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How Childbirth Became Industrial
April 17, 2012 2:33 PM   Subscribe


 
And each contraction pushes the baby’s head down through that funnel, into the pelvis. This happens even in paraplegic women; the mother does not have to do anything.

This sounds fascinatingly odd to me. How is this possible?
posted by elizardbits at 3:07 PM on April 17, 2012 [1 favorite]


Hmmm, I thought it'd be more about this.
posted by FatherDagon at 3:12 PM on April 17, 2012 [1 favorite]


How is this possible?

Half-educated guess: it's because the contractions would be controlled by the autonomic nervous system (which has to still be functioning in order for them to be paraplegic and not just, y'know, dead.)

Agree it's a bizarre-seeming fact nonetheless.
posted by ook at 3:15 PM on April 17, 2012 [1 favorite]


I didn't know this. I wonder if Ray Davies did.
In 1817, for example, Princess Charlotte of Wales, King George IV’s twenty-one-year-old daughter, spent fifty hours in active labor with a nine-pound boy. His head was in a sideways position, and too large for Charlotte’s pelvis. When he finally emerged, he was stillborn. Six hours later, Charlotte herself died, from hemorrhagic shock. She was King George’s only legitimate child. The throne passed to his brother, and then to his niece—which is how Victoria became queen.
posted by Mental Wimp at 3:20 PM on April 17, 2012 [1 favorite]


My wife's contractions were never closer than four minutes apart and were actually decreasing in frequency when delivery started. This was quite inconsistent with the script we'd been given ahead of time.

Great article.
posted by Slothrup at 3:20 PM on April 17, 2012 [1 favorite]


When I was a kiddo I used to wish for flying cars, but now that I'm a grown woman contemplating childbirth, I wish for artificial uteruses.
posted by muddgirl at 3:22 PM on April 17, 2012 [2 favorites]


Normally I don't mind old articles but this definitely seems a bit outdated. The Business of Being Born brought all these issues mainstream in 2008.

Interesting read but kinda all over the place. Even though it was only 6 years ago, it seems a lot older. I suppose that's a good thing? (Or maybe my perception is skewed b/c I live in Berkeley.)
posted by mrgrimm at 3:23 PM on April 17, 2012 [1 favorite]


someday i will probably become a mother but for now i will continue to be icked out by the process of delivering a baby
posted by mlo at 3:24 PM on April 17, 2012 [1 favorite]


When I was a kiddo I used to wish for flying cars, but now that I'm a grown woman contemplating childbirth, I wish for artificial uteruses.

Up until I was old enough to know better, that's how I thought "test-tube babies" were gestated.
posted by mrgrimm at 3:25 PM on April 17, 2012 [3 favorites]


The article is what it is. I enjoyed the longform writing and have passed it on to an obstetrician friend. Thank you Rope Rider.
posted by taff at 3:31 PM on April 17, 2012 [1 favorite]


[Comments removed. It's flag and move one, folks, not flag and then also complain in the thread.]
posted by cortex at 3:34 PM on April 17, 2012


And each contraction pushes the baby’s head down through that funnel, into the pelvis. This happens even in paraplegic women; the mother does not have to do anything.

This sounds fascinatingly odd to me. How is this possible?


The hormone oxytocin stimulates uterine contraction among its other effects. It's mentioned in the article as Pitocin.
posted by euphorb at 3:34 PM on April 17, 2012 [1 favorite]


If you want more of this, Gawande covers a lot more of this kind of ground in both Better and Checklist Manifesto. He talks about the Apgar scale in one of them, and I can't recall which one offhand.
posted by rmd1023 at 3:40 PM on April 17, 2012 [2 favorites]


The story of the forceps is both extraordinary and disturbing, because it is the story of a life-saving idea that was kept secret for more than a century.

So there were numerous documented cases of fetal skull fracture in the late 19th, early and mid 20th century from forceps. There was a case a few years ago in the UK as well. Doctors (before the use of ultrasound) used to feel the top of the fetal head, looking for the sutures to determine where to slip the instrument into the birth canal in order to avoid puncturing the very fragile fetal skull, or crushing it inadvertently, or tearing either the vaginal or uterine membranes. It was inexact, and dangerous for both the baby and the mom.

But their use also likely saved countless lives. Forceps were typically used in difficult births, and as the article mentions, they were kept a secret. Some doctors, afraid that mothers would see the instrument and freak out, would bring them into the operating room in enclosed boxes, and only use them once the mom was blindfolded.

These days, ultrasound is mandated for use of forceps.
posted by zarq at 3:43 PM on April 17, 2012 [1 favorite]


How about vacuum-assisted births? Has the vacuum replaced the forceps?
posted by ThePinkSuperhero at 3:49 PM on April 17, 2012


I had a forcep birth, so definitely no! The risks are different. They pretty much don't do "high" forceps anymore because that kind of prolonged dragging is replaced by the c-section, but they definitely do "low" forceps when the baby needs to come out right away and pushing isn't going as quickly as planned but the baby is right there ready to come out. (In my situation my baby's heart rate went down to 60 and stayed there, which is bad news, but it all worked out perfectly and neither one of us is worse for the wear).
posted by the young rope-rider at 3:54 PM on April 17, 2012 [1 favorite]


Holy crap, really? They don't use forceps at all at the hospital where I delivered. Did you know that might be an option going in?
posted by purpleclover at 3:59 PM on April 17, 2012


I pretty much love everything Gawande writes. Thank you for this.
posted by Afroblanco at 4:00 PM on April 17, 2012 [1 favorite]


ThePinkSuperhero: "Has the vacuum replaced the forceps?"

In many cases, obstetricians do seem to prefer vacuum-assisted delivery. But it has not completely replaced the forceps, no.

Of course, in cases where the fetus is in distress a c-section remains an option.
posted by zarq at 4:01 PM on April 17, 2012


Ditto, Afroblanco.

It is my recollection that vacuums were essentially a fad as they are in fact worse than forceps as far as incidental injury to the newborn is concerned.
posted by ocherdraco at 4:02 PM on April 17, 2012 [1 favorite]


(And by "were" I mean "are".)
posted by ocherdraco at 4:03 PM on April 17, 2012


ocherdraco: " It is my recollection that vacuums were essentially a fad

Really? I know that they're still being used in the hospital on Long Island where my wife gave birth. Or at least they were 4 years ago.

...as they are in fact worse than forceps as far as incidental injury to the newborn is concerned."

Not according to the studies I've seen.
posted by zarq at 4:08 PM on April 17, 2012


Hmm... the book where I thought I read about vaccum extractors not being as effective as forceps doesn't seem to contain that information. So maybe disregard that, unless I can locate it elsewhere.

However! In said book (Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank by Randi Hutter Epstein, MD), one of the three index entries for vacuum extraction leads to this interesting tidbit:
...orangutan dads are the best helpers of all. When the newborn is crowning, the dads stick their big fleshy lips to the newborn's head and suction the little guy out of the birth canal like a vaccum extractor.
posted by ocherdraco at 4:12 PM on April 17, 2012 [5 favorites]


Holy crap, really? They don't use forceps at all at the hospital where I delivered. Did you know that might be an option going in?

If they don't use forceps that means they would've done an emergency c-section, possibly under general anaesthesia, which has its own risks (and benefits).
posted by the young rope-rider at 4:13 PM on April 17, 2012 [1 favorite]


Yeah, zarq, I'm thinking that my memory on that (from a big binge on medical history books last fall) is way, way off. Disregard! Disregard! Vacuum extractors are A-OK!
posted by ocherdraco at 4:13 PM on April 17, 2012


OMG. HA!

Ocherdraco, that's awesome.
posted by zarq at 4:14 PM on April 17, 2012 [1 favorite]


Yeah, here's the medscape summary comparing VE and forceps: here.
posted by purpleclover at 4:14 PM on April 17, 2012 [1 favorite]


My son was a forceps birth. He wanted to stay inside so badly, the doctor actually put one foot up on the delivery table to get better leverage getting him out. She did an amazing job - he came out smoothly without any marks on him and in in perfect health. But using the forceps required a massive episiotomy. I spent the first month sitting on an inflatable donut and didn't heal fully for well over 4 months. I know from pieces like this and The Business of Being Born that I should be thrilled that I avoided a C-section, but I look at my recovery time against my friends and family members who had sections, and it's just... really hard to be objective about this.
posted by Mchelly at 4:14 PM on April 17, 2012 [9 favorites]


ocherdraco: "Yeah, zarq, I'm thinking that my memory on that (from a big binge on medical history books last fall) is way, way off. Disregard! Disregard! Vacuum extractors are A-OK!"

You might actually have been thinking of the Towner series? See purpleclover's link.

