Germaine Greer On Caesarian Births And Misogyny

April 28, 2004 9:51 PM

Grin And Bear It, Woman! Think Of England!Caesarean births in the U.K. should be severely curtailed, say the medical mandarins. Germaine Greer says, in a cracking column, that the new guidelines are misogyny pure and simple. Is it just my impression (think of American Pie-type teenage movies; advertising; "guy lit") or are hatred of women and beery, bozo celebrations of indifference to the feminine sex on the up and up?
posted by MiguelCardoso (64 comments total)

Well, having been through 27 hours of agonizing labor before being rushed into surgery for a c-section, I can guarantee you that were I at all interested in having another child, I would opt for the c-section straight away.

Labor, at least in my experience, was dreadful and not something I'd care to repeat, if there's a way around it. After my c-section, I was up and about and threatening nurses in less than 18 hours, and while I had to be careful, I certainly wasn't incapacitated by it. I think that mother's should have the right to decide how they want to deliver.

Some women, especially those giving birth to tiny babies, may opt for the no-drugs, natural methods...and yay for them. But for those of us that tend towards 11 pound babies...I'm not pushing a bowling ball through a straw if I can help it. Youchies.
posted by dejah420 at 10:32 PM on April 28, 2004

Totally unrelated, but thanks to your post, I just had the same experience as this guy regarding "on the up and up."

On topic:

"If women now regard their pelvises as inanimate boxes to be peered into, unzipped and scraped out repeatedly over a lifetime, it's because a huge amount of time, money and energy was devoted to indoctrinating them."

So... People who hate women came up with these elective procedures that have clear health benefits because... they wanted to make women uncomfortable once a year? Is there some international cabal of bitter frat-boy doctors or something?
posted by whatnotever at 10:35 PM on April 28, 2004

I have to admit, I read the whole Guardian story last night wondering, "... and the reasons for NOT having a Caesarian are... ?"

I came away from the article with the impression that the reason they are to be avoided is that it is, indeed, women's lot in life to suffer.

Are there any real reasons to skip the slit?
posted by mwhybark at 10:40 PM on April 28, 2004

Dear Dejah: Exactly! When my wife became pregnant, I developed an awful condition: whenever I went into an artificially heated environment (like a shop) or peeled an orange, I started itching something terrible and would actually have to fall to the floor to maniacally scratch myself silly.

Anyway, I eventually was directed to a top psychiatrist at Manchester University who diagnosed an "hysterical pregnancy". His cure: holding the hand of dozens and dozens of women who gave birth without the presence of a partner. This I did, for two months, and it cured me completely.

I stood by at about 40 births and the one common denominator was the excruciating pain of those poor women (later conformed by my wife's delivery of two premature, identical twins, now 23: one's a philosophy graduate; the other a psychologist; both earning more money as models!).

It's said (I think falsely) that mothers forget the pain of childbirth. But it's certainly violent and, I think, stupid not to use the advances of medical science to make it less traumatic.

Some women, especially those giving birth to tiny babies, may opt for the no-drugs, natural methods...and yay for them. But for those of us that tend towards 11 pound babies...I'm not pushing a bowling ball through a straw if I can help it. Youchies.

The right to decide, as you say, is the very least of rights!

(A friend of mine, 32 years ago, delivered a healthy child under general anaesthetic - didn't feel a thing. According to the English doctor who delivered the baby, this is not a risky procedure at all. This is the only example I know but it impressed me.)
posted by MiguelCardoso at 11:21 PM on April 28, 2004 [1 favorite has favorites]

A meta-analysis done by a professor at my university found that women who had cesareans experienced less immediate and long-term satisfaction with the birth, were less likely to breast-feed, longer time until they first interacted with their baby, less positive reactions to their baby, and interacted with their baby less at home. This was done in 1996, so there may more information about the psychosocial outcomes of cesareans, but I don't know about it.

So basically, yes, there's quite a few reasons to skip the slit.
posted by stoneegg21 at 11:28 PM on April 28, 2004

Tangential pedantry: do people who spell 'cesarean' without the 'a' also write 'Julius Cesar'?
posted by riviera at 11:44 PM on April 28, 2004

Anyway, I eventually was directed to a top psychiatrist at Manchester University who diagnosed an "hysterical pregnancy". His cure: holding the hand of dozens and dozens of women who gave birth without the presence of a partner. This I did, for two months, and it cured me completely.

This is completely unrelated to your post, but: seriously?!
posted by Hildago at 11:47 PM on April 28, 2004

I think the main reasons to avoid the slit is that the dangers present with any surgery (anesthesia, slicing through your flesh, etc), and potential damage to your abdominal muscles. It's just a generally good principle to avoid cutting your body up without a really good reason. Now, that doesn't mean banning elective surgery, but I certainly would never want to go to the other extreme where C-sections to become the main option for childbirth (at least for myself).
posted by jb at 11:53 PM on April 28, 2004

This is completely unrelated to your post, but: seriously?!

It's actually very common, Hildago. It's also known as a "sympathetic pregnancy": when a male is so preoccupied with his female partner's pregnancy that he develops strange symptoms, sort of to show that he's involved too. Very embarrassing it is - it certainly removes a big wedge of your "macho" image" - but the symptoms are real.

Tangential pedantry: do people who spell 'cesarean' without the 'a' also write 'Julius Cesar'?

