Battle lines drawn over C-sections (Women's choice vs Doctors' liability)

[antigone382]

By Rita Rubin, USA TODAY
Wed Aug 24, 7:01 AM ET



For some women, birth has become the latest battleground for reproductive rights.

At a growing number of hospitals, women are being forced to schedule a repeat cesarean section just because they already had one. Doctors and hospitals say they fear lawsuits if they allow a patient to attempt a vaginal birth after a C-section - called a VBAC - and something goes awry.


"We think the risk is more of a legal risk than a medical risk," acknowledges Bob Wentz, CEO of California's Oroville Hospital, which banned VBACs two years ago.


As the overall C-section rate in the USA continues to climb, so will the proportion of pregnant women who have already had one. C-sections hit an all-time high of 27.6% in 2003, the most recent year for which information is available.

(More at article)
http://news.yahoo.com/s/usatoday/20050824/ts_usatoday/battlelinesdrawnovercsections

[Sgent]

1. A bigger issue

is that JACHO requirements effectively ban VBAC's in all but the largest tramua center. In addition, when your paying 150,000+ a year malpractice, in a profession that makes 200-300k, adding 50k to your malpractice hurts.

[antigone382]

3. Yes, I read about that in the article.

It certainly is a very difficult issue; on the one hand, it bothers me that they aren't letting women make their own decisions about what is best for their body...but on the other hand, I understand how offering VBAC's can hurt doctors a lot economically. Damn insurance companies!

[malmapus]

2. Yeah, Dr's seem to really rather deal with a C-section

I remember when we were expecting the doctors kept trying to talk my fiancee into having a c-section (lol freaking doctor had planned a vacation when she was due with our daughter so wanted to schedule a delivery like 2 weeks prior).

We eventually dropped that doctor and just managed to find another (found out how hard it was to find a new doctor when she was at 35 weeks).

But yeah, I think doctors do like c-sections too much and really push for moms to opt for it.

[Dulcinea]

7. They make more money off of c-sections.

A cesearean section is major abdominal surgery, requiring a longer hospital stay & a longer recovery time. Thus, more money for the doctor & the hospital. Plus, you can plan them rather than waiting for the inconvenience, time (and pain) of labor.

I'm so thankful I never needed one! I had 2 vaginal births & was up & around in a couple of days both times! I stipulated to my dr. and midwife that I only wanted a c-section if absolutely medically necessary!

[malmapus]

9. Yup my fiancee too

We both fought tooth and nail against any doctor that tried to talk her into going in for a c-section (was really crazy how much she was getting pushed to get one).

Her recovery was soo much quicker than a friend of hers that did have a c-section, she was out of it for weeks afterwards.

[newscott]

14. Went through this with my wife. Had to have a C-section

for the first one, but it was mostly due to how she's designed there.

It was tough because we tried natural for 9 hours, had drugs and then the surgery. It was a very painful and long recovery for my wife.

The second time we just scheduled the surgery and it went much better for her recovery time.

[Leeny]

34. Sometimes the truth is SO obvious!

Of course it all comes down to money. Any way you cut it (no pun intended) it's all about the money.

And I find it hard to believe that the risk of a vaginal after you've had one C-section is any greater than the risk of having a second C-section. But I'm not a doctor, so what do I know.

[knitter4democracy]

45. According to the studies I've read, there isn't much but some.

There is a risk, but it's not statistically all that much. That's what the insurance companies grab onto, though, in their recommendations, as it's enough for a lawyer to use to say that doing a VBAC was malpractice if the patient has a uterine rupture (that's the scary one that can kill patients pretty quickly).

The doctors are between a rock and a hard place. They want to do the right thing, but the science is murky (studies are going both ways on this issue), and malpractice rates are through the roof for Ob/Gyns (doubling every year is not unheard of). They have to do what the hospital lawyers and higher-ups tell them to do (or lose their admitting privileges and their jobs), but they want to treat women right. Most docs I know (my hubby's an internist, so we know a few docs socially) hate the system more than any of us do and are mad as heck.

[lastliberalintexas]

46. Perhaps, but far too many of them are voting that system into place

Sorry for the following, since your husband sounds like one of the good guys, but most doctors have allowed themselves to be used as tools for the insurance companies who have put these systems into place. They have blamed my profession rather than Big Insurance, and we're all getting screwed because of it.

And there are many dangers associated with the VBAC. The risk of one happening might be fairly slight, but the damage done when the problem arises is rather significant- either one or two fatalities or a severely disabled/impaired child and a devastated mother.

[knitter4democracy]

50. Many are starting to wake up.

They're seeing that lawyers aren't so much the problem as the insurance companies are. Most lawyers are just trying to help a family with a hard situation and make the right thing finally happen. Insurance CEOs make millions more every year as they jack up their prices to make up for losses in the market.

