Caesareans are for everyone?

[panzerfaust]

'I grew tired of having to explain to my friends why I wouldn't want to give birth naturally. In some way, they found it offensive that I didn't want the pain or the uncertainty of labour. But the more I researched it, the more I realised that although it involves an abdominal operation, it's a very safe one. From the Guardian

As someone who has spent most of a lifetime in operating-rooms, I think that the risks of surgery and anesthesia (anaesthesia in this case) are generally under appreciated, and certainly seem underestimated by the above author. Still, the actual risk of a truly elective c-sxn vs a normal vaginal delivery in healthy women is, in fact, unknown.

Additionally, as someone who has attended many terrible deliveries and rushed, risky, and frightening emergency c-sxns I can sympathize with her point of view. Not to mention that the author is likely correct in saying that, for most women, there would be less overall pain with elective c-sxn, and very likely, less physical damage from the birth…

Please note, the Guardian article does not speak of coercing all women into having Caesareans, but does make the point that, perhaps, all women should be offered one. That the preferred method of delivery should be up to the mother, with choice unconstrained.

Ich fand dieses Faszinieren

[Divernan]

1. One consideration is the cost, and what that does to insurance rates.

Back in the 70's, when Ob-gyns had fewer babies to deliver, the rate of "medically necessary" C-sections increased dramatically. A major labor union (I don't recall which one, but at the time I was teaching a woman's studies class at a major university, and had the documentation for it), did a study and determined that at least 40% were NOT medically indicated. At that time, C-sections were considered to carry more overall risk to the health of the mother, and they were particularly significant because the medical thinking was that once a woman had had one Csection, she could never have a normal vaginal delivery. It also meant a much longer recovery time- two weeks in the hospital - no steps for a couple of months - all the complications and after-effects of major abdominal surgery. The unions had concerns for (1) health of the women and (2)the impact on the cost of health insurance. The unions concluded that the doctors were recommending the Csections because they got paid more for them and this made up for the docs' loss of income from the lower birth rates.
Nowadays, I suppose women are sent home from the hospital in what 2/3 days after a C section? But they will still take a lot longer to recover from the procedure. Do you know what the cost differential if between normal delivery and C sections?

[muriel_volestrangler]

2. The cost given in the article for a UK hospital

This judgment was partly based, however, on the cost implications. Caesareans are twice as expensive as normal births, costing the NHS about £3,500 each, compared with £1,800.

[LizW]

3. Still a fairly significant cost difference

When I had my c-sections, my ob-gyn brought in another doctor to assist. The first time it was a surgeon, the second time it was another ob-gyn in the practice. We got separate bills from them in addition to the bills for the c-section.

When I was debating whether to have the second baby by c-section or to try a vaginal delivery, we looked at the cost difference, and it was, as best I remember, several thousand dollars.

I had two c-sections, but never a vaginal birth, so I can't compare the pain and recovery time. However, I'll say that the recovery from the c-sections was lots longer than I expected. There was significant pain and soreness for six weeks, to the point that my activities were very limited.

[TNDemo]

4. My cesarean section was a day at the beach

compared to my vaginal ones. I had a 4th degree that ripped open a week or two later and had a lot of painful cauterization trying to get it to heal together. Second baby was lodged in the pelvis, they FINALLY took me for a section, the anesthesiologist never showed up and an hour later somehow the baby managed to come out the regular way with much help when my pushing came back in earnest (but I ended up in ICU because of aspiration after my OB pushed pentathol) and my third one was a planned section (good thing because she had a true knot). It was so lovely to not have hours of labor and to have to pee or poop over incisions. I healed quicker and just enjoyed my time in the hospital watching TV and having my food brought to me. I have not had a "normal" vaginal delivery so I have no idea what that would be like but seems like that would be the way to go if that baby is in the right position and not too big. Anesthesia risks are definitely there (ask me) and infection risks are greater with an open wound but there is a time and place for a section.

[panzerfaust]

5. United Kingdom: NHS

Remember that the Guardian is published in a civilized country with national health care.

Yet the article deals at length with cost – “Caesareans are twice as expensive as normal births, costing the NHS about £3,500 each, compared with £1,800” – and argues that cost should not be the issue, especially as those women who are “too posh to push” can “go private” and have a c-sxn for £4,000

Yes, I realize that the NHS is one of the largest portions of Britian’s budget, and that, if everyone had a Caesarean, it would double the immediate cost of birth.

However, I do wonder if the overall cost (delivery + dealing with maternal and neonatal injury) might not actually be less. This is not addressed.

[China_cat]

6. 2 to 3 days?

Next morning at the latest. If you come out of recovery without being too dizzy you're kicked within 8 hours.

[Katherine Brengle]

9. I think this depends on the hospital --

I had a normal delivery, no serious injuries, and remained in recovery for two and a half days.

