GUEST POST
Caesarean Births a Better Option for Mothers? 
I don’t know how to quite describe my distain for the article I recently saw published in Saturday’s (13th August, 2011) “West Australian” newspaper. It was a summary of an article which was published in the Victorian paper “The Age”. The article can still be viewed online
My first reaction when I read this article was an eye roll (my husband should have known better than to show it to me, but I believe that he takes great delight in seeing me get angry over such childbirth issues). I have just received a Masters in Midwifery, where my main focus has been breech birth so I have repeatedly picked the ‘Term Breech Trial’ (Hannah, Hannah, Hewson, Hodnett, & Willan, 2000) paper to pieces and contradict ever single recommendation that the authors made via more current and better controlled research. Then as the days went on I couldn’t let it go. I had planned many ‘letters to the editor’ and I figured that I would have a limited audience and the newspaper editors would not publish the mad woman on her soap box anyway!
So many questions have emerged in my midwife/mother brain.
1. Why are they using a study which has been poorly controlled, repeatedly debunked, criticised, picked to pieces and recommended to have the findings withdrawn (by obstetricians as well as midwives) as an example to demonstrating outcomes (Banks, 2000, 2001; Barker, 2010; Daviss, Johnson, & Lalonde, 2010; Glezerman, 2006). I could talk all day about this but the main reasons the data from the TBT are irrelevant to use as an example here are:
Many of the vaginal breech births were attended by birth attendants that were not considered appropriately skilled to attend such births (despite that being a requirement of the study), however, there were 100% skilled obstetricians at 100% of the caesarean sections
The “planned vaginal birth group” remained grouped despite how the births occurred (for example, spontaneous natural labours and births were grouped with women that had inductions, epidurals, instrumental assistance and non-elective caesarean sections).
The researches themselves acknowledged they could only measure short term maternal morbidity, that the true impact on a woman’s health, her future pregnancies and future children after undergoing a caesarean section were possibly greater.
Childbirth is complex phenomenon and you cannot accurately compare two groups of women and say “that is the outcome”. There are too many factors at play and randomized control trials have been described as inappropriate for application to complex phenomena. (If you were comparing two different caesarean section methods, that would be more appropriate as there is much more control, there is too many factors at play during a vaginal birth – ie, the labour, the attendant, the birth position, medications, analgesia, mode of birth etc.) (Kotaska, 2004).‘Vaginal birth’ is not simply ‘the birth of a baby via the vagina’ – you may have induction, augmentation, instrumental assistance, etc.
2. Authors of the TBT attempted to perform a study randomizing elective caesarean and planned vaginal birth for cephalic presenting babies in normal, healthy women after their conclusions of the TBT were published and were denied by ethics committees (Hannah, 2004).
3. In New Zealand, women are not able to access publicly funded caesarean sections for no obstetric cause. One Auckland district health board sought legal opinion – which supports the refusal of non-medically indicated caesarean sections.
4. In the USA, women are being forced into court ordered caesarean sections. A woman who refused a caesarean and home birthed her twins – one which subsequently one died was arrested and charged with murder!!!
5. Caesarean section does not “save” a mother from experiencing pelvic floor problems later in life. The weight of the enlarged uterus and contents during pregnancy (including amniotic fluid, placenta and baby!) in conjunction with relaxing hormones do more ‘damage’ to the pelvic floor than the actual act of birth. A recent study showed that women who had never had a labour still had some urinary incontinence in 40% of cases when compared to women who had not had only had vaginal births experiencing urinary incontinence in 55% of cases. There was no difference in levels of faecal incontinence. Caesareans not as “posh” as commonly believed:
6. The sample size of 1000 women (500 elective caesarean and 500 planned vaginal birth) is too small to have significant results which can definitively prove either delivery method to be more superior over the other. It lacks the ability to truly measure the rare, yet major risk factors associated with either birth method.
7. I have concerns that this will measure short term outcomes only – not look at the long term impact on women who undergo unnecessary major surgery nor the impact that may result in future pregnancies.
As a midwife, I am all about choice. Well informed and ethical decision making. I also believe that caesareans are a fantastic tool to have… as a life saving operation for mother and/or baby. The current childbirth culture in Australia (and much of the developed world) seems to have taking this life saving procedure and turned it into a ‘birth choice’. Women state reasons for electing to have a non-medically indicated caesarean for many reasons:
Fear of birth – without seeking any assistance to address these issues during pregnancy. Who do we blame for the rate of fear instilled in women today? More to the point, why is it not addressed appropriately in the antenatal period?
Fear of complications – to “prevent” a potential birth complication. We must remember that major surgery has a phenomenally high range and severity of potential complications.
To plan around the arrival of the baby, because we know what day the baby will be born (unless of course you go into labour before your very convenient schedule!) Don’t want to face the “indignity” of childbirth – because laying on a theatre table like a star fish, surrounded by at least 10 strangers, having a urinary catheter inserted and then most of your body exposed and you have several hands on and in your belly manually manipulating a baby through a surgical incision is sooooooo dignified! Maybe next time I should count how many times the theatre door actually opens during the procedure – it is many!