I don't know any doctor who likes insurance companies, actually. If you can check out the Placebo Journal ( http://www.placebojournal.com ) for a doctor's darkly humorous take on the system, I'd recommend it. His Sickna (Cigna) piece is actually getting him in hot water, as Cigna is threatening to pull out from the clinic and hospital he works with.

It's even getting into the medical journals that the insurance companies are the problems, and more and more doctors are dropping insurance entirely--even liability coverage. The articles on those guys are really interesting. Cash payments from patients (usually a sliding scale), so no huge forms and crap to deal with, and no huge bill on the overhead to worry about.

[lastliberalintexas]

56. I'd say from my experience about a quarter have their eyes open

And yes, that number is growing. But it's been amazing to me how they've been screwed so badly by Insurance and most can't see it. Our governor even vetoed fast pay and fair pay legislation, and the vast majority of doctors still stuck with him for his promise of tort reform. Just bloody amazing.

Lawyers certainly aren't perfect either. I just don't want us to get the blame for something that's not our fault- when there is plenty to blame us for that really is our fault! :)

[knitter4democracy]

58. Yeah, if I remember right, AMNews pretty much endorsed him.

:eyes: Whatever. That rag never even mentioned Dr. Dean when he was running, so there ya go.

My husband gets sick of the lawyer bashing (of course, his brother's one, so that might be it ;) ), and he goes out of his way to explain what's really going on to everyone.

[Mayberry Machiavelli]

37. Actually I thought that was not true. I thought insurance paid

a set fee for the obstetrician's care including prenatal visits through delivery regardless of whether it's vaginal or surgical, to avoid precisely this conflict of interest.

[knitter4democracy]

43. The doctor doesn't, but the hospital does.

Ob/Gyns charge a flat rate for prenatals, labor, and delivery. They keep more of their money for an uncomplicated birth, but the hospitals make more money off a c-section, so there's sometimes a behind-the-scenes pressure.

Also, many doctors feel pressured by patients to give c-sections. I've heard that from too many Ob/Gyns to think it's a myth. Patients want the scheduled birth often more than the doctor does.

So, with hospital pressures, insurance pressures, and even some patient pressures, what do you think doctors will choose to do?

[redacted]

19. I have friends that are OB's and they can hardly schedule anything

with their families. It's a hard profession from that standpoint.

[knitter4democracy]

47. It's a very, very difficult job.

It's a five year residency after the four years of expensive medical school (we racked up just over $25K in interest on the school loans in a three year residency, so you can imagine what they owe when they're out). During residency, it's not uncommon to be on call every other night or in a nice one, every third night, meaning that they work 120 hours a week or more. They get paid about $40K a year for that (or even less), and the divorce rate in some residency programs is 100%.

Once they get out, they still work at least 70 hours a week, most often quite a bit more, and they work often 30 hours or so at a stretch, having been up all night with calls from patients, deliveries, and emergency surgeries.

They do it for the love of it, and once they're in, they need to stay with it to pay off their debts. It's a very hard part of medicine, mucking around in sexuality and birth as they do, with everyone blaming them for everything. They're damned if they do and damned if they don't. I'm so glad my hubby just went into internal medicine, which is hard enough.

[stellanoir]

4. It's such bull.

Often they are scheduled out of timely convenience that physical need.

I had a home birth, wouldn't have had it any other way and generally, negative outcomes have indicators long before labor starts.

Pregnancy is not a disease and should never be treated as such.

Expedience alone or liability should never cost a child a life's worth of readiness. That's sadly, what it often does.

IMHO

[LynzM]

13. Awesome post, Stella

I totally agree: Pregnancy is not a disease and should never be treated as such.

I'm glad that interventions are there if necessary, but sad and angry about how much they are pushed on women, (often as opposed to actually educating women about what you go through in childbirth, what is normal, coping mechanisms, things that can speed labor, etc) for the sake of 'convenience' or money. Convenience for the doctor, sure, but recovering from a c-section is NOT more convenient for the mom than recovering from a natural birth, the vast majority of the time. And she's the one that needs to be healthy to care for a newborn!!

[MountainLaurel]

21. Excellent points

Pregnancy is not a disease and should never be treated as such.

What amazes me is how counterproductive most hospital-mandated protocols are: You can't get up and move or have something to eat, so your labor slows. Labor isn't progressing quickly so you get some drugs. Those drugs increase the intensity of contractions, so you need some pain drugs. The pain drugs then have their own impacts, and the next thing you know the doctor is calling for a c-section. Or, if not, you have to be monitored to make sure that the drugs aren't affecting the baby, and you have to give birth lying flat on your back, which is probably the absolute worst position to be laboring in other than standing on your head.

