How lucky are we
July 9, 2014 11:15 AM   Subscribe

Sorry You Were Tricked Into a C-Section What disapproving friends don’t understand about cesarean births
posted by ThePinkSuperhero (134 comments total) 15 users marked this as a favorite
 
I'm not sure exactly what the term for this is, but I've seen a lot of these types of articles lately: pushback against advocates of non or low intervention births, often with the uncontroversial claim that women shouldn't be pressured into anything they don't want to do regarding birth.

Which is really frustrating, considering the massive economic, structural, financial, medical, social, etc. pressures there are for an interventionist birth.

I mean look at this article. She acknowledges that the C-section rate is too high and is high for reasons that aren't good. But what's the focus of this article? Facebook comments. Not the massive structural incentives.
posted by MisantropicPainforest at 11:32 AM on July 9, 2014 [9 favorites]


The fact remains that not every C-Section is necessary. There is no good argument for the high rate in the US, and while it may not be appropriate to talk about this with a new mother who just had one, that doesn't erase the fact that women are being cut open without really needing to be.

That said, every doctor I've ever spoken to says that all C-Sections are medically necessary. I am currently pregnant and SO MANY PEOPLE want to tell me about every last horrible thing that can possibly, maybe go wrong in giving birth. I am being actively shamed and called irresponsible because I am not actively freaking out about the remote possibility that it's all going to go wrong for me. Instead, I'm focusing on how I'm healthy and choosing to trust the process until I'm given a reason not to.

So, sure, I'm not going to talk to my friends who had C-sections about how I think they were the victim of a system that is out of control, but this article is not going to make me stop thinking it.
posted by ohisee at 11:38 AM on July 9, 2014 [10 favorites]


Almost all of my friends who have had children in the past year (close to 10 people) have had emergency C-sections. I have no idea if they were emergencies or not, but they were told they were necessary.
posted by roomthreeseventeen at 11:40 AM on July 9, 2014 [1 favorite]


ohisee: "So, sure, I'm not going to talk to my friends who had C-sections about how I think they were the victim of a system that is out of control, but this article is not going to make me stop thinking it."

Uh ... thanks, I guess?
posted by Eyebrows McGee at 11:42 AM on July 9, 2014 [40 favorites]


One positive of a forceps birth is that people are too busy cringing and crossing their legs to have an opinion!
posted by the young rope-rider at 11:47 AM on July 9, 2014 [10 favorites]


Nice handwaving by the good Dr as they blithely dismisses the too high C-section rate.

Could many people use more work being more sensitive when they talk to pospartum mothers? Yes.

Do some postpartum mothers who've had a cesarean (that perhaps they suspect wasn't necessary) actually wish to talk about it and process the experience with trusted friends? Absolutely.
posted by skjønn at 11:50 AM on July 9, 2014 [3 favorites]


Two weeks late, two days in a sort of kinda-painful-but-nowhere-near-real-labor-pains, and they eventually brought my wife in for a C-section. Waiting alone in the room while they prepped her was probably the longest 20 minutes of my life. I'm sure it was a bit worse for her. Eventually they let me into the OR where she was strapped down to the table, her arms stretched out. She made a "Dead Man Walking" joke and then they told her to take a breath. I took a peek over the curtain, because when am I ever going to get a chance to look into my wife's abdomen? They reached in and yanked my son out of her belly, holding him up like one does after catching a large trout. My first impression upon seeing him for the first time was that he looked kind of like my brother. If my brother were covered in goo.

They hosed him off and handed him to me but she was still strapped down so she couldn't hold him for about an hour, after she was stitched up. I got to go with him while they cleaned him off, measured him, prepped the frets and checked the intonation and whatever the hell else they do with a newborn. He looked up at me the whole time, which was kind of awesome. I know he was just staring off into that blurry world that babies see, but it still felt like he was interested in seeing his dad.

It wasn't an emergency c-section so much as a "let's get this the hell over with" c-section, but there's a good chance if this technology didn't exist my wife, or son, would not be around today. Sometimes we regret not having gone through that Play-doh Fun Factory moment but in the end, especially after sitting through the class on episiotomies and other other such horrors, I think we were both perfectly happy having a child this way.

This all happened before Facebook existed, but the number of friends (on-line or otherwise) who made any sort of judgey comments or otherwise second guessed the doctor was zero.

Which is kind of surprising because there's nothing like having a kid to bring out the judginess in every goddamn person on earth, parents and non-parents alike.
posted by bondcliff at 11:50 AM on July 9, 2014 [73 favorites]


I mean look at this article. She acknowledges that the C-section rate is too high and is high for reasons that aren't good. But what's the focus of this article? Facebook comments. Not the massive structural incentives.

I'm not so sure that the article is "about" the c-section rate so much as it's "about" the boorish behavior that some people have towards new mothers - the tendency of some people to be critical after they've heard a friend's had a c-section. "ooh, I'm sorry your doctor claimed it was necessary. I'm sorry you were tricked into that."

I agree with the author that those comments really aren't fixing the problem because they're being directed at the person who is least able to do anything about it by virtue of the kid having already been born. What do they expect the mother to do - shove the kid back up inside her and go back to the doctor and demand a vaginal delivery do-over?

Jeez. The busybodies should go attack the doctors if they're really concerned about the rate of c-sections and should leave the poor and exhausted and sleepless new mothers the fuck alone.
posted by EmpressCallipygos at 11:53 AM on July 9, 2014 [30 favorites]


Sometimes we regret not having gone through that Play-doh Fun Factory moment

OMG, I am dying over here. I had my doubts but you have made this thread worth it for me.
posted by ThePinkSuperhero at 11:54 AM on July 9, 2014 [29 favorites]


Don't mistake the general for the specific. There are too many C-sections in the West, for a variety of not-good reasons. However, even though that is true, it does not follow that any particular recipient of a C-section was necessarily the victim of a truly inappropriate C-section. Unless you have actual knowledge of the circumstances of that birth, let alone the desires of the mother, then you just don't know.
posted by Sticherbeast at 11:55 AM on July 9, 2014 [36 favorites]


I'm not so sure that the article is "about" the c-section rate so much as it's "about" the boorish behavior that some people have towards new mothers - the tendency of some people to be critical after they've heard a friend's had a c-section.

I agree. My problem is that where are the articles in prominent outlets talking about the high C-section rate in the US?
posted by MisantropicPainforest at 11:57 AM on July 9, 2014 [1 favorite]


I had two. Loved them both. Just saying.
posted by pearlybob at 11:57 AM on July 9, 2014 [1 favorite]


OMG, I am dying over here. I had my doubts but you have made this thread worth it for me.

I have to give credit for that comparison to an old 'Bobcat' Goldthwait routine. I believe he referred to birth as "The Playdoh Fun Factory of Life." I've always loved it. In fact I love it so much I've used it even in the most inappropriate situations. Carry on.
posted by bondcliff at 11:58 AM on July 9, 2014 [9 favorites]


Sorry, that was unnecessarily angry. While it is widely acknowledged that the C-Section rate is higher than it needs to be, it is true that the rate will never go down to zero. Some are necessary, and I have no way of knowing which are and which aren't, so I wouldn't question anyone individually because I don't know which category they fall into.

Everyone I know who has had one has been told theirs was necessary. I think it would be horrible to offer anyone other than support for their experience, but even the doctor writing this article acknowledges that that is not really true.

That question always exists in the back of mind, was this really necessary? Were you really about to die or did you have an overzealous doctor? I doubt anyone truly knows in the moment, and they err on the side of safety, or not getting sued, or whatever.

But I do think it's good practice to save my ire for the doctors and medical system and not for individual women who are generally doing the best they can. And that includes the doctor who wrote this article.
posted by ohisee at 11:58 AM on July 9, 2014 [1 favorite]


Wouldn't part of trusting the system until you have a reason not to be believing doctors when they say the c-sections they provide are medically necessary?
posted by ChuraChura at 11:59 AM on July 9, 2014 [1 favorite]


In other words: High C-section rate==huge fucking problem.

Rude comments from other mothers disapproving of a C-section==not cool but not a huge fucking problem.

I would blame this entirely on Slate but I've seen this tendency in other media.
posted by MisantropicPainforest at 12:00 PM on July 9, 2014 [1 favorite]


My problem is that where are the articles in prominent outlets talking about the high C-section rate in the US?

....Just as the new mother is not the person to criticize about whether her c-section were necessary, I suspect the article about rude facebook commenters is not the article to criticize for not being about the high c-section rate.
posted by EmpressCallipygos at 12:00 PM on July 9, 2014 [5 favorites]


My problem is that where are the articles in prominent outlets talking about the high C-section rate in the US?

I just googled "c-section rate". Turns out that Fox News had a story on this two hours ago. The New York Daily News had a story on extra risks from C-sections six days ago. There are also recent articles critical of C-sections (and their rates) in Forbes and the WSJ.

I mean, I understand why there needs to be more advocacy on this issue, but it's not exactly obscure.
posted by Sticherbeast at 12:02 PM on July 9, 2014 [11 favorites]


ChuraChura, I'm seeking care with midwives and avoiding doctors unless the midwives tell me I have a reason to see them. I am not generally anti-medicine, but I don't think OBs are the best option for healthy pregnancies. The high C-Section rate is one of my main reasons for thinking this.
posted by ohisee at 12:03 PM on July 9, 2014 [2 favorites]


I doubt there are doctors who are recommending C-Sections if waiting would produce a good outcome, doctors recommend C-Sections for births that are problematic in some way. Long labor, irregularities with fetal heartbeat, etc. Now, would 70% of those things perhaps resolve themselves if given more time? Perhaps. But what about the 30% that won't, and that need intervention?

In this case, although C-Section is serious business, I'd rather err on the side of caution. Basically, I trust my doc, if I'm getting this as a recommendation, then let's do it.

No one has a crystal ball. Doctors aren't doing C-Sections for the hilarious fun of it, they're doing them because they're in the best interest of mother and baby, given the information they have in the moment.

And ANYONE who is saying anything judgy about anything having to do with a new mom and her baby...if we want any shit from you, we'll squeeze your head.
posted by Ruthless Bunny at 12:04 PM on July 9, 2014 [8 favorites]


MisantropicPainforest: "I agree. My problem is that where are the articles in prominent outlets talking about the high C-section rate in the US?"