What I find the most disturbing is that those who require caesarean section surgery (for whatever reason) are often left being treated as “depressed” or “needing referral” if they feel sad or disappointed by experiencing a caesarean section instead of a vaginal birth. Has the world really come to this, that when a woman is disappointed at her birth outcome that the hospital midwife/doctor will spit at her that she should “just be happy that you (she) have a healthy baby and not to worry – you (she) will be able to wear a bikini again” (this is what was said to a friend of mine earlier this year who was teary after an emergency caesarean section!).
If a woman wants to “choose” a caesarean section with no medical reason to have one I say “OK”. I am sure you are thinking I am completely mad and how can I call myself a midwife? Truth is, I think that woman is completely mad, but she is the one that has to live with the consequences of her choices and who am I to tell her what is best for her? If she can articulate to me that if she has a caesarean she is:
Four times more likely to die
Will lose, on average, double the blood loss of a vaginal birth
Will not be protected from pelvic floor damage
Is at an increased risk of thromoembolism which could lead to pulmonary embolism, myocardial infarction or stroke (all which could be fatal)
Could experience a wound infection which could be mild or severe enough to be fatal
Painful adhesions leading to future, ongoing, gynaecological problems
May experience difficulties lactating
Is more likely to experience post natal depression and bonding issues with baby
Will be unable to lift heavy objects or drive a motor vehicle for approximately 6 weeks
Could have complications from an epidural anaesthesia including infection, meningitis, severe headache, seizure, temporary or permanent paralysis, death
If the epidural is unsuccessful – she will need a general anesthetic and she will be unconscious when her baby is delivered (who will also be unconscious)
Future pregnancies could be impacted including:
i. Fertility problems and difficulty falling pregnant
ii. Increased risk of miscarriage
iii. Increased risk of unexplained still birth
iv. Abonormal placentation including placenta praevia (placenta over the cervix, which not only means repeat caesarean section but also a risk of life threatening heamorrhage, preterm birth and hysterectomy at delivery); placenta accreta/percreata (the placenta implants through the scar which results in a hysterectomy being required at delivery – and therefore increasing the risk of death from blood loss exponentially)
v. Increased risk of preterm birth with the presence of adhesions
The baby has a greater chance of requiring admission into the neonatal nursery for respiratory assistance at delivery and for at least 24 hours after birth, feeding difficulties, unexpected prematurity (accidentally delivering the baby prematurely), anesthetic complications (more common with general anesthetics)
The baby has an increased chance of experiencing asthma, allergic disorders (including anaphylaxis) and eczema in childhood.
It really doesn’t paint a pretty picture. I thought that maybe I should be giving Dr Stephen Robson the benefit of the doubt. Maybe is on the “natural birth” team and is constantly frustrated by these very able bodied women requesting unnecessary caesareans while those that might be better suited to a caesarean delivery beg for natural birth. Then I read his quote: ”It dawned on people, what if it turns out to be safer to have a caesarean birth if you’re a healthy mother? … What would that mean? How would that affect society? The topic led to great discussion at a meeting I was at recently where one cheeky guy said, ‘Maybe we could do away with labour wards forever and save hundreds of millions of dollars,’ ”
My very small, slight glimmer of hope quickly turned into disappointment. While I want to hope that he does have staggering results and multiple complications in his elective caesarean section group, I don’t want to wish such heartache on those families. Let’s just hope that common sense prevails and maybe the government can take a leaf out of New Zealand’s book and stop giving away my tax dollars for very expensive major surgical procedures which are completely unnecessary. I wouldn’t want to pay for someone’s facelift, so why should I pay for an non-medically indicated, unnecessary caesarean section when my mother, grandmothers and all their mothers before them just sucked it up and got on with it. Let us just hope that the women recruited to this study already had their non-medically indicated caesarean sections on their wish list and are not coerced into the procedure for research purposes and those in the vaginal birth group are on the path to an uncomplicated, happy delivery! It doesn’t cost anything to dream…
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Could not have said it better myself Lisa! You are an amazing midwife!!
Thanks, I am not a midwife but a birth advocate.
I’m guessing that the reporters never read the studies they are writing about let alone look at the methodology. If someone in a white coat told them thats good enough.
There are a couple of typo errors in this piece which will be seized upon by the “we hate birth” nutters sure to be descending on this in 3,2,…1.
Meh.
I got the same comment about bikinis after my unecessary surgery. “Why are you crying? You’ll still be able to wear a bikini!!”. Um, no actually I’m crying because I didnt get to give birth, I’m in pain and I still havent held my perfectly healthy baby that HAS to stay in the nursery cos its policy.
No tears after my HBAC!!!! Love you Lisa!!!
email me murasaki and I will correct, it was a guest post so i didn’t correct anything really but am happy too; although I wouldn’t want the “we hate birth” brigade to suffer, they love to complain.
Please can you post this for this woman
Congrats on the Masters, a huge achievement. Where do you find the time? And based on my own academic experiences, how did you manage to get through it? I found that if I challenged markers’ comfort zones, my marks suffered accordingly!