And purpleclover, thank you. That's fascinating and educational.
posted by zarq at 4:29 PM on April 17, 2012


Hmm, that may well be the study I was reading about, but my hazy recollection upthread is still a bad summary.
posted by ocherdraco at 4:39 PM on April 17, 2012


In many cases, obstetricians do seem to prefer vacuum-assisted delivery.

Also, depending on how far out in the sticks you are, there's the plunger.
posted by XMLicious at 4:59 PM on April 17, 2012


Mchelly, I know someone who had a vacuum extraction who would have preferred a c-section. I only had a second degree which healed pretty well, I'm not incontinent...basically what I'm saying here is that my OB, although a total ass, is totally getting a Christmas card (possibly with a picture of my bits with a word bubble that says THANKS)
posted by the young rope-rider at 5:01 PM on April 17, 2012


zarq: Forceps were typically used in difficult births, and as the article mentions, they were kept a secret.

In Better, Guwande says that the forceps were a trade secret of a french family of obstetricians for a few generations. Blindfolding the mother had more to do with keeping their technique secret than keeping the mother from freaking out.

Btw, the apgar piece was in Better, rmd1023.
posted by dr_dank at 5:05 PM on April 17, 2012


dr_dank: " In Better, Guwande says that the forceps were a trade secret of a french family of obstetricians for a few generations. Blindfolding the mother had more to do with keeping their technique secret than keeping the mother from freaking out."

No, I did see that. My wife's OB told me once that, similar to the way dentists used to hide certain instruments up their sleeves so as not to alarm their patients, OB's once did the same thing with forceps -- even to the extent of keeping the instruments out of the room unless needed.

However, it's perfectly possible he was wrong, and that the only people that ever had to hide them were the Chamberlen's, in the interest of secrecy.
posted by zarq at 5:22 PM on April 17, 2012


I don't like the end of this article. There was a chance to do something really big here, and the writer copped out by using the quotes from a mother who was devastated essentially saying, "all that matter is that I have my baby."

And I call bullshit on that. There was a start of doing something great by pointing out a need for Apgars for mothers (and other patients), but the writer just copped out.

There are studies that show that women who have c-sections don't respond to their babies cries the same way as a mother who has a vaginal birth at least during the newborn period -- that through MRIs its been shown mothers who've had c-sections can and do have a hard time bonding with their babies (sure, not every single one, and yes, this was just one study). There's an entirely new field of counseling psychology emerging dealing with the aftermaths of traumatic birth experiences in particular.

The writer could have looked into these, could have said more about the immensely positive outcomes midwives have compared to obstetrics in both terms of vaginal births and in terms of how mothers and babies do after the birth.

Interesting a read as some of it was, it didn't go far enough to do what it was trying to do.
posted by zizzle at 5:26 PM on April 17, 2012 [7 favorites]


Interesting a read as some of it was, it didn't go far enough to do what it was trying to do.

I think it was trying to explain why C-Sections became so prevalent, not convince the reader that C-Sections are terrible and midwives are awesome.
posted by Diablevert at 5:35 PM on April 17, 2012 [13 favorites]


I had a C-section with my first because his butt was wedged in my pelvis. We tried to have him turned (cephalic external version) and that was actually the most painful thing I have ever experienced in my life (including the C-section), AND he remained super-stuck. When they delivered him he had two adorable little bruises on his butt from being stuck in my pelvis.

This didn't occur to me, and nobody told me (I guess because it could only have made me more upset and scared, and I was like a SUPERNOVA OF UPSET AND SCARED when I found out I had to have a C-section), but when you have a frank breech baby who's delivered doubled over (or has to be maneuvered around) by C-section, this is HELLA MORE TRAUMATIC to your body than a C-section that comes out head-first. In retrospect this is obvious, but they had to reach in there, yank and shove his butt out of my pelvis, and then PUUUUUSH and pull really hard to deliver him basically doubled over. They said, "You're going to feel some pressure on your upper abdomen ... keep breathing! keep breathing!" And I was like, "I would but some asshole is STANDING ON MY CHEST," because they had to push so hard from the top to get him out. Recovery sucked and I was on sooooo many painkillers.

Anyway, my second one was a C-section too, because I wasn't a great candidate for VBAC and issues with hospitals and, well, when you already have a toddler, the allure of a scheduled birth is huge. My second one was in proper position, so 3 minutes after they began the surgical procedures, an entire baby slid out so easily I was kind-of like, "Wait, when's the surgery part?" Recovery was really easy and smooth that time.

My first C-section I thought the most horrific invention of modern medicine is the idea of being awake and alert while YOUR ABDOMEN IS SLICED IN HALF. I mean, seriously, it's like a horror movie. And I couldn't have anything to ease the anxiety abject terror because they don't want it getting to the baby. My second C-section, I was chatting about basketball with the anesthesiologist because I was totally chill, and here's the thing about an epidural: you can feel pressure, but not pain. So this time, being calm and not freaked out, I could FEEL my abdomen being separated and the incision being held back. It's hard to explain what it felt like, because the sensation is faint and having only pressure-sensation is very odd, but I could feel them moving things around and I knew when they'd pulled the skin back to get at the next layer. I could feel the OB reach in for the baby, and I could feel the hollowness descending as they pulled the baby out. (This time they only pushed a tiny bit up top to help him along.)

And then after they took the baby out and they were putting everything back together, the surgeon said, "Hey, could you hold this uterus for me for a second?" to one of the nurses. I said (out loud, because the second time I was so relaxed and unworried), "Wow, that is not a sentence you really go through life expecting to hear." The surgeon laughed and apologized, but I said, no, it's cool, how often do you get to hear the commentary of someone doing surgery on you? (I also had him take off a suspicious mole since I was numb anyway, which was both good and bad, it saved a lot of money and hassle, but handling a second surgical dressing, even a small one, when you're recovering from a C-section is awkward.)

Both times I had my babies at the height of allergy season and I was soooooo stuffy and I couldn't have any sudafed or benadryl and they stuck that stupid oxygen thing in my nose which made me feel MORE like sneezing, so, things to worry about: what if I sneeze during abdominal surgery? Surgeon's answer: Try not to. With the second one, my blood pressure was low (my blood pressure's kinda low anyway), so they gave me epinephrine right into my IV. Holy CRAP is that better than sudafed!

So yeah, modern medicine: Awesome, but also sort-of creepy.
posted by Eyebrows McGee at 5:35 PM on April 17, 2012 [21 favorites]


well, when you already have a toddler, the allure of a scheduled birth is huge.

No, it isn't.

The lure of a much easier physical and mental recovery is huge, and for me, that involved having an HBAC.
posted by zizzle at 5:37 PM on April 17, 2012 [1 favorite]


This is what the industrialization of childbirth makes me think of.
Mother, on the table: What do I do?
Doctor: Nothing, dear! You're not qualified.
posted by XMLicious at 5:41 PM on April 17, 2012 [2 favorites]


well, when you already have a toddler, the allure of a scheduled birth is huge.

No, it isn't.


I think what you meant to say is 'not to everyone'? Pretty clearly, it was for Eyebrows.
posted by jacalata at 6:31 PM on April 17, 2012 [12 favorites]


well, when you already have a toddler, the allure of a scheduled birth is huge.

No, it isn't.


It sure as hell would be for me!

(personally, the idea of a home birth is absolutely horrible, so this all really is subjective ain't it?)
posted by tristeza at 6:34 PM on April 17, 2012 [2 favorites]


This article reminds me why I don't want give birth.

Unless I am able to find a doctor who is willing to stage an epidural with C-section photoshoot such that it looks like the baby is blasting out of my stomach like in Alien then crawling up my chest to take out my jugular as I make horrified faces. Best baby album ever.

Curiously I have yet to meet anyone who is as enthused about this idea as I am so I'll probably just end up adopting.
posted by schroedinger at 6:40 PM on April 17, 2012 [3 favorites]


Scenario for my first birth was rather similar to the story in the article - late, failure to progress, epidural, pitocin, low blood pressure, fetal distress, c-section. Kids 2 and 3 were born at home to avoid another section. Wish I'd opted for midwife and home birth with the first!
posted by leslies at 6:57 PM on April 17, 2012 [1 favorite]


so this all really is subjective ain't it?

That was exactly my point.

I'll take the natural childbirth at home with my daughter where after I was able to sleep all night without anyone coming in to disturb me or her over the hospital c-section with failed anesthesia, a nurse mixing up my records with someone else's, the year of PPD and PTSD, etc., etc., etc.

Other women will certainly choose and feel differently.

Extrapolating to experiences in general may mean someone else extrapolates in general back.
posted by zizzle at 6:57 PM on April 17, 2012


I think part of the reason I got a vasectomy is that the idea of childbirth has always seemed completely horrifying, and not something I ever want to put anyone else through.

