March 29, 2006

Go ahead and choose C-section!

There's no reason to discourage women from giving birth by Caesarean section, says the National Institute of Health.
As the number of Caesareans increased through the 1970s, in part because of rising malpractice suits, medical groups launched campaigns that reversed the trend. Many medical authorities viewed the procedures as unnecessarily expensive and risky, and advocates of "natural childbirth" saw them as turning a natural experience into a "medicalized" one.

But the number of Caesareans began to increase again in 1996, reaching an all-time high of 29.1 percent of all births in 2004. The trend was fueled by factors including doctors' concerns about the safety of attempting a vaginal delivery after a previous Caesarean, women's fear of the pain and physical trauma of traditional labor, and the convenience of being able to schedule deliveries.

The rapid increase triggered an intense debate and prompted the NIH to convene the panel to make the first new assessment of the procedures since 1980, when the focus was on preventing Caesareans....

The panel concluded that Caesareans increase the risk for some serious, potentially life-threatening complications, particularly devastating uterine ruptures during subsequent vaginal deliveries. For that reason, women planning large families should avoid them, the panel said. And the procedure should not be done before the 39th week of pregnancy unless the baby's lung development has been verified. But there was also evidence that the surgical deliveries reduced risks such as bleeding by the mother and possibly brain damage to the baby.

The evidence on other complications is mixed. The risk of infection, for example, appears to be lower after vaginal deliveries, and the risk of incontinence may be lower following Caesareans, the panel found.
The right to choose! You decide! What would you rather have, an infection or incontinence? A uterine rupture (avoidable by not having a subsequent vaginal delivery) or a baby with brain damage (permanent and irreversible)?

And all these years people have been trying to guilt trip women into having "natural" births! Ha!

48 comments:

Aspasia M. said...

A woman should be able to choose a optional C-section if she wants one.

I've heard that a C-section takes longer to heal. And it is abdominal surgery.

However, vaginal birth can lead to bad vaginal tears. But if the baby is too big - that can cause serious pelvic problems & should come out by C-section.

If the baby is in danger of low oxygen - of course you need to get the baby out as fast as possible. That's why monitoring the heart rate is a good thing during labor.

My nephew was born vaginally a few weeks ago with the help of vaccum suction, because they were a little alarmed by his heart rate. The vaccum suction caused a bruise on his head. But he's healthy and happy - so all is well!

Steve Donohue said...

Thank God I'm a man.

Ann Althouse said...

The NIH is validating purely elective C-sections, not just when the monitoring shows distress or there is some other sort of problem.

As to what it's like to have a C-section -- I've had two. I have two children -- they are adults now -- and have never experienced one minute of labor. But it does take a lot to heal from the C-section. You learn how much you use your abdominal muscles for ordinary things like standing up.

Aspasia M. said...

Thank God I'm a man.

Yeah. I want a uterine replicator! Somebody hurry up and invent one!

tiggeril said...

Dear god. I think I'll just go the celibacy route.

reader_iam said...

I was in labor from a Saturday to a Monday. Son finally experienced distress but it was too late for a C-section. I won't go into the gory details, but he ended up in ICU for three days for reasons directly related to his arrival (and not the "distress") and my first adventures in breast-feeding him (which was also the first time I got to see him, almost 11 hours after he was born, due to my condition) involved juggling dueling IV stands, or whatever you call those rolling things.

Had I had a second child, a planned C-section would have been an attractive option. I'm told that in my case, the full-recovery time would have been less.

No one size fits all, I say.

Palladian said...

Advocating a nation full of MacDuffs are you?

reader_iam said...

Um, his stay in NICU had nothing to do with the dueling IV-stand parts.

For want of a comma ...

vh:gqfus

chezDiva said...

I know it's a tough recovery. I have had abdominal surgery in the past and I know full well the pain and difficulty that comes with that type of surgery and recovery. However I also know that my sisters both suffered through long and painful labors which in all three cases ended with emergency c-sections.

So, even though I haven't had a child yet I will definately go the route of an elective c-section when it's time.

knoxgirl said...

reader said: "No one size fits all"

truer words were nary spoken!