LMGTFY

USNews - HuffPo - USA Today - ABC News - NPR - Consumer Reports - NYT - CDC
posted by Eyebrows McGee at 12:04 PM on July 9, 2014 [12 favorites]


I thought that the c-section rate was high in the U.S. was because women becoming mothers today are more likely to be older and overweight than they have been historically.
posted by kat518 at 12:04 PM on July 9, 2014 [4 favorites]


I was a bit troubled by this since our twins were C-section.
Afterwards, we heard everything from "that's too bad," to "you should get them 'rebirthed'"....I had to go home and google "rebirthing".
posted by whatgorilla at 12:04 PM on July 9, 2014 [6 favorites]


I have had two c sections. Most people I know don't know enough about my medical history OR have the medical knowledge to ascertain whether or not they were necessary. Therefore, it would be ridiculous for anyone to voice that opinion. Giving unwanted and ridiculous advice seems to be a sport these days though.

People just can't keep their comments to themselves. I had someone ask me if i felt like i had really given birth since I never went into labor. Um, yeah. Got a baby out of the deal. Pretty sure that was the end game the whole time, ya nosy weirdo.
posted by domino at 12:05 PM on July 9, 2014 [23 favorites]


Rude comments from other mothers disapproving of a C-section==not cool but not a huge fucking problem.

I guess that depends on who you are and what kind of painful, life-altering shit you just went through, that was maybe not what you were expecting, no?
posted by The Bellman at 12:06 PM on July 9, 2014 [10 favorites]


My problem is that where are the articles in prominent outlets talking about the high C-section rate in the US?

One second of searching found this long article in the Wall Street Journal from a month ago, which says, among other things,

"Vaginal breech births are also seen as a way to reduce the high rate of C-sections, which carry their own risks, such as hemorrhage. About one of every three births in the U.S. and Germany are delivered by caesarean, a rate public-health officials say is too high."

Or here's something on Fox news from two hours ago:

"That’s because more C-sections are performed nationwide than are necessary, and rates have been rising. To put a number on that rise, the national C-section rate was 22 percent in 1990 and jumped to 32.7 percent just 20 years later in 2010. More recent data suggests nationwide cesarean section rates have been leveling off in the past few years, but averages are still much higher than decades past. Currently, only one state in the country performs cesareans at a rate below the 1990 average."

Here's the New York Times from April, about the difficulty women are having finding hospitals to handle VBAC:

"The reluctance to adopt the guidelines has been especially strong in rural areas, where medical resources are sparse and doctors tend to prefer repeat cesareans, despite a nationwide push to reduce the number of women having these procedures."

The idea that too many babies in America are born by C-section is expressed in major media all the time.
posted by escabeche at 12:06 PM on July 9, 2014 [3 favorites]


I thought that the c-section rate was high in the U.S. was because women becoming mothers today are more likely to be older and overweight than they have been historically

Yes, the fault is definitely with the fat women who selfishly prioritized their careers over baby-making.
posted by sparklemotion at 12:07 PM on July 9, 2014 [18 favorites]


That question always exists in the back of mind, was this really necessary? Were you really about to die or did you have an overzealous doctor? I doubt anyone truly knows in the moment, and they err on the side of safety, or not getting sued, or whatever.

After my son was born via c-section, I asked my OB why it happened that way (why didn't I go into labor, why didn't the induction work, etc), and she basically just shrugged and said, there's a lot about birth that is still a mystery. I trust her training and experience, and I trust the rest of the medical team and the attending who made the call to do a c-section (the attending, incidentally, also delivered my doctor's kids). Was it "necessary"? Could I have done this, that or the other thing and had a vaginal birth? Who knows. "No one has a crystal ball", indeed. I'm healthy, the kid is healthy, the end. And now I get the fun adventure of seeing if a VBAC works out!
posted by ThePinkSuperhero at 12:09 PM on July 9, 2014 [11 favorites]


I had to go home and google "rebirthing".

Sincere question - I'm only finding links to attachment therapy methods and breath-training for meditation; what did you find for "rebirthing" when it came to baby care?
posted by EmpressCallipygos at 12:10 PM on July 9, 2014


Well maybe there's just a lot more of the FPP type articles going viral and distorting my perception. I stand corrected.
posted by MisantropicPainforest at 12:10 PM on July 9, 2014


Previously.
posted by Catblack at 12:10 PM on July 9, 2014


I stand corrected. From the NYT article mentioned above:

Despite the fact that unnecessary C-sections produce worse outcomes for more money, America’s C-section rate is growing fast — it has risen 50 percent in the last 10 years and now is used in a third of all births. This is not because of aging mothers or assisted reproduction — these make up a small fraction of births. Nor is it due to rising obesity — the two trends don’t track each other. The biggest increase in C-section rates is among women under 25. Most of the increase has come in low-risk births.
posted by kat518 at 12:11 PM on July 9, 2014 [2 favorites]


Another thing that should be Safe, Legal, and Rare, right?
posted by mikelieman at 12:11 PM on July 9, 2014 [6 favorites]


kat518-

There was a Slate article about a study in Scotland where age tracked C-section rates. That may be what you're remembering.
posted by MisantropicPainforest at 12:13 PM on July 9, 2014


they err on the side of safety

THE MONSTERS!!!!
posted by Sticherbeast at 12:13 PM on July 9, 2014 [3 favorites]


[Comment removed; do not use mefi threads as a signal boost for your blog posts.]
posted by cortex (staff) at 12:16 PM on July 9, 2014 [3 favorites]


The problem with this article is the same as the problem with any article from the recipient of a C-section: it is one person's experience. Yes, she's experienced many births, but she is still one person.

The public-health data do show that there are too many C-sections, and that those happen for many reasons -- including (many) doctors' preferences, weekend or vacation schedules, and erring towards the "safe" option when it might be just as safe to let a mother continue laboring, as new data show.

The author of this article cannot extrapolate her own experience and good intentions onto all C-sections, any more than an author who was a recipient of a C-section.
posted by Dashy at 12:20 PM on July 9, 2014


they err on the side of safety

THE MONSTERS!!!!


I know! The problem is that the people making that call are trained in looking for complications.

As quoted in the NYT article linked above, one OB says, "“I trained as a high-risk obstetrician. I’m best at dealing with complications."

We all know that confirmation bias is a thing. If you are looking for the worst possible scenario, you are more likely see that. I want my first line of defense to be someone looking for a healthy birth. If they don't see that, I want to be sent to the person looking for complications. It seems perfectly logical to expect that in my healthcare.
posted by ohisee at 12:21 PM on July 9, 2014 [2 favorites]


there's nothing like having a kid to bring out the judginess in every goddamn person on earth, parents and non-parents alike.

Oh god, so true. I'm a non-parent, so I'm goddamn sure I have no fricking idea, but still, so so so true. Everything a person does is a rejection of someone elses' upbringing. Or religious beliefs. Or strategy for raising their own kids. Or expressing favoritism over one set of familial backgrounds over another.

And on, and on and on and on and on.
posted by aramaic at 12:22 PM on July 9, 2014 [9 favorites]


The Onion has a helpful breakdown of the pros and cons related to natural childbirth.
posted by kat518 at 12:25 PM on July 9, 2014 [8 favorites]


I was told by a birthing busybody that if I had just shined a flashlight at my hoo-hah, I wouldn't have had to have a C-section, because the light shining up my vagina would have made my frank-breech baby turn himself head-down to swim towards the light.

Joke's on her; I TOTALLY tried shining a flashlight at my hoo-hah. Desperate pregnant ladies try a lot of dumb stuff.

--

People can be really nasty about it. When I was struggling with new motherhood it was tremendously upsetting how people were like "Oh, now you won't be able to bond with the baby" or "His lungs will be weak because you gave in to a C-section" or "You shouldn't expect to breastfeed him very long since you had a C-section, especially since you didn't even try laboring, you have to labor or your milk won't come in" or -- my favorite -- "Well, I mean, it's not like you GAVE BIRTH, you just had the doctor pull the baby out, so I don't think you should really be saying you GAVE BIRTH to him, do you?"

Now it's easy for me to laugh it off and see how ridiculous these people were, but it was hard at the time. It's absolutely true that the proper venue for discussing too-high C-section rates is in a public health discussion that is not about any one person but about the issue as a whole; but unfortunately most people stick to just being nasty to women who have recently given birth, since that's a lot easier and requires less work or expertise.
posted by Eyebrows McGee at 12:31 PM on July 9, 2014 [65 favorites]


At the very least, I think we can all agree that we (unlike all those other cranks -- you know who I mean) know exactly what's best for the mother and all the things she did wrong, and we should not waste a single opportunity to tell her.
posted by Behemoth at 12:35 PM on July 9, 2014 [3 favorites]


I doubt anyone truly knows in the moment

Oh, my ob/gyn knew, when she looked at me, that I had severe "textbook" pre-eclampsia, that my liver was shutting down and that if she didn't deliver my son immediately both he and I would have died. She knew because she had been trained to see those things.

So I acknowledge that there are probably more C-sections than are medically beneficial in the US right now, but what with women's ability to make health care decisions for themselves being infringed already, I worry that some of this pushback against interventions is going to go too far the other way, and we'll end up with insurers and politicians deciding that anesthesia isn't a real necessity during labor, or that doctors must get second opinions before intervening, or that a pregnant woman has to have a documented medical history of risk before a c-section is allowed.

I hope I'm worrying unnecessarily.
posted by daisystomper at 12:36 PM on July 9, 2014 [24 favorites]


MisantropicPainforest: Rude comments from other mothers disapproving of a C-section==not cool but not a huge fucking problem.

They are indeed a huge fucking problem for the women that have to repeatedly hear them.
posted by Rock Steady at 12:41 PM on July 9, 2014 [22 favorites]


Sometimes we regret not having gone through that Play-doh Fun Factory moment but in the end,

This is the worst thing I've heard all day.
posted by discopolo at 12:46 PM on July 9, 2014 [1 favorite]


My wife and I had planned a home birth. We did all of our prenatal care through the midwife practice, met all of the midwives, gotten all of the supplies, done all our prep. A week after the due date a friend made us a spicy Indian dinner, and at 3:30am on a Friday my wife’s water broke. I thought “here we go,” and called the midwives.

But then nothing happened. No contractions, nothing. Through Saturday, we waited. Still nothing. The midwife came by over and examined my wife. Everything seemed, fine so we decided to wait a bit longer. On Sunday morning, we were starting to get stressed out. We looked up ways to make labor progress. My wife took castor oil. She went to an acupuncturist. Still nothing. Finally, at 6pm on Sunday night, the midwife came by again, and together we made the decision to go to the hospital. We had already waited much longer than recommended.