Riviera: you win the award for best male comment of the year: childbirth as an illustration of spelling fashions. Me, I suffer that the "a" and the "e" are analphabetically separated. I know that the "ae" agglutination is somewhere available but it's certainly not on my keyboard, as it damn well should be. When my great-grandfather surfed the Internet, it was one of the most easily available keys. :)
posted by MiguelCardoso at 12:01 AM on April 29, 2004

stoneegg and jb pretty much nailed the top reasons to "skip the slit" but the fact that the question even has to be asked frightens the hell out of me. It's somewhat akin to asking why everyone doesn't pursue optional colostomies; after all, think of the time, energy and bother you could save if you never have to bother with going to the bathroom again.
posted by Dreama at 12:40 AM on April 29, 2004

Three reasons for not having a c-section besides the obvious hassle of going through surgery:

1. Women that have had a c-section have a lower fertility rate.

If they do manage to get pregnant again
2. There is an increased risk that the placenta will place itself in harms way - either by blocking the actual birth canal or by growing on the scar from the c-section - thereby making a second c-section a much more difficult operation.

3. And finally there is also an increased risk of the uterus actually just rupturing - life threatening for the mother not to mention the child.

These reasons alone suggest that choosing a c-section is not something that should be easily recommended.
posted by FidelDonson at 12:41 AM on April 29, 2004

Riviera: you win the award for best male comment of the year: childbirth as an illustration of spelling fashions.

Why, thank you. I was going to talk about how this debate seems motivated by heat! magazine's implicit endorsement of caesareans as the perfect celebrity alternative to, er, 'slack fanny syndrome', but wondered whether such grossly petty and sexist notions deserved any more publicity than they've already received..
posted by riviera at 1:12 AM on April 29, 2004

"His cure: holding the hand of dozens and dozens of women who gave birth without the presence of a partner. "

I don't know, sounds a particularly crafty -- if cold-blooded -- way to pick up single women, but what do I know

*scratches Miguel's forearm, goes off to have a Caesar Salad for braekfast*
posted by matteo at 1:39 AM on April 29, 2004

anything that increases the risk of maternal death by about four times , robs me and the baby of the peaks of oxytocin, endorphins, catecholamines, and prolactin that kickstart all sorts of feel-good antidepressants and bonding hormones and then to top it all off my baby will be in another room for a few hours while we both sleep off some drugs... Well I'd rather not, unless it's absolutely necessary. It just doesn't make sense to me.
posted by dabitch at 1:41 AM on April 29, 2004

Its easy to think about avoiding 27 hours of child birth. But try recovering from major abominal surgery for a few months. An amusaement park of choicaes.
posted by lightweight at 1:59 AM on April 29, 2004

ugh yeah, you can't even pour yourself a glass of milk as lifting the carton hurts in the stomach muscles (and you shouldn't lift anything that heavy for at least a week).
posted by dabitch at 2:14 AM on April 29, 2004

There has been a veritable epidemic of unnecessary caesareans in Korea over the past few years, mostly as a result of the fact that doctors can charge more for doing it.

This article says

"According to the ministry of health, South Korea now has the highest rate of caesarean sections in the world with nearly half of all pregnant women opting for an operation. It cites, among other things, superstition, and a belief that caesareans are safer, pain free and more convenient. "

but the word on the streets is that it's greedy docs.

I am not fond of doctors in general, but I am positively disdainful of most Korean ones.
posted by stavrosthewonderchicken at 2:48 AM on April 29, 2004

Miguel, don't you think it's a little over-the-top to view these medical guidelines as misogynous? Germaine Greer quotes should be taken with a pinch of salt.
posted by SpaceCadet at 7:39 AM on April 29, 2004

After so many generations of indoctrination it would be surprising if the lone woman didn't fear that her inadequacy might contribute to an adverse outcome, that she might disgrace herself, that she might behave in an unforgiveable way to her husband . . .

This was the subject of an old, funny Mr. Blue column, where the husband was holding a grudge about his wife's swearing and hitting in the delivery room and was basically told to stop being a dork [scroll down.]

Miguel, between the hysterical pregnancy from orange peeling, the super-smart twin model daughters, and the literary career, you are becoming, in my imagination, some sort of fantastical, mystical creature. Maybe a centaur. Or a gnome.

I always thought a caesarian left a scar.
posted by onlyconnect at 7:39 AM on April 29, 2004

Miguel, I think you should listen to SpaceCadet because he knows what he's talking about when it comes to misogyny.
posted by onlyconnect at 7:46 AM on April 29, 2004 [1 favorite has favorites]

Doctor's glee and eagerness to cut pregnant women open, even when it was not entirely necessary, were what I thought of as being, if not misogynistic, then pretty uncaring and hostile acts. Greer seems to think that women (just as men) are not capable of being trivial regarding their choices. How many idiots vote for such-and-such because they have a nice smile ... but come medical issues of childbirth and womankind is so well versed in the issue at hand that doctor's guidelines are unnecessary and , well, misogynistic.

I mean, I actually quite like her, but do people still take Greer entirely seriously?
posted by Blue Stone at 8:01 AM on April 29, 2004

Posting histories aside, SpaceCadet does have a point. I'm one of the biggest Germaine Greer fans out there, but sometimes (and generally on purpose) she does go quite a bit over the top for effect. This definately appears to be one of those times. As already pointed out, there are a lot of very valid reasons against slicing when not necessary.
posted by fvw at 8:02 AM on April 29, 2004

Why is this being debated? It is a medical decision made between a woman and her doctor, and the rest of the world should butt out. If a woman knows the risks and potential long-term results of such an operation, and does it anyway, then that's her choice.