I hate it when women are self-righteous about natural childbirth or try to guilt you into it. So bogus. And I don't blame women who want to bypass the whole thing by having a c-section.

With that said, I had a fair amount of anxiety about labor, and I can say with all honesty that I actually enjoyed it once I was given the epidural. Just when my labor pains approached "unbearable," in swooped the anaesthesiologist (my hero!) and everything was just peachy after that.

Maxine Weiss said...

There are still cases of women who die in childbirth. An embolism can break off the amniotic fluid and attach to the vessels....

...I know of someone this happened to. The gal insisted on natural childbirth.

C-section would have saved her life.

Peace, Maxine

Aspasia M. said...

A friend who recently gave birth had a relatively easy and quick labor. But, she took the epidural too late. Because of where the baby was positioned on her spine her foot fell asleep, but the pain relief wasn't distributing around her body. But it all worked out well- mother and baby are both healthy.

Once at the hospital my mother had a 6 hour labor with her first (me) and a 3 hour labor with her second.

So, I'm hoping I take after her.

Aspasia M. said...

Um, his stay in NICU had nothing to do with the dueling IV-stand parts.

I'm glad everything worked out well. I'm sorry about that scare, though.

gj said...

The panel also heard presentations about costs but limited its conclusions to the medical risks and benefits.

It's a shame that the article did not discuss any of the cost-related information. At local hospitals in Boston, standard of care is a two-day stay for a vaginal delivery and a four-day stay for a C-section.

I'm all for giving women choices, but should we all pay to subsidize women with no pregnancy-related complications (age, blood pressure, position of the child, etc) who choose a procedure that is going to cost many thousands of dollars of more? (A quick google only yielded 1986 data, which was $8K for a C-section versus $4K for a vaginal delivery. I'm sure both numbers have at least doubled in the last twenty years.)

Add to this the fact that the United States has very poor birth outcomes compared to other developed countries that make much higher use of midwifery and have much lower C-section rates. To me this is just another indication that there is something very wrong with our medical model.

Ruth Anne Adams said...
This comment has been removed by the author.
Robin Goodfellow said...

The prevalence of the "women have been giving birth for millenia, doctors are almost unnecessary" meme is a great example of how people are generally really poor at intuitively understanding statistical data. Sure, women have been giving birth for millenia, the human race has survived, that's proof enough that without doctors the system "works". However, just because it works for nature doesn't mean it works on an individual basis. Women have also been having miscarriages, still births, and worse for millenia as well. For much of human history whether a pregnancy would result in a healthy, live baby was a chancy affair comparable to, maybe, a flip of a coin. Good nutrition and health in the mother combined with general good sanitation in the environment help bring those odds up a lot. Even so, without modern medical care involved the risk of adverse outcomes for the child or mother are higher than most people would like (just look at the levels of infant mortality in the undeveloped world).

Also, in response to gj's statement:

"Add to this the fact that the United States has very poor birth outcomes compared to other developed countries that make much higher use of midwifery and have much lower C-section rates."

These sorts of statistics are not always directly comparable at a fine scale across countries, because of different standards of reporting. For example, what gets reported as a "still birth" in one country might be reported as a "premature birth" (involving the use of incubators and artificial breathing, perhaps) in another country.

Ann Althouse said...

As to the economic side of it, you'll have to put a number on the medical problems for the mother and baby that are avoided. C-sections may cost twice as much, but things like brain damage in a newborn will offset a lot of C-sections. And that's just considering dollar amounts.

We spend money for safeguards against injuries all the time. How much expense is added to your car for safety features?

Alexandra said...

I had a planned C-section on New Years Day, and it was the best New Year's Eve I ever had!

A woman should be able to choose what she does with her own body, unless the men deciding it for her know what it feels like to have an umbrella opened up inside their body.

My child came out, no sceamimg or yelling (by me or her), not traumatised by having to fight her way out, calm but simply curious. As soon as she was given to me all she wanted to do was to have a good look. Straining her little eyes in the bright light to open them and to see this new world around her.