A masters supervisor who moonlights as an independent midwife is always going to be a good thing! The research is the research… so as long as you stick to what is published you don’t need to worry about “crossing boundaries” etc.
I was on maternity leave with a baby that slept very well and wouldn’t accept any substitute for the breast (i.e. expressed milk in any way, shape or form other than fresh!) made getting through the masters quite helpful… I was feeling bored but could not return to even casual work… so off to uni I went!
She was also a breech baby (2009) and I walked the path of a mother carrying a breech and not feeling that I ‘needed’ a caesarean, so that was my inspiration for focussing my masters work on breech babies and I became even more aware of the ‘Term breech trial’ and all it’s pitfalls. I was angry enough when I read this article about the non-medically indicated elective caesarean section, but to see them quote a study which should be dead and buried by now, I was fuming (and still am!)
Lisa, a fantastic post, can I ask who your Guest poster was?
Roxi
Lisa as usual you write and speak sense in an insane world. You continue to inspire me. I have been following the progress of these and related issues for many years now and truly hope that your wisdom, passion, dedication and courage continue to have a forum to be heard and acknowledged.
Hi Lisa, have stumbled across your website and absolutely love it! This was a difficult article for me to read. I had my daughter (first child) 7 months ago via c section
I was ten days overdue, she never engaged and turned out to be 8 pound 14, not overly large but not small either, apparently was also posterior. I had an 18 hour labour and only “progressed” to 6-7 cm. I was adamant that I wanted to birth her naturally, and was extremely dissapointed. Although she is a beautiful healthy baby. I’ve been told that “failure to progress” is a condition that can repeat itself, and this has affected my confidence in achieving a VBAC, however after reading the stories on this blog, I believe I can do it.
The bit about the effects on future pregnancies and future children really hits deep, Given that my c section probably didn’t need to happen. However I will remain positive that next time things will be different! It’s a pity you don’t still work as a home birthing midwife otherwise I would definitely employ you!
You can employ birth Advocates at home.
Hey LeahGem. I was failure to even get started first time round and second time I had a beautiful birth at home and i would hire Lisa again in a heartbeat.
I’m sorry to hear that, LeahGem. Sounds like you experienced failure to wait, not failure to progress which isn’t a condition of women but of obstetricians. I hope you have a beautiful birth in your own home next time, at your own pace, and that the first hands to touch your baby are yours. Love and healing to you. <3
“I wouldn’t want to pay for someone’s facelift, so why should I pay for an non-medically indicated, unnecessary caesarean section when my mother, grandmothers and all their mothers before them just sucked it up and got on with it.”
They didn’t have computers either, but you have know problem using those advancements of civilization. There are many things our “mother’s, grandmother, and all their mother’s before them” had to do that we don’t have to do anymore. There are many things we are able to do they weren’t allowed to do…vote, own property, work outside of the home. It may not make sense to those who are afraid of progress and change but there are good reasons women around the world may choose an elective csection. Including, arranging the birth around maternity leave and work responsibilities. Perhaps mom has a tramatic past and is scarred by sexual abuse and instead of giving this as her reason she says she doesn’t want to damage her vagina. In reality, the process of giving birth would retraumatize and trigger her and she would be unable to bond with her child!
I’m all for home birth and natural birth for the women who want it as I was born at home and have attended many home births. However, I don’t agree women have to follow in their ancestors foot steps who “just sucked it up”. It seems a natural progression of an intelligent being to try to discover technology to prevent it from having to experience pain during childbirth and at the same time giving it’s offspring a better chance at being born alive. I find it hard to believe we have created the internet and smart phones, but haven’t found a way to safely block the pain of childbirth or that csections are so completely horrible. The only reason women feel sad and depressed after having a csection is because so many natural birth advocates make them feel guilty. They are weak, right? Failures? If they’d only “just sucked it up”?
As far as, having bonding and lactation issues, anecdotally I’ve seen women having those issues regardless of the method by which their babies were born. One of my clients who had a csection produced more breast milk then any of my other clients. Her baby had her first feeding within 45 minutes after the procedure. Mom was up walking around later that day. Like with any birth, it all depends on the individual. Midwifery is supposed to focus on the individual and treat every single birth as unique and special. That’s not what comes across to me when someone writes an article about csection and insists that women the world over, who they don’t know, should be able just suck it up and are “completely mad” if they choose an elective csection. What a judgmental bunch of crock! How is choosing an elective csection more insane then refusing a csection to save one of your baby’s life? Then being surprised when people are mad you chose to let your baby die instead? Seems “completely mad” to me. I’m rubbed the wrong way by so much of the attitude of this piece. Even if I agree with some of the information presented I can’t get past the way it was presented and with such a nasty tone! Blanket statements about birth methods of any kind are unacceptable because “childbirth is complex phenomenon and you cannot accurately compare two groups of women and say “that is the outcome”. There are too many factors at play.” That same statement applies to elective csection reasons and risks versus benefits of those choices. You don’t know what the individual’s reasons may be for making such a choice. At least the women who choses the csection has a greater chance of having two living twins. Doesn’t seem all that “mad” to me.