At the hospital, she was examined, given morphine, hooked up to the monitors, and told that if nothing was happening in the morning, they would induce labor. So Monday the order of the day was pictocin and an epidural, which were already much further in terms of interventions than we wanted. Still nothing. Finally, a 9pm on Monday evening the examined my wife who was now maybe 3 centimeters dilated. The doctor watched the fetal heart rate for a minute or so and told us that he was seeing accelerations, and that they were going to do a C-section.

Now, I admit I know nothing, but I had been watching those monitors for 24 hours, and damned if I could see any kind of a difference.

So my first daughter was born two hours later in an operating room. It wasn’t the birth that we had planned, and a part of me feels that if they hadn’t wanted to free that bed, they could have waited a bit longer. But then again, maybe I'm wrong. And even if I'm not wrong, it may have been that a C-section was the only safe way my daughter could have been delivered. But it isn't the sort of thing I dwell on. My daughter was born, and she was (and is) healthy, and in the end that's the important thing.
posted by Lazlo Hollyfeld at 12:47 PM on July 9, 2014 [6 favorites]


A good rule is to never talk to someone about their misfortune if they're not aware of it.
posted by michaelh at 12:47 PM on July 9, 2014 [24 favorites]


Which is kind of surprising because there's nothing like having a kid to bring out the judginess in every goddamn person on earth, parents and non-parents alike.

The first thing that happens after the baby is finally out, one way or another, is that you get thrown into the breastfeeding judgement bonus round.

The amount of well-meaning pressure, unsolicited advice, tsk-tsk-ing, statistics citation, guilt and other "support" my wife had to endure made me want to cry. And that starts just moments after delivery.

She had great success breastfeeding all our kids, including tandem feeding twins. But she had to basically yell at healthcare workers to back the hell off and stop stressing her out. People judgy about bottle feeding get death glares from both of us now.
posted by CaseyB at 12:48 PM on July 9, 2014 [12 favorites]


the light shining up my vagina would have made my frank-breech baby turn himself head-down to swim towards the light.

whoa

If it worked, wouldn't pregnant ladies have to have blinkers on their business or dress and undress in the dark? Otherwise the baby would be making a break for it all the time?
posted by winna at 12:51 PM on July 9, 2014 [10 favorites]


Fortunately, the c-section is the last major decision about which people will feel entitled to make nasty comments to a new mom. Strangers, friends, and relatives will avoid saying mean things about the decisions she makes regarding whether, when, and how to return to work, daycare, when to introduce solid foods, sleep training, and how and where the baby sleeps. They know this is a stressful time, she needs support, and that any advice should be offered in a loving and constructive manner.

People are particularly kind to the minority of new mothers who don't produce much milk or who can't breastfeed because of breast reduction surgery or a pre-existing medical condition.
posted by Area Man at 12:52 PM on July 9, 2014 [18 favorites]


If it worked, wouldn't pregnant ladies have to have blinkers on their business

Blinkers on the Business Maternity Wear. We are going to be RICH!!!!
posted by ThePinkSuperhero at 12:54 PM on July 9, 2014 [6 favorites]


At least until I launch my downmarket alternative, "Landing Stripz" (exclusive at Target).
posted by selfnoise at 12:58 PM on July 9, 2014 [8 favorites]


I wanted a low-intervention birth. Lots of polite ignoring my Mom who thought c-section would be much nicer and more convenient. Went to the nice Birthing Unit, with wallpapered walls, Mom & Baby-centered, yadda. Instead, on my due date I went in for a stress test - 2 days of pitocin and a fetal monitor. No productive labor, baby fine. Went home. At 2 weeks post-due date, I got induced, membrane ruptured (ouch), pitocin, labor, 10 cm., pushing, pushing, and, early morning, had my baby surgically. 10 lbs+ and a Very Big Head. Without intervention, who knows when labor might have started. And my son had the umbilical cord around his neck 3x. His head was too big to engage, my cervix never got that pressure, my pelvis never widened enough. No c-section, he might have died, I might have died.

Then, nearly as soon as I got home from the hospital, I had a high fever and went back to the hospital for several days of IV antibiotics for the infection that was almost certainly hospital-induced. Thankfully before the days of MRSA. 100 years ago, I might easily have died.

In birthing class they said "1 birth in 4 will be c-section." That's it. No other preparation. Nobody prepared me for having half my vagina numb for 6 months because of the catheter, for how to nurse a baby who wants to kick the incision, for being on a surgical floor (you don't get to go back to Maternity) with a newborn, for having the stretched skin of my abdomen further screwed up by the layers of incisions, and a lot more. Nobody prepared me for the possibility of an infection.

Tell your doctor you don't want a c-section. It's better for you, by quite a bit. It's better for the baby, by quite a bit. The baby's lungs may be prepped for breathing by getting squished in the trip through the vagina. The baby gets better exposure to Mom's bacterial profile. So much more. Tell your doctor and partner at what point you might consider a c-section. By the time the doc suggested it, I'd forgotten such a thing even existed; as far as I was concerned, I was in labor and would always be in labor. Personally, tell the birthing staff to chill the fuck out - I got drugs forced on me far before they were useful, and they made it worse for me because I passed out between contractions. But you may have a c-section, so be prepared for that. I knew my baby was big, and knew it was 50:50.

And, yeah, some people I know made me really defensive about the surgical option. Fuck 'em. I got a healthy baby, and I got healthy pretty quick. There's way too much intervention in birth in the US. But remember, in the US, the developed world, and especially in the not-so-developed world, birth is dangerous, mothers die, babies die, and one or both might live, but with serious injury.

Here's what the article says that got my attention:
Almost(emphasis added)by definition, that option is less desirable for everyone in the delivery room. It can have adverse effects on maternal health, either immediately or long-term. And despite a widespread misapprehension that cesarean birth is “safer for the baby,” there is growing data showing that cesarean sections have disadvantages for them as well. I had my kid 27 years ago, and the evidence even then was far in favor of vaginal birth - for the baby and for the Mom. This is not stated nearly strongly enough in the article.

No matter what, be healthy, nurse your baby as much as possible, love the little critter, and don't make birth into a competition.
posted by theora55 at 1:01 PM on July 9, 2014 [5 favorites]


Here's a tip: if the attending nurse checks for dilation and says, "where on earth is your cervix?", you're going to have a bad time.

The cyst was right at the cervix, about the size of a softball, significantly changing the shape of the birth canal. Babies don't go around corners. We don't begrudge our emergency c-section at all.
posted by fantabulous timewaster at 1:16 PM on July 9, 2014 [9 favorites]


My second child was born on the operating table. I had been prepped for an emergency c-section; the baby's heart rate had been dropping and he was clearly in distress. This was the last domino in a cascade of medical interventions begetting more medical interventions; by this point, a c-section was indeed medically necessary, but IMHO as a direct result of actions taken by my OB while I was in labor, principally breaking the amniotic sac to attach a fetal monitor to the baby's skull before the baby's head was firmly engaged in the birth canal. That was done for the convenience of the nursing staff, rather than the well-being of the baby.

When I think about it I am enormously grateful that things turned out fine, because it could have gone horribly wrong. I am lucky that when I was told, "okay, one last push, and if this doesn't do it, we're doing the c-section" I was able to reach down inside me and find something extra to get my baby delivered, because I really, really wanted not to have a c-section.

tl;dr: I no longer pass judgment on the decisions that people make about labor and childbirth. If you weren't there in the room, you just don't know enough to have an opinion.
posted by ambrosia at 1:43 PM on July 9, 2014 [5 favorites]


Maybe the focus of the article is to stop shaming women and blaming them for undergoing a damn c-section.

Maybe we should trust that women and their doctors are able to make appropriate healthcare decisions.
posted by inertia at 1:47 PM on July 9, 2014 [5 favorites]


I feel like we need a flowchart....
+---------------------------+       +-------------------------+                +-------------+
|                           |       |                         +----+ Yes +---> | It Depends. |
| Should I criticize or     |       | Are you a doctor or     |                +-------------+
| second-guess a woman's    +-----> | social-worker who is    |                              
| medical decisions?        |       | caring for this person? |                +-------------+
|                           |       |                         +----+ No +----> | NO!!!!!!!!! |
+---------------------------+       +-------------------------+                +-------------+

posted by schmod at 1:51 PM on July 9, 2014 [20 favorites]


Like most women who give birth I didn't particularly want a c-section, but I had one anyone, and I have found the constant drumbeat of "c-sections are terrible" fairly distressing.
That so-called epigenetic study from last week was a case in point. A study of the cord blood from less than 100 infants was used and in the c-section babies there was a higher concentration of something in the blood and therefore c-sections are causing obesity asthma and cancer! The sample size was tiny, it was one sample done one time, and there's no evidence afaik that the levels of methylation these researchers detected have anything to do with disease in later life, as this too is not proven science yet. And again from my research, strong epidemiological links between c-sections and various diseases are really lacking. Maybe I just want to believe that to salve my conscience, but anyway.
Is the c-section rate too high? Possibly - I think that is a really difficult question to answer, because no-one wants to do a RCT on pregnant women and their children to finesse the rate, and I don't want to be in the control group with my pregnancy and childbirth either, thanks very much.
But I also think the causes of the c-section rate being so high are a shitload more complex than anti-c-section advocates want to make out. It's not just lazy doctors and their golf games - it's population factors, smaller family size, later child birth, pre-existing complications, risk aversion, and yes also the fact that a c-section is generally much more predictable than a vaginal birth, and doctors often have genuinely no way of knowing if yours is the birth that is going to go very wrong or not.
The fact is, c-sections aren't like knee replacements or even cardiac surgery: they're in their own special class of medical procedure, done on two individuals simultaneously. And there is a whole lot of ideology about childbirth (on both sides, medical and natural) and about what mothers should or shouldn't do that gets wrapped up with it all, and so much pressure on women to do the right thing from the first instant.
I'm personally grateful I had a c-section when I read about the Irish women who were given symphisiotomies against their will or when I look at the vast vast numbers of deaths in childbirth throughout history. My scar is not a sign that I was duped by the medical profession but rather it is a sign I had a baby, full stop, and it was no less a birth than the traditional method, and I am no less a mother, and my daughter has no less of a wonderful future ahead of her.
posted by jasperella at 1:51 PM on July 9, 2014 [14 favorites]


When I gave birth five months ago, my doctors gave me the chance to avoid a c-section. I had been induced for severe preeclampsia and burgeoning HELLP, but they were trying to spare me even more misery unless it was necessary. Also, sometimes people experience extreme bleeding with HELLP. They weren't trying to invite THAT situation to get even worse.