It feels like the article wanted to be about how much better the process of reproducing is now, but that the writer felt compelled to add some booga-booga scary technology to it to appease the natural childbirth enthusiasts.
posted by fnerg at 7:03 PM on April 17, 2012


"Extrapolating to experiences in general may mean someone else extrapolates in general back."

zizzle, I think if you were willing to give a charitable reading to someone who chose a C-section instead of a VBAC, which I know you're not inclined to do, it's pretty clear I was speaking of my own experience, explaining some of the reasons why I had a second one and why it was so different from my first. It makes me sort-of sad that out of my long comment, trying to share my experience and express some of the scary and cool things from my C-sections, since I don't think that many people know what it's like to FEEL major abdominal surgery occurring while it's occurring, you had to latch on to one small factor in my decision to have a second C-section (I even said right before that I wasn't a great candidate for a VBAC!) and turn the thread into a discussion about that and nothing else.
posted by Eyebrows McGee at 7:04 PM on April 17, 2012 [13 favorites]



It feels like the article wanted to be about how much better the process of reproducing is now, but that the writer felt compelled to add some booga-booga scary technology to it to appease the natural childbirth enthusiasts.


The author's a surgeon, and intimately familiar with the range and likelyhood of complications developing from major surgery. Like someone cutting a big smiley face on your gut through three layers of muscle. I think when he says he has reservations about surgery becoming the preferred treatment option for so many births, that's the place he's coming from. His hands have been the scales which weigh life and death, and he's felt how slight a weight may balance or unbalance them.
posted by Diablevert at 7:14 PM on April 17, 2012 [2 favorites]


The element of childbirth I feared the most was the possibility of a c-section. The way it was described (courtesy of the natural childbirth teacher) made it sound positively medieval. I spent a lot of time watching video of cesareans just to desensitize myself to the process. Hearing experiences such as Eyebrows McGee's would have helped enormously in allaying my fear, which was almost pathological.

I managed to avoid a c-section, but after 2+ years, I still catch my breath in terror sometimes when I think about the experience of birthing Toddler theBRKP.

"Even today, if a mother doesn’t deliver within twenty-four hours after her water breaks, she has a forty-per-cent chance of becoming infected."

Which explains the massive, multiple doses of antibiotics I was given after Toddler theBRKP was born.
posted by theBigRedKittyPurrs at 7:20 PM on April 17, 2012 [1 favorite]


Extrapolating to experiences in general may mean someone else extrapolates in general back.

An eye for an eye leaves the whole world blind. Be the change you want to see in the world. You don't have to stoop to their level. etc etc etc.
posted by jacalata at 7:32 PM on April 17, 2012


I will be forever grateful to Wanda, the amazing obstetrics nurse who I had the great fortune to be assigned to when I delivered. I firmly believe that it was her perseverance in having me experiment with every conceivable position to push that allowed me to have my baby vaginally.

It was only a few weeks ago, in fact, that Mr. Leezie told me that just before I delivered, the talk had been that I was perilously close to a c-section. Wanda saved my .... stomach.

The thing, though, about births these days that I have found is that so many women go in with set notions about what will and will not happen. I will not have an epidural or monitoring, but I will consent to an IV.

I had no such requirements. I just wanted to basic stuff: a healthy baby without too much fuss. I didn't care if the birth was the most medicalized event of the 21st century because it wasn't about me at that point. It was about having a healthy, living child.
posted by Leezie at 7:33 PM on April 17, 2012


I ended up with a c-section for baby#1, and feel entirely confident that it was the right choice. I also feel entirely confident that my OB only recommended it, eventually, because it was the best decision for my baby (based on several previous conversations with her, my understanding of her opinions on c-sections in general). I had a scheduled C-section for baby#2, because like Eyebrows, I was not a good candidate for a VBAC.

I wish I could have had a crunchy granola all natural childbirth experience, but it didn't happen that way. I'm OK with the outcome. I do think that there are many doctors practising in the US who rush to c-sections for their convenience, and that this is a bad thing. However, I am also heartily sick of being made to feel like an idiot, for agreeing to a c-section. It was what was best for us. I am not an idiot. If I could go back in time, I would not do it any differently, because it was the right choice for myself and more importantly, my baby.

Eyebrows, thanks for the great account of your C-section. I appreciated it greatly.
posted by Joh at 7:35 PM on April 17, 2012 [9 favorites]


OK Eyebrows McGee, I have no kids or opinions on vbacs or hbacs but holy cow...the idea of having a baby stuck in sideways who then has to be pulled out through a massive incision in my abdomen, WHILE I'm awake...ok, you got my attention. And I think I do have an opinion now...I want to be heavily medically monitored and sedated through the whole process. Or just have a stork come to visit.

Also Atul's writing is always great, although I will admit I got sidetracked here a bit by the comments.
posted by bquarters at 8:05 PM on April 17, 2012 [1 favorite]


NEVER. BIRTHING. A. BABY.
posted by 200burritos at 8:11 PM on April 17, 2012 [8 favorites]




Baby #1 came eight weeks early. Water broke for no good reason, labor presented abnormally (something more painful than the contractions masked that discomfort, so there was time wasted wondering whether it was labor or not) and then stalled. Finally decide to induce, get an epidural, run the Pitocin. I don't remember Apgar scores, but it took that baby a very, very long time to cry.

Baby #2 went to term. Labor started and stalled. At one point the attending nurse came in to check our progress and said, "this is really strange, where is your cervix?" Baby's heart rate drops and the surgery team bursts in, we are having a C-section now, come this way. Turned out there was a softball-sized fibroid on the cervix, no way any baby could have squeezed out that way.

My sister has five children and had the last three at home. I admit that I'm a little jealous. But every time I read an article like this I am reminded how lucky I am to have my family at all. Without these "industrial" interventions I would almost certainly have no children and no wife.
posted by fantabulous timewaster at 8:14 PM on April 17, 2012 [13 favorites]


If you enjoyed this article I would recommend his books. I think his detachment adds something to his other articles/books, and the addition of his own wife's pregnancy feels like it has taken his writing outside of his wheelhouse.
posted by PJLandis at 8:19 PM on April 17, 2012


It was actually my midwife who discovered the frank breech, the old-fashioned way where they feel the positioning of the baby from outside the belly. She located the firm round bit up under my ribs, paused, and said, "This is not a butt, this is a head." Felt around some more and said, "I'm going to go get the ultrasound tech and the doctor, because this baby is breech." The ultrasound confirmed what old-fashioned midwifery had discovered, he was breech and he was STUCK.

In terms of the granola/medicalized debate, I go to a practice composed of doctors and midwives in equal measure. You can deliver with either, and you know the doctors respect the lower-tech, more relational mode of the midwives. And when your normal pregnancy that was going to end in a simple midwifed delivery turns frank breech in week 38, you can move on to the doctor and the surgeon with the midwife at your side. I wasn't suddenly dumped into a scary medical world but transitioned easily to colleagues of my midwife who worked with her daily and respected her judgment. It's a good model for an obstetrics practice if you can find it, I think.

The situation as a whole was very frightening for me because I was terrified of the surgery, but they made it easy and,yes, natural. My midwife was like, it's all normal, sometimes things go wrong, and now you'll get the safest care. They made the transition medically easy and made it easy for me psychologically. I was still scared but they helped me always feel in control.

And during the section itself, they showed me the baby, made a big deal of apgar score, cleaned the baby up with dad's help where I could see, while the anesthesiologist took pictures. And then I got to hold and kiss him for a couple minutes. And then dad and baby went off to the nursery for baths and weighing and I got finished up and went to recovery, and them two hours after the birth we recovened in our maternity room and breastfed, which went fine. And bonded, which went fine.
posted by Eyebrows McGee at 8:44 PM on April 17, 2012 [9 favorites]


Eyebrows McGee: "This didn't occur to me, and nobody told me (I guess because it could only have made me more upset and scared, and I was like a SUPERNOVA OF UPSET AND SCARED when I found out I had to have a C-section), but when you have a frank breech baby who's delivered doubled over (or has to be maneuvered around) by C-section, this is HELLA MORE TRAUMATIC to your body than a C-section that comes out head-first. "

Oh my god, YES! My first was a frank breech C-section, and all the tugging and pressure scared the hell out of me!
posted by misha at 8:58 PM on April 17, 2012 [1 favorite]


A while ago someone here linked to the Rural Doctoring blog, and her stories about births she has attended are fascinating. The one that sticks with me most is the one about a bad shoulder dystocia, in which the baby is in serious danger during birth (the baby ends up fine). If you had a bad birth experience, you may want to skip these for obvious reasons; very frank medical descriptions of tough births.