Sincerely,
A doula who supports each woman individually
Rain… I think you have completely missed the point of my post! The tone is not supposed to be nasty or aggressive, but indeed factual and based on research (that’s why it is referenced!)
This research I am referring to is not substantive and they have sighted an article (the Term Breech Trial), which has been heavily criticized and debunked, as their stimulus to look into the “low-risk non-medically indicated caesarean over low-risk vaginal birth”.
“They didn’t have computers either, but you have know problem using those advancements of civilization.”
No, they didn’t have CTG foetal monitoring machines to use during a woman’s labour either. A piece of technology that was introduced without being proven to be of benefit which has made NO CHANGES to morbidity or mortality rates but has INCREASE birth intervention. There’s technology for you… not necessarily as helpful as you think.
“It may not make sense to those who are afraid of progress and change but there are good reasons women around the world may choose an elective csection
Having babies is not a convenience… even when you “plan” things, there are no guarantees. Just because you book your baby to be born at 38 weeks does not mean it won’t decide to turn up at 36 weeks. Pregnant women need to realise that an EDD is exactly that, and Estimated Date of Delivery… “term” is considered between 37 and 42 weeks gestation… the “magic number” at 40 weeks is an INDICATION only, it is not set in stone.
Have you ever had to start a baby on breathing machines because it is not coping… prepare it for transfer emergency ambulance transfer to a hospital away from it’s mother who has just had a “scheduled routine caesarean” where the baby has been unexpectedly delivered preterm… I have, many times. How do I look that woman in her tear filled eyes and tell her it is going to be ok when I don’t know if it is going to be?
“It seems a natural progression of an intelligent being to try to discover technology to prevent it from having to experience pain during childbirth and at the same time giving it’s offspring a better chance at being born alive.”
Sometimes I wonder how intelligent humans really are… we are animals and fairly arrogant the way we treat our planet and each other… I would like to dispute your comment that we are “intelligent”… self centred and greedy as a whole… by that is merely my opinion not based on fact.
Normal healthy babies born via caesarean section are four times more likely to need admission to the neonatal special care nursery in the 24 hours after birth than their vaginally born counterparts. I’m sorry, but you need to check your research here… fact is fact. Normal healthy babies born via caesarean section are actually more likely to die than those that are born vaginally. There is a natural process with labour and birth which protects the baby, not increases its risk of death. The hormones released and massage from uterine contractions are proved to stimulate the immune system, reduce the risk of childhood asthma and allergies and the ‘squeeze’ the baby experiences while it is being born removes excess fluid from the gut and lungs, providing a much better start to initiate respirations and feeding. Caesar babies miss this and there is no way to “simulate” this experience.
If you think that we have “found a way to safely block the pain of childbirth or that csections” have you ever seen a woman with a CSF leak and blinding headache after an epidural… I have. Have you ever seen a woman not able to work properly weeks after birth due to unexpected nerve involvement… I have. Have you ever seen a woman have a seizure because her epidural has somehow ended up in her spinal blood supply rather than the epidural space… I have… and it was the most terrifying day of my life!
“The only reason women feel sad and depressed after having a csection is because so many natural birth advocates make them feel guilty. They are weak, right? Failures? If they’d only “just sucked it up”?”
Women who have laboured for hours and then end up with an emergency caesarean who feel sad are not victims of the “natural birth advocates”, they are NORMAL! Many women see birth as a right of passage and should not be treated poorly if they feel sad that things did not go to plan! It’s ok for a bride to cry on her wedding day if the flowers aren’t quite right, but if she cries because her birth didn’t go to plan we need to send her for a psyche referral… honestly? A caesarean that is required is not a failure… that is what they are there for. You are again blanketing caesareans and not talking about non-medically indicated caesarean sections!
“As far as, having bonding and lactation issues, anecdotally I’ve seen women having those issues regardless of the method by which their babies were born.”
So have I… but once again, you cannot argue with the research. There are MORE problems for women who have had caesareans than those that have not. Elective caesareans have an absence of labour hormones to stimulate the commencement of lactation, emergency caesareans are often the result of a long arduous labour… both can interfere with laction but it is not necessarily guaranteed.
I believe what I said was that I personally believe women are mad for electing to have an unnecessary caesarean, but so long as they are educated and aware, then I support their decision. Correct me if I’m wrong.
“How is choosing an elective csection more insane then refusing a csection to save one of your baby’s life? Then being surprised when people are mad you chose to let your baby die instead?”
You are clearly not referring to a NON-MEDICALLY INDICATED ELECTIVE CAESAREAN SECTION here. If a caesarean is going to save the mother and/or baby from experiencing significant morbidity or mortality then I would not consider it to be “non-medically indicated”, rather than an ‘elective caesarean WITH obstetric cause”. There is a significant difference between the two. I don’t expect women to put themselves or their babies at risk… this is why I am concerned if they are selecting a non-medically indicated caesarean – because they ARE putting themselves AND their babies at risk!