So I delivered vaginally, and my baby had a shoulder dystocia. The entire room of OBs freaked out and performed multiple procedures to save her life. And they did. They got her out. She was then suctioned below the cords for poo aspiration. Her one minute Apgar was a 2, although it rose to 8 at 15 minutes.

Since then, very very few people have asked me if I'd have been better off with a c-section. The assumption is almost universal that I would not have been better off, but I think it's debatable. I lost a tremendous amount of blood, anyway. My baby could have developed hypoxia during the time she was stuck. I guess the doctors were trying to balance my life with my baby's life, and I deeply appreciate that they did the best they could. They were, overall, caring and compassionate providers.

But people have been judgy about the interventions I did get, and I was very sick. I have heard some frigging horrible things said to women who've had c-sections and other major interventions - like we're a bunch of dumbass failures. Totally sold out to the birth industry. The doctors only induce you so they can get your birth over with! (Never mind that I labored for over 30 hours and delivered after midnight.)

Whatever. If that's what the birth supremacists need to hear, then fine. I'm a failure. Why they feel like it's so important to tell me that from the smug security of their Perfect Birth - that, I'll never know. Nor will I understand the people who want to exorcise their birth trauma, by trying to make me hate the obstetricians that flat out saved our lives.
posted by Coatlicue at 1:53 PM on July 9, 2014 [20 favorites]


As a childfree woman, I'm happy to make a deal with friends who have borne children: I'll never criticize your birthing decisions if you promise never to tell E&E* stories, particularly at the brunch table. Actually I wouldn't do it anyway, but if you don't tell me the details, you're 100% guaranteed.

* Epidurals & Episiotomies. (I eventually stopped having brunch with those ladies after I nearly passed out once from a detailed description of events.)
posted by immlass at 1:57 PM on July 9, 2014


I find it a little disingenuous to say that "the public health minds of this generation are working on this problem," as though all obstetricians are operating with best practices and if only we knew more about what those were we'd do a better job of preventing c-sections.

I hesitate to bring this up because it seems silly to bring one contentious issue into a thread about another contentious issue, but I have a pet theory that the moderate crappiness of obstetrics practice in America contributes to the anti-vaccination trend and a lot of the other sort of anti-science behavior we see from parents. Personally, I had very little interaction with the medical field until I started having children, which I think is the case for a lot of people. I was very surprised to find that my highly respected obstetrician was constantly telling me things that couldn't be backed up by any sort of research, that some of the things she suggested went directly against existing research, etc. And I am one of the many people who isn't 100% sure my "emergency" c-section was warranted (though I don't have any negative emotions about that, it's over and I've got my kids).

Anyway, I definitely ended up with a "do the research and make your own decisions" mindset on obstetrics issues, and I wonder sometimes if other people are reaching similar conclusions, but for the whole medical establishment.
posted by gerstle at 1:57 PM on July 9, 2014 [3 favorites]


This hits close to home for me as my wife just gave birth via an unplanned c-section without which she very nearly could have died. Coping with her own disappointment is hard enough for her, she doesn't need anyone else giving her shit about it.
posted by Joe Chip at 1:58 PM on July 9, 2014 [9 favorites]


Fortunately, the c-section is the last major decision about which people will feel entitled to make nasty comments to a new mom.

Breastfeeding over formula. Formula over breastfeeding.
posted by Buttons Bellbottom at 1:59 PM on July 9, 2014


Wow Coatlicue - that sounds like an extremely scary, tough way to end a pregnancy - glad you're both ok!

I had a c-section with my first child after being induced for being post-date, 36 hours of labor with pitocin, failure to progress and fetal heart decelerations. Necessary? Well by that point for sure. In retrospect I wish my ob had been willing to wait a few more days but I'm tiny and the baby was good sized. Kids two and three were born vaginally and were bigger still.

One thing people don't talk about much when making the decision to have a c-section is trouble down the line. Good reason for that since future issues are kind of beside the point when you're looking at fetal or maternal distress. They are real though - I've had two ectopic pregnancies caused by scar tissue from the c-section.

Regardless of how one gives birth one has done just that - given birth and ultimately the aim is healthy baby and healthy mom. The path to that point isn't always clear and no one needs to be second guessed or criticized for it!
posted by leslies at 2:00 PM on July 9, 2014 [2 favorites]


> One positive of a forceps birth is that people are too busy cringing and crossing their legs to have an opinion

Shop-vac, here. Fwuuup!
posted by The corpse in the library at 2:01 PM on July 9, 2014 [3 favorites]


Maybe we should trust that women and their doctors are able to make appropriate healthcare decisions.

Re: the former. Absolutely 100% without question.

Re: the latter, why? OBs, which the author of the article is, have a whole host of incentives/needs/wants/desires/viewpoints/biases that encourage them to have goals that aren't shared by the mother. While ignorance should prevent us from judging or criticizing specific and individual decisions made by OBs, we do know that there are too many C-sections and that OBs share some of that responsibility.
posted by MisantropicPainforest at 2:02 PM on July 9, 2014


Dolphin-assisted, noiseless birth in a bathtub full of kombucha or gtfo
posted by resurrexit at 2:11 PM on July 9, 2014 [10 favorites]


> Was it "necessary"? Could I have done this, that or the other thing and had a vaginal birth? Who knows.

Yeah, same here. With mine there was definitely something going wrong during labour, and they couldn't work out what was causing the problems, so we ended up in theatre in quite a hurry with a doctor and a midwife preparing me for the idea that the baby might well have problems. Nope - big healthy baby with APGARS of 9/9, came out yelling. So I suppose I could tell that story as "...and therefore I didn't even need the section, she'd have been fine!" or "...and therefore they got her out just in time, thank heavens for the section!" but the truth is I'll just never know, and I'm okay with that.

It did feel really important to me to own the decision I made to agree to the section, though. I still won't describe it as "I had to have a caesarean" - I chose to have a caesarean. Okay, the choice was hardly made in a vacuum, because I was going by the advice of the medical staff and their risk calculation (and had this been twenty years ago or twenty years in the future, maybe their risk calculation would have been different), but it was still mine to make. (The whole language of 'had to' around birth and pregnancy drives me a little nuts still, though - my daughter was born 16 days late, and I am still amazed by the number of people who said things like "I didn't think you were allowed to go past two weeks!", like I'd had to get a special permission slip or something.)
posted by Catseye at 2:13 PM on July 9, 2014 [4 favorites]


One problem with doing 'research' on childbirth is that there is an unbelievable amount of bullshit written on the topic. For instance, I was keen to try hypnobirth so I signed up for a book and some CDs. The book was the biggest load of codswallop I've read on any topic. It basically posited that the pain of childbirth isn't real, that women only experience pain because they're conditioned into it by doctors, and there was something about Druids in there too much which really pushed my woo buttons because Druids are pretty much a totally made up thing.
There really is a surprisingly large industry devoted to pushing non-interventionist birth and what I will call "alternative" birth practices, and much of this is bollocks. Moxibustion, herbs of goodness knows what origin, wacky diets and so on. So if you try to research birth as a layperson, you often end up wading knee deep into rivers of terrible misinformation.
Does this mean that I think doctors are wonderful saints and never do anything wrong? Of course not, I think improving obstetric care is vital, especially for at risk and disadvantage populations. So much of this conversation tends to be about what happened to well-off white ladies, whereas the childbirth outcomes for disadvantaged groups around the world are truly shameful.
posted by jasperella at 2:13 PM on July 9, 2014 [11 favorites]


Bear in mind that "Emergency C-Section" means (at least in the UK) a C-section that wasn't planned in advance. It doesn't necessarily mean 'massive-rush-lights-flashing-urgent', it (often) just means it was not planned in advance. So the opposite is the 'elective C-section' or 'planned C-section' which is when everyone knows weeks or months in advance that thats the way it will be done.
posted by memebake at 2:15 PM on July 9, 2014


Right and emergency is not the same as crash section where they're really in a hurry. My "emergency" section happened in maybe 5-10 minutes from the time they decided it was necessary - no one was fooling around but they weren't treating it as baby is in imminent danger of dying.
posted by leslies at 2:18 PM on July 9, 2014 [1 favorite]


It is my opinion that there are too many C-sections in the US.

It is my opinion that women should discuss the possibility of a C-section with their OB and evaluate their stance on the procedure.

It is my opinion that I should keep my damned opinions, about C-sections or any other decisions parents make, strictly to myself when discussing birth with a new mum or da.

(except for my opinion that your babes is ABSOLUTELY ADORABLE, coochie coochie coo)
posted by BlueHorse at 2:20 PM on July 9, 2014 [2 favorites]


...I had to go home and google "rebirthing".

This is a thing? Good grief.
posted by BlueHorse at 2:21 PM on July 9, 2014 [1 favorite]


Yeah, in my case I was reading actual research. But I think that when people perceive their doctors to be untrustworthy, they go looking into all sorts of other sources, and obviously that is a problem.

The whole language of 'had to' around birth and pregnancy drives me a little nuts still, though - my daughter was born 16 days late, and I am still amazed by the number of people who said things like "I didn't think you were allowed to go past two weeks!", like I'd had to get a special permission slip or something.

This drives me crazy as well. The word "let" -- "how late will your doctor LET you go?" Aaaargh.
posted by gerstle at 2:22 PM on July 9, 2014 [1 favorite]


My issue with the anti-c-section industry is that it becomes yet another thing that women must do to be perfect.

It's the baby that matters, and the health of the mother, but if someone who isn't me wants to avoid six hours or w/e of agonising pain because they just do? I think that's ok.

Speaking as a husband whose wife had a C section without which we'd quite possibly have lost our daughter, and whose nephew might have ended up deaf because his mum was so desperately goddam keen on a natural birth.
posted by Sebmojo at 2:23 PM on July 9, 2014 [4 favorites]


I had 2 emergency c-sections and I did indeed get a 'well that's too bad' vibe from some people while while talking about delivery. Oh, so sorry 14 hours of unmedicated labor weren't enough for you....
posted by bq at 2:24 PM on July 9, 2014 [3 favorites]


(disclaimer: not an expert on this but going to lots of ante-natal classes and things at the moment so this is on my mind)

re: whether any given C-section was 'necessary' or not:

Childbirth is a complicated orchestration of hormones and body signals. Some of those hormones work better in a relaxed environment, without bright lights, interruptions, being watched, being among strangers etc. A hospital environment (bright lights, interruptions, being watched, strangers) can lead to higher levels of things like Adrenalin that get in the way.