Also her childbirth philosophy post series, which describes her initial thoughts when she first started and how those thoughts have evolved given the realities of the medical system etc.
posted by LobsterMitten at 9:36 PM on April 17, 2012 [4 favorites]


Good god this article is total body horror. I read it while on line at Whole Foods with my mouth actually hanging open. Also, MAN, people are so judgmental about having babies! Although I should probably include myself in that category; my mother delivered my (breech) younger sister at home, and she came out blue, with the umbilical cord wrapped around her neck. It worked out, but I think my parents were nuts. Nature is terrifying, and science is just fighting the good flight. Also, I love Atul Gawande.
posted by citizenface at 9:38 PM on April 17, 2012


I had a great c-section. Totally fine, awesome bonding, easy breastfeeding, although I did not have the fairy-dust vaginal bi-- wait, you guys had tears where?

Oh.

My scar rules.
posted by purpleclover at 9:59 PM on April 17, 2012 [1 favorite]


I have a straight up and down old school section scar. My son was a frank breech, his head was too big to come out and likely we both would have died without an emergency C-section, which was under general anesthesia. My
daughter was VBAC before it was at
all common. Both kids were healthy, I bonded fine with them.
I am so glad no one stuck a forceps up my business!
And I am glad to be alive with grandkids. Back In The Day, this would not have happened.
posted by Katjusa Roquette at 10:10 PM on April 17, 2012 [4 favorites]


I too had a c-section (elective) on the advice of my OB, and I don't regret it for an instant. My recovery was easy, the surgery was relatively trauma-free for, you know, surgery, and I ended up with a beautiful healthy baby girl who I adore beyond measure. I also had no problems bonding or breastfeeding.

(Anecdata, I know, but whenever people announce that c-section mothers don't bond with their babies I can't help feeling just a little judged, because I do not know how I could possibly have bonded more with my daughter.)

I am 100% for people choosing the sort of birth they want (with caveats for doing so under appropriate medical supervision - unassisted birth is just scary) but the idea that this means all women will choose an unmedicated home birth is complete bullshit. Many many women will choose, as I did, to go with a highly trained OB in a medical setting. Birth may be medicalised and if you have a problem with that, that's fine. I didn't - I liked being in a hospital with reassuringly disinfected surfaces and stern but caring midwives etc etc.

As for whether there are too many c-sections? I don't know. I don't know how to weigh up the calculus of babies' lives against unnecessary surgeries. If say, 1000 c-sections save one baby's life, and the other 999 were not needed, is that ok? Or do we accept the death of one baby as the price we pay for not performing 999 surgical interventions? Or is even one baby's death too many? Because I think regardless of whether you think there are too many c-sections or not, you have to admit that c-sections save lives, but it is often unclear which c-sections are life saving and which c-sections are not.

I like Gawende's writing & I like this story, but my baby just woke up so that's all I have time to type.
posted by jasperella at 10:44 PM on April 17, 2012 [6 favorites]


We were going through photos of mr. brambory's early days with his mum yesterday and it was stricking how much more medicalised her birth was than mine. In the photo, she's in a surgical mask and gown, in a white metal bed, with a number on her wrist so the nurses could give her the appropriate baby at the appropriate time. She said she didn't mind that much because 'that was the way it was' but she regrets that mr. brambory's dad couldn't be there for his birth.

30-something years later, the photo we have of baby brambory's birth is me and mr. brambory cuddling him, just a few minutes old, in our living room (after he'd managed to pee all over me, I might add - the baby, that is, not mr. brambory). The best part? That I had the option of a C-section, forcepts, epidural, stitching in the operating theatre, etc just a quick ambulance ride away should me or the baby need it.

I consider myself incredibly lucky to live in this day and age.
posted by brambory at 2:35 AM on April 18, 2012 [2 favorites]


I really liked this article. I've read a lot of anti-caesarian stuff, and it often has a tone of conspiracy theory, as if obstetricians are indifferent to women's and babies' wants and needs. I found the historical progression of how c-sections became prevalant in this article pleasantly free of ax-grinding. It read more descriptively in general, and touches on how various forces can push a whole group of people into an outcome none of them want--as the author touched on when ob's who feel like they do too many c-sections were mentioned. I particularly found the bit about c-section being essentially a single intervention that can address a wide variety of problems interesting.
posted by not that girl at 6:33 AM on April 18, 2012 [4 favorites]


This was a really excellent article. Thank you so much for bringing it to my attention.

I've had two vaginal births, both of which were pretty much without complications although I was induced for the first one with pitocin because I was at 41 weeks. I have a feeling that it was superfluous though, because I went into labour less than an hour after it was applied. For my first delivery I had an episiotomy and for the second I had tearing. Both made toilet times horrible for a while but anything of that kind is just to be expected after childbirth.

I didn't know the story behind the Apgar score and the potted history of obstetrics which was given here has given me an enormous amount of things to think about.

I have friends who would never have considered a hospital birth and others who were open to any kind of intervention necessary during childbirth in order to make the whole thing less excruciating.

One friend, as she discovered upon the birth of her first child, was simply incapable of vaginal childbirth because her pelvis was too small. She laboured for an incredible amount of time before she had the c-section, and her baby was born with an amazing bruise on the top of his head after straining against the bones of his mother for all that time. She would have suffered Charlotte's fate if she hadn't had the option for an emergency c-section. As it was, she almost bled out and took months to recover from her major abdominal surgery. Her subsequent two children were born via scheduled c-sections and she got through it (albeit with some increasingly impressive scarring) because she knew in advance that she was going to experience the after effects of a c-section.

Another friend, who believes in the most natural of births and who gave birth in a car twice and once before the water was in the splashing pool, considers difficult births to be the inevitable consequence of a bad attitude towards the pain of childbirth. Personally, I think she has been very lucky.

I really enjoyed reading this. Thanks for posting.
posted by h00py at 7:16 AM on April 18, 2012 [1 favorite]


There are studies that show that women who have c-sections don't respond to their babies cries the same way as a mother who has a vaginal birth at least during the newborn period -- that through MRIs its been shown mothers who've had c-sections can and do have a hard time bonding with their babies (sure, not every single one, and yes, this was just one study). There's an entirely new field of counseling psychology emerging dealing with the aftermaths of traumatic birth experiences in particular.

The writer could have looked into these, could have said more about the immensely positive outcomes midwives have compared to obstetrics in both terms of vaginal births and in terms of how mothers and babies do after the birth.


Yeah, I agree, but then again, it was written in 2006. I think a lot has changed in the public perception since then.

I consider myself incredibly lucky to live in this day and age.

Amen.

I really liked this article. I've read a lot of anti-caesarian stuff, and it often has a tone of conspiracy theory, as if obstetricians are indifferent to women's and babies' wants and needs.

No conspiracy needed. All that's needed is a desire for a free weekend. Check the C-section rates throughout the week. There are tons of other complicating factors, but the self-interest of doctors/hospitals and also the effect of malpractice litigation are major factors in patient care.

Also her childbirth philosophy post series, which describes her initial thoughts when she first started and how those thoughts have evolved given the realities of the medical system etc.

That Rural Doctoring blog is fantastic, and I missed it the first time. Thanks!
posted by mrgrimm at 8:01 AM on April 18, 2012


I think the reason I really like this article is that it managed to go the whole way without using that dirty phrase - 'Quality Assurance' - even though that's exactly what it's talking about. I had never heard about the Apgar scale before, which is a shame because it's the kind of (dare I say "Quality Assurance") technology that I love. It's a technological solution to a social problem.
posted by muddgirl at 8:06 AM on April 18, 2012 [1 favorite]


I should note that when I say I 'love' it, I mean anthropologically. I know that metrics like the Apgar scale tend to create other problems like the ones described in this article - since mother-outcomes (beyond mortality) aren't tracked in the same way as offspring-outcomes, they start to fall by the wayside, for example. It's fascinating because I see this process in hardware design all the time, and I guess it never occured to me that it would happen in other endeavors.
posted by muddgirl at 8:20 AM on April 18, 2012 [1 favorite]


I think part of the reason I got a vasectomy is that the idea of childbirth has always seemed completely horrifying

I think popular culture does a lot to propagate this myth, but it's really not true at all. You should watch some birth videos.

I wish I could have had a crunchy granola all natural childbirth experience, but it didn't happen that way.

Personally, I think it's hard to consider C-sections or childbirth in general rationally, because childbirth has become a bit mythologized--after all it doesn't happen very often to you. However, I think all the petty sniping between advocates for different experiences is tiring.

From my own anecdata, friends who've had C-sections seem to have struggled a bit more with post-partum depression, but that's a very limited sample of moms.

it wasn't about me at that point. It was about having a healthy, living child.

This is a common argument for those who seem to reject any reasons for delivering naturally without unnecessary interventions, but I don't think it's true. The health and safety of the mother should always be a huge consideration, and "good health" should mean more than "staying alive."