[China_cat]

10. No, it depends on the insurance company.

[Katherine Brengle]

13. I had MA state health insurance at the time, and it paid

for the delivery and the hospital stay -- perhaps some are less kind -- I can certainly believe that.

[China_cat]

16. My last was c-section

34 years ago and I only got 2 days in hospital then...and it wasn't one of those nice little bikini incisions, either. It was one of the belly button to pubis slashes.

[Katherine Brengle]

21. That sucks --

Don't know what else to say -- that's just a lousy deal. Stories like this just go to show how little our society values women and mothers -- bringing a new life into the world should be celebrated by society, and this should include making sure that that mother gets the care and respect that she deserves. While my hospital stay was not as bad as this, it was still frustrating. Every time I would push that button for a nurse (for medication, for whatever), I would get an intercom yelling, "What do you want?" at me. It sucked.

Bah.

[Mayberry Machiavelli]

24. That is still more than the 8 hours you are claiming now. The standard is

about 3 days these days, post C-section. Vaginal delivery is another story, especially if it's uncomplicated and not the first delivery.

[China_cat]

58. That's also 34 years ago WITH insurance.

[Mayberry Machiavelli]

63. The hospitals I work in now, the ladies stay at least 3 days even if they

have no insurance or are on Medicaid. So unless you can provide a link showing a hospital that boots ANY C-section patient out in less than 48 hours, I'm sorry but I don't believe it.

Again, vag delivery is a completely different animal.

On edit: Hospitals don't like to eat the costs for uninsured patients, but they like even less to be sued for millions of dollars if they boot patients out early against standard practice for monetary reasons, and those patients have catastrophic bleeding or infection complications after a C-section because they went home too early.

[Coexist]

11. I was up and around in hours with all my vaginal deliveries

my first one, I was cut too far, and it was harder to walk, but my second and third were with midwives who used perineal massage, and I felt great, just a little tired.

[Ilsa]

17. It is still 3-4 days where I live in Tx. The mother is allowed

a narcotic IV PCA pump for pain control. It is pretty much the next day or so for a vaginally delivery unless complications for mother or baby arise.

[Mayberry Machiavelli]

22. People are NOT discharged within 24 hrs. after a C-section, not in any

hospital I've ever worked at. It's a major surgery.

You may be thinking about vaginal delivery.

[fedupinBushcountry]

7. My first born was by C-Section

after 6 hours of pushing they finely decided he wasn't coming on his own.Also it was in a Navy hospital. It was always said once a C-section always a C-section, so I was surprised when I went to have my second a civilian doctor told me he would see how it goes and would be ready for a C-section if needed. I ended up delivering my second child vaginally with the help of forceps. So come the third time I thought well I guess I will be delivering naturally, but this civilian doctor scheduled me for a C-section, but I went into labor 3 weeks early and barely made it to the hospital before my daughter came out naturally. I had my 3 kids in 3 different states, Ca., N.Y., and N.J., so was not able to have the same doctor each time. It was very hard for me to pick out a civilian doctor, luckily I had my second one in my hometown, and was able to get help from my sister-in-law in choosing one at 7 months along. But the third one was right out of the phone book, since my husband was in the Navy, and for some reason I could not use the Navy hospital in Philly, now that was scarey.

The cost to me was $25., no matter which way I delivered. I was in the hospital for 6 days with the C-section, 3 days with my second one and 2 days with my third. The C-section took much longer to recover from and luckily it happened on my first, since I was 3,000 miles away from home and had no family around to help me out.

[OmmmSweetOmmm]

50. I also went v-back, with my second child. My first had to be

delivered via c-section because he was placenta previa. If I were to go into labor with him there was a good chance either one or both of us would die. I spent 3 months in bed rest prior to delivery, and the recovery period, with a newborn to take care of (a colicky one at that) was long and painful. So when I discovered a little more than 2 years later I was pregnant again, I decided to try vaginal, although my doctor wanted to schedule a section for me. I told him that we could wait and see how the pregnancy progressed. Although I was in labor for about 12 hours (most of not as bad a period pains I had experienced..another story), I didn't ask for drugs until the pains came right after another, and while the anesthesiologist was interviewing me, my nurse who was very alert, had me lay down on the bed for an exam. My baby's head was starting to show but the monitor showed he was in trouble, the chord around his neck. The doctor performed a deep episiotomy and in three pushes he came out, and not breathing. Luckily the anesthesiologist was still on hand and he siphoned out my son's lungs. Sam cried heartily until he reached my arms and I said "hello Sam" and he stopped crying.

There was a trade-off to the v-back and the section. The episiotomy caused me great discomfort for a few weeks but at least I wasn't on heavy drugs, and not recovering from major surgery. If I had it to do again (but I declared the baby shop closed), I would go vaginal if all things went well. And yet on the other hand....

If I did deliver Sam through c-section he would have had the chord around his neck, and those precious minutes, when he wasn't breathing caused him to have borderline cerebral palsy. He was always a year, physically developmental behind his peers until he became a teen. He is now all caught up, thank goodness.