At that stage babies see nothing, but they feel everything, and I am a great believer that natural childbirth is the greatest myth, other than of course the existence of a state called "Palestine".

knoxgirl said...

"the United States has very poor birth outcomes compared to other developed countries..."

The US tends to try a lot harder to save risky pregnancies and to deliver babies who are born unbelievably premature. When these babies are successfully birthed and later die in the hospital, it makes our infant death rate seem high...when other countries aren't necessarily even trying --or able--to make these pregnancies work.

The US's "poor record" for infant deaths is an innacurate but often quoted statistic.

bearing said...

No thanks. Assuming no medical complications that require surgery, I'll take natural birth any day. Why substitute a major and expensive medical intervention for something that the body can do just fine on its own (remember, we're talking ELECTIVE cesareans here?)

Besides, I have a sneaking suspicion that in the calculation of risks, the researchers were assuming that women will have no more than one or two children, and therefore that they will have no more than one or two cesarean sections. The risks to future pregnancies and births rise significantly after that.

Multiple previous c-sections are a strong predictor of uterine rupture, placenta previa, placenta accreta, and placenta percreta, among other things. I am personally aware of one woman whose placenta accreta in her fifth pregnancy (after 4 c-sections) meant she went under for a hysterectomy/c-section combo knowing she had a 10-20% chance of not surviving the surgery; and I know one woman whose uterus ruptured shortly into labor with her 3rd child after 2 sections, killing the baby and nearly killing her. Anecdote, data, yadda, yadda, but I'm afraid I can't be so cavalier about c-section for anyone who thinks it's possible they may have more than 2 pregnancies.

And I just don't buy that paying for optional, "lifestyle cesareans" is offset by reduced cost in paying for treatment of birth injuries and sequelae. That requires that there be a large number of marginal cases who *should have had cesareans but didn't.* If anything, the U.S. common practice is to be cover-your-ass conservative, ordering cesareans when there's the slightest whiff of risk --- from a lawsuit.

No, this comes from an unholy combination of (a) insurance carriers paying for them and (b) c-sections being more attractive to doctors (schedulability and the perception that aggressive treatment shields them from lawsuits). Economically speaking, the incentive to section every woman who comes through the door is pretty high.

bearing said...

Oh, oops, I just noticed that the article quoted does, in fact, acknowledge the greater risks of c-section to women with more than 2 kids.

Good for them.

("Large families" in this context probably does mean 3 or more children, btw --- that's when the risk shoots up, if I recall correctly. Don't be fooled into thinking they're talking about an outlandishly large number of children.)

gj said...

As to the economic side of it, you'll have to put a number on the medical problems for the mother and baby that are avoided.

We're talking about elective C-sections for women who have low risk pregnancies. The article says that elective C-sections aren't worse than vaginal births (unless you plan on having more than 2 or 3 children), but it also doesn't say that they are medically superior.

No one in this thread is arguing against medically indicated C-sections.

gj said...

OK, time for an historic interlude:

Perhaps the first written record we have of a mother and baby surviving a cesarean section comes from Switzerland in 1500 when a sow gelder, Jacob Nufer, performed the operation on his wife. After several days in labor and help from thirteen midwives, the woman was unable to deliver her baby. Her desperate husband eventually gained permission from the local authorities to attempt a cesarean. The mother lived and subsequently gave birth normally to five children, including twins.

(Let's see if Ann starts getting a lot of hits from people searching for "sow gelders".)

Ann Althouse said...

bearbee: Having had C-sections, I would say it's bizarre to want one if there is no special reason for it. It's major surgery, a really extreme thing to do to your body. I'm not recommending it. Nevertheless, there is a risk of harm to the baby from a normal vaginal delivery, and it's up to you to judge the odds and choose the precautions you want to take.

Jennifer said...

Of course women should be able to choose how they want to deliver their babies. Women "elect" for all kinds of surgeries (plastic comes to mind) that are wholly unecessary. Why should this be different?

That said, I agree with you Ann. Why anyone would choose major surgery over delivering a child I have no idea.

