my doctor TOLD me I have it during my second c-section! He told (actually, screamed at) me that my babies and I would have DIED without a cesarean!

...Of course, I didn't have it with my midwives when I pushed my third, fourth, and fifth children into the world... ROFL

*

















:LOL







:LOL







:LOL

Good to know.


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## Greaseball (Feb 1, 2002)

Yes, the human pelvis is remarkable. Although it's often too small to birth a 7-lb baby, for some reason it will be big enough for a 10-lb baby in the future.

I think it comes with the unacceptable sizes stamped on it, or something. Or maybe it periodically expands and shrinks, just to play a joke on us.


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## Kari_mom (Jun 1, 2003)

But isn't part of the conundrum about CPD is that it can really only be diagnosed at the time of birth? In the absence of the conditions cited above, rickets or pelvic injury, from what I understand it can't be diagnosed with xrays or exams, because the pelvis changes so dramatically during birth.

And couldn't the diagnosis change from one pregnancy to another, as the mother's body changes and of course, her babies are not all identical. For example, a 42 week delivery in a first time mom might be CPD, where the same woman could deliver her third at 38 weeks easily. Even if the baby is bigger, its head might mold more, and her pelvis stretched out more. ( This is just a generality, I am sure there are women who have had the opposite experience.)

I do think that it is overdiagnosed, and that the majority of cases are probably nothing more than the baby in a less than ideal presentation. But it does seem to me that it is impossible to second guess this accurately. The mistake OBs and women make, IMO, is to not try again with subsequent births. An open-minded, supportive caregiver is pretty essential as well.


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## applejuice (Oct 8, 2002)

So, copslass, is your CPD now cured?

I am happy for you that your third, fourth, and fifth VBAC babies restored your faith in yourself.


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## Pynki (Aug 19, 2002)

I haven't been able to get a babe out all on my lonesome yet.. If I had maybe dh would be open to a HB, but I don't know because it hasn't happened..

I don't think my pelvis IS big enough.. DS1 was a c/s for breech.. The OB on call said i would always have c/s because my uterus is mis-shapen.. She was wrong.. I've had 2 vbacs now, BUT both of them required help on the exit.. DS2 required forcept because after 4 hrs of pushing and 18 hrs of labor.. I didn't have it in me to push anymore.. He was a high forcepts delivery, and i was just glad he wasn't another c/s... Our latest Ds3 was helped with a vaccuum at the very end.. I probably could have done it, but his tones were decelerating, and not rebounding after the contractions..

Maybe one day I will have a birth that doesn't require help.. It's possible.. Millions of generations of women have done it I know.. I also think that in previous generations.. I would have been one of those women that died..

I know alot of members roll their eyes at sentiment like that, but you are not me, and you have not had my births..

You do not live the lives of women who are told they have CPD.. Or a mis-shapen uterus.. If I didn't have such a VBAC supportive OB.. I would have had another c/s.. And it wouldn't have been neccesary.. I'm glad it was "avoidable" the 2nd and 3rd time..

I NEVER judge a woman for her birth... It does no good to tell someone after the fact.. Well you know.. You really didn't _need_ to have a c/s..

If you felt you needed one, then you probably did..

Babe awake..

Warm Squishy Feelings..

Dyan


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## Greaseball (Feb 1, 2002)

Quote:

I've had 2 vbacs now, BUT both of them required help on the exit..
If there is room to get the forceps in, there is room to get the baby out. (NOT meant to be judgmental!







) Most likely you were just exhausted.

My first was a low-forceps delivery after a 38-hour labor that included 4 hours of pushing. I'm having a homebirth with #2 and I know the same thing is not going to happen again. It had nothing to do with my pelvic size, it had to do with forced pushing - being told that if I didn't start pushing immediately, the baby would creep farther and farther up, and every time I rested between pushing I had to hear how far up the baby was climbing, so I really wore myself out. If I was allowed to push only when I felt the urge and encouraged to rest in between, I would have had the energy I needed. I've also learned that it's normal for the baby to retreat a bit between pushes.