So it's a crap shoot really, isn't it?

[Katherine Brengle]

8. A c-sxn might reduce the pain of labor and delivery, but the recovery is

longer and more painful.

I don't think this should be an elective procedure, but I'm not going to tell anyone they can't do it (if that makes any sense).

If the only concern is the pain, there are very effective pain medications available during labor (as I can attest--epidurals are your friend, lol).

Unless it is necessary, it just seems like a cop-out that doesn't have many benefits.

IMHO.

[Daphne08]

12. I have had one of each, one normal vaginal delivery and one

Caesarean.

Both deliveries were difficult, but I was able to function normally again within days after the normal delivery.

It was months before I felt normal again after the Caesarean although I am thankful to have had it. Otherwise my second child (and I) probably would not have survived the childbirth since I was in labor for over 30 hours with no dilation.

Anyway, they are both grown now and all is well.

I've endured four surgeries in my life, and surgery is most definitely an invasive procedure which should be avoided if at all possible. (I've also noticed that each successive surgery took a definite toll on me, but that could be due to the general anesthesia I had with each. I really do believe anesthesia is detrimental to the brain although I have no support for that belief.)

[indie_voter]

15. Me too

The vaginal delivery was a much better experience. The recovery time was much faster too.

I was so happy I had a doctor who encouraged a VBAC (my caesearean came first, my son was breech and I had severe pre-eclampsia).

[Horse with no Name]

14. There is always an inherent risk with anesthesia

and complications from them such as blood clots, wound infections, excessive blood loss, etc.
The most "uncomplicated" deliveries that I have ever seen have been performed by midwives (in a hospital setting) who took the time to manually stretch the perineum to avoid an episiotomy, and basically just took time for nature to take it's course.
Not everyone is wealthy and can take the necessary 6 weeks "off" after a section nor does everyone have help afterwards.
I had a dinner party for 10 the week after I had my first child vaginally and was playing softball after two weeks.
Childbirth hurts--whether you take the pain up front during or incisional/surgical pain after.
I think it is absurd (and dangerous) to treat a surgical procedure like it was a walk in the park. It is not.
You also have to address hospital staffing issues. If you have an entire floor of fresh c-sections, it will require more staff thus creating a larger cost to the hospitals. If this were to become trendy, I daresay you would have more ob/gyns refusing to deliver babies (this is a huge problem in the rural areas) and you would basically render midwives obsolete.

[Mayberry Machiavelli]

35. You might be surprised. A lot of OBs would like and welcome the situation

where people elected C-sections as a choice or if it was the norm.

If an OB does a C-section and there is a significant complication, from bleeding, wound infection, etc., certainly there is potential liability for that doctor.

However, the single biggest liability for OB doctors is a bad fetal outcome, death or brain damage, cerebral palsy etc., which could be blamed on a botched delivery, late decision to do a C-section etc. This is probably the single biggest reason for so many of the "unnecessary" C-sections. If the OB doc at least made an early decision to operate, even if the reasons for surgery were "so-so" and not "RED ALERT", if the outcome of the fetus is bad, at least it will be very hard for them to be blamed for sitting on a bad labor. I'm not saying it's right, I'm just saying this is what I perceive as the reality of the situation.

A lot of OBs would very much like the predictability of elective C-sections, in terms of their lower risk of bad fetus outcome lawsuits, and the predictability in their lifestyles (i.e. not attempting to labor that patient until 2AM then C-sectioning). They might even make more money, if they bill different fees for C-section versus vaginal delivery, not sure about this. I had heard in some settings OBs charge a fixed package fee for the whole prenatal care and delivery which was the same regardless of delivery method but I don't know the facts about that.

Of course OBs who don't like to operate wouldn't like it at all. Practices would probably sort themselves out with some OBs becoming "surgery only" OBs and others "specializing" in vaginal delivery. That'd be my guess.

[atommom]

18. I had two chidlren by c/s. I wouldn't recommend it unless it's medically

necessary. The recovery was longer than I would have liked, and it's no fun taking care of a newborn right after having major surgery. OTOH, I can understand why some women see the c/s as a safer, less frightening option, especially if they've seen others have bad experiences with vaginal birth.

My first c/s was an emergency ... the baby needed to come out ASAP. I scheduled the second c/s on the doctor's recommendation. I'd had to have some uterine repairs (and a blood transfusion) during the first surgery, and she told me that the risk of a rupture would be unacceptably high with a VBAC. Some of my acquaintances still criticized me for making that choice ... I just explained my position and refused to discuss it any further.

Personally, I think these choices should be between the doctor and the patient. I, personally, wouldn't choose to have surgery if I didn't think it was necesary, but each person should be free to make her own choice.

[Mayberry Machiavelli]

23. A lot of OBs don't even really offer VBAC as an option depending on

where you are. It's a somewhat controversial issue with some fluctuations in "fashion" depending on what studies have come out most recently and what incidence of catastrophic uterine rupture was demonstrated in those studies.