I'd agree this was put forth out of concern for women, if it didn't just smack of those without a uterus once again trying to control the ones who do.
posted by FunkyHelix at 8:14 AM on April 29, 2004

Isn't there a big difference between (1) ensuring that mothers are properly informed of the risks of caesarians, and perhaps even discouraging the procedure because of those risks, and (2) taking the choice of a caesarian away from a mother who wants the procedure, despite being fully informed of those risks? I thought the guidelines were doing the latter, which does seem somewhat more extreme, if not quite misogynistic.
posted by onlyconnect at 8:24 AM on April 29, 2004

Why is this being debated? It is a medical decision made between a woman and her doctor, and the rest of the world should butt out. If a woman knows the risks and potential long-term results of such an operation, and does it anyway, then that's her choice.

But nobody lives in a vacuum; we are all influenced by the changing values of the times and many of us do things that might in the future be viewed as having been obviously dangerous (such as breast augmentation using dubious materials). So yeah, the choice is between a woman and her doctor, and it may even be an informed choice, but I think the jury is still out as to whether it is the right choice. Or as the saying goes, if everybody was named Cliff, would you jump off of them?

Just for you, Miguel, cæsarian. The html code is &#230
posted by ashbury at 8:53 AM on April 29, 2004

The only thing worse than having an unneeded caesarian is not having a needed one.
posted by konolia at 9:12 AM on April 29, 2004

then to top it all off my baby will be in another room for a few hours while we both sleep off some drugs... Well I'd rather not, unless it's absolutely necessary.

I was wide awake and nursing my son as soon as the apgar tests were completed...maybe 5-10 minutes.

Its easy to think about avoiding 27 hours of child birth.But try recovering from major abdominal surgery for a few months.

I was healed within 2 weeks. I had no problems at all...and I'm in my late 30's. I was back at the gym within less than a month. For the record, after 27 hours of childbirth, my heart rate went to 40 and the baby's went to 160...it was operate or both of us died.

The studies from the 60's strike me as absurd. I nursed until he got teeth...at which point, he got weaned. I'm not losing a nipple so that the granola-eating, birkenstock-wearing, nipple nazi's wont' try to make me feel guilty.

C-sections aren't for everyone. Nobody is suggesting that everyone should have one...but nobody who isn't intimately aware of my medical history has the right to make that decision for me, or my doctor.

And it chaps my ass when people suggest that I had one because I was too lazy to continue trying to push an 11 pound baby through a cervix that refused to dilate past 7 and was far too small even if it had dilated. How dare someone suggest that I don't have the same bond with my child that they do with their own because I chose to live through the experience rather than letting both of us die because I refused surgery. And how dare anyone suggest that they, with no medical degree and no knowledge of my medical history suggest that my choice is wrong on the offchance (gods forbid) I got pregnant again. Grrr!
posted by dejah420 at 9:30 AM on April 29, 2004

If and when I give birth, I might be one of those women who would adamantly refuse a Ceasarean unless I or the baby was near death. In my opinion, abdominal surgery is way scarier than giving birth, which is a natural process!
posted by agregoli at 9:46 AM on April 29, 2004

First off, a correction. When I read this story, it was not in the G, but on the Beeb web site.

When I read the article, I was literally wondering what the arguments against C-sæctions were, as the article appeared to assume that I already knew why they were bad, as if it was self-evident that natural methods of birth are superior. Which set off my BS detector. Two sentences devoted to the topic seems light.

stoneegg, jb, et al: your summations were helpful. Without putting words into the BBC writer's mouth, why do you suspect that information was not clearly presented? Is it buried in the UK health info guidelines? Was it skipped at the press conference?

(I have no idea how or why you would know these things.)

And finally, yes, it leaves a scar, and yes, I've spent time helping a relative recover from abdominal surgery, so as far as recovery time is concerned, I do understand.
posted by mwhybark at 9:47 AM on April 29, 2004

You tell 'em, dejah.

And Miguel, another excellent post. Genial!
posted by languagehat at 9:48 AM on April 29, 2004

Dejah, I don't think anybody in this thread is suggesting that you made the wrong choice. Obviously, cæsarians are sometimes a necessity.

BTW, I like the phrase chaps my ass. Could I use it one day?
posted by ashbury at 9:49 AM on April 29, 2004

Miguel, I think you should listen to SpaceCadet because he knows what he's talking about when it comes to misogyny.

I certainly know about people who don't understand the meaning of the word and love to label people as such. I brought this up because, you know, if somebody posts something about prostate cancer and starts bandying the word "misandry" around, you can expect people like yourself to huff and puff and get all uptight. I always like to see how the shoe fits on the other foot. Aparrently, not very well. I guess I'll have to start using the word "misandrist" as liberally as people use "misogynist" round here.
posted by SpaceCadet at 9:50 AM on April 29, 2004

Riviera: Yours is an apposite question, and one that I've wondered about myself. Interesting that the 'boyzone' mefi hasn't chosen to cautiously posit and answer isn't it?!

I've not got an answer myself but there's been several persuasive arguments made herein as to why elective c-section isn't necessarily the undiluted good that a cursory heat of Heat might convince one... (See, Natalie Appleton, et al ad nauseam)

Deja: More power to you.