Again…
“At least the women who choses the csection has a greater chance of having two living twins. Doesn’t seem all that “mad” to me.”
Nor me… if there is a medical concern for her or her twins, why would she chose to have them any other way than a caesarean???
Not that long ago I had to walk into a patients room. There was a young father holding his newborn son in his arms. His wife was still around in theatre after her second caesarean. How do you think it made me feel to have to stand there and tell him that his 24 year old wife still hadn’t stopped bleeding, that there was a problem where the placenta implanted around her old scar. She has just had 5 bags of blood and they are now performing a hysterectomy on her to try to save her life. The helicopter is on the way to transfer her to a tertiary hospital where she will need to be in ICU. A father sitting there with joy and pride in his eyes as he holds his newborn son, he suddenly turns white as he realised that he might lose his wife (and this would be her last child).
Forgive me for trying to save other families from experiencing the same trauma if it is avoidable!
“Sometimes I wonder how intelligent humans really are… we are animals and fairly arrogant the way we treat our planet and each other… I would like to dispute your comment that we are “intelligent”… self centred and greedy as a whole… by that is merely my opinion not based on fact.”
So you dislike the human race as a whole and believe in your heart we are all greedy and self-centered. It makes me very wary that you truly have the best interest of anyone choosing to reproduce at heart. Perhaps subconsciously, or maybe not so subconsciously, you’d like to see a return to a time when more women and babies died in childbirth. This would help control population and protect the planet. I personally love humans and have hope we are evolving in a positive direction.
You’re right I can’t argue with the research because you didn’t post it.
Yes I’ve seen the same woman suffer from a blinding epidural headache…twice actually. Both times she decided for herself the pain of the headache was more bearable then childbirth for her. It doesn’t matter what my thoughts are on this choice because it was hers to make.
I am opposed to elective csections before 39 weeks but other then that it’s a personal choice. There are many complications that can come with vaginal birth. Vaginal birth isn’t always roses and sunshine and you’re doing women a great disservice if you don’t inform them of those as well. Bladder or rectum damage, vaginal or cervical damage, fistula, hemorrhage, infection, death etc. and don’t tell me these never happen in undisturbed, natural births because that would be a lie!
Finally, I noticed you didn’t address a women who was a victim of past sexual abuse may choose an elective csection for the same reasons another woman may choose to have an unassisted birth! I believe this should be acknowledged as a valid choice! Also, a business executive or some other employee with restricted maternity leave options may feel they must pick their baby’s birthday. You see this as convenience, but they see it as necessary to protect their family! If you don’t like that then work to change maternity leave laws and not bash women who choose the csections. I don’t know what maternity leave in like in OZ, but in the US it’s horrible! Some women get none at all and others are lucky to get 6 to 8 weeks and if you have a csection you are automatically allowed 2 to 3 extra weeks with your baby!
I think it is appalling that somebody would opt to undergo a surgical birth to get an extra two or three weeks with their baby. It is probably necessary to recover from the surgery and it is also unfair! IF women are being put in this situation then that in itself is a whole other issue. As far as “limited maternity leave” and “planning your baby’s birthday” – that fact is, you cannot! Babies come at any day or time – even if you have your caesarean booked for a certain day and time… and what is wrong with trying and induction first if it is THAT important to have the baby at a certain time? This is also a practice that I don’t agree with, but where we have a strong fly-in-fly-out workforce community when fathers can be away for weeks at a time – it is not uncommon to “plan” a babies birth around their rotations. When they get flown 5 hours away from home to work only to then get the message your wife has gone into labour – there is no telling when he might get back! (sometimes it takes days)
It’s not my birth, it is not my decision. If you care to read my original post in the outset, I believe that I said I would support a woman opting for an ELUSC if she could articulate to me the risks. If I am comfortable she is making a fully informed decision, then I am comfortable supporting her. I am not comfortable with her entering the doctors office and saying “I want a caesarean” and the doctor responding “OK”. This happens and it is not informed consent and it is negligent practice! Ask any lawyer!
I am not considering someone with previous sexual abuse a “non-medically indicated caesarean section”. Psychiatric implications of someone with severe issues because of such a history MIGHT indicate the need for a caesarean section, but not necessarily for ALL women that have experienced this. I once looked after a VBAC woman who had an appalling history and it was hard for her, but she certainly coped a lot better with her vaginal birth with her obstetrician, midwife and husband in the room rather than her previous experience with an operating theatre full of nurses, paediatricians, anethetists, orderlies and everyone else! It is personal choice and preferance and I would suggest that any mother with such a history needs extensive counselling and support throughout their pregnancy, not a ‘quick fix’ caesarean for which your tone is suggesting!
I never for one minute suggested vaginal birth was all roses and sunshine. I am fully aware of that! You are putting words in my mouth that I did not speak. Intervention is there for when it is needed and I am grateful that it is available. I, myself would be dead without it.