I'm amazed that acquaintances would even attempt to question your personal medical choice, especially when what you chose is in fact the most common thing done.

[atommom]

27. My doctor actually did offer VBAC as an option to most patients.

And she did say I could try if I really wanted to ... but that I'd have to be in a different hospital, with very careful monitoring, and she thought it was an unnecessary risk. After talking it over with her, I had no qualms about scheduling the c/s.

The people who questioned me were people with an intense dislike of medical interference in the birth process. I thought they were sincere, but extremely naive.

[laundry_queen]

34. I don't think they were naive.

Probably well-meaning, but naive most of those women are not.
As for your doctor, she may OFFER VBACs but with caveats like those, who would take them? I wonder what her VBAC rate is.
Some women don't like medical interference and some comfort in it and both want control over their choice of delivery. I've been on both sides (VBAC and scheduled c/s). It should be up to the woman, but also I think there is a void of information for the risks of c/s for patients of OB's. As I said down thread, an increase in c/s is a win-win-win for doctors. Better hours, more money and less liability. That's why is often imperative to find your information elsewhere because your doctors is often firmly on the side of c/s - without much research to back him up.

[atommom]

59. Maybe naive was not the best choice of words.

But I have to point out that I know several patients of hers who did VBACs successfully, and she did not give them the same warning she gave me. My problems were due to a structural malformation that made a rupture much more likely, so my case was different from most. Some MDs may indeed do too many c/sections, but that wasn't the case with mine.

[SmokingJacket]

30. I have almost exactly the same story, and same conclusions.

Except that I was willing to do a VBAC, but my doctors all refused.

I had very bad reactions to the anesthesia both times (passing out, heart racing, vomiting) and would have preferred a more natural birth.

On the other hand, I didn't get all torn up, which is nice.

[mopinko]

19. this is why i had 4 babies at home.

people would say- isn't that risky? and i would say, no, because there is zero risk of an unnecessary c-section. my docs had a 4% c-section rate. no that is not a typo- 4%. that is the real number of medically necessary c-sections, people.

[Mayberry Machiavelli]

26. You are right that there is zero risk of an unnecessary C-section, but

there is also a low chance that a baby could be extracted in time from certain types of trouble.

Your statement that your OBs have a 4% c-section rate in no way proves that is what the community rate should be. It is not a statement based on any scientific data.

Did your docs deliver all these babies at the mothers' homes? How would you know if any fetal deaths or brain damage occurred that might have been preventable in a hospital setting? Do you know how many, if any, cases they settled out of court? How would you know this?

Don't get me wrong... I think many, many unnecessary c-sections are done for a whole lot of reasons. And I'm glad your deliveries went well and validated the choice you made.

But there are at least two sides to every issue. It's not all good or all bad. You may largely avoid unnecessary c-sections based on "soft" indications by delivering at home. In addition, you pretty much eliminate the risk of hospital acquired infections.

However, if you chose this, and were unlucky to have certain situations arise that WOULD require urgent surgery, you also would be buying into increased risk of complications and death for the fetus and mother by having made this choice. I think the choice is a little more complicated than how you have presented it.

[carolinalady]

29. True-most home births are done by midwives, not Docs and

in PA where we had a large Amish population, we had some of the messiest failed home births.

[Mayberry Machiavelli]

37. Most OB physicians would not want to buy into the liability of doing

deliveries in a home setting. The hospitals they are affiliated with would likely not grant them privileges or maintain their privileges if they brought in one or two "disasters" for crash C-section where it took, say, half an hour to get the patient to the hospital through traffic, and had a bad outcome. Potential millions in lawsuit payout.

The malpractice insurers would likely charge such OBs much higher rates, if they would insure them at all.

Of course it would be a different scenario if we are talking about a rural area without much access to hospital etc.

Disclosure: I'm not an OB so I don't know the full details of this, this is my guess based on my knowledge of the current U.S. medical universe.

[mopinko]

48. wrong about that.

the docs i had have such a clean record that they have no insurance problems.
a lot of what goes wrong in hospitals is their own damn fault. i had my first in the hospital, and nearly ended up with a c/sxn. just because they wouldn't feed me, and discouraged me from walking around. at home, it is about support. no procedures and rules that are for the benefit of the staff. and no "tee time sections". strap a laboring woman down with a monitor, and wonder why labor stalls. duh.

[Mayberry Machiavelli]

49. I said MOST. I checked out your doc's website. Certainly an exception.

[mopinko]

51. i admit they battled for a long time.

they are up against a lot of perceptions. and the hospitals hate them. many of their back up docs have been threatened with loss of privileges.
but they have a track record now that no one can legitimately question.