Of course, I don't know what your birth experience was like, but you probably do not have an abnormal body.


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## Al Dente (Jan 8, 2004)

T At another board I'm a regular on, which shall remain nameless, 5 out of the 6 women who have been induced (early, I might add, in all cases) ended up with c-sections. I'm one of the last left without a babe because I refuse to be induced-although it's been brought up at the last 2 appts. But I admit to being scared by the scare tactics, kwim? The stillbirth rates and all that, and you can bet the OB has brought them up.

Now...on the other hand, I think my babe has turned transverse again. So I have no problem deciding to have a section at this point if he is...because I've done absolutely everything I can (herbs, chiro, accu, exercises) to get him to turn.

But to have an (almost certain) section because you want the babe to be out earlier? Well of course no one likes the last couple weeks of pregnancy, they are miserable! But why put your body through that unless there is a documented medical reason?

Just my .02


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## Peppamint (Oct 19, 2002)

Quote:

_Originally posted by Greaseball_
*How is the pit connected? Can't the patient turn it off, or pull out her IV?*
If I did that I would paint the walls with my blood! With my dd's hospital birth I had bruises on the backs of my hands, insides of my wrists and arms where they tried to get the IVs in. Blew lots of veins!


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## Peppamint (Oct 19, 2002)

Quote:

_Originally posted by RacheePoo_
*







T At another board I'm a regular on, which shall remain nameless, 5 out of the 6 women who have been induced (early, I might add, in all cases) ended up with c-sections. I'm one of the last left without a babe because I refuse to be induced-although it's been brought up at the last 2 appts. But I admit to being scared by the scare tactics, kwim? The stillbirth rates and all that, and you can bet the OB has brought them up.*
I noticed that when I was posting on a board like that. I finally left because I couldn't take the postnatal weaning at 2 weeks and Ezzo stuff... but anyway... the other gals due the same week as I were all induced early. The were going nuts at 36 weeks and already planning to ask for their inductions.


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## nissa (Mar 28, 2004)

I am new to this forum, this is actually the first topic I picked to read and I read every bit of it with relish! Thank you all for discussing this topic which has been so difficult for me to work through. This is the first time I've encountered an open honest discussion about c-s and pitocin induction. I usually have the feeling that the only acceptable way to discuss c-s in AP circles is to focus on avoiding, preventing, listing the risks and dangers, which leaves me feeling as if sharing my own experience would be unwelcome. So thanks for starting this discussion, and to everyone who contributed. It gives me peace. I look forward to checking out the rest of these forums!

I would like to add one reason to plan a c-s to the original list, because it is my experience, and becasue it was so lonely when she was a newborn and no one seemed to have heard of it. It is Birth injury. My daughter was born at 42 weeks after 48hours of pitocin with nerve damage to her right shoulder (called Brachial Plexus Injury because of the nerves involved). This was the result of the maneuvers the midwife used to release her shoulder when it was stuck during delivery (shoulder dystocia) The birth itself was traumatic for me, especially because I did not know for several minutes if my daughter had survived, and after I realized she was ok a paralyzed arm at first seemed minor to me. Over the years (she is 5) she has recovered beautifully through physical therapy, but some degree of nerve damage is permanent, and it certainly has not been easy taking her to therapy since she was two weeks old, and recently having her put under general anesthesia for a MRI of the shoulder. The point of this is, I chose to have a c-section when I was pregnant with my son. Not everyone in my situation does, but there is an increased chance of repeat injury which I was not willing to risk. Surgery was certainly not fun, especially armed as I was with so much info about the risks, and it was painful as well becase I had to give up my life long desire for a natural birth. But my son's c-s birth is the birth I remember as the fabulous moment when a healthy pink baby entered my life, just like a dream come true.

Thanks again,

Nissa:


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## pumpkinhead (Sep 15, 2003)

Quote:

_Originally posted by Pynki_
*

I know alot of members roll their eyes at sentiment like that, but you are not me, and you have not had my births..