Now if you would kindly stop attacking me as a person and a professional, I urge you to read my original post again. I believe that I am 100% refering to NON MEDICALLY INDICATED CAESAREAN SECTIONS and I also believe that there are several links to information and studies when back up what I have written.
Rain, I totally agree with your comment.
I am pregnant with my first baby and have been researching the methods of labour and birth to find the one I am most comfortable with. What I have seen, not just on this site but on other birthing are people who choose to have a high risk homebirth are labelled as “empowered” and “have the right to choose” whilst women who choose an elective c section are labelled as “completely mad”. As a first time mum walking wide eyed into labour and birth this has disappointed me. There are many reasons women would choose an elective C section, and her reasons, in my opinion, are no less valid than someone who chooses to have a homebirth against medical advice.
a ceasarian section is a major operation that puts mother and baby at a high risk, 4 times higher than a normal birth. Also everything in the life of mother and baby are there after affected so it should only be considered when the risk of death is higher from a normal birth. There are not many reasons to chose an elective ceasarian, there are just medical indicators like placenta previa, vasa previa, persistent transverse lie etc etc. Medicine doesn’t own birth or have the right to chose venue of birth. I can’t think that a well informed well researched woman would be “empowered” to have a section for no actual reason. Empowered means that someone is giving you that power. a Section doesn’t ever give you power it can help you avoid and on occasions it can potentially, (not certainly) save a life when no other option could give that chance. In any other circumstance it is a dangerous and unnecessary surgical procedure.
Luckylady…
If you went to an obstetrician at 5 minutes pregnant and said:
“I want a caesarean”
and the response you got was:
“OK”
I would be seriously concerned that you were not making informed consent or making a fully informed decision.
If the same scenario was to occur again and the obstetrician wanted to have an indepth discussion with you about the pros and cons of vaginal birth and caesarean sections including the potential long term impact and you still were insistent on a caesarean section… then I would say you were quite within your right to make that decision. I would support you.
I still stand by my comment that if your decision was based on emotional, not medical reasons, I would rather my tax dollars be spent on something else! You are more likely to have complications from surgery, complications in future pregnancies (if you can get pregnant again) and your baby is more likely to end up in the neonatal special care nursery… but if you were willing to pay for the procedure yourself, then you are wearing the consequences of your decision. That is every woman’s right no matter where/how she chooses to birth.
No-one has addressed the scenario Rain raised of a woman with a history of sexual abuse wanting to have a CS to avoid vaginal birth “triggering” her with PTSD.
My opinion – such a woman should be counselled to choose a birth method that will be about her doing her own birth, not having it done to her. It’s the sense of powerlessness that’s likely to trigger past trauma. This might happen to her in either surgical or non-surgical settings. I would fervently hope that in such a situation the woman would be counselled to plan for a natural birth where she will hold the greatest likelyhood of avoiding bed-bound postures that might revictimise her.
Given something like 30% of women experience unwanted sex at some time in their lives I’d say this situation is not uncommon.
So Rain, in short – a CS, lying down helpless while people do stuff to her most initmate parts…taking something precious from her body… a dead-cert trigger risk. Vaginal birth well supported with her catching her own baby – the best possible option.
I agree with you! Unfortunately not every women will share this information with her care provider. On my client in take form I state if you have any history of abuse you think my affect your pregnancy or birth and your ability to feel safe during either you do not have to write anything on the form. If you wish you may talk to me privately & this information will not be shared with your partner or care giver. You are not alone and there are resources to help you through this. I always hope a dialogue can be opened up, since it’s not possible for every woman I am never quick to judge the choices any woman makes. I do not know what has lead them to make those choices!
Lisa,
As a previous hospital midwife who must have seen many women go through cesarian section, it is hard to see how you come up with the conclusion that C/S is such invasive and dangerous surgery – the facts don’t support what you say. Do you have references for your statement that C/S is a “major operation that puts mother and baby at high risk?” In fact, while C/S carries a very small risk for the mother, it is safer for the baby. Here are some references for those who want to look them up:
Lancet – on breech presentation:
http://www.sciencedirect.com/science/article/pii/S0140673600028403
From Pediatrics – comparing elective C/S vs TOL – neonatal outcomes – C/S was associated with transient respiratory problems but TOL with greater rate of infection.
Regarding the complexity of surgery – C/S in not very complex and not very invasive – compared to – say – bowel resection for cancer, liver repair for bleeding, ruptured aortic aneurysm, open heart surgery, lung resection for cancer. Those are examples of “major” surgery.
The, I want to comment on the line “medicine doesn’t own birth”. There is no such entity as “medicine” – orthodox medical care consists of a large number of doctors, nurses and allied health professionals working in both the community and in hospitals. How can such a community of people propose to “own” anything – except perhaps responsiblity to provide care when it is needed?
Please don’t quote the debunked and flawed hannah trial, it will lose you all credibility. 1 in 2500 women die from c/s and 1 in 10,000 die from a normal birth. You are 4 times more likely to die from an operation. These figures are publicly available for you to check out any time. Section is complex, and I can’t see how cutting into your uterus and taking a baby out is not invasive. The facts support everything that has been said.