Childbirth is an incredibly powerful event for moms, and the possible physical and psychological issues for new moms are legion. That was pretty much the main message of the article for me: we focused so long on "well, it's a healthy baby!" that for a while we forgot to give two shits about how mom was doing:

"You reach in, and, instead of finding a tumor or some other abnormality, as surgeons usually do when we go into someone’s belly, you find five tiny wiggling toes, a knee, a whole leg. And suddenly you realize that you have a new human being struggling in your hands. You almost forget the mother on the table."
posted by mrgrimm at 8:31 AM on April 18, 2012 [2 favorites]


As a woman with a "rocking hot ass" as the cool kids say, you would think I'd have no trouble delivering vaginally.

I felt like I had failed when not one but both of my boys had to be delivered through c-section.

Most of that feeling came from reading what other mothers, who should know better, wrote criticizing women who gave birth by c-section.

My first, as I said, was frank breech. He also had hip dysplasia, which was immediately diagnosed by our wonderful pediatrician in the hospital.

My second was footling breech (basically, one foot was in the birth canal during my last month of pregnancy, and yes, that IS as uncomfortable as it sounds). I had to be knocked out for an emergency c-section when I was 8 centimeters dilated. I wanted to try to deliver vaginally anyway (again, that pressure we put on ourselves!) but we were told there was a danger of the cord being tangled around his neck due to his odd positioning.

Turns out I wouldn't have been able to, anyway. My hips may be round but my pelvis is narrow (which is why I had to have my total hysterectomy abdominally rather than vaginally, too). Who knew? I felt like Edwina in Raising Arizona when I found out.

No woman should be judged for the way she chooses, or ends up through complications, giving birth. Believe me, we all do this judging in our own heads, anyway, and it doesn't help having complete strangers with different birth experiences telling us we should have had a "natural" childbirth and delivered vaginally. Oh, and now we should be doing that at home! And if we have a c-section, our children won't bond with us?!

Give me a break. Both of my kids bonded with me just fine, thanks, and I with them. I did not in any way love them any less, or feel divorced from them--after all, I'd carried them inside me for nine months! And if a woman is having trouble bonding, there are real conditions like postpartum depression that could be causing that, and we should be getting her help instead of criticizing the way she gave birth!

That bonding study, btw, was clearly biased--to give you an idea of the bias the researchers had going in, the title of the study is "comparative study of mothers after normal delivery and cesarean section."--Harrumph. And anyway it's from 2008, and has not been replicated.

More recent studies suggest that repeat c-sections may be safer than VBACs, so telling Moms to have a VBAC is not in their best interest from a health standpoint, either.

As far as home births go, they may be just fine for low-risk pregnancies. Not every woman knows, going in, if they will end up having complications that could change that low-risk to an emergency situation in an instant. Bear in mind that when a home birth runs into trouble, the mother ends up going to the hospital for emergency care: "up to 9% of parous and 37% of nulliparous women intending home birth require intrapartum transfer to hospital. Thus, adverse outcomes among the latter deliveries are attributed to hospital births." via

In that meta-analysis comparing planned home birth vs planned hospital births , "Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate."

That's right: Three times as many babies died.

But I am not saying "no one should have have a planned home birth", because many home births go just fine. And so do many hospital births.

And sometimes both situations turn utterly chaotic, no matter how you plan for them.

I just want Moms to know, and to believe, that after all the trauma of childbirth, if you and your baby are alive and healthy, it doesn't matter how you got there.

Moms, please stop judging other Moms! And stop beating yourself up for not having a perfect birth experience. I doubt there is any such thing, anyway.
posted by misha at 8:49 AM on April 18, 2012 [6 favorites]


I think popular culture does a lot to propagate this myth, but it's really not true at all. You should watch some birth videos.

I think that modern medicine has done a lot to help us forget about how horrifying birth really can be. After you watch the birth videos, read up on fistulas.

It isn't always horrifying, but that is definitely one way it can go.
posted by the young rope-rider at 8:54 AM on April 18, 2012 [3 favorites]


Yeah, I think it's important to note the difference between 'it's wrong when doctors routinely schedule C-Sections regardless of whether it's the best decision for mother and baby', and 'it's wrong having a C-section. Childbirth can be fraught enough without the baggage that you are going to be judged for how the kid came out of you.

My biggest regret was not having a doula. I think a lot of my labor would have gone differently if I had an informed, paid-to-be-awake advocate in the room with me. My husband was wonderful, but exhausted and didn't know what to tell me to do when things were stalling. Our first labor nurse was terrible (actually reprimanded for her inactions during my labor). The second one was fine, but at that point the damage was done - I was too exhausted to push properly. It just plain never occurred to me that the people whose job it was to get me through it all, might not know or care what they were doing.
posted by Mchelly at 9:12 AM on April 18, 2012 [1 favorite]


I had one great hospital birth, where excellent care by my labor nurse helped avoid a C-section (I had some worrying late decels, but they were fixed by maternal oxygen, and my labor was incredibly fast so the baby got born before it became critical. When she was crowning, we discovered the occult cord prolapse, cut the cord on the perineum, and she was delivered with apgars of 9 and 9 and almost no tearing) but I had really shitty aftercare (waking me up every 45 minutes to an hour, yelling at me for having such floppy breasts, freaking out about the baby's massive weight loss and pressuring me to supplement with formula even though the weight loss was very obviously water thanks to the epidural and she was gaining 2.5 oz a day through breastfeeding at that point).

When it came time to have my next kid, I decided that while the epidural was AWESOME, that shitty aftercare was horrid, so i would have him in a birth center. That was all great, until the birth center was full when my contractions were 5 minutes apart. We converted to home birth, and my baby was born after 78 minutes of extremely intense active labor.

I have no particular investment in home vs. hospital birth, or medicated vs. unmedicated labor. I actually hate the term "natural" childbirth, because, well, it's kind of all natural, you know? Seeking pain relief when you are in pain is natural. Intervening in labor to help keep things on the right track is, if not "natural" by the strictest of definitions, at least a practice going back thousands of years, probably more, and C-sections are wonderful amazing surgeries that save lives, both infant and maternal.

But I do think that many institutions have policies in place that are designed more to make labor conform to a specific pattern then to maximize the likelihood of a good outcome, and being subject to those policies can leave a woman feeling disempowered and pissed off, not to mention dealing with the physical aftermath of invasive procedures that may have been unnecessary. Those feelings are important. The sequelae of those procedures can be life-altering, even when they don't rise to the level of "major" or "severe" complications. Dismissing women who have concerns or who are upset as being "crunchy granola" or "unenlightened birth warriors" or whatever is really unhelpful; the fact that my baby was born healthy does not mean that my shitty care in the hospital didn't happen, and it doesn't mean it doesn't count. Mom is a patient too, and she deserves to have agency in her care.
posted by KathrynT at 9:17 AM on April 18, 2012 [7 favorites]


The Wax meta-analysis study, by the way, is not entirely uncontroversial.
posted by KathrynT at 9:21 AM on April 18, 2012 [1 favorite]


I actually hate the term "natural" childbirth, because, well, it's kind of all natural, you know? Seeking pain relief when you are in pain is natural. Intervening in labor to help keep things on the right track is, if not "natural" by the strictest of definitions, at least a practice going back thousands of years, probably more, and C-sections are wonderful amazing surgeries that save lives, both infant and maternal.

OffbeatMama has adopted the term "unmedicated" childbirth precisely to avoid this baggage.
posted by ThePinkSuperhero at 9:22 AM on April 18, 2012 [1 favorite]


I believe that meta-analysis linked by misha is the one out of Maine Medical Center in Maine, and if it is, one of the Canadian researchers whose data was used in it has openly stated several times now that his data was used incorrectly and the meta-analysis was designed to suit the researcher's wishes and failed to reflect at all what the data has actually shown.

As for VBACs being more risky than c-sections --- the fact is, birth is involving at the least a dyad. There is the mother, and there is the baby. And sometimes what is safest for the baby and what is safest for the mother are in conflict with each other.

And with regards to the study on RCS being safer than VBACs --- well, for whom? That study is only focusing on the outcomes of the baby, not the outcomes of the mother or the baby and mother as a single unit dyad.

What it all comes down to is which risks a particular mother wants to take on when she chooses where she wishes to birth. I know of women who have had horrifying vaginal births who, to feel emotionally safe and prepared, had a c-section with their subsequent baby. I know a lot more women like me who had terrible, dehumanizing c-sections who seek out alternatives to hospitals and obstetrical care the next time.