So you can have a given chain of events (going to hospital, labouring in an unfamiliar room for hours, labour progressing too slowly etc) that lead to a C-section as the "correct" next step. But would the C-section have been necessary in a completely different environment? Its impossible to say for any one case, but you can investigate the stats to get some idea.

Another example is that Induction is (I'm told) likely to lead to a cascade of interventions: induction can lead to stronger more intense labour, which leads to needing an epidural, which leads to being stuck lying on a bed, which leads to prolonged labour, which leads to ... etc

On the other hand, telling everyone to have babies at home with visiting midwives and gas-and-air doesn't make sense because even with the best run-up in the world, some people are going to need medical intervention.

A good middle ground in the UK are midwife-led Birth Centres, nice almost hotel-like environments which are generally in hospitals one short lift ride from the labour ward. I'm not sure if you have something similar in the US.
posted by memebake at 2:26 PM on July 9, 2014 [5 favorites]


Absolutely - and that cascade of interventions definitely played a part in my section. It's why kids 2 & 3 were born at home.

There are birth centers in the US but they vary greatly in facilities and staffing and they're not common.
posted by leslies at 2:28 PM on July 9, 2014


A good middle ground in the UK are midwife-led Birth Centres, nice almost hotel-like environments which are generally in hospitals one short lift ride from the labour ward. I'm not sure if you have something similar in the US.

We have them, but they're rare, and they cater almost entirely to rich white upper class women.

This is changing (slowly) though, for the better.
posted by MisantropicPainforest at 2:35 PM on July 9, 2014


We have 248 of them.
posted by The corpse in the library at 2:37 PM on July 9, 2014


We've just been through the whole producing a child thing. Not that I, as a male, did much of the hard work, but I did go to all the classes and spent a lot of time in and around maternity wards and midwives.

My wife specifically chose a hospital without a birthing centre, because she is comforted by skilled professionals with large amounts of diagnostic equipment on hand and is not comforted by fluffy things or pools of water or medical things trying not to look medical.

I was initially opposed (but silently, it's her choice), because the very local hospital had a state of the art birth centre (pools, balls, hypnotists etc.) , but she choice a further away hospital which had a kick ass anaesthesiology department with all the best drugs.

It turned out to be a great plan, because there was a need for various high tech medical gadgetry, and also a week after the birth we needed to go into the nearby hospital and whilst their natural birth centre was state of the art their actual maternity ward was dangerously underfunded. I can only assume they spent all their money on the birth centre.

The worrying thing everywhere was all the posters and advice telling you (for example) how great breastfeeding was but without mentioing any alternatives
The same thing happened in baby school, we were told all about natural child birthing, but not about the different types of epidurals. We were shown a big epidural needle and told that if you had one you might not be able to walk for a few days afterwards, and when we did our own research with information from the hospital we were planning on going to she was practically shouted down. The result was that another couple from the class ended up in labour for 7 days because she was so terrified of any intervention.

Anyway, my point is, not that natural childbirth and childcare is bad, but that there is so little information on the alternative (in the UK anyway) that it is very difficult for people to make an educated choice.
posted by Just this guy, y'know at 2:39 PM on July 9, 2014 [4 favorites]


I had a "rush, codes,holy crap, go,go,go!" C section after 27 hours of labor without an epidural. I think I would have broken and sucked the marrow from the bones of anyone stupid enough to "pity" me and my son for surviving. And I tell you what, when I saw the size of my gorgeous 12 pound baby, I was really, really, REALLY happy that my cervix said "oh....but no.", and that the medical technology exists that meant I didn't die because I was a hobbit giving birth to a hill giant.
posted by dejah420 at 2:43 PM on July 9, 2014 [15 favorites]


Our son was born via C-section. And not the bikini-cut version. The old-school "splayed-open-like-a-gutted-animal" version. He was some kind of stuck-and-not-coming-out breech. My wife has a vertical scar running the length of her lower abdomen up to just below her navel.

Miraculously, when we later had our daughter, she was delivered VBAC, with no complications.
posted by Thorzdad at 2:44 PM on July 9, 2014 [1 favorite]


Memebake, I know the whole "nice setting, no strangers, dim lights" thing sounds plausible, but if you think about it for a little while, it really doesn't make much sense. Women give birth in all sorts of stressful situations - warzones, the back of cars, in ditches, in abusive relationships, way too early, etc. I think having a nice soothing* environment to give birth in is great for the mental state of the mother, but I'm unconvinced it's got much to do with physiological processes behind giving birth.
In fact, I tend to think the mantra that "women need to be relaxed" to have a good birth is akin to telling infertile people they could conceive a child if they relaxed about it. Relaxation is fabulous and great and I'm all for it, but it's not a cure-all.
(*I personally am soothed by the proximity of people who know how to do neonatal resuscitation! And the thought of giving birth in my home makes me wonder who washes the bloody sheets and whether I'd have to do it.)
posted by jasperella at 2:45 PM on July 9, 2014 [8 favorites]


Oh, by Baby School I meant NCT classes. I forget it's not actually called baby school.
They incidentally have some* detractors.



*this one is a Daily Mail link. Sorry.
posted by Just this guy, y'know at 2:52 PM on July 9, 2014


memebake: "A good middle ground in the UK are midwife-led Birth Centres, nice almost hotel-like environments which are generally in hospitals one short lift ride from the labour ward. I'm not sure if you have something similar in the US."

In my part of the US, basically ALL of the obstetrics practices are doctor/midwife practices, which is actually really great. At my practice you pick your primary provider (whether doctor or midwife) and you see that person at your primary visits where they do important things, but at visits where they just measure your belly and check the heartrate, you rotate through seeing maybe four other doctors and midwives, so whoever's on call when you have an emergency, you've at least MET them.

My first pregnancy I had a midwife and it was my midwife who, at 38 weeks, was feeling for the baby's positioning from the outside, in the low-tech, old-timey way, and felt the round firm part up under my ribs and said, "That's not a butt, that's a head ... let me call the ultrasound technician." In less than 15 minutes, they had ultrasound-confirmed he had turned breech, and 5 minutes after that, one of the doctors, whom I'd already met, was in with me and my husband and midwife, discussing our options. We tried having him turned but he wouldn't turn and in the end (over the course of a week or so) we all agreed a C-section was the best option, and I was seamlessly handed off from midwife care to surgeon care, with a doctor/surgeon whom I'd already met. (The midwife offered to come to the hospital and attend my C-section, be there for prep and all, but I liked the doctor a lot and I was okay with him. Another friend of mine in a similar situation, same practice, had the midwife with her all the way through the prep and surgical delivery and recovery.) You also know, in a practice like that, that the doctors respect and support the lower-intervention midwife model, and that the midwives are medical professionals.

Where I am, at all the local hospitals, labor, delivery, maternity, & the nursery are all attached together in one wing of the hospital. (I live in a high-poverty area, it's just the way the hospitals around here all are, not "just" the wealthy-people hospitals.) You labor in a sort-of hotel-ish looking room with rocking chairs and recliners and a medical bed and TV and yoga balls and sometimes a birthing tub; deliver in that room (there are secret SOOPER MEDICAL BRIGHT-O LIGHTS that drop from the ceiling in case its necessary, and the closet's sliding doors actually hide a medical battery of STUFF); recover; and then are moved to the maternity part of the wing for the stay in the hospital, which is also pastel-hotel-y looking, and partners (and babies) can stay in the room with mom if you want (a chair converts to a bed for partner). I was prepped for surgery and recovered from surgery in one of those labor/delivery rooms, although the surgery happened in a small, C-section-specific operating room two doors down that was part of the maternity ward, not the surgical ward.

Anyway, I was super-stressed about having to have a C-section, but the actual process of it was lovely and human and very low-key. And very me-focused. The one thing some people might take issue with was, I did not get to hold the baby immediately after birth because they were sewing me up, but my husband was able to hold him right away and to bring him over to me to touch and smooch while I was on the operating table. (The anesthesiologist took pictures for us.) But I actually feel okay about that part, and my husband felt like he really had a big role in the birth because he was the Boss Of The Baby for the first hour or two. I'm a little sad I missed those things, but I had so many special and unique things with the baby (being pregnant, giving birth, breastfeeding, etc.), I'm really glad my husband got to have that first couple of hours being Solo Dad In Charge because it was a very special thing for him and made him feel very bonded with the baby.

jasperella: " So much of this conversation tends to be about what happened to well-off white ladies, whereas the childbirth outcomes for disadvantaged groups around the world are truly shameful."

Preach it. I now ignore almost everything about childbearing that is well-off white ladies yelling at other well-off white ladies for Giving Birth Wrong. If you focus on "WHITE LADY, YOU MADE A BAD DECISION WHAT WITH YOUR GOOD PRENATAL CARE, MONEY, AND ABILITY TO COMMUNICATE WITH DOCTORS, AND THIS IS THE BIGGEST CRISIS IN OBSTETRICS," and don't mention race, socio-economic status, language barriers, access to medical care, or anything other major barriers and failings in US maternity care, it's pretty clear this isn't about the safety and health of mothers and babies, it's about being moralistic about pregnancy and birth.
posted by Eyebrows McGee at 3:00 PM on July 9, 2014 [31 favorites]


I had an emergency c-section and do you know what was the hardest thing about it? The crippling self-loathing for not having given birth in the "right" way. I cried for months. I felt I had failed my child. Now, 2.25 years later I still feel the need to justify my experience when talking to people. "It was an EMERGENCY c-section because blah blah blah."

Sure there may be many unnecessary c-sections, but when talk about this procedure as an odious choice made by selfish or incompetent people, or forced on clueless imbeciles by THE MEDICAL MACHINE, we stigmatize and oppress all pregnant and post-pregnant women.

I am so grateful to have given birth in Canada, in 2012. Without modern medicine, my son and I might both be dead.
posted by arcticwoman at 3:06 PM on July 9, 2014 [8 favorites]


I understand the concern about the rising rate of C-sections, but jeez, before modern medical interventions you had a 1-2% chance of dying during childbirth (way higher in maternity wards) and something like a 1 in 6 lifetime risk of dying in childbirth, period. Mother Nature may have built a lot of bonuses into vaginal delivery but damn if she didn't make it a dangerous undertaking. I am always surprised when people talk about C-sections like they're technological butchery rather than a miracle intervention that's saved the lives of countless women.
posted by schroedinger at 3:07 PM on July 9, 2014 [12 favorites]


all the posters and advice telling you (for example) how great breastfeeding was but without mentioing any alternatives

Because... you didn't know about the existence of formula? Really? NHS policy can be pretty crappy regarding breastfeeding (not least through sticking up a few posters in hospital corridors in place of providing real, trained, decent support for women who want to breastfeed), but in a country with breastfeeding rates as low as the UK's, I don't think lack of knowledge about formula is exactly a massive problem.