It really bothers me when midwives start spouting these statistics is you all NEVER acknowledge the racial disparity in these statistics. Caucasian women, wealthy women don’t die at those rates. The poor and minority women die at a shockingly high rate which raises the overall figures! It really upsets me midwives claim to be helping women, but most of their clients are Caucasian women who are not living below the poverty line! Those women and babies aren’t at risk! I respect midwives who work in poverty stricken areas in the South in the US or in 3rd world countries. They truly are helping the women and babies who need help!
@SUE, I have had a c-section, and almost bled to death on the table. I had to have a complete blood transfusion, IV antibiotics for the MASSIVE infection that followed and have been left with a stomach that is hanging and scarred. I was told by my OBGYN that c-section was major surgery, major surgery by its nature is invasive. Have you had a c-section sue? Go and have a look at the medical release you have to sign before your ceaser, which lists all the risks involved…then tell me there is very little risk to mum and none to baby.
Natalie – you ask: “Have you had a c-section sue?”. The answer is “yes” – I have had one, and have also looked after women who have had one. You say that you “almost bled to death on the table.” And yet, in countries with little access to hospitals, so many women bleed to death from vaginal delivery. As I said before, some examples of major and invasive surgery include: repair of ruptured abdominal aneurysm, brain surgery to resect a tumour, bowel resection for cancer, and many others. Cesarean might be more complex than having a skin lesion removed, but it is not complex or invasive in the realm of surgical procedures. And yes, there are some small, and almost all short-term, maternal risks for cesarean, but outcome for the baby are better. The “squeezing the lungs” mechanism is often cited in these discussions, and yet large studies show that the only observable effect in the cesearan newborns is a temperary increase in respiratory rate. The allegation that you need labor to produce hormones so you can breast feed is also wrong – were you not aware that mothers who have had cesareans breast feed? So much ideology here, and so little fact.
Thanks Janet me too
Lisa, just wanting your opinion on what is a ideal waiting time on becoming pregnant again after a c section? I hear many different things eg: 2 years, 1 year, 2 months! not quite sure which is right! Thanks in advance
I generally hear 2 years LeahGem, but I have seen it done earlier.
It really depends on the comfort level of your care provider. Maybe that is something you could discuss with them (if you have an idea who you will get to care for you) before getting pregnant???
All the best! I’ve seen lots of successful VBAC’s – choose the right person and place and you should be fine!
xxx
There are all sorts of recommendations. It’s a hard one. If a dr does a full arm joint or knee replacement on a sports man they get intensive physio and go back out to play, nobody says if you don’t wait for 2 years your arm will explode or fall off. I often wonder if Obs are so bad at surgery that they don’t trust their work or if they think women are so faulty that they don’t heal in the same way.
I Just had the pleasure of birthing with a woman who had a VBAC less than 18 months after her section. Her baby weighed 4800g and there wasn’t an explosion. The risk of rupture according to the 2010 data is 0.01% and goes up to 1.9% with induction and/or augmentation. It makes no mention of a time period where the rupture rate is more.
That’s good to know!
I wonder if they say ’2 years’ often due to the entire scarring process usually takes 2 years to complete? Any surgical scar I’ve ever had (including the stab wounds from scopic shoulder surgery) have suddenly become really itchy at 18 months, then shrunk and are hardly visible afterwards (after being red and raised since surgery).
I guess we are all human and we are all different?
Thanks! I’m DEFINITLEY wanting a homebirth! so I guess will they only take me on board if it’s been two years?
For those that wish to continue to quote the Hannah, 2000 study… I would just like to quote the 2 year follow-up study from the same authers (Pg 926):
Hannah, M. E., H. Whyte, et al. (2004). “Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: the international randomized Term Breech Trial. .” American Journal of Obstetrics & Gynecology. 19(3): 917-927.
“However, immediate postaprtum maternal morbidity is somewhat higher with planned caesarean section and the risk of problems in subsequent pregnancies, which our study was not able to address, may be increased. Observational studies have found that delivery by cesarean section increases the risk of placenta praevia, placenta accreta, uterine rupture, and the need for a repeat cesarean section in subsequent pregnancies.”
They acknowledge themselves that they are not looking at the long term impact of caesarean section and this must be taken into consideration when you are going to scream that caesarean IS safer… it is NOT proven.
You suggest that government’s should not fund c-sections? You would rather “your tax dollar” didn’t go to women who make informed choices about their birth? You are an ideologically-driven fascist who has no interest in mothers or babies – just an obsession with medieval birth. You do realise that the greatest killers of mothers and babies worldwide is birth? That’s why modern medicine is so important, it liberates women from what you refuse to admit is a very dangerous process. This makes you dangerous. Of course, you will never see that as, like all ideologically driven people, you are blind to any evidence that undermines your dangerous philosophy.