On an unrelated note, I'm getting very bored of bashing SpaceCadet for being misogynist. Is it not possible to be judge his comments on their merits (or otherwise) or are we that deep in the thickets of GrudgeFilter?
posted by dmt at 9:52 AM on April 29, 2004

I see a lot of ad hominem attacks on this thread but no convincing rebuttal to the argument that modern medical technology has reduced the risk in caesareans to a level where they become a viable elective birth option: so why deny mothers the choice?
posted by plenty at 9:59 AM on April 29, 2004

my baby will be in another room for a few hours while we both sleep off some drugs

As dejah420 said, they're rarely done under general, they're almost always done under spinal anaesthetic nowadays (so the mother is awake throughout), so this objection at least isn't based in fact.

And what dejah420 and plenty said.
posted by biscotti at 10:12 AM on April 29, 2004

The only thing worse than having an unneeded caesarian is not having a needed one.
posted by konolia at 9:12 AM PST on April 29

Amen, konolia.
posted by ilsa at 10:17 AM on April 29, 2004

Is it not possible to be judge his comments on their merits (or otherwise) or are we that deep in the thickets of GrudgeFilter?

That would mean people actually reading my posts, taking their meaning into account, and responding to the points I raise directly. Some people do that. Not many.
posted by SpaceCadet at 10:20 AM on April 29, 2004

BTW, I like the phrase chaps my ass. Could I use it one day?

Yes, yes you may. :) And I probably overreacted based on the reactions I got from my mother-in-law and others who all assumed that I'd had a c-section for my own convenience, rather than as a medical necessity. My response, I believe, is also predicated on the treatment I've gotten from women who had successful labor, who then whip around on me and accuse me of taking the easy way out, which is just frustrating. I mean, if it's the easy way, then by god, you had the option too...don't get superior on me just because you can spit out a baby like a watermelon seed, and I couldn't.

Although, to be fair, even if I did have one for convenience, or because I don't like pain, or because the sky was a particular shade of blue that day...how is that anybody's business but me, the father, and my doctor? I mean, to be honest, nobody knocks people out for c-sections anymore, except in dire medical emergencies...so the anesthesia risk is actually lower than when I had knee surgeries and had to be knocked out for hours. Epidurals, which are the common method for c-sections deliver almost zero drugs to the baby, because the time between drug insertion and knife insertion is minimal.

Hell, I know people who get knocked out to have their teeth cleaned, most of the trophy wives in my neighborhood have had their tits, tummy and butts done...all of which require general anesthesia...but somehow the medical community and the gunnysack crowd have gotten together and decided that women should suffer for the privilege of giving birth. Just absurd.
posted by dejah420 at 10:23 AM on April 29, 2004

I know that if and when I have a second child, I will have a second c-section. Like dejah, the first was not optional; neither will the second. I only pushed for 5 hours and my son was 9lb 2oz. However, the shape of my pelvis did not allow his head to pass. Even when he shattered my tail bone, pushing it out of his way, there just wasn't room. I'm glad my doc stopped me when she did and said it was time to go to the operating room.

I remember her discussing the risks with me prior to the room switch. The one that really stood out to me was the risk of damaging my bladder or bowels. Had that happened, it would have required more surgery to repair. I'm still not sure how a punctured bladder would repair since its walls are so thin. Either way, it was necessary.

The end result? My son and I survived childbirth, bonded and love each other tremendously. It took about a year for the tail bone to heal enough for me to sit in relative comfort. The incision healed in only a few weeks. I loved the fact that the lochia was less of an issue thanks to my doctor's efforts. I, too, nursed though I had difficulty which I don't believe was related to the c-section.

Additionally, of the women I personally know who have had c-sections, all were for genuine health reasons. Vanity be damned in this case. What woman would opt for a scar longer than the length of her hand that didn't result in a nice flat tummy?
posted by onhazier at 10:40 AM on April 29, 2004

Miguel, don't you think it's a little over-the-top to view these medical guidelines as misogynous? Germaine Greer quotes should be taken with a pinch of salt.

SpaceCadet: I, for one, much enjoy reading your lively opinions. I also fail to see how your thoughtful, politely worded comment could be said to be misogynous.

I'm one of the biggest Germaine Greer fans out there, but sometimes (and generally on purpose) she does go quite a bit over the top for effect. This definately appears to be one of those times.

fvw: Nowadays, you have to go a bit over-the-top for effect - it's up to the reader to figure out the current subtraction rate. Fwiw, I thinks she's not exaggerating at all in this article - it chimes in perfectly with her life's work. One of her very best books, which many fans may have missed because of the subject, is "The Change", her polemic on the menopause. I heartily recommend it - even to old-time smoking-jacket ex-lotharios such as myself, always keen to gain any insight into the feminine psyche. We musn't forget that women are smarter than us and the smartest we men can get is to be humble enough to learn from the unholy bitches. ,)

I was going to talk about how this debate seems motivated by heat! magazine's implicit endorsement of caesareans as the perfect celebrity alternative to, er, 'slack fanny syndrome', but wondered whether such grossly petty and sexist notions deserved any more publicity than they've already received.

Riviera: Quite right, I agree. As always, dammit.

Just for you, Miguel, cæsarian. The html code is &#230

You're a mensch, ashbury!