NCT classes seem to really vary depending on the teacher. Mine were really useful and not at all 'natural childbirth is the only way!'; a good friend of mine had pretty useless ones, where the teacher skipped right over a lot of info about forceps, ventouse, etc., which was not much help to the 75% of that group who didn't have a straightforward birth.
posted by Catseye at 3:07 PM on July 9, 2014


Because... you didn't know about the existence of formula? Really?

Well I certainly knew about the existence of breasts.

And to be honest, no, I didn't know about formula. I vaguely knew it existed, but suddenly faced with buying some for a dehydrated week old child (because the maternity ward told us we needed to giver her some but refused to supply it at 11 at night) I had a dizzying array of powders and pre mixed and bottles and sterilisers and so on with not a clue what I should buy.

If it had been mentioned by anyone just once in the process that it is maybe a good idea to have some formula on hand because sometimes breastfeeding is difficult then maybe that would have been a more relaxing weekend.
posted by Just this guy, y'know at 3:14 PM on July 9, 2014 [10 favorites]


I was a c section baby. The only side effects I've noticed are a predisposition to jump out of cakes and a strong affinity towards the Alien franchise.
posted by grumpybear69 at 3:15 PM on July 9, 2014 [23 favorites]


Eyebrows McGee Anyway, I was super-stressed about having to have a C-section, but the actual process of it was lovely and human and very low-key. And very me-focused.

Yes I hear C-sections can be fairly nice. In the UK you can (if you ask, and if things go well enough, it varies from hospital to hopsital I think) have a C-section then have the baby placed straight on your tummy for skin-to-skin contact etc and then they sew you up afterwards. I've heard of people asking for quiet at the point of delivery, and turning off some (not all obviously) of the surgery lights etc. The NHS can be pretty amazingly flexible if you get to talk to the right people. I'm wondering if C-section might be preferable to induction for us (if it comes to that) because induction can lead to a cascade of other things.
posted by memebake at 3:17 PM on July 9, 2014


I had a dizzying array of powders and pre mixed and bottles and sterilisers and so on with not a clue what I should buy.

Ugh, your hospital was crap at helping you out there, let alone letting you get to a week past delivery with enough feeding problems to result in a dehydrated baby (wtf, why were the community midwives not on top of that?). Mine did at least send me away with a 'how to safely make up a bottle' information sheet, in case I ended up needing to know (albeit very NHS grainy-photocopy-of-a-photocopy style, but still!)
posted by Catseye at 3:22 PM on July 9, 2014 [3 favorites]


Dammit, the internet ate my post. To make it short:
Had two (emergency) c-sections, A++, would do again. Compared to the eight hours of labour, c-sections are heaven.
posted by Omnomnom at 3:22 PM on July 9, 2014 [2 favorites]


My wife specifically chose a hospital without a birthing centre, because she is comforted by skilled professionals with large amounts of diagnostic equipment on hand and is not comforted by fluffy things or pools of water or medical things trying not to look medical.

I thought I was the only one!
posted by Ralston McTodd at 3:25 PM on July 9, 2014 [1 favorite]


My story: 16 days past my due date, induced at the hospital, 24 hours of back labour, attempted forceps delivery, c-section. Throughout the ordeal, two nurses repeatedly told my OB that I wanted to avoid a section at all costs. Meanwhile, I'm in the background like the not-dead-yet guy in Monty Python and the Holy Grail saying that, actually, I had no objections to c-sections at all. Turns out the umbilical cord was coiled around my daughter's neck like a boa constrictor and there was no way she was coming out the traditional way.

Had I been a better advocate for my own care back then, I would have weighed my options and chosen the c-section hours earlier. Then I wouldn't have had to recover from surgery on top of all that labouring. Seventeen years later, I'm very grateful for the surgical option, annoyed with the (no doubt well-meaning) nurses, and full of scorn for the person who told me afterwards that maybe next time I could "really experience motherhood."
posted by atropos at 3:46 PM on July 9, 2014 [7 favorites]


the person who told me afterwards that maybe next time I could "really experience motherhood."

ahahahahahaha. Because looking after a newborn while recovering from major surgery is Motherhood Lite, clearly.
posted by Catseye at 3:59 PM on July 9, 2014 [10 favorites]


Because... you didn't know about the existence of formula? Really?

The recovery ward I was on didn't allow formula at all. There was one baby crying continuously through the night, and I heard the mother begging the nurse for formula as she was unable to breastfeed (even after a long session with the lactation specialist). The nurse told her - at 2am - to wait until the Boots across the road opened and she could get some then. As my daughter was IV-fed for the first few weeks (after abdominal surgery an hour after birth) I had plenty of milk i was expressing and freezing, so I gave her a bottle and the baby stopped crying, and we all got some rest. I discovered shortly afterwards there was a cupboard full of formula just down the hall (for the babies in the NICU). That's just cruel, to the mother who couldn't breastfeed, her baby, and all of the other mothers and babies on the ward who were denied much-needed rest shortly after birth.

I'm highly grateful to the wonderful people who delivered my daughter on the operating table, otherwise neither my daughter nor I would be alive today. I'm glad my midwives and OB made that decision, a decision I couldn't make because I was unconscious. No one has ever given me shit for having a c-section, and if they did I'd have to stop myself from punching them. Thank the blessed dog for medicalised birth.
posted by goo at 4:00 PM on July 9, 2014 [8 favorites]


The nurse told her - at 2am - to wait until the Boots across the road opened and she could get some then.

Okay, that is fucking horrendous, and I am fairly sure against NHS infant feeding policy too.

But... I still don't think the problem here is the NHS being pro-breastfeeding. It's a bigger problem with abysmal lack of support being provided when breastfeeding isn't working out. The whole issue's reduced to browbeating individual women and setting them up to feel like failures, not changing the system - in the same way that the C section issue in the OP is put on the woman giving birth, not on the wider system around her.
posted by Catseye at 4:17 PM on July 9, 2014


Yeah, I gave birth in the US and had the same sort of treatment from the nipple nazis. My son is 11, and I'm still furious, literally furious, about the way breastfeeding/formula was dealt with in the private (Baptist) hospital where I gave birth. At one point in time, I swear before all that is holy, a mere 12 hours after major surgery, one of the "lactation specialists" started slapping my breasts as hard as she could, I mean, pulling back and hitting me hard enough that both of them moved...and I have some big ol boobs, y'all. At the time, they were almost Fs with the pregnancy. She said she was hitting me so the milk would release. They pinched my nipples harder than I've ever had a partner do it. I called my doctor the next day to show her the handprints this nurse left on me because I wasn't breastfeeding "enough". And I mean, fuck, it's not like I didn't want to. To the best of my knowledge, that woman is still a lactation specialist. (And it's a testament to my good character that she still breathes, frankly.)

My son lost almost 3 pounds before I decided that the whole LLL and everyone connected with them were evil fucking evangelical puritans, and I bought some damn formula so my kid wouldn't starve because I couldn't produce enough milk for a 12 pound newborn.

Furious. I'm still fucking furious. 11 years, and it feels like it happened yesterday. Fuck people who use their positions to punish and humiliate women at their most vulnerable.
posted by dejah420 at 4:53 PM on July 9, 2014 [10 favorites]


That is outrageous and makes me think you should have filed assault charges against her!
posted by leslies at 4:56 PM on July 9, 2014 [4 favorites]


I was a c section baby. The only side effects I've noticed are a predisposition to jump out of cakes and a strong affinity towards the Alien franchise.

And a beautifully shaped head, or so I've been told.
posted by arcticwoman at 4:56 PM on July 9, 2014 [2 favorites]


I was a c section baby. The only side effects I've noticed are a predisposition to jump out of cakes and a strong affinity towards the franchise.

I was too, but didn't get those side effects thankfully. For me it's mostly a predisposition towards killing fictional Scottish Kings.

For real though I'm pretty lucky to be alive. Someone fucked up the dates and my mother was induced a few weeks (I want to say 6, but I don't remember and that sounds a bit high, frankly) before she was due.

My daughter came out immediately after the doctor said, "Okay, one more push and then we'll have to go in for a c-section." It probably wasn't intended as motivation, but my wife sure saw it that way at the time.
posted by ODiV at 4:57 PM on July 9, 2014


My wife and I have some time to go, but we've already scheduled our c-section. High-risk twins are nothing to fool with. I'm also going to run interference for next year or two on anyone who decides that they'd like to make a value judgement on that. I've got a few stock replies stored up, but suggestions are always welcome. Also, anyone (including immediate family) who doesn't get a TDAP booster and a flu shot will not be meeting the babies, sorry. Not even getting in the door.
posted by Existential Dread at 5:09 PM on July 9, 2014 [5 favorites]


Natural labor with doula and non-interventionist midwife, many hours of "good" pushing, non-emergency c-section that probably would have been an emergency an hour later. The best and worst of both worlds; recovery from stuff related to pushing was worse than the surgery, and I'm also very glad of modern western medicine.

I always make a point to say the section was not an emergency because I think the current paradigm is "You don't understand, unlike Those Women, *I* needed one," and the world needs less of that segmentation. (Another bonus: when you say it wasn't an emergency you avoid having to go through your medical history with people who won't have a good faith conversation about birth choices. Sometimes silent judging is preferable.)
posted by tchemgrrl at 5:37 PM on July 9, 2014


Fuck the breastfeeding nazis. Fuck them.

My daughter was born with a tongue tie and the LC at the hospital decided she did not need it snipped "because she could still breastfeed". Sure, she could eat just fine, while chewing my nipples off.

The pediatrician finally determined she had a tie so severe it needed to be snipped twice, but too late. I cried while feeding her, that fucking poster claiming that "breastfeeding is the favorite part of my day!" mocking me from the hospital room wall.

I started pumping at 3.5 weeks. I started exclusively pumping at 6w and was happy as a clam to not have a baby at my breast anymore. I feel horrendously guilty for not enjoying feeding my child (the most natural thing in the world! The best kind of bonding! The only way your child will know you love her!!), but fuck that. My sanity and bodily autonomy are worth it.