You seem to pressume that modern medicine has all the answers. If that were so then we we would all live for ever and no-one would die of disease or the perils of life like war, famine, inevitable accidents etc, etc. Life is painful and difficult at times (more so for some) but we need to except that it comes with a certain degree of risk regardless. We all die, at different times and in different circumstances. It is something that none of us are able to avoid. Sadly death often arrives in difficult to understand circumstances (be it beginning, middle, or end), which can create uncertainty, dissonance, anger, deep sorrow etc. Each of us need to come to terms with this in our own ways, and find meaning within this from our own perspectives in a secular, heterogeneous global environment. This can be a particularly difficult time which can be ameliorated by support, guidance, careful consideration, space, and a tolerent heart and mind – not judgment and attack. Perhaps the energy expended by your hateful post would be better spent supporting and making it easier for those that have to endure the difficulties of loss…..I’m sure you know someone who has experienced loss.
Would a woman be culpable if she took a risk and ran across a busy intersection against the lights and was responsible for the death of her unborn baby? She knew the risks of crossing the road. She will live with that forever. Will you? Should we incubate women and their babies, monitoring and measuring every potential risk that can impact on both mother and babies well-being in a thousand different ways so that we can produce perfect human beings? Perfect in whose eyes? Who’s the fascist now? And what would we be producing these babies for? To operate our industries, to devastate our environments, to send to war to be possibly killed, all to serve the ruling classes? Don’t we teach our children to take responsibility for their actions (I do), or do we defer to someone else who’s main priority is their own ego and fragile sense of self…..we are minnows in the consciousness of others mostly. Are we just slaves to a system of knowledge that does not yet have all the answers and thus cannot define our lives with any authority?
Perhaps you should read Lisa’s blog more closely because I believe she is far from a fascist or medieval. I am not sure of the statistics but I would hazard a guess that infant and mother mortality rates have decreased not as a consequence of c-sections, but rather, improved sanitation and accessibility to midwifery knowledge and simple non-intrusive interventions. Yes, C-sections are sometimes necessary but often performed unneccessarily and with many negative outcomes which impact on the quality of life for both mothers and babies.
Definition of fascism
noun
A governmental system led by a dictator having complete power, forcibly suppressing opposition and criticism, regimenting all industry, commerce, etc., and emphasizing an aggressive nationalism and often racism.
Perhaps this definition is more in line with the AMA’s approach to birth, not Lisa’s.
I suggest that you retreat to your redneck cave, where all intolerable, uninformed, controlling fascists belong.
My body and my mind are my own!!!!!!!!
Donna, your long passionate essay seems to have little to do with “Cesar’s child”‘s post. You say: “If that were so then we we would all live for ever and no-one would die of disease or the perils of life like war, famine, inevitable accidents etc, etc.” I didn’t see CC’s post claiming that modern medicine had produced immortality, only that it makes sense to use our intelligence to improve our lives’ circumstances. Just like we are all now blogging rather than talking around the camp fire or embroidery circle. Modern medicine has VASTLY improved the outcome from the perils of “war, famine and accidents”. if your child breaks their arm, do you just accept that as part of life, or do you take them to the doctor?
Your comment about incubating “perfect human beings” is raising a straw man – I can’t see anything like that in the post you are responding to. If a woman chooses to run across the road and gets hit by a car, the medical system will do all it can to save her and her baby – would you want her to be just left to die? Even though she was personally responsible for a poor decision (as are some women who choose HB in risky situations – like twins for example), the health system still fulfils its responsiblity to do all it can to save them. Both sides of this discussion need more rationality and less ideology and name-calling.
Obstetirican sare held accountable for the outcomes of their decisions – legally as well as morally. ANd what do they most often have to answer for? Not doing a cesarean – or not doing one soon enough – when a baby is damaged by vaginal birth.
Excellent point Sue. A very prominent Ob is currently before the Australian courts for not doing a C section and a recent American case awarded $144M against an Ob for not doing a section.
There is no justification for an unnecessary intrapartum death these days.
There is no womens choice to what is effectively a last minute abortion.
You sound just a little crazy here. I read the post by you on your blog. You totally backed the ob claiming shoulder dystocia was unavoidable. Made me laugh out loud.
I believe what I said was I did not want to pay for “non-medically indicated caesarean sections”. This is not dangerous, it is infact safer as women are at a greater risk of death if they have surgery they do not need and infants are at a greater risk of ongoing health problems if they are also subjected to a caesarean section they do not need (http://www.ichr.uwa.edu.au/media/1314).
Maybe you need to learn to read before you refer to me as an “ideologically-driven fascist”. Or maybe all New Zealanders are “ideologically-driven fascists” because they do not fund NON-MEDICALLY indicated caesarean sections?
Author of the Guest post : can you pls link to the actual study you cite – your link only shows a press release. It would be good to see the data sets and how they were analysed and interpreted. Thanks.
The study is underway… it has not been released yet. That is what I find so concerning. That the authors of the TBT were declined ethics approval to perform a similar study but somehow an ethics committee in Australia has agreed to allow it to happen here.
I guess when the study is released we will hear what the results are and start a whole new debate… no matter what the results are (unless they are negligible to be of benefit to either side, in which case it will never be heard of again).
Why isn’t this in the paper? I can’t believe people are just going to let it happen.