You do not live the lives of women who are told they have CPD.. Or a mis-shapen uterus.. If I didn't have such a VBAC supportive OB.. I would have had another c/s.. And it wouldn't have been neccesary.. I'm glad it was "avoidable" the 2nd and 3rd time..

I NEVER judge a woman for her birth... It does no good to tell someone after the fact.. Well you know.. You really didn't need to have a c/s..

If you felt you needed one, then you probably did..

Babe awake..

Warm Squishy Feelings..

Dyan







*
Dear Dyan,

I have NEVER told a woman that she didn't really 'need' a c-sec. As someone has already said on this thread (maybe it was you, I can't exacly remember







) most c/s are necessary but some are also avoidable. As in, ESSENTIAL at the time it was conducted but the steps and interventions leading up to the event may have been avoidable. Yk? Ultimately it should always be the Mama's descision. WE have to do what we feel is best for our children and ourselves with the information we are given, right?

The problem here, in my HUMBLE opinion, is MISINFORMATION. WE are constantly told by our husbancds, relatives and Doctors that we CANNOT do something! "You can't push a baby out with a pelvis that small", "If you don't give that child antibotics he'll go deaf!", "if you don't vaccinate that baby he'll infect the rest of the modern world with Diptheria!!!", "If you don't circumcise that baby his penis will start growing green fungus and fall off" and so on and so forth...

If an OB or a midwife with much experience in catching babies tells a woman she can't birth vaginally, well, if she is of lesser experience (esp first time Mama's) she's prob going to believe them, whether it is accurate or not. She'll forever doubt her ability to birth a babe vaginally. This affects every ASPECT of labour and delivery! A woman's state of mind and ability to relax are very important when giving birth and if you always have "The Doctor told me I couldn't do this" in the back of your mind, how can you relax?

In the births I have heard of thru friends, my own, and those (only 2







) I have witnessed, it has been my experience that how a woman labours and how the pushing phase is managed has more to do with how babe is born than the size of a woman's pelvis.

We are ALL different and each babe and birth is DIFFERENT! How dare someone try to tell us that we will ALWAYS have to give birth one way?! There are always extenuating circumstances and there are lots of good reasons why a Mama shouldn't even attempt a vaginal birth.

I guess that's more of what I was getting at when I started this thread. What are the reasons why a Mama shouldn't even attempt to birth vaginally. I don't think there are a lot, but there are some.

Again, I would like to reiterate that no one has any right to pass judgement on a Mama for a well thought out descision to have a c/s she felt was in the best interest for her child! No ONE!!

I have to say (if I haven't already) that I have and am thoroughly enjoying this discussion! There has been virtually no malice and everyone has been very respectful of one another. I have and am learning lots! Thanks so much ladies!


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## Peppamint (Oct 19, 2002)

Quote:

_Originally posted by pumpkinhead_
*If an OB or a midwife with much experience in catching babies tells a woman she can't birth vaginally, well, if she is of lesser experience (esp first time Mama's) she's prob going to believe them, whether it is accurate or not. She'll forever doubt her ability to birth a babe vaginally. This affects every ASPECT of labour and delivery! A woman's state of mind and ability to relax are very important when giving birth and if you always have "The Doctor told me I couldn't do this" in the back of your mind, how can you relax?*








Too true. This happened to me to a certain degree. Having given birth a second time and rethinking through my first birth... I truly believe I was ready to push long before I was told I was fully dialated. I kept feeling pushy and feeling the need to be upright (because I was induced I was supposed to stay in bed







) and I heard the nurse tell my mom it would be dinnertime before I gave birth. My mom knew better and was so angry that the nurse said that, especially in my hearing. I was actually fighting against my body's natural urge to push because I thought it wasn't time yet because of what the nurse said. BTW, that was around 1pm and my dd was born at 3:34pm (It took 30 minutes to push her out on my back).

My second birth I went from 9cm to ds in my arms in just 1/2 hour... I was trusting my body to do it's job that time!


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