I don't know, sounds a particularly crafty -- if cold-blooded -- way to pick up single women, but what do I know

Matteo: all your posts can be mapped along two axes, the lefty axis and the Italian axis. This was a rare 100% Italian.
If I were Italian too I'd answer: "But Matteo! My wife was pregnant at the time - picking up single mothers is not something a decent man would do at that time!" ;)
posted by MiguelCardoso at 10:46 AM on April 29, 2004

Thanks, FunkyHelix, yes, it's a decision between the woman and the doctor. However, it's also a public health issue, and should be discussed on a macro level.

Vaginal delivery is generally healthier for mother and infant. Surgical birth is very useful when needed, but carries a higher risk of infection and other complications.

Congratulations on your excellent recovery, dejah. Not everyone has your experience. One in 4 or 5 American births is likely to be surgical. Childbirthing classes seem to mention that fact in passing, but do nothing to help women prepare for that possibility. I had my 10+ lb. baby surgically removed. I went home after 3 days but had to return to the hospital with a high fever and infection. I had other side effects as well. It was a really unpleasant experience, and I was not prepared for it at all.
posted by theora55 at 10:52 AM on April 29, 2004

Additionally, I forgot to add this about the anesthesia. As dejah said, general anesthesia for c-sections are only used in emergencies. Emergencies requiring general anesthesia are the cases where the doctors literally have less than a few minutes to get the baby out prior to it dying. This happened to a girlfriend of mine. They kicked the family out of the room and delivered the baby in less than 3 minutes.

The other time general anesthesia is used is when the mother can still feel despite the increased anesthesia the epidural is delivering in preparation for surgery. This nearly happened to me. Every time they tested to see if I could feel my feet or legs, I could. Finally, just before they decided I needed to go under general, I lost enough sensation for them to proceed. The fear of the medical staff is that I'd feel the surgery or that the anesthesia would wear off prior to completion of the procedure. This was a very real possibility since I tend to shake off the numbing effects of anesthesia pretty quickly. (I've had to tell a previous doctor that his stitching was "uncomfortable".)

So, yes, general anesthesia used to be common. Now, it's used in emergency situations.
posted by onhazier at 10:56 AM on April 29, 2004

I will just say that it seems against the interests of women to take the option of a much-performed and reasonably safe procedure away from them when some women might really prefer not experiencing alot of pain or in special cases be intensely shy about having everyone peering at her privates or even prefer not to undergo all of the required vaginal stretching that ensues. If the quotes that Greer offered were true, the people at NICE didn't seem to be probing into the reasons of why 7% of U.K. women were having non-health-mandated caesarians beyond attributing it to squeamishness and a wish to be posh, but were instead just directing doctors to refuse the procedure.

There is a general feeling from the article that not all the risks had been fully disclosed to women, in which case that seems the appropriate first step, before banning purely voluntary caesarians.
posted by onlyconnect at 11:31 AM on April 29, 2004

I think I got that wrong -- I think it was really 7% of all U.K. caesarians performed being voluntary and not health related, as opposed to the much larger figure I gave above of 7% of all U.K. women.
posted by onlyconnect at 11:48 AM on April 29, 2004

The only problem with your conclusion, onlyconnect, is the phrase "reasonably safe procedure." As has been pointed out in this thread itself, and can be verified with a cursory googling of medical sites on the matter, caesarians post a much higher risk of both fetal and maternal death and open a vector for severe (to the point of potential fatality) complications and infections which are entirely absent in normal birth. Post c-section, in addition to the extensive and extended physical recovery, research shows that the vast majority of women experience some negative effect upon bonding, breastfeeding, future fertility, future childbirths or some combination of the four.

Yes, the procedure saves lives when it's necessary, and no one in their right mind would or could say that c-sections should not be a possibility after an unsuccessful labor (or trial thereof) or for women who have pre-existing conditions which make normal L&D medically inadvisable. But when the surgery is optional -- having no medically sound reasoning behind it, just a preference -- it is not nearly "reasonably safe" enough or free from complications enough to be considered a neutral alternative method of bringing a child into the world, no matter how well the risks are explained or cogitated upon. A public health policy which affirms that truth and demands that doctors act accordingly is in the best interests of women and their children. This isn't even saying "think twice before you cut" which is something that natural childbirth advocates -- viewing the outrageous rates of c-sections in some hospitals -- have been crying for years. It's saying "don't cut women just because they ask for it" which really ought to go without saying.
posted by Dreama at 12:21 PM on April 29, 2004

onhazier, shattered your tail bone? OMG, you poor baby! ouchies!

theora55, I'm so sorry you had all those complications! I think my getting better so fast was because it was the only way I was going to get the demon of a mother-in-law out of my house...because as she said "I'm staying here to help until you get better."

Of course, her idea of help was to take my son out of my arms and carry him upstairs, or outside, or to the park, where I couldn't get to him...she wouldn't even bring him to me to nurse, she said it would be better if I dried up and gave him formula. Of course, she would only pull these tricks when my husband wasn't home. (This is the same woman who refused to call my parents, but told us she had, when I went into labor because "she didn't want to share the experience with anyone.", so my own mother wasn't there.) She's as batty as a bridge in Austin, I tell you what, and I despise her with a passion that is only rivaled by how the Israelis and Palestinians feel towards each other. Having the psycho-hose-beast gone was serious motivation to get well fast. ;)
posted by dejah420 at 12:22 PM on April 29, 2004

Dreama, I would agree with you if there really is sufficient evidence to suggest that there is significantly greater risk to caesarians, when they are being chosen as an elective surgery, over vaginal birth. But a quick googling does not really verify this -- for example the "Too Posh to Push" article has medical professionals saying that "I think there's enough evidence to support elective Caesarian section to (give women) the opportunity to choose" and notes that the American College of Obstetricians and Gynecologists agreed. If you're right that the safety difference is significant, then I'm with you, but if it's actually marginal then I think there should be a choice.