I don't think repeat c-sections are wrong. But what I do think is that obstetricians don't provide truly informed consent. At the hospital where Toddler Zizzle was born, if I had wanted to have a VBAC with the midwifery group, I would have had to have a meeting with an obstetrician so the obstetrician could explain the risks of uterine rupture. Just the risk of uterine rupture. Not any other risks associated with a VBAC and not any of the numerous risks associated with a repeat c-section. Just uterine rupture, which has a 1% chance of occurring. Hemorrhage from surgery has a far greater chance of happening.

What I would really like to see are studies that focus on the mother and baby as a unit so the best outcomes for moms and babies AS A UNIT are better understood.
posted by zizzle at 9:24 AM on April 18, 2012


I think if we look at the public reaction to recent recommendations to reduce the number of mammograms in the US, we'll see why such efficacy studies (which focus on more than just mortality rates) don't find a lot of support, and it's one of the subtler theses of this article.

And I think this issue gets even more muddled up because, frankly, the US sucks at routine obstetric after-care compared to other western countries, whether it is a vaginal birth or a cesarian (it seems like it's another story for mothers whose babies end up in the NICU). And in my experience, the majority of doctors and nurses don't want to suck at routine after-care, it's just not something that they're paid to do. I know this is something that can change, as other countries have managed just fine.
posted by muddgirl at 9:50 AM on April 18, 2012


It just plain never occurred to me that the people whose job it was to get me through it all, might not know or care what they were doing.

You know, that is a fantastic one-sentence reminder for me to tell people when they say "oh, childbirth class isn't important; it's only one day and then it's over; parenting is the important part."

Well, duh, but you learn as you go with parenting. You don't have time to do that in labor. I don't need a class to teach me how to put on a diaper because I'm going to end up doing it 5,000 times. I'm only going to help my wife deliver our baby once or twice.

And also, the nurse and even delivering obstetrician/midwife you get could be a total crapshot. They might TOTALLY SUCK. Read that Rural Doctoring blog to get an idea of the wide variety of skills and ability of care providers.

For my wife's first delivery, the nurses and midwife were amazingly helpful; for the second, the nurses were chatting about all sort of nonsense and not really paying attention and our doctor wasn't available so we got a sub for the delivery.

If you do care about minimizing interventions and feeling positive about the experience, or are even just anxious about the process at all, I highly recommend some sort of training from a professional, like a good childbirth class.

It isn't always horrifying, but that is definitely one way it can go.

From my experience, the scariest part of childbirth for both mom and dad is the unknown. Experiencing multiple childbirths and understanding the reality of it alleviates that fear, imo.

I know about obstetric fistulas. Not sure how that's really relevant here...

On preview: unmedicated is the preferred term. I agree "natural" is problematic.

I do think is that obstetricians don't provide truly informed consent.

Again, totally. That's why I recommend owning the process yourself and learning as much as possible. You, the patient, should be in control; my wife didn't want an IV during childbirth; the sub doctor ordered one in case she needed blood afterward (when it's harder to put in an IV). We said no. No IV. What were the risks there? You'd better know. Same with fetal monitors, Vitamin K injection, and all that shit. I definitely wanted to know how all that worked before the serious shit went down. Class was a huge help. I personally couldn't have learned what's important on my own.
posted by mrgrimm at 10:19 AM on April 18, 2012 [1 favorite]


Oh man, this article is bringing back some foggy memories.

Finally, there is the maneuver that no one wanted to put his name to but that through history has saved many babies’ lives: you fracture the clavicles—the collar bones—and pull the baby out.

Yikes. It wasn't done purposely, but one of our son's collar bones was fractured on his journey out. He had to be tugged out with forceps, it was a really rough delivery. I think we were getting close to emergency c-section territory, and honestly, I didn't care how they did it at that point, I just needed that baby to get out of me. Little dude's collar bone is totally fine now and no permanent damage was done by the forceps.
posted by banjo_and_the_pork at 10:50 AM on April 18, 2012


Unless I am able to find a doctor who is willing to stage an epidural with C-section photoshoot such that it looks like the baby is blasting out of my stomach like in Alien then crawling up my chest to take out my jugular as I make horrified faces. Best baby album ever.

Curiously I have yet to meet anyone who is as enthused about this idea as I am so I'll probably just end up adopting. -- shroedinger
If I were not already happily married and a parent, I would totally have your back on that process. I wish we'd thought of it!
posted by ChrisR at 11:15 AM on April 18, 2012


It's amazing to see how many people don't understand how far we've come with just pregnancy/delivery medicine and vaccination. You read history and you are boggled by the frequency with which women and babies died in childbirth and with which children died of infection before the age of 5. Or visit an old graveyard and read the markers to see how many young women and children there are. Nature is not particularly gentle in selecting us for survival, and our development of medical technology has softened those blows considerably, for which I am grateful daily. My family would be half its current size without modern medicine.
posted by Mental Wimp at 11:56 AM on April 18, 2012


Hi! A few things!

It is rude and terrible to invalidate a woman's bad birth experience with "All that matters is a healthy baby."

It is also rude and terrible to invalidate a woman's good birth experience by saying that the healthy baby -- and her choice to put herself at slightly higher risk to help her baby's odds -- is unimportant. I say: "All that matters is that my son was healthy" about my own experience. And I mean it. I would make exactly the same choice today. Other mothers might have accepted more risk for their baby, but I didn't. I don't understand why it's a thing that I'm denigrated and judged for.

(Anecdata, I know, but whenever people announce that c-section mothers don't bond with their babies I can't help feeling just a little judged, because I do not know how I could possibly have bonded more with my daughter.)

Yeah, I don't feel a little bit judged. I feel a lot judged. It's terribly rude. The only bad feelings I had about my C-section happened because of the reactions from other women -- and hell, they were my friends. The gamut ranged from pity to holier-than-thou judgment to complete bafflement that I could breastfeed. Yeah, that made me feel pretty bad. I don't think that's the C-section's fault, though.

That bonding study, yeah, seems so preliminary as to be not a real thing. Twelve women, and the differences disappeared in a few months. This all seems to have to go back to this idea that initial bonding has to happen in the first few minutes. As though we are geese and we need to imprint. Even the super-crunchy author of Our Babies, Ourselves didn't give much stock to that idea. Because if the first few minutes after birth are the most important ones, what does that say about fatherly bonding? About adoptive parents? About ladies who have vaginal births but can't bond immediately? Yeah, not buying it.

From my experience, the scariest part of childbirth for both mom and dad is the unknown. Experiencing multiple childbirths and understanding the reality of it alleviates that fear, imo.

Well, aren't you lucky. You know that's not true for everyone, right?
posted by purpleclover at 12:16 PM on April 18, 2012 [4 favorites]


Yeah, the whole c-section bonding thing is something I don't believe based on my knowledge of fathers, mothers who didn't gestate the baby, grandparents, foster parents, aunts and uncles and honorary aunts and uncles...hell, I've strongly bonded with children I've nannied for.
posted by the young rope-rider at 12:22 PM on April 18, 2012 [3 favorites]


If you're looking for another good read on the topics of this article, I recently read Pushed: The Painful Truth about Childbirth and Modern Maternity Care by Jennifer Block. I'm (hopefully) less than two weeks away from my first birth, and am opting for as non-medicated as possible in a hospital. But going in with the full understanding that anything can happen, and if having a healthy child and a healthy mom means I need to get an epidural or a c-section, so be it.
posted by bibbit at 12:48 PM on April 18, 2012 [1 favorite]


One thing I'd stress, bibbit: you can have, say, an epidural or a C-section just because you want to, or because you feel like it's best. Don't push yourself into a corner where you feel like you can only choose interventions if you NEED them. I absolutely did not need an epidural in my first birth, but I very much wanted it, and I am very happy with my decision to get one.

That might not be what you meant, at all. But often I see this horrible dichotomy set up, like, "Oh, it's OK if you got a C-section if you really NEEDED one," implying that it's not OK to have one if you didn't really need it. But the fact is, those decisions are up to you, and if you decide that you'd be better off or happier with an epidural, or Pitocin augmentation, or a saline drip, or an internal monitor, or a C-section -- or with none of those things -- that is absolutely OK.
posted by KathrynT at 1:23 PM on April 18, 2012 [3 favorites]


mrgrimm: " From my experience, the scariest part of childbirth for both mom and dad is the unknown. Experiencing multiple childbirths and understanding the reality of it alleviates that fear, imo."

For some people.

My wife had twins. And it was a pregnancy filled with serious complications, several of which could have been (and in two cases nearly were) life threatening to her. Several of which were also life-threatening to one or both of her fetuses. Her OB and perinatologist opted to deliver preemies rather than further risk.

Not to mention, the extra hospital stays, and the daily stress and fear of wondering if our children were both going to survive to term or if they would be dangerously premature. They were nearly delivered at 28 weeks.