[laundry_queen]

31. There have been many studies done on homebirth.

And the chances that the mother requires urgent surgery and the baby dies are the same in the hospital as for at home.
I don't know if you've ever given birth at a hospital, but frequently during labor, you are left to your own devices for hours at a time. Nurses breeze in once in awhile. Doctors only come in if called by the nurse. The anesthetist is often only on call (especially in smaller centers).
At home a midwife is with the woman the WHOLE time and is trained to spot and react on problems much sooner than most nurses are. Not to mention in the case an emergency surgery is required, the midwife will often call ahead giving the OR the same amount of time it would need to be ready as it would need were you sitting in a hospital bed.
The statistics just do not bear your opinion out.

[carolinalady]

33. I have to disagree with you-Nurses are highly trained to spot and

react to problems and they have nationally accepted standards of practice for monitoring patients in various stages of labor. I am not sure where you are getting your info from on hospital labor and delivery nursing standards, but if it is from a personal experience, then I would not go to that facility again. Labor and delivery nurses are highly trained in fetal monitoring and what corrective actions to take in the case of distress.

[Katherine Brengle]

41. I am sure that nurses are well-trained, but I can attest to the "breezing

in and out once in awhile" claim.

I spent most of the time I was in labor (in the hospital) watching television with my husband without a nurse or doctor in sight.

Also, when you think about, midwives are essentially specialists--all they do is deal with pregnant women--therefore they probably do have more experience in dealing with deliveries. Doesn't mean that nurses aren't capable and well-trained, just that they aren't necessarily better.

[carolinalady]

42. Not saying nurses are better, but you would be surprised how

many times nurses deliver the little critters. Labor and delivery nurses are specialists as well. That is all they do and many of them have just as much or more experience than midwives. When you get your midwifery license, you receive training in the whole perinatal process including meds, screeing tests, etc, but the actual birthing part is the same as an l&d nurse. Of course, l&d nurses don't do episiotomies and they turn over the case whenever the doc decides to show up! LOL.

[FearofFutility]

61. Labor and Delivery Nurses are also specialist

That is all they do and are highly trained. Nurses in hospitals most often have 2, sometimes 3 other mothers who are laboring and are not able to spend every minute with one patient. Laboring is also a natural process, and it is not necessary that the nurse is present for every single minute. Monitors are placed on the mother so that the baby is continuously monitored. BTW, a lot of midwives are in fact nurses. At the birthing center I went to for prenatal care, all of the midwives were nurses.

[FearofFutility]

56. I had a midwife with my second child

but delivered in the hospital because I was VBAC. She was with me the whole time and was absolutely wonderful. One thing I'd like to point out, though, is that on labor and delivery units, the OR is ready in a matter of minutes if it's an emergency. I witnessed this first hand in nursing school. We had a patient who needed an emergency c-section ready and on the table in under 5 minutes. That was the norm at that hospital. Unless you live next to a hospital, I'm sure it would take much longer than that. When a baby is in distress, every minute counts. I totally support those who choose home births, but those who choose that route need to fully educate themselves about the increased risk of a bad outcome if the baby is in distress.

[mopinko]

38. they have delivered 30,000 babies

only one dead that i know of. also recently made a statement that of the many babies in their care, many are not immunized for religious reasons, and they have yet to see a case of autism.
this is an urban area, where pretty much every family is within 15 minutes of an OR. except for the fact that turf wars get in the way with the hospitals sometimes, those women get into the OR pretty much as fast as they would if they were down the hall. they like to make it seem like magic in the hospital, but it still takes time to open a room and assemble a team. it takes the same amount of time, no matter where that woman is.
they do tend to attract a lower risk demographic, but since many of their families do it for religious reasons, they do have a pretty full cross section.
but before this doc started his practice, he worked with a woman who did home births, through the public health dept., for the poorest of the poor in chicago, and had a similar, stunning record of safety.
homefirst, my docs

[Mayberry Machiavelli]

43. "That you know of." Also, we will have to agree to disagree on your

statement that "it takes the same time". I'm a physician who works in an operating room setting, and having been part of many emergency surgeries, I would agree with your statement that even when people are "in house" it takes some time to assemble an OR crew etc.

However, to say that people being at home, even a few miles from a hospital, is the same as being "down the hall" I will totally disagree with. Say you place an emergency call. Time how long it takes for the dispatch to contact the ambulance, ambulance to arrive at your door, EMTs to place mom in stretcher, roll stretcher down steps and into ambulance, and get through the hospital doors and up into the OR.

I guarantee you it'll be LOT longer than "down the hall" and into the OR, although if it is a true emergency then the OR crew, OB doc and anesthesiologist/anesthetist should already be mobilized while the patient is in transit, and waiting for patient when they arrive, so a few minutes THERE are saved.

You are describing a specialized situtation if a lot of the patient population seeks this practice out because of religious or cultural affiliations. You are already conceding that they may have a lower risk demographic, but then you backtrack and say they have a full cross section. Which is it? Even if OB's see all the same types of patients, but one sees forty percent high risk no prenatal care indigent patients, and another sees only 4 percent patients of that type, it's a huge difference in the complication rate, C-section rate etc.