I'm going to quit as soon as I can get a handle on the mommy guilt. Rationally I know formula is totally fine (and our pediatrician agrees!) but I just can't get over the peer pressure.
posted by lydhre at 6:23 PM on July 9, 2014 [10 favorites]


Also, there is no way you could have paid me enough to give birth somewhere other than a hospital. Medical professionals on hand, plus anesthesia, made me a much happier laboring woman. The birth itself was very pleasant, thanks to wonderful nurses and a magical epidural, an epidural which probably prevented a c-section given that my daughter ended up being 9.5lbs and compound presentation. There are days, though, even 12 weeks later, when my vulva wonders if a section wouldn't have made my life a little easier.
posted by lydhre at 6:38 PM on July 9, 2014 [1 favorite]


I was a c section baby. The only side effects I've noticed are a predisposition to jump out of cakes and a strong affinity towards the Alien franchise.

OK, I cannot be the only person who wants to have a C-section with a photographer in the room. The doctor pulls the baby out of the incision bit by bit, posing it for the photographer like it's burst out of my stomach then crawled up my chest to finally lay against my neck while I make horrible faces like it's tearing at my throat. It would basically be the best baby album ever and would surely bring the child joy and laughter years down the line.
posted by schroedinger at 6:43 PM on July 9, 2014 [15 favorites]


I've been a little freaked out by the doctors I've heard say that they wished every woman would just stop being silly and selfish and schedule a c-section at 40 weeks, but until a few minutes ago I had honestly never heard of anyone making a negative remark to a woman who had had one. What would the point even be, after the fact?
I enter an operating room to do an unscheduled cesarean birth with sadness...

...I enter an operating room to do an unscheduled cesarean birth with gratitude. Gratitude so large and specific that perhaps it should just be called relief.
Those two statements seem contradictory to me.
posted by The Underpants Monster at 7:12 PM on July 9, 2014


One can be sad that things did not go as planned, while at the same time being grateful (and relieved) that things will probably still go well.
posted by sparklemotion at 7:15 PM on July 9, 2014 [3 favorites]


My husband just reminded me that the best part about the c-section is when they'd strapped me to the crucifix type table, and have pumped me full of drugs; apparently I started singing "Your Own Personal Jesus", and offering people cookies. Which, in retrospect, may have been why the lactation nurses were mean. Not everyone is a Depeche Mode fan.
posted by dejah420 at 8:10 PM on July 9, 2014 [14 favorites]


Lazlo Hollyfeld: "at 3:30am on a Friday my wife’s water broke… Finally, a 9pm on Monday evening… The doctor watched the fetal heart rate for a minute or so and told us that he was seeing accelerations, and that they were going to do a C-section"

For whatever it's worth, I used to work in perinatal research, and as I remember, the evidence is overwhelmingly strong that a delay that long between the water breaking and delivery really does expose both mother and baby to significant risk of infection.
posted by Lexica at 9:35 PM on July 9, 2014 [5 favorites]


One thing I have learned in recent weeks from our own experiences and hearing those of others including those in this thread is that childbirth and parenting carries its own set of unique traumas for each person and we need to be kind to ourselves and others.
posted by Joe Chip at 9:56 PM on July 9, 2014 [10 favorites]


What does it mean to say the rate of c-sections is "too high"? Too high for what? Higher than medically necessary? How are you determining that?

If the woman giving birth is having her first child over the age of thirty, she is more likely to need a c-section. That's not blaming anyone, it's simply biology. I've heard that c-sections are also more neccessary for obese women, though I'm not as familiar with the research there. Again, no blaming involved---one can be obese and still have every right to have a baby!---just a statement that birth is about a body, and a different body will have a different birth.

But everyone is throwing around the words "too high", and I don't see what those mean, or how anyone would decide.

My spouse was in labor for 54 hours before deciding "Fuck this, airlift it out." Her only regret was not deciding to do it at hour 20.
posted by ThatFuzzyBastard at 10:18 PM on July 9, 2014 [5 favorites]


Emergency and elective are also administrative terms. I had no choice about a c-section from the 20th week because of the risks, but I'm still marked down as an emergency c-section because they held off on the surgery until the last possible moment to give the baby as much as possible time in the womb.

Regular delivery is supposed to be better for preemies because of the biofilm and the contractions during delivery helping the lungs get started, but it's not always possible due to other risks.
posted by viggorlijah at 1:28 AM on July 10, 2014 [1 favorite]


Rude comments from other mothers disapproving of a C-section==not cool but not a huge fucking problem.

Don't trivialise how this feels to new parents, especially when post natal depression is involved. The parental judgement complex has much to answer for.
posted by smoke at 1:39 AM on July 10, 2014 [3 favorites]


What does it mean to say the rate of c-sections is "too high"? Too high for what? Higher than medically necessary? How are you determining that?

It's because caesareans come with a risk of complications in and of themselves. So, if you have a large population where nobody has access to caesareans, you'll obviously see a lot of bad outcomes; if only the women who need them (however that's determined) get them, the rate of bad outcomes falls; but if you give everyone a caesarean, the rate of bad outcomes rises again. There's a tipping point on a broad population level beyond which they're causing more problems than they're preventing, in other words, and 'too high' means 'past that point'.

Of course determining where that point is is a whole other issue. The WHO used to say something like 15% roughly, but don't put a figure on it any more.
posted by Catseye at 3:09 AM on July 10, 2014 [3 favorites]


My friend's first baby was delivered via c-section after she laboured for over 24 hours with him only to discover that her pelvis wasn't wide enough to actually allow for the baby to be born naturally. He was born with a massive bruise on the top of his head because he wanted to come out vaginally but she was physically incapable of delivering him (and consequently his sister and brother) that way. She would have died without the c-section, there's no question about that.

People seem to forget that childbirth can be fraught with danger. How dare anyone give a mother a hard time about how her child was delivered? My mind is continuously boggled over this judgement bullshit.
posted by h00py at 3:20 AM on July 10, 2014 [2 favorites]


Don't trivialise how this feels to new parents, especially when post natal depression is involved.

I didn't mean to, and I apologize. Its obviously a big fucking deal to those involved. My beef with the article is that this is an OB with a pretty big platform to talk about the myriad ways birth is screwed up in the US and how to improve it, yet she doesn't use that platform to get her own house in order. If this was a non-healthcare worker who reported on their experience I would have no problem.

And yes, race and class is a huge fucking issue here--and its even more stark because in a lot of city hospitals in the US you will have rich middle aged white women giving birth (usually attended by a supporting family and FOB) and next door you will have a 15 year old poor black girl, alone and laboring. Guess which one is more likely to get rushed into the OR, and then out the door?
posted by MisantropicPainforest at 6:01 AM on July 10, 2014


One can be sad that things did not go as planned, while at the same time being grateful (and relieved) that things will probably still go well.

Yes, I can totally see this for a patient - I've been there myself. But for a surgeon it stil seems weird to the point of either disingenuity or being too emotionally mercurial to be effective at one's job.

I've had my share - some say more than my share - of surgery, both planned and unplanned. In many cases, other treatments were tried before surgery and failed. To a man, none of the doctors involved were BOTH sad and relieved. If a doctor was sad that surgery was necessary, he referred me to a surgeon who was happy to do the best job he could and relieved that there was something he could do. But that's the minority.

If the doctor gets to the point where she firmly believes that surgery is indicated, she's got nothing to be sad about, which is basically the thesis of this article. Every sentence except the one where she declares herself to be sad supports the idea that a C-section is a positive experience that nobody should criticize. That is why I do not believe her when she says she feels these two opposite emotions. It's the same thing as if she started an essay with, "I enjoy being a vegetarian," ended it with, "I enjoy eating meat," and everything in the middle was all her favorite beef recipes.
posted by The Underpants Monster at 6:29 AM on July 10, 2014 [1 favorite]


How dare anyone give a mother a hard time about how her child was delivered? My mind is continuously boggled over this judgement bullshit.

It's pretty easy to do this when you see childbirth as a passively experienced, political event needing a stranger's input, as opposed to a difficult, rewarding, glorious, and inherently risky thing, before and during which people make active choices.

To the extent that people choose where and how to birth, the decision-making process can never rely on clearly drawn arguments that are simultaneously universally true and individually applicable. Individuals have different wants and needs. Individual births are different from one another, and not always predictably so. The pros and cons of various approaches are not always symmetrical - X risk of ABC, or Y risk of DEF?

My wife's experience giving birth in a hospital was quite positive. Of course this is just an individual experience. She had been adamant beforehand about delivering at a hospital and receiving an epidural, and she made the right choice for herself. Our OB said that he would only perform a C-section if necessary, and lo, she did not get a C-section, because it was neither wanted nor needed. And when things suddenly became very complicated, we were delighted (in retrospect, of course) that the hospital was able to speedily marshal a flotilla of professionals to help out.

Do other people have bad experiences at hospitals? Of course! These structural problems must be addressed. Could she have had an equally positive experience with a natural homebirth? I don't know, but sure, probably? Either way, my wife wanted and needed what she wanted and needed. Nuts to the people who would ignorantly judge otherwise. As an active person with a mind of her own, she made the right choice for herself and the kid.
posted by Sticherbeast at 6:43 AM on July 10, 2014 [2 favorites]


How dare anyone give a mother a hard time about how her child was delivered? My mind is continuously boggled over this judgement bullshit.

There are people who think that they know everything, and that anyone who decided counter to what they believe must obviously just be ignorant. I once overheard a woman stop to harangue another woman for wearing high heels because they were unhealthy and bad for her back and "patriarchal brainwashing". (She rode off on her bike before I could cut in and say that assuming another woman wasn't capable of making her own choice was counter to what I'd always believed feminism was about, sadly.)

Some people really are just shits.
posted by EmpressCallipygos at 7:21 AM on July 10, 2014 [1 favorite]


The worst part about my emergency C-section (low-risk pregnancy, went late, labored too long at home after my water broke without my doctor realizing it, got a uterine infection, bam) was the way my friends and family suddenly interpreted my son's birth as a tragedy. I was actually getting condolences from visitors while I was still in the hospital, trying to figure out how to get up to use the toilet, or how to breastfeed. It was a pretty traumatic birth process, for all that everyone came out mostly healthy. And there were, in fact, some serious problems with the medical care I received, both before and after I gave birth (NONE OF WHICH I COULD HAVE PREVENTED, THANKS). But some of the people closest to me were sad for me, or indignant for me, and it made me feel like it was a day full of regrets, instead of the day I got to welcome my child into the world. At the time I was heartbroken, and now I look back and want to throttle them into silence.
posted by libraritarian at 8:08 AM on July 10, 2014 [6 favorites]


Well, I suppose it's a good thing all births are exactly alike, so we can apply a single method of giving birth.
posted by grubi at 9:22 AM on July 10, 2014


What does it mean to say the rate of c-sections is "too high"? Too high for what? Higher than medically necessary? How are you determining that?