I've had one labor induced (electively, I might add. My husband was leaving for training and I wanted him to at least "meet" his first child before he left.) and took the epidural. And, I've had one child with nothing but a midwife and no medication. My recovery times were ridiculously short. After the totally natural birth, I was walking around Waikiki playing tourist in just over a week.

Jennifer said...

Lest I give the impression that I'm some sort of birthin' machine, I should add that my weight generally comes in under 120 when I'm not pregnant and my babies were just over 8 and 9 lbs respectively.

So, take heart ladies!

Ann Althouse said...

Jennifer: Here's a reason I could see choosing a C-section: If it was combined with well-done plastic surgery to help you regain your shape! I think there is a great medical niche here: elective C-sections with tummy tuck. You could charge a lot for that, doctors!

Selesai said...

I just think this whole thing is ridiculous. If you're going to choose to have a baby (although not everyone intentionally chooses it) why do we try so hard to avoid childbirth? And for an elective abdominal surgery?
Maybe if more women were told that they are capable of delivering a baby naturally, and believe in their bodies, we wouldn't have something so silly as an elective c-section.

Ann Althouse said...

Selesai: Do you presume in favor of natural across the board? Why wear shoes? Why drive a car? Clearly, humankind has invented a lot of improvements on nature. We need to think hard about why we are pushing women to do the natural thing in just this one area. What is that all about? And why would someone who wanted a baby not want to go through childbirth? Come on! The answer is obvious. There are millions of things we want without wanting the process of getting there. Why would I want to be rich and yet not want to work hard? Why would I want to spend a week in Paris and yet not want to have to spend time on a plane? Why would I want to be thin and yet not want to go on a diet?

Selesai said...

Perhaps part of my point is that most women don’t know if this is an improvement over nature because they wouldn’t think of experiencing it any other way. The choice is thus painted as pain versus no/much less pain, which completely ignores all of the other merits of natural childbirth. I believe more education and openness is needed. Why should women be afraid of their bodies?
No, I don’t advocate natural across the board, but neither do I advocate a blind commitment to the supposed “improvements”. Of course there is a place for c-sections, just as there is a place for cars and shoes (though shoes are not really an apt example). But that doesn’t mean we should unquestionably accept those things as necessary or better in all situations.
Of course humans want the things they want without effort, or as much effort. This is America, a consumerist society. What I’m questioning is the wisdom of that attitude, particularly when it’s based on a lack of education or information.

Aspasia M. said...

Haven't evolutionists theorized that walking upright has caused problems for human pregnancies? Isn't there something about the position of the pelvis that causes more difficulties?

Now, that said, my sister in law was up and about after a vaginal birth very, very quickly. (She gave birth in March.)

I would want to be up and around as fast as possible to care for the newborn. A good vaginal birth heals much quicker then a C-section.

Doesn't labor also trigger breast milk? I know doctors ususally recommend some labor (prior to C-sections) for medical reasons.

Sara said...

I think these articles have got women's reasons for elective c-sections wrong. I don't believe people are really choosing c-sections because they think it will be safer or less painful or whatever or shorter recovery time or whatever.

My hunch is the real reason people choose elective c-sections is that they're scared of labor. They're scared of being out of control and not being able to cope. They know that labor is something that you do, and they're worried they might do a bad job at it.

I think they're relieved to have a c-section because they're off the hook on actively participating in their labors. It's easier to have childbirth done to them than to have it be something that they have to do themselves. So what if they have a little extra recovery time, they think, if they avoid all the "trials of labor."

I can understand this fear and aniexty about labor. But there are other ways to help women cope with these fears besides foisting major surgery on them. For example, they could talk with a doula throughout their pregnancies to help them cope with their fears and mentally prepare for labor. I would even be willing for my health insurance to cover that.

But major surgery to prevent women from facing their fears? Not a good solution. And I don't want my health insurance premiums to pay for it.

37383938393839383938383 said...

I propose a bill to ban all C-sections except when the life of the mother is at risk. I'm sorry, but the idea of women opting out of pain in their vagina just rankles me as a patriotic American. Yes, this is ironic.