And, not to threadjack into a different topic, you mentioned no autism in babies not immunized. Well that's to be expected if the autism is attributed to preservative in the vaccination. But what about cases of measles, mumps, rubella, whooping cough etc. in babies not immunized, which is the reason for the immunizations in the first place, NOT to prevent autism?

[carolinalady]

44. Our OR was right in the L&D suite. If we had a baby in distress,

the nurses began prep of the patient and instruments. We all had to learn to assist in C-sections. Even if the Docs were not there yet, when they got there, all they had to do was scrub in and start working. The patient was prepped and in position, and everything was ready. It was very fast.

[davsand]

54. My daughter was an "emergency" C-Section delivery.

It was some time around noon when they told me her heart rate was dropping and that I needed an emergency C-Section. She was delivered at 3:30 that afternoon...

I sure as hell didn't see much of an emergency response on the part of the Docs or the hospital. The were WAY too laid back about an "emergency", IMO.

Hell, if I hadn't been so scared for my kid, I'd have had time to buy groceries, get my hair cut, and get a full manicure before they ever rolled me into a surgical suite. I'm not sure there IS much argument for going to a hospital if they all treat "emergency" deliveries with that kind of speed.



Laura

[Mayberry Machiavelli]

62. If they actually made that decision around noon and she wasn't delivered

until 3:30PM, that is really too long. The American College of Obstetrics and Gynecology (ACOG), the professional society for OB's, goes with a "30 minute rule" for "decision to incision" that basically says that hospitals should be able to begin a C-section within a half hour of the decision to do so, even if it's for the less urgent, common, reason of the labor simply not progressing well, baby doing fine etc. There is some controversy over the 30 minute rule, but that's what we're currently going with.

Obviously if it took hours for them to start this, their real sense of urgency about the problem was not very acute.

Now it's a different story if they were just "thinking about" doing a section at noon due to some concern over the fetal monitoring, but hadn't definitely arrived at that decision until later in the afternoon...

[davsand]

68. They told us they were waiting for the room to open up..

They did say that they thought everyone was "stable" after they turned off the Pitocin, but even so--to the folks who were scared shitless about a baby is distress it was WAY too long.

I'd been on that Pitocin IV since 5 am and they turned it off when they noticed her heart rate had dropped. What was so panic inducing was the response they had. About three docs and a handful of nurses came running into my room and they all had to discuss it before they told me what was going on.

My husband had gone out to grab some lunch with my parents (He'd been there with me since I was admitted at 4:30 am.) Hubby had left me there with my doula and was due back pretty quickly. I asked them if they could wait on my husband to get back and the perintalogist said, "...If he hurries."

About 90 minutes later they took me down to get a spinal and get prepped.

Baby was fine--her apgar was perfect. She emerged screaming and pissed OFF at them all. Her little hands were waving around and she was kicking. That was the best noise I have ever heard, however, I was left wondering just how much of an emergency it really was.

Thanks for your input, Doc. It is nice to hear that maybe there was some basis for my later criticism. At the time I was so very happy to just have a healthy baby I really didn't question it--ya know?

Peace.


Laura

[mopinko]

47. i only say "that i know of" because

i haven't seen them in a long time. my littlest is now 12. i guess he could have some dead babies that he is hiding in the closet, i wouldn't know.

[Mayberry Machiavelli]

53. By the way, the website says 15,000 not 30,000 as you state. The only

doc named is Dr. Eisenstein. I am assuming there must be other OB's involved that are not named on the website otherwise it would be very difficult for one guy to cover multiple pregnant patients especially when they are all delivering at home at various locations around town.

It is a very specialized kind of practice. Since the emphasis appears to be on homebirth (I see that Dr. E has his own radio show and has published books on this topic, has a store with related products etc.), and minimal meds and intervention, I'm assuming there's probably no availability of epidurals or narcotic pain relievers. I find it interesting that Dr. E has a law degree as well.

People choosing this practice would likely be a self selected group of highly motivated, anti medical intervention type people, such as I would imagine yourself to be. Again, highly motivated for this type of approach.

Just the nonavailability of epidurals alone would make this kind of practice a "no sale" for the huge majority of pregnant ladies in my area. Culturally, the patients I see most frequently WANT intervention, most like the paternalistic OB telling them what to do, and they want their epidural yesterday. They're also by and large not very motivated to avoid a C-section. That's just a feature of the area I happen to be in right now.

[mopinko]

69. my bad, like i said, its been a while. and

they had 4 clinics, 7 docs, i think when i was there. scattered about the suburbs.
i know the epidural thing is big. i dunno, i guess i have weird pain response, i never thought about it. my first was in the late days of lamaze. it seemed cowardly to me.
i didn't find them or the clientele to be all that "anti-" anything, but maybe that's me. i'm not anti-medicine. half my family would be dead without doctors. but i admit i hated the whole hospital experience.
i just think that it's a family event that belongs in the family. wanted a birth, not a babyecotmy.



as far as demographics, i still refer you back to (i think) dr beatrice white, of the chicago public health service. i believe she slightly preceded dr quentin young, if you know him. plus, there is a subset of religiously motivated patients that are a far more random sample. same stats.