It's because caesareans come with a risk of complications in and of themselves.


Yeah, because all surgeries do.

My youngest was born c-section and grew up on formula because he could/would not breastfeed. We (well, she) went through 24 hours of midwife-assisted natural, drug-free labor before we had to go to the hospital. When the doctor took a look, he saw that the boy was turned the wrong way (not breech, but oriented incorrectly) and so the doctor reached in — not once, not twice, but three times — and turned the infant around. Oh, ho, ho, said the not-yet-born child, fuck your plans.

I laughed and remarked that he was truly my child. Even pre-birth, I said, he was showing his immense stubbornness.

And the baby had to be oriented a certain way because the passageway was too small for him to pass through if he was flipped around. So the doctor said, in hour 25, a c-section would be necessary. So we okay'd it. Went fine, as nearly all do. He just turned 18 in April, still as stubborn as ever. But healthy as a horse. An especially healthy horse.

We went headfirst into the whole-foods, granola-crunchy, midwifery and water birth and no-drugs and La Leche program. And the baby, being an individual, was not going to operate under those parameters. In the end, it was a c-section and formula feedings. And he turned out very healthy. I, too, was raised on formula, not breastmilk. ANd I have been much healthier than average. You know what that means? Nothing! We're individual cases. I doubt either my son or I would have been much healthier than we've been all our lives if we were brought up on breastmilk (and keep in mind, I'm still pro-breastfeeding; I understand mother's milk is generally better for the infant in a variety of ways). I just don't want the judgmental bullshit that comes with "Oh you did that thing? You're awful." No, fuck-ass: we're individual. I'm not going to deny my crying infant formula because of a commitment to ideological purity.

(Also, speaking of Baby Issues and the Controversies that Surround Them, I was circumcised; my song was not. SOMEHOW WE BOTH SURVIVED.)

Since each case is individual, and various factors contribute to each birth, it's much more logical and generally respectful to get off the backs of mothers who had to go in either direction, c-section or vaginal or MAGICAL OSMOSIS THROUGH THE SPINE. If they're not abusive, not negligent, then ease the fuck off mothers. It's a hard enough job without telling them they're wrong for having given birth to a human being in a certain way. Short of "We sacrificed a town hall meeting's worth of humans in order to give birth", there's not really worth criticizing when it comes to method of childbirth. Most babies, regardless of childbirth method, are healthy. Whether mom was cut open, squeezed 'em out, had painkillers, breastfed, or otherwise, babies gonna baby.

My challenge to the critics would be to ask for the death rate of babies and mothers in "natural" childbirth vs caesarean. I have a funny feeling more babies and mothers die in the former than the latter.
posted by grubi at 9:40 AM on July 10, 2014 [4 favorites]


Since each case is individual, and various factors contribute to each birth, it's much more logical and generally respectful to get off the backs of mothers who had to go in either direction, c-section or vaginal or MAGICAL OSMOSIS THROUGH THE SPINE.

Totally agreed. But that doesn't mean we can't have a conversation about whether or not the c-section rate is too high; it just means that kind of conversation should be about birth at a broad population level, not an individual one. There is a world of difference between "the national c-section rate is too high" and "...therefore, Jane Smith of 7 Acacia Avenue, your section shouldn't have happened."
posted by Catseye at 9:59 AM on July 10, 2014 [1 favorite]


What does it mean to say the rate of c-sections is "too high"? Too high for what?

Well, even the World Health Organization itself says that their recommended rate of 15% needs re-evaluation, but the U.S. does have one of the higher C-section rates in North America and Europe, but not the lowest infant mortality rate among the same group of nations.
posted by The Underpants Monster at 10:13 AM on July 10, 2014


My challenge to the critics would be to ask for the death rate of babies and mothers in "natural" childbirth vs caesarean. I have a funny feeling more babies and mothers die in the former than the latter.

Yeah---for all the talk about how c-sections carry a risk of complication, it's important to remember that so does childbirth (often a much *higher* risk).

It's good to remind people not to judge mothers who have c-sections, but that's easy for this community. The more difficult, and more valuable conversation is how much sense it makes to judge doctors for doing c-sections. Even many of the judgemental incidents (like the awful experience described by libraritarian) are clearly judging the hospital, not the mother... but still having consequences for the mother.

Or to be more internetty about it: If you're gonna be outraged about the c-section rate, show why it's a problem or GTFO.
posted by ThatFuzzyBastard at 11:05 AM on July 10, 2014 [1 favorite]


I have no problem judging the doctor who said, "Let's cut her, I have a lecture to go to".

And yes while that was crudely put similar sentiments are expressed all the time in hospitals. Its not just OBs either, nurses do it too.
posted by MisantropicPainforest at 11:11 AM on July 10, 2014


My challenge to the critics would be to ask for the death rate of babies and mothers in "natural" childbirth vs caesarean. I have a funny feeling more babies and mothers die in the former than the latter.

Not sure why natural in vaginal childbirth/drug free vaginal childbirth/drug light natural childbirth is in quotation marks, but then again, I'm not the CIA with their Oxford commas (I expect that from MI6, but CIA?).

Here is some research into what you proposed supports your conclusion from uncited data.

http://www.sciencebasedmedicine.org/does-c-section-increase-the-rate-of-neonatal-death/

Only looks at neonatal deaths, concludes the "3 times as likely to die in C-section deliveries" line bandied about in the popular press is false. Does not look at maternal deaths.

This is a popular news article that discusses the lack of a drop in maternal mortality rates, but c-section is at the bottom of the list, after other factors are noted as contributory, such as diabetes, obesity, hypertension and cardiovascular disease. It notes that it's rarely "one thing" going wrong, but a combination of things, and that a problem may be masked by what is taken for the normal stresses and breathing or pain issues of childbirth, natural, medicated, or surgical.

If you want something a little harder, here's the CDC program data tracking maternal mortality rates over the past ~28 years.

The death rates may be markedly or insignificantly different, but not necessarily because of the choice made at the point of delivery to be vaginal vs cesarean.
posted by Buttons Bellbottom at 11:28 AM on July 10, 2014


Not sure why natural in vaginal childbirth/drug free vaginal childbirth/drug light natural childbirth is in quotation marks

As a catch-all. Leaving the word "natural" doesn't adequately describe all traditional (or what is thought of as traditional) childbirth techniques. I didn't mean for it to be seen as a dismissal or pejorative.
posted by grubi at 1:33 PM on July 10, 2014


Well, even the World Health Organization itself says that their recommended rate of 15% needs re-evaluation, but the U.S. does have one of the higher C-section rates in North America and Europe, but not the lowest infant mortality rate among the same group of nations.

Infant mortality is not the right measure here, you want perinatal mortality.

Our abysmal healthcare system, poverty, and our willingness to count babies that other countries consider to be fetuses as "infants" all contribute to our high rate of mortality (birth to 1 year).

Perinatal mortality is very low in the US. Babies, to be frank, do not die from c-sections. The c-section / vaginal birth choice is not actually easy, there are competing interests at play. The mother's interests and the baby's interests are not identical by any means.
posted by the young rope-rider at 2:44 PM on July 10, 2014 [4 favorites]


I had a vaginal birth with some complications for our son (i.e the OB waited too long so I got an infection and our son had some heart drops every time I pushed along with a nuchal cord around wrist, leg and neck and then he was swimming in meconium). Our friend had only the nuchal cord and she went in for an emergency c-section. Honestly, I think our son should have been born via c-section. Not that I"m all "woo hoo strap me down and cut me open" because I would have been terrified but a c-section would have spared a lot of emotional anxiety that lead to PPA and probably would have prevented our son from an apgar 1.

It wasn't my OB who delivered our son. My OB promised she would be there no matter what (and it was Xmas Day nonethe less) but instead her daughter wound up with a broken nose due to an accident so out of the entire staff who I liked, I wound up with the one doc who I didn't care for. When things started to go haywire, a lot of the nurses in the hall talking with my husband said "she really should go for a C-section so get prepared." It never happened.

I have a hard time thinking an OB would push for a c-section for no good reason. But I could be wrong. I didn't think an OB would push for vaginal birth when clearly a c-section would have prevented a lot of problems.
posted by stormpooper at 7:37 AM on July 14, 2014


OK, got some collected family anecdata to share. Famlecdata?

I’ve been at a lot of family gatherings lately, and a young cousin has recently given birth, so there have been a LOT of war stories being swapped. I paid a lot of attention to the stories of mothers from a few years older than I am, on down. Bear in mind that this is a relatively small sample, and mostly related by blood, so any patterns could be due to some quirk in our family medical history. N.B. that we do tend to be large babies (I was a ten-pounder, myself, but I began to crown in the elevator and was out in two pushes).

The younger the mother, the more likely she is to have had a C-section. Most of the C-sections took place when the mother was giving birth at a hospital where Pitocin is routinely administered to all laboring mothers upon admission; most of the fetuses later developed distress and C-section was indicated.

Most of the vaginal births after the early-to-mid 90’s, the mothers described having to argue with the doctors and nurses (and even their husbands/partners) to varying degrees in order to get them. The most extreme case was where the doctor on call (not her regular doctor) was pushing for a C-section after a couple of hours (she wasn’t clear on exactly how many) and the whole team started asking her if she wanted her baby to die. She told them her mother had labored for eighteen hours and worked on the farm the next day*, and she was walking out of there and driving to the next hospital if they didn’t shut up. She and the newborn baby were both fine a couple of hours later.

The only conclusions I feel I can draw are: do the best you can to find practitioners you really trust (not always easy in the current healthcare system when you’re on a deadline, I know), and make sure you have advocates in there with you who both know you really well and have done research with you on both what probably will and what possibly might happen.

*Mom was canning tomatoes the morning her water broke. She was in the hospital overnight, came home the next evening, and finished the tomatoes. I know I was her third birth, but still, she is a total badass.
posted by The Underpants Monster at 9:38 AM on July 15, 2014 [1 favorite]


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