Maxine Weiss said...

Jennifer: More and more women are putting off having children until later. The older you get, the more that can go wrong. What's "natural" at 25----the average age that women used to have children

......isn't so "natural" at age 42---an age when more and more women are choosing to have babies.

Anyone having children over age 40, and maybe even age 35...should strongly consider C-section.

You read all these stories about Cindy Crawford giving birth in a jacuzzi etc... Very new-age-y. But it really isn't appropriate for everyone.

I think the La Leche League is a little too aggressive in their promoting of breast feeding. Breast feeding isn't appropriate for everyone. Some women can't, and yet they are made to feel like they are criminal. It's not like bottle-fed babies grow up to be mass murderers.

Groups like La Leche, and the natural childbirth brigade make many women feel like failures for choosing a different path.

Peace, Maxine

Ann Althouse said...

I don't want my health insurance premiums covering aesthetic for your next root canal or tooth extraction. In fact, why don't you do your next tooth extraction yourself at home with a pair of pliers, as nature intended? Are you so alientated from your own body?

Ann Althouse said...

You don't need to have a vaginal birth in order to breast feed! (Speaking from personal experience.)

Ann Althouse said...

.... I mean alienated.

37383938393839383938383 said...

I was about to say, Ann. Alientation is a bizarre fetish involving Martians and potatoes. Yuck!

OPolly said...

Somehow, the NIH failed to note the huge increassed risk of anesthetic morbidity and mortality--yes, death---associated with C sections.
Can't imagine what they were thinking on saying these are equivalent events.

Jennifer said...

I think there is a great medical niche here: elective C-sections with tummy tuck. You could charge a lot for that, doctors!

Ann: LOL! Toss in a coupon for a boob lift, redeemable upon weaning, and I might have signed up.

kate said...

I have had a C-section and 3 VBACs ( Vaginal Births After C-section) I have given birth naturally and with epiderals with and without Pitosin. C-sctions sound alot better while one is in labor or if one is afraid of labor (hypatia makes a very strong point on this) but afterwards they are much worse. Moving hurts. It hurts for a long time. You may not be able to lift your baby. For 6 weeks you should not lift anything heavier than your purse ( I did like the ban on vacuuming)and your household takes that much longer getting to the new "normal". In addition you are forever a "high risk" pregnancy even if the C-section was because of the child- not you, as in my case ( breach). That meant $15,000 per pregnancy to the OBGYN alone in the early '90's instead of $5,000. Do not ask me to help you pay that for non-medical reasons.
With my 4th child, epideral and pitosin because she just did not want to leave ( due 8-30, born 9-11), I went home with my baby 8 hours after she was born, my mother cooked and cared for me (bliss!)the whole family helped and enjoyed for a few days and then I was up to speed.
BTW Maxine, my pediatrician had a stock phrase for over anxious mothers : "don't worry it won't make him grow up to be an ax murderer".
Oh, for those of you who want to lose weight fast after birth and do not want the tummy tuck Ann envisioned ( me too) go for really long labor. My second child I had contractions 20 min apart from Thurs thru Sun afternoon, James was born 3am Mon. I do not think I was EVER skinnier than that week after.

Kathy said...

Maxine said:

There are still cases of women who die in childbirth. An embolism can break off the amniotic fluid and attach to the vessels....

...I know of someone this happened to. The gal insisted on natural childbirth.

C-section would have saved her life.


Actually, an internet acquaintance died just a few weeks ago during a C-section because of this same complication, so a C-section does not eliminate this (very rare) risk. Childbirth, like almost anything else worth doing, is inherently risky, although much, much less so now than in the past or in countries with less developed medical care.

I've had three babies, all naturally without pain relief, but I have very fast labors and in two of the three cases they wouldn't have been able to give me an epidural anyway. Is it painful? Yes! And if it lasts for a long, long time, you're going to need to have some coping skills (i.e. have really prepared for it ahead of time with classes and practice). I might try an epidural for my next one if we have another. I'm getting older and the memory is staying fresh longer! *g*

C-sections have a lot of pain during recovery, per my c-section friends, and there is also a high risk of infection in the incision site for people who are overweight. My friend who has 30-hour labors had a c-section for #3 because the baby was breech, and she found it to be the most difficult of her deliveries.