[BeTheChange]

60. Birth Centers..

are becoming more and more accessible. I was glad to know that my insurance actually includes the ones in my area. These are usually a midpoint between homebirth and hospital birth and they make precautions with ambulatory companies in the case that something did require more urgent measures.

I find it appauling that we have such a high infant death rate. I find it appauling that the links between bonding and labor arent more widely studied.

[Ilsa]

20. I've just about given up. If people want to remain stupid about

their choices and the effects on their bodies, then there isn't a lot I can do to stop them. They spend 9 months reading every detail about a pregnancy, then don't bother to look at the long term effects of either type of delivery or breastfeeding or parenting.

[Katherine Brengle]

40. Very true--

It's as if the actual pregnancy and delivery is the most important part of having a child for some people--of course it is important to be educated about keeping yourself and your baby healthy while you are pregnant, and it is absolutely necessary to know (as much as you can know) what will happen during the delivery and what your options are, but this is not the be-all-end-all of becoming a parent.

When it comes down to it, parents will face many, many more obstacles and need to know much more about actually parenting their children than they need to know abour birthing their children.

[carolinalady]

25. I used to be a labor and delivery nurse. I had one child via

c-section after 48 hours of failure to progress, then I had the second child VBAC after 20 hours of labor. Six weeks later, I grabbed my husband by his throat and said, "Listen to me. I do not care if you die tomorrow, I am never doing this again." Two weeks later I had a tubal ligation and that was the best surgery, I ever had! I've tried it both ways and both ways suck!
;)

[fedupinBushcountry]

64. I had surgery to get pregnant

and then the C-section, then I had to have surgery again to get pregnant again (my fallopian tubes were twisted), luckily just needed help with forceps with him. Now the third time was not expected (no surgery) and she slipped rightout, thank God.

Well my husband knew I got my girl, the first 2 were boys, I had 3 brothers no sisters, so I desperately wanted a girl. Well anyway, he looked at me and said, I'll make the appointment in the morning, no way was he going to make me go through surgery again, especially after what I went through just to open the damn things up. LOL.

[carolinalady]

65. I see your point and I admire your bravery for number 3- I had

two boys and just came to the conclusion that I don't do girls (even though I would have love to have one). I wasn't brave enough to risk the odds.

[indie_voter]

66. LOL!!

I hated being pregnant. I hated my c-section, had a better experience with my VBAC. I never want to do it again.

MHO, the problem is not that c-sections are bad, they aren't. It saved my life (severe pre-eclampsia known as HELLP).

I just don't understand why a person would choose a c-section BEFORE ever experiencing labor (be it fear, wanting to schedule the birth, etc). However, there are very legitmate reasons to have one.

[laundry_queen]

28. Offering a c-sxn to all women only works if the actual risks are disclosed

Too many c-sxn risks are routinely downplayed - like the risk of anesthesia, post operative infection, bladder problems (the bladder has to be peeled away from the uterus before the uterine cut can be made), difficulty breastfeeding, hemorrage (women who have cesareans lose on average twice as much blood as those who deliver vaginally) and so on.
Many women are scared shitless of labor and in this day of control freaks, most would rather not 'lose control'. With a cesarean, everything is 'controlled'. For some women this=comfort.

I've had an emerg. c-sxn after a long labor, a vaginal birth after a normal labor and a planned c-sxn with no labor and without question the vaginal birth had the easiest recovery, I was home 12 hours later and felt great. I could do my normal daily chores the moment I returned home. Unlike my c-sxns where I spent 4 days in hospital recovering and many more at home nearly immobile from the incision, unable to care for my other young children.

After my last planned c-sxn (which was not my first choice, a vaginal birth was but my dr insisted) while I was in pain trying to move my legs off the hospital bed, wincing in pain every inch of the way, I yelled to my dh, "who in their right mind would CHOSE this??" People forget you might skip the pain of labor, but the pain of recovery is often very intense and lasts much, much longer.

I think it's the doctors that generally are pushing for this - more money for them, more 'regular' hours and less liability. It's a win-win-win situation for them. And then they come under this nice little guise of 'women's rights and choice' which I do believe they should have, HOWEVER, to trust a doctor to give women the straight facts about it is kind of like trusting Fox news to give you the straight facts about the current administration. :P

[Mayberry Machiavelli]

45. I agree with pretty much everything you've said in this post. Risks of

complication in general are downplayed too much. This is an honesty and communication issue. Especially if people are to make a important choice like this, it's not really a very valid choice if the consequences of the decisions are not communicated well.