Knowing the mechanics of childbirth would have done nothing to eliminate our fears. For both of us, the scariest part of her pregnancy wasn't the birth. And the scariest part of childbirth wasn't the unknown. It was the risks we knew that we worried about.

Respectfully, every pregnancy is different and comes complete with its own unique hazards, risks, and good & bad experiences. Experiencing one childbirth does not necessarily prepare you for the second. One 'normal'-risk pregnancy does not necessarily prepare you for a high-risk one. There are many childbirths that can happen smoothly with midwives, and others that absolutely require medical intervention so baby and mom survive. It would be unwise to try and extrapolate a "good for every case scenario."
posted by zarq at 1:41 PM on April 18, 2012


From my experience, the scariest part of childbirth for both mom and dad is the unknown. Experiencing multiple childbirths and understanding the reality of it alleviates that fear, imo.


Count yourself lucky. Both of my deliveries were terrifying in their own unique way, and after the second, my husband looked at me and said "that's it, we're done having kids, you don't have normal deliveries, and I can't take another one of these."

My first labor I assumed I'd be laboring for ten or twelve hours. After three hours of contractions 6 or 7 minutes apart, lasting about 30 seconds, I figured I'd take a shower in anticipation of heading out the hospital eventually. While I was soaping up my contractions changed dramatically and I had this really strong urge to bear down. Turns out my water broke in the shower (convenient, but impossible to notice) and while soaping up I felt this slippery thing coming out. I was afraid it was the umbilical cord, but I couldn't see a damn thing because 41 week belly was in the way. So I start yelling for my husband to come and look. He says "I can't really see, lie down on the floor so I can get a better look" and I did, and then he said "oh my God, you're crowning." Now my husband happens to be trained as an ER doc, so he knew all the things that can go wrong with deliveries and was not up for doing it on his own. A call to 911, the fire department is there in like four minutes, and bam! A perfectly healthy baby and two freaked out, terrified parents. It's awesome now because the Fire Department lets us have birthday parties at the Fire Station.

For my second, my birth plan consisted of "get to the hospital." Which I did, but wound up having a highly medicalized birth that was the result of one medical intervention begetting another medical intervention, and I wound up delivering vaginally on the operating table in the OR as they prepped me for an emergency c-section. My son was gray and that first cry took too long and was very faint, and seeing my husband's worried face as they whisked our son away to work on him was horrible. He perked up after a few minutes, but those were very long minutes. To this day I second-guess my decision to get an epidural for that delivery, wondering if that was the trigger to the chain of events.

I am extraordinarily lucky that both of my deliveries turned out OK, but I am really clear that childbirth can be beautiful and miraculous and terrifying and perilous. I may have all sorts of opinions about things like vaccinations and feeding and whatnot, but childbirth gets a free pass- I'm not going to second guess anyone else's decisions about their deliveries. If you weren't there, you just don't know.
posted by ambrosia at 1:48 PM on April 18, 2012 [4 favorites]


See now, zizzle, I don't want to argue with you, but this:
What it all comes down to is which risks a particular mother wants to take on when she chooses where she wishes to birth. I know of women who have had horrifying vaginal births who, to feel emotionally safe and prepared, had a c-section with their subsequent baby. I know a lot more women like me who had terrible, dehumanizing c-sections who seek out alternatives to hospitals and obstetrical care the next time.
Well, that sounds pretty judgmental. It's like you're saying that women who have had traumatic vaginal births choose c-sections because they are easier.

I can just tell you that in my personal experience, c-sections suck.

With my first c-section, the migraines were so bad, I threw up if I tried to sit up. i woke up from general anesthesia with a bruised throat and a raging infection, running a temperature of 104, with my second, and the nurse with the key to the painkiller cabinet was on break, so I practiced my focused breathing until she got back a half hour later.

You hurt. You have a gigantic hole in your stomach. You're healing from major surgery, while sleep deprived, on top of taking care of your newborn. I can't really imagine anyone thinking that is the easy way to give birth.

But then again, I don't feel that suffering 3rd degree lacerations from a vaginal delivery after hours of pushing is an easy way to give birth, either.

You had a c-section, and found it dehumanizing, so you sought out an alternative, and were able to go without a c-section the second time around.

That's great! I'm glad it worked out for you.

But if I had done that, my youngest son would be dead.

So while I agree with your, "sometimes what is safest for the baby and what is safest for the mother are in conflict with each other," I'm not sure we got there in quite the same way.

Like you, I think every woman should be informed and empowered in childbirth. I just don't think that anyone who makes a decision different from mine must be weak, misled or delusional.

I think she is doing what is right for her.
posted by misha at 7:13 PM on April 18, 2012 [2 favorites]


Before choosing "Natural Childbirth" I would read a bit of Dr Amy The Skeptical OB.
posted by RuvaBlue at 10:31 PM on April 18, 2012 [1 favorite]


I agree with many of the ideas the Skeptical OB promotes, but she is a poor advocate for the position. She is judgmental, aggressive, cherry-picks data, and refuses to debate civilly and transparently. I think she does her profession a grave disservice, personally.
posted by KathrynT at 11:03 PM on April 18, 2012 [3 favorites]


Heh, @purpleclover, I had my sarcastic voice on when I said I found it a "little bit" insulting.

Things my OB said he believed contributed to the rising c-section rate: risk aversion in doctors & parents (no-one wants a dead/damaged baby - it's not about convenience, it's about care), rising age of first time mothers especially here in Australia (uterine muscles do age & it's harder having your first bub at age 35 than 19, plus IVF), and reduced fitness of mothers in general. He also said epidurals do make it harder for women to push, which was honest of him.
posted by jasperella at 12:23 AM on April 19, 2012


Before choosing "Natural Childbirth" I would read a bit of Dr Amy The Skeptical OB.
posted by RuvaBlue at 1:31 AM on April 19 [1 favorite +] [!]


The Skeptical OB practiced in the area I live in.

Her Boston area peers roll their eyes whenever she's mentioned. While they may agree with her, they don't like someone who has been out of practice for close to 20 years taking on the issues they would actually like taken on.

The fact that she's maligned by currently trained and practicing OBs suggests she's just as rogue as she would have people believe homebirth midwives are.

Plus, that's her only schtick.

And she doesn't account at all for OBs like Dr. Tate in Georgia who takes on far riskier patients for vaginal births than homebirth midwives or, even, other OBs.
posted by zizzle at 6:46 AM on April 19, 2012 [1 favorite]


So, I think the skeptical OB is a useful blunt object. I have substantial reservations about the fact that she's been out of the game so long, and I've read criticisms of her manipulation if homebirth stats. But to pretend that the pro-homebirth, anti-obstetrics people are making awesome, nuanced arguments? That's not been my experience. It's mostly:
- Women gave birth for a long time at home (mumbling transition) HOSPITALS KILL BABIES
- Evolution designed us to give birth (not how evolution works; does not apply to individuals)
- Babies come when they're ready (with no explanation of how that magical event takes place. Also, no acknowledgement that stillbirth rates rise after 39 weeks, so the 41-week induction that many OBs recommend is based on sound science)
- If you don't think it will hurt, it won't. (With a weird, almost macho, undercurrent of pride at suffering.)

I mean, I think that the obstetrical establishment is terrified of losing women to "alternative" birth situations. And they are doing an awful job of explaining that they want you to get induced at 41 weeks because that's the way we get the most live babies, not because of a golf date. That the GBS swab isn't random humiliation -- it can keep your baby from life-threatening pneumonia. (Antibiotics are the only thing that can help this; there is no alternative remedy.) That some births require medical intervention and that things can go bad in just a few minutes. That the IV is there to rehydrate you, because many women in labor are dehydrated even though they think they aren't, not to torture and tether you.

Listen, I don't think anyone should have to go into the baby factory to be sliced open like a side of beef. I don't think that you should have to be forced to work with a doctor you hate. I don't think being awakened every 45 minutes by fluorescent lights is a good way to prepare or recover from giving birth. Of course!

But that is not the only way a hospital birth can go. I had a great hospital experience. I was surrounded by women (doctors, including my own solo-practice doctor, who delivered my baby; and nurses, who were the best; pediatricians; and lactation consultants). They were respectful of my getting enough sleep. They let me decide when and how I'd be awakened. They answered my questions and let me feel informed and empowered.

I hate this notion that doctors are in obstetrics just to rack up as many Friday C-sections as possible before going to golf, or that the standard of care is somehow out there to hurt you. For me, I spent 9 months with my doc and four days with the hospital staff, but this is literally their life's work. Do you think they're all naive? Brainwashed? Stupid? I don't. I worked with people I respected, and whose body of knowledge fascinated me.