The article also notes a perception that the surgeries may be more risky for the mother but less risky for the infant who is "spared the potentially 'dangerous' passage through the birth canal." In many cases it appears women are choosing these surgeries to protect the lives of their babies, though it may be riskier to themselves. If they've been fully informed and they want to do this anyway, I think they should have that option.

Finally, is it not also possible that statistics on the safety of caesarians are already somewhat skewed because they usually have involved more high-risk deliveries?
posted by onlyconnect at 1:00 PM on April 29, 2004

I will just say that it seems against the interests of women to take the option of a much-performed and reasonably safe procedure away from them when some women might really prefer not experiencing alot of pain or in special cases be intensely shy about having everyone peering at her privates or even prefer not to undergo all of the required vaginal stretching that ensues.

Do you really think shyness about having doctors see your vagina is a good reason to undergo surgery? As a procedure recommended by the doctor, I don't see any problem with a C-section. As a procedure to avoid pain, it doesn't make any sense, because it's the anesthetic that helps you avoid pain, not the procedure itself - in fact, I would imagine that a C-section would be more painful than natural childbirth if there were no anesthetic available for either. To avoid vaginal stretching also seems sketchy, as you would be opting for having many layers of skin, muscle, and organ tissue sliced and then sewn back together instead, which really doesn't seem any better. The vagina at least has evolved to be capable of a certain amount of elasticity.

If the quotes that Greer offered were true, the people at NICE didn't seem to be probing into the reasons of why 7% of U.K. women were having non-health-mandated caesarians beyond attributing it to squeamishness and a wish to be posh, but were instead just directing doctors to refuse the procedure.

How is "squeamishness" or a "wish to be posh" different from the reasons you listed above, ie, not wanting to show one's privates to medical professionals, or not wanting one's vaginal canal to undergo stretching...? They all seem to be in the same area to me.
posted by mdn at 3:16 PM on April 29, 2004

By shyness I was alluding to cases involving intense religious belief or sex issues including abuse -- in fact the "Too Posh to Push" article I linked notes that caesarians can be appropriate for psychological reasons in the latter case (I've not heard of it in the former but could imagine it being an issue). Re pain, some women might rationally decide that twenty-six hours of labor for a vaginal delivery would be more painful for them than a caesarian. Re the stretching, I am thinking of old wives tales about sex before and after a pregnancy and assuming a caesarian doesn't affect the lower birth canal at all, though perhaps it is the pregnancy itself and not the delivery that causes stretching? (I don't know. I admit I am insufficiently informed there, so that argument may have been, well, a stretch.)

I'm not saying it's the right choice, but if it is about as safe, I don't see why it shouldn't be an option.

The "squeamishness" and "wish to be posh" quotes bothered me because the NICE people assumed these were the reasons rather than investigating. And I don't think any of the reasons I listed have anything to do with a "wish to be posh."

Finally, here is a link to one women's experience with an elective caesarian. (NSFW, maybe, includes some far away pics of the operation.) Her doctor apparently explained to her that "a vaginal birth presents the lowest risk to the mother, but a slightly higher risk to the baby. An elective section presents the lowest risk to the baby but a higher risk to the mother. An emergency section, presumably coming after some amount of normal labour, presents the highest risk to everyone because it combines the risk of vaginal birth and section, as well as being performed on a woman and baby who are exhausted from labouring for some hours." I don't think this woman was being vain or selfish or posh at all in electing a caesarian (though she admits that avoiding the hours of labor were a consideration), and I'm glad she had the option available to her.
posted by onlyconnect at 4:18 PM on April 29, 2004

right choice for everyone
posted by onlyconnect at 4:21 PM on April 29, 2004

I nursed until he got teeth...at which point, he got weaned. I'm not losing a nipple so that the granola-eating, birkenstock-wearing, nipple nazi's wont' try to make me feel guilty.

No one has to lose a nipple. Some people, myself among them, choose the Failure Is Not An Option mode of nursing, which entails *solving* nursing problems instead of giving up in the face of them. Call me a nipple nazi if you want, but the truth is plenty of women succeed at nursing well beyond the age when their children get a bit chompy.

You chose not to be among them.

Epidurals, which are the common method for c-sections deliver almost zero drugs to the baby, because the time between drug insertion and knife insertion is minimal.

Uh, "the time between drug insertion and knife insertion is minimal" is certainly NOT true in many if not most cases. This "zero drugs to the baby" line is just bullshit. The drugs *do* get to the baby.

I loved the fact that the lochia was less of an issue thanks to my doctor's efforts.

This is something I am unfamiliar with. What, did your doctor change your pads for you or something?

The article also notes a perception that the surgeries may be more risky for the mother but less risky for the infant who is "spared the potentially 'dangerous' passage through the birth canal." In many cases it appears women are choosing these surgeries to protect the lives of their babies, though it may be riskier to themselves.

It should be noted that cesarian babies are denied the substantial squeezing effect of the birth canal on their ribcages, which helps rid the lungs of excess amniotic fluid. C-section babies often have "wet" lungs, and a higher incidence of pneumonia.