I think the point I'm making is that both routes have risks, and the cost/benefit analysis will vary from person to person. My insurance charges me more if I have a c-section or even if I use an epidural. So I share some of that extra cost, which is as it should be.

Verification word: nkevd
Yep, that's what led to all of this in the first place.

lisa said...

I actually suffered an Amniotic Fluid Embolism (AFE) 4 yrs ago when I gave birth to my boy. He was fine but I spent a month in hospital (failed epidural, had enducing drug, lead to 2 operations, blood transfusions, a week in ITU/ICU, ARDS, DIC). Well let's just say I was one of the lucky ones. Now believe it or not I would like to have another baby. AFE has no pattern so they cannot say if it will happen again. I will be having a planned c-section next time. I hope they agree that I have a valid reason why!

cherrybomb said...

I have a very sensitive vaginal/anal area. I can barely tolerate sex. So I am petrified of natural birth. I am at 37 weeks and at my last exam the doctor inserted her hand and it was very painful. She isn't slow about it, doesn't use enough lube and made a comment, "This is just a finger- not even a baby's head." For three days now it burns when I pee because I feel like she was a bit rough. I try to imagine that time 10 (for birth) and my heart starts to race. I just know that after all the pain meds (epidural etc) fade I am going to be so miserable for so long. Anybody have any ideas?

Jennifer said...

Why does everyone claim that the only reason women elect to have a C is because of fear of pain and labor? I spent 30 hours in labor, 15 of them with no medication cause I was so determined to have a natural delivery with my daughter. Never happened. After contractions, "strong enough to deliver a horse" I never dialated past 3 cm, and my daughter was a C. I agree with the person who said she was super quiet and curious, and today she is a happy, healthy 4 year old.
I am pregnant with my second, and my dr is pretty adament on anohter C, and I have to say I quite agree. The recovery time was because I was so freaking TIRED from the extended labor, not the C itself. I don't say this unresearched. Those with short labors vaginally DO recover much more quickly, but many with no labor C's also have a short recovery. (for the record, I begged to go home after less than 2 days). It's not the pain or the labor I;m afraid of. I don't want to be so exhausted after labor that I cannot care for my new born.
I have researched this throroughly and I have found that my frieds who had Elective C's had a shorter recovery period than my VBAC friends.

Jennifer said...

Oh yeah, and Cherybomb.... chill just a bit. Your brain will release endorphins that will help. according to my buddy with 4 kids the SURFACE (which is where you sound like you are sensitive) doesn't hurt all that much cause of the pressure from the baby's head... (same priciple of pinching the skin before a peircing). It's the CONTRACTIONs that hurt, and in the imediate afterbirth, even after a C you are so thrilled with your baby that you can ignore the pain. AND to relieve you a bit further, my epidural was in for half a day (they left it in for the C and for half of my really long labor) and it NEVER wore off. It CAN if you REQUEST it to. And I know what it's like to have painful sex and urination and hating exams for that reason. I'm a bit sensitive.

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buradimari said...

I am all for voluntary C-section. I grew up hearing about the births of my siblings and I. Two emergency C-sections after hours of labor (I'm one of those two), a too-big baby born naturally, and a planned C-section premature to avoid complications. The planned one was, of course, the easiest of them all. The natural birth was the hardest on my mother. She was healing for a year. And she's not generally a slow healer. I knew way back then that I wanted a voluntary C-section, but didn't know if you could get one without a medical reason. Now, though, I do have many medical reasons. I'm planning on adoption due to those and my fertility problems from a past bout of cancer, but my fertility seems to be getting better and I don't know if I'll accidentally get pregnant or choose to with the permission of my doctor. If I get pregnant, I will definitely get a C-Section and I am very relieved about it. Because of my babies' safety and my own. My heart literally stopped when my mother was in labor with me.