And I hate the idea that being risk-averse (sometimes phrased as "afraid of malpractice") is a bad thing. Here is when malpractice suits happen: When something awful happens. I'm guessing the price of malpractice insurance is not the only factor in trying to avoid those scenarios.
posted by purpleclover at 8:50 AM on April 19, 2012 [2 favorites]


That's not been my experience. It's mostly:
- Women gave birth for a long time at home (mumbling transition) HOSPITALS KILL BABIES
- Evolution designed us to give birth (not how evolution works; does not apply to individuals)
- Babies come when they're ready (with no explanation of how that magical event takes place. Also, no acknowledgement that stillbirth rates rise after 39 weeks, so the 41-week induction that many OBs recommend is based on sound science)
- If you don't think it will hurt, it won't. (With a weird, almost macho, undercurrent of pride at suffering.)


Where do you hear this stuff? I'm curious. Blogs, books? Which ones are the worst? Or are these just off-hand anecdotal comments from (mumbling transition) "friends"? I mean anyone can be an asshole...

The childbirth classes I took were billed as "natural" but they covered many of the things mentioned above (zarq's premature deliveries; ambrosia's sudden onset, etc.) I guess I was lucky enough to have a class that focused on the full pregnancy and post-birth recovery, not just labor.

My class was taught my a Lamaze-trained instructor and all but 1 of the couples were giving birth in hospitals.

These adamant, judgmental, assholish "natural" birth proponents seem an awful lot like a strawman to me.

If you don't think it will hurt, it won't.

I mean this just seems ridiculous. "If you put your mind to it and commit to preparation, you can probably avoid pain medication" does not imply there is no pain.

Babies come when they're ready (with no explanation of how that magical event takes place. Also, no acknowledgement that stillbirth rates rise after 39 weeks, so the 41-week induction that many OBs recommend is based on sound science)

And that's absolutely ridiculous. My class definitely discussed the rationale for the standard 41-week induction policy, and you're right, the statistics support it. Statistics also show that the *average* gestation period for a first-time mom is 41 weeks, so there's a heck of a lot of people delivering after that.

Our crunchy but not granola midwife for our first baby induced my wife when she was 12 days overdue. That was about her upper limit, and hey, did you know that those magic fetal monitors can also check in on the overdue baby before labor? They are called non-stress tests, and again, thanks, childbirth class for covering all about NSTs because I would have been really pissed off otherwise.

I don't know how to refute the first two claims other than they are idiotic and I've never heard anyone make them, aside from, sure, women have mostly given birth at home, sure. We chose a hospital because it was where my wife wanted to do it.

Your argument (and several of the anti-natural childbirth arguments here) sets up a total strawman, imo. I'm sure there are natural-childbirth assholes, but that hasn't been my experience at all.

For me, I spent 9 months with my doc and four days with the hospital staff, but this is literally their life's work. Do you think they're all naive? Brainwashed? Stupid? I don't.

Confirmation bias. There are certainly doctors and nurses who are stupid, naive, self-centered, and just overall poor practitioners. To pretend there aren't is even more naive then your contentions about natural birth proponents.
posted by mrgrimm at 9:22 AM on April 19, 2012


That the IV is there to rehydrate you, because many women in labor are dehydrated even though they think they aren't, not to torture and tether you.

Or, you know, women could just be allowed to eat and drink during labor WHICH MANY HOSPITALS DO NOT ALLOW despite evidence that there's no reason (not even an emergency surgery reason) they shouldn't.

The OB who sliced me open? Yes, this was her life's work, and she fucked it up. But she doesn't have to live with those consequences. I do. For her it was Monday. For me it was the worst day of my life. And no one --- not the hospital, not the anesthesiologist, not the OB --- will even say they're sorry. I've sent letters, and I've called the office. And no one will just say, "My bad."

If any one of them would just admit that they fucked up big time, I'd have done a lot better because I'd have known that it wasn't my imagination that things were as bad as they were. It would have gone a long way to validate my experience.

But hospitals don't apologize to people. Medical personnel don't apologize to people. They don't ever admit mistakes.

Why?

Because admitting a mistake leads to evidence for a malpractice suit.

I would have been less interested in pursuing a malpractice suit if anyone had just owned up to their errors. As it was, since they didn't, I looked into one. And know what I learned? It's nearly impossible to win a malpractice suit for any birth related reason that ends up with a healthy baby at the end of it. No matter what happened to the mother in the process. Believe me, something awful happened to me. But suing, much as I wanted to, couldn't get me anywhere.

And that is why obsetrics has lost me and why I refuse to set foot into the same room as an OB unless there is absolutely no other choice (and I did have a few no-other-choice matters crop up since my son was born).

Different women will choose differently. I know plenty of women who have good hospital births. I wasn't one of them. And that's what led me to learn more about hospital policies and the actual harm they can and do inflict on women regularly.

I'm a huge proponent of women birthing where they're most comfortable. I don't fault anyone for a hospital birth, but I do fault the field of obstetrics for being so risk averse they're actually raising risks!
posted by zizzle at 9:23 AM on April 19, 2012 [2 favorites]


But to pretend that the pro-homebirth, anti-obstetrics people are making awesome, nuanced arguments? That's not been my experience

Yes, they absolutely are. Lots and lots of them.

Here's one I picked fairly randomly. (Fifth Google result for "research epidural oxytocin" fyi.)

"Epidural analgesia is a highly effective form of pain relief and a useful intervention in certain circumstances.

However, epidurals and spinals also cause unintended side effects in both the mother and baby, and interfere with the natural birth process and bonding between mother & baby.

In some cases epidurals may be beneficial, but the evidence suggests that they should not be used as routinely as they currently are in the U.S. and other industrialized countries."

Tell me that's not a nuanced argument.
posted by mrgrimm at 9:31 AM on April 19, 2012


Zizzle, that's terrible. I'm really sorry.

That random article you linked to, mrgrimm, doesn't account for the possibility that perhaps women chose epidurals because they were in more pain. Because the birth was going poorly. It's possible that women who were having a rough time of it because their baby was positioned unideally or was too large or whatever would have had those perineal tears or dystocia anyway, which led to more pain upfront, which led to asking for pain relief.

And ... I'll just quote in full here. This is the abstract of the study linked to with the sentence "[Epidurals] lengthen labor."

Mothers given an epidural rather than parenteral opioid labor analgesia report less pain and are more satisfied with their pain relief. Analgesic method does not affect fetal oxygenation, neonatal pH, or 5-minute Apgar scores; however, neonates whose mothers received parenteral opioids require naloxone and have low 1-minute Apgar scores more frequently than do neonates whose mothers received epidural analgesia. Epidural labor analgesia does not affect the incidence of cesarean delivery, instrumented vaginal delivery for dystocia, or new-onset long-term back pain. Epidural analgesia is associated with longer second-stage labor, more frequent oxytocin augmentation, hypotension, and maternal fever (particularly among women who shiver) but not with longer first-stage labor. Analgesic method does not affect lactation success. Epidural use and urinary incontinence are associated immediately postpartum but not at 3 or 12 months. The mechanisms of these unintended effects need to be determined to improve epidural labor analgesia.

They're associated with longer second stage labor, but we have the same chicken-egg, correlation-causation problem. I haven't read all the links (on phone) but the ones I've read (increased C-section rate, perineal tears, lengthen labor) could just as easily be turned around to say Women Who Have Easy Births Don't Need Pain Meds Because They Have (relatively, i know) Easy Births.
posted by purpleclover at 10:09 AM on April 19, 2012 [1 favorite]


I would have been less interested in pursuing a malpractice suit if anyone had just owned up to their errors. As it was, since they didn't, I looked into one. And know what I learned? It's nearly impossible to win a malpractice suit for any birth related reason that ends up with a healthy baby at the end of it. No matter what happened to the mother in the process. Believe me, something awful happened to me. But suing, much as I wanted to, couldn't get me anywhere.

zizzle, I hope you will expound on what happened. It sounds like you really endured something terrible. I mean, c-sections are never easy for anyone, but you shouldn't be traumatized for the rest of your life because of this doctor's negligence! I don't know what you experienced because you haven't chosen to share your experience here yet, but if this doctor was negligent, she should not be practicing any more.

If you were traumatized and/or have serious health issues as the result of your doctor's negligence, you DO have a malpractice case and you can certainly sue the doctor! You do not need any admission of guilt. You can make your case without it. All you have to do is get copies of your medical records, which you are legally entitled to, and hire a lawyer to take your case.

Doctors get sued all the time. They carry malpractice insurance because those suits would break them financially otherwise--even good doctors sometimes settle cases rather than risk an emotional appeal to a jury swinging the case against them in court.

Maybe suing your former doctor so that no one else has to go through what you did will help you find that closure. At the very least, I'm sure you want to make sure no more women go through what you did.
posted by misha at 6:01 PM on April 19, 2012


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