So it's not always safer for the baby.
posted by beth at 5:28 PM on April 29, 2004

You chose not to be among them.

No, no. Seriously Beth, be more confrontational... That's helpful....

So it's not always safer for the baby.

Because it's ipso facto, a one sided argument isn't it?

Oh fuck it, I can't be bothered.

Look, seriously, try and put your dogma aside for a moment and go and talk to a midwife....
posted by dmt at 7:41 PM on April 29, 2004

Dmt, beth's right. Going thru the birth canal does help get the fluid out of the baby's lungs for that first breath, etc.

I have never had a csection, and my first baby was over nine pounds. But I had a pelvis that allowed for that. Not everyone does. (there are three main shapes and only one is fit to give birth to half-grown younguns.)

The focus should be on the health of the mom and of the baby. Period.

(Dejah, now I know why you had such a rough labor. Your baby was afraid to come out!)
posted by konolia at 8:13 PM on April 29, 2004

First: "The neonatal death rate has dropped. While analysing 31,905 deliveries in a tertiary referral hospital it was found that the neonatal death rate (after c.section) is 2.1 per cent when compared to 2.8 per cent after vaginal delivery." So caesarians appear slightly safer for the baby.

Second: As dejah alluded to earlier, isn't this similar in many ways to many elective surgery procedures that people may choose despite the risks simply because they choose them? Another medical article confirms this: "Although natural parturition may be the biological intention of most women, requests for elective caesarean delivery are on the increase. Gunasekera and colleagues have also discussed some of the ethical and moral issues involved. They compare the requests for caesarian section to the choice of the patient in deciding on management of non-life threatening interventions such as selecting a contraceptive and the treatment of menorrhagia." As long as she makes an informed decision with her doctor and SO, it's her body and her choice. Especially if the tricky issue of the baby's rights aren't at stake where the operation is in fact safer for the baby.
posted by onlyconnect at 9:13 PM on April 29, 2004

Some people, myself among them, choose the Failure Is Not An Option mode of nursing, which entails *solving* nursing problems instead of giving up in the face of them. Call me a nipple nazi if you want, -beth

Ok. I will. See, you've just proven my point with the "I'm so much better than you" attitude. So, according to you, I'm a failure. A year of nursing MY son isn't good enough for YOU! Note that you never even asked if I kept using the pump or not...you just assumed your "I'm so much better" attitude and ran with it.

Nurse your kid till he graduates from medical school for all I care...but when I have to get ER treatment because of my son's biting...yeah, he can get his milk from a bottle. How dare you get on your high horse and declare that I failed.

People like you are the Nipple Nazis. You're cruel, you're ill informed, you're judgemental, and you're hateful.

This "zero drugs to the baby" line is just bullshit. The drugs *do* get to the baby. -beth

And you got your medical degree from where, exactly? Cause my drug doctor and my ob/gyn got their respective degrees from two of the finest medical schools in the country....and considering that they didn't give me the drugs until 5 minutes before surgery, I'm going to have to say that you're talking out of your ass there princess...but that's hardly a surprise from someone who considers a mother who doesn't breastfeed her children into their teens a failure, is it?

(Dejah, now I know why you had such a rough labor. Your baby was afraid to come out!) - konolia

Yeah, I'm not sure how to take that...but my initial response is pretty darn angry.
posted by dejah420 at 9:27 PM on April 29, 2004 [1 favorite has favorites]

*hugs dejah420*

How bloody unfair! My sister (three medically necessary C-sections, the last one resulting in a dead baby and wisely but sadly advised - leading to a long depression - she couldn't do it again) went through the same hell, despite all her altruistic suffering and being such a good mother, like you.

Another hell was from people who unfeelingly couldn't sympathize with the loss of her third baby and told her to cheer up and thank God for the two she'd got and make the best of it. And you know what? Most of it came from other women, smug and smarmy, of the "Be like me or die" school", very common in Latin countries. Perhaps misogyny gets its lifeline from a few other women-hating women?

Beth: how callous can you be? You're drawing yourself into a very dangerous little circle if your only way to feel well is to make other people feel bad. You're also deeply misinformed and out of any rational loop I can think of. Reread and reinterpret your words as applied to you - many of us remember the sensitive Beth we love - and you'll understand why the Nazi epithet is well applied.
posted by MiguelCardoso at 11:22 PM on April 29, 2004

Finally, is it not also possible that statistics on the safety of caesarians are already somewhat skewed because they usually have involved more high-risk deliveries?

Bingo! For a true apples-to-apples comparison we should use data based on elective caesarean births only (that were NOT medically necessary).

Let's face facts: the medical case against modern caesarean procedures is inconclusive at best and more likely closer to non-existent. Instead of making claims of dubious scientific veracity, the anti-caesarean folk need to be honest with themselves and admit that it just seems unnatural to them. They have the right to this view, but not the right to impose it on others, especially when it relates to something as sacred as reproductive choice.
posted by plenty at 12:04 AM on April 30, 2004

I too got a c-section, but after 14 hours of labor, her heart rate was dropping and my blood pressure was rising eventually got to 180/??? or something like that. My doctor was considering it and I finally just requested one and am SO HAPPY I had the choice.

Afterwards, I bonded perfectly with my baby, and although I had to wait 12 hours to breastfeed her (until my blood pressure stabilized), she's 4 months old and we're still going strong. I am VERY glad that the option for a c section was available to me. We both *probably* would have made it vaginally, but why take the chance? I had probably 10 more hours of labor left (was only at 5 cm.) and she wasn't doing well and I hadn't slept for 2 days and my blood pressure was rising..so why not?