Another topic is that many patients abdicate their informed consent by "not really wanting to know" unpleasant realities and even waving off their doc when they are attempting to consent them. They really just want the paternalistic doc to tell them what to do. How this correlates with watching Fox news or voting shrubco, you'll have to tell me. ;)

As you will see in one of my other posts on this thread, I agree with you on the "win-win" aspect of this for the OBs.

[cynatnite]

46. It's the horror stories women hear about

Horror stories get more attention and inflict more fear than anything else. I think that's what's driven a lot of this.

The unexpected is more likely to happen if a woman hasn't had prenatal care during her pregnancy. With the advent of regular exams, ultrasounds, other tests and specialists women have more tools at their disposal to insure the health of their baby and themselves.

Another point is, no matter how minor the possibility, no woman wants to take any risk whatsoever with their life or baby.

I will take normal labor and delivery over a c-section any day of the week. Three children and one of those a c-section...no contest. Recovery from a c-section is hell.

[FearofFutility]

70. I agree with you

Another issue is the increased incidence of respiratory problems for babies delivered by c-section which to me is a a very big reason not to have an elective one.

[AzDar]

32. I have had two children; one vaginally, one Cesarean...I have NEVER

experienced pain like the pain I felt after my abdominal wall had been sliced open. Even the morphine admimistered wasn't enough to assuage it.And oh, dear..the pain when walking a day or so after was excruciating.The incision leaves you less mobile, which translates to needing more help with the baby..
Give me a vaginal birth (with an epidural, of course)ANY day over Cesarean.
I had to laugh when I read an article stating that Britney Spears was going to "schedule" a c-section, because she feared the "pain of child-birth".
Clueless.

[seabeyond]

36. epidural, best of all words. love my nurse bob..... n/t

[Neil Lisst]

39. So you're not going to have a Caesarian?

That was the title to a chapter in one the books I read nearly thirty years ago when my ex was pregnant with our first. We were doing the Lamaze classes and committed to the natural birth.

The chapter I read informed me of the need for caesarian in certain situations of fetal distress. I read the chapter carefully, and noted all the indicators of fetal distress. When those indicators arose during labor, I knew to get the doctor immediately, and knew that the C section was necessary to save the baby.

I think that involved the best approach. Go with nature's way, but use our knowledge to intercede to protect mother and child.

[nonconformist]

52. I've had two children vaginally.

I was AMAZED how fast my body recovered. Literally AMAZED. I was up and about within a couple of hours, and pretty much completely back to normal within a couple of days. In fact, I had more pain with the episiotomy I had with the first birth than I did with the small tear I had with the second birth.

I've never had a c-section, and would never unless the life of the baby or my own was in danger. I know many people who have had c-sections, and have witnessed their recovery. Their many, many weeks of recovery and intense pain. Their resulting scar. I can't imagine that anyone would choose to actually have an unnecessary one.

[spuddonna]

67. Same here...

Hospital delivery both times in 'labor centers'. My first (son) had a huge head! lol Well, not really funny cause the episiotomy was KILLER. I could not sit down properly for a week after the birth, although the rest of me was fine.

With my daughter, I felt great the next day. I tore naturally, tiny episiotomy (which took a lot longer to heal than the rest of the tear), and I was able to sit normally the next day.

I knew a lot of women where I worked who had emergency c sections. Almost everyone talked about a two week recovery time. I don't understand how they can offer that as the 'quick and easy' solution? All these women had to have family come to help take care of the baby or other kids because they could barely move the first few days. I understand if there is a true health risk to baby or mother, but why have a major surgical op if you don't need to?

Also, I had the epidural and pitocin on my 1st because he didn't want to leave (I was a week overdue), but no epidural or pitocin on my second. My second was sooo much easier. I had wave after wave of labor pains with the pitocin on the first labor (why I got the epidural)... It was a totally different pain on the 2nd natural childbirth. It was much more bearable. Looking back, I wished I had gotten a midwife for both...

[earth mom]

55. I had a c-section and

I got the impression from my doc that he did it because of the "potential" for a malpractice suit. My labor was long, but not as bad as I'd expected from what I'd heard of from friends who'd had labors much longer and more agonizing than mine. Since I'd expected the worst, I was surprised when the doc said let's do a c-section. Afterward, I thought he'd made a smart decision- especially considering that the surgery cost between $10K to $13K and a big chunk of that fee was his. This was over 10 years ago, and since then, I've found that the trend for c-sections is definitely on the upswing.

[bleedingheart]

57. I have done it both vaginally and c-section

and you heal faster from the vaginal delivery....problem is that vaginal delivery can go on a very long time and in my case it was 12 hours of labor with the last three being constant pain and pushing...no drugs. It was awful. My son didn't want to come out...so they brought a vacuum extractor and on the second try he was out...but if it had not worked...I would have had to undergo a c-section.....4 days later I was in congestive heart failure...

My daughter was born c-section due to being breach and because my heart was again a bit stressed...I was awake for it...but had a spinal to numb the pain...didn't feel anything but pressure.