Reasons NOT to do it
1. It is major surgery and any major surgery should be avoided if necessary
2. It's way more expensive! (my delivery was $56,000 rather than the $20,000 or so it would have cost w/o the c-section.)
3. Recovery sucks.
4. The needle in the spinal cord is dangerous...although many women get it anyway for vaginal surgery.
5. I'm sad I didn't get to push her out and experience that. The c-section is so much more impersonal, clinical, and unnatural feeling.

Reasons TO do it.
1. Saves the life of mom or baby
2. If you've had one before
3. You don't get lovely things like hemorrhoids, leaky plumbing, you don't bleed like the devil for 6 weeks, you don't get an episiotomy (which are sadistic) or rips down there...the list goes on and on.
4. OR Any reason you and your doctor agree on.

If c-sections are so awful, why do most female OB's schedule c-sections for themselves when they give birth? Hmmmm?

I agree with all above that it's fine to suggest people avoid a c-section, and educate them of the vaginal vs. C-section issues, but in the end, back off and let the woman decide.
posted by aacheson at 9:21 AM on April 30, 2004

And BTW, Beth, your high-than-though "choose the Failure Is Not An Option mode of nursing, which entails *solving* nursing problems instead of giving up in the face of them" is TOTALLY uncalled for. Breastfeeding is a personal choice and NO ONE should pass judgement on anyone for whether or not they do it, nor how long they do it. I, and most of my friends my age, were bottle fed from birth because that's what was "done" back in the early 70's. We are all fine and happy and healthy and some have chosen to breastfeed their kids, others didn't. I'll do it until I don't want to anymore or until Lucy doesn't want it.

Don't pass judgement on people for a lifestyle choice. How would you like it if I said that people breastfeed their kids even when they're old enough to ask for the boob and co-sleep until their kids are 6 are really disturbing and have serious separation anxiety. It probably wouldn't make you happy....

Your smug and callous words are uncalled for and Dejah's reaction is totally within the bounds.
posted by aacheson at 9:32 AM on April 30, 2004

Dejah, what I meant is that your baby might have wanted to hide from your mother in law. Sorry I wasn't more specific. That woman would have put my Christianity to the test.

As for nursing, I nursed two-and a half of my kids. The middle kid weaned herself before she turned three months old (she figured out I was pregnant again before I did) and did just fine on the bottle, A whole generation, of which I am one, was mostly bottlefed and we are fine. No fancy formula either, back then- evaporated milk, corn syrup and water. I imagine a vitamin drop or two found its way in somewhere.

But nursing is cool if you can manage it, but a lot depends on what else is going on in your life. No nipple Nazi am I. I do think the poops smell much better on breast milk...one particular formula my daughter was on briefly stank so bad on the other end that I took the rest of the case back to the store. (SMA, if you are wondering. Don't know if they still sell it. Enfamil and Similac were better.)
posted by konolia at 10:51 AM on April 30, 2004

You know, I think we might have missed one of the issues re the original posts-they have nationalized medical care in Great Britain, right? Doesn't that remove a lot of patient choice in the equation? Now THAT scares me.
posted by konolia at 11:08 AM on April 30, 2004

Doesn't that remove a lot of patient choice in the equation?

No, and being from Canada I've found a lot of Americans seem to think this way about socialized medicine. Americans often seem to think that socialized medicine means they have no say in the matter, when, having now lived in both Canada and the States, the only real difference I've noticed is that I have to actually pay money in the States (and waiting times for many things are much shorter, it should be said), but in terms of the amount of control you have over your care, there's no difference whatsoever. Yes, there are some things which aren't covered under some US insurance plans, and some things which aren't covered under OHIP and other provincial health care plans, but the amount of choice and control you have is the same under both systems.

And dejah, you go, girl. I'm behind you.
posted by biscotti at 12:26 PM on April 30, 2004

Here's what the new U.K. guidelines actually require:

Women who want to give birth by caesarean section rather than undergoing labour will no longer automatically get their wish, under guidelines produced yesterday for the NHS. Those who are frightened of the pain of childbirth or are "too posh to push" will be offered counselling and detailed information on caesarean births. . . . Although doctors will be able to refuse a request if there are no medical grounds for a caesarean, they must offer a referral to another doctor for a second opinion.

The part about this that is good is the fact that women will be offered detailed info on caesarians. I'm not really sure that counseling is necessary, and if there are no additional risks for this particular woman I'm not sure whether a doctor should be able to refuse it on principle. Patient choice is being taken away.

I continue to find it odd that this article and so many other sources are attributing women's decisions for elective caesarians to "fright" and to being "too posh to push." Some women, as I've linked, are advised by their doctors that a caesarian would be safer for their baby, if riskier for themselves. Why is the main story that these women are spoiled and lazy rather than, perhaps, heroic?
posted by onlyconnect at 1:29 PM on April 30, 2004

Dejah, what I meant is that your baby might have wanted to hide from your mother in law.

Yeah, that's what I figured once I wasn't feeling quite so spikey. :)


Patient choice is being taken away.

Exactly, and the articles about it that I've read are semantically loaded so as to make it seem like removing that choice is the only rational thing to do. Which is just absurd.
posted by dejah420 at 7:54 AM on May 1, 2004