[Arkansas Granny]

69. Great post!

I remind every young woman I know who is pregnant that pregnancy and childbirth are why a woman's body is designed the way it is. It is a perfectly natural process and can be a wonderful experience if you keep the right frame of mind.

[fshrink]

5. I wonder

whether, in these dark religious ages, Caesareans are not a way of avoiding the pain without having to bear the stigma.

[Eloriel]

6. Huh?

I have no idea what you're saying. The question is: do YOU? LOL. If so, please explain it to us.

[Krupskaya]

8. Are you seriously saying C-sections are less painful?

If so, please sit down and be quiet.

[whatever4]

12. Loud female laughter :) nm

[Leeny]

35. Order up

I'll take one vaginal with a nice epidural, please.

Let's not argue about what's the most painful or who suffers the most. We're all tough as nails as far as I'm concerned.

I had two children, both vaginally and both with epidurals. I thought I'd do it au naturel of course, but EEGADDS that first contraction changed my mind in a hurry!!!

We just need to make sure that we continue to have a CHOICE in the matter.

Choice... now that's a subject worth talking about.

Oh, okay, I'll shut up - for now.

:grouphug:

[Dulcinea]

36. Seconded!

My first delivery was by the book, 12 hours, w/ epidural.

My second time, labor advanced so quickly that it was too late for an epidural by the time I got to the dr's office, so I pushed her out unmedicated. It only took 3 hours start to finish, but the pain was incredible!

Sometimes you don't have a choice, like times of fetal distress, but if you do, DON'T let anyone talk you out of exercising it! It's YOUR body & YOUR baby.

[OzarkDem]

66. My first was a C section

after 20 hours of labor/ with epidural the last hour. 10 lb baby in a tiny woman. His shoulders were too big, his heart rate started to slow down.

I could have done a VBAC with the second one, who was smaller, but at the last minute the substitute doctor told me I should have another C-section. When my regular ob got back in town he was PO'ed about what happened. He indicated he thought the other doc did it for financial reasons.

Women should have a choice in VBAC and shouldn't be bullied or frightened into another C-section if there are no complicating factors.

[whatever4]

42. Yup

That's what I was thinking, when the idiot doctor told me I delived a 10 pound 6 ounce baby. With forcepts. Friggin jerk military ob doc/military womans health care, you gotta wonder, you know? A choice in the matter would have been nice.

Don't feel too badly for me though, I was quite vocal, and not a passive suffering victim at all. I'm sure he thought twice before doing that again, letting some small person deliver a huge baby without pain meds for no good reason. Probably not much more thought though, A hole was proud of himself, belive it? Unreal. But I'm sure my negative karma took points off his soul.

Men wonder why we don't trust them, blatant generalization for the day, but then they turn around and do things like this, someone professional that I should have been able to trust, medical system that systematically denies pain medication and standard treatement to people based on gender, with barely a notice of "gee, that sucks" from other men. Talk about it, it's boring to them. Uniformly put down and messed over, but not their problem, not their pain, not their concern. Sad.

I like that part, "We're all tough as nails as far as I'm concerned." :)

[HuckleB]

27. Well...

it is interesting that I know two women who chose C-sections because they didn't believe they could handle the pain of vaginal delivery.

Perception means a lot when it comes to pain.

[knitter4democracy]

62. I've heard that myself.

I couldn't understand it and still don't. Personally, I think many, many women fear birth and think it's better to be as knocked out as possible for it (even though most C-Sections aren't like that anymore).

[enlightenment]

63. Have to agree, that many women are choosing

C-sections -- for a variety of reasons. Over the past 5 years, I've known 11 women who've had babies. 9 were 1st timers, 1 was on #2, and the last one was working on #3.
8 of the 1st timers had C-sections, as did the one having the 2nd child.
ONE of those C-sections was because of complications -- the one having the 2nd child. Her BP went through the roof.

5 of the 1st timers had "planned" c-sections -- I'll buy the necessity of one of them (a very petite woman with a big, big baby). The other 4 who "planned" them had commented at the beginning of their pregnancies that there was "no way" they were going through labor. Guess their doctors agreed.

The 3 first time moms remaining were in surgery within 9 hours of the start of labor -- NOT when they arrived at hospital, but the first contraction. No problems, mind you, no failure to progress, no fetal distress, no problems developing with mom -- it just seems like 9 hours is the new "max labor."

I know it's been 26 years since I gave birth, but I used to be a birthing coach and I could have sworn that 18 hours plus (total) was considered normal for a 1st time mom. I'm not close enough to the process to understand what's really going on -- but it seems like it must be some combination of factors. Not just the doctors, or the insurance companies, or the hospitals, or the moms -- but all combined in some nasty nexus that has made childbirth both a disease and an unacceptable inconvenience.

It's sad.

[HuckleB]

70. Indeed.

They've been rushing moms off for C-Sections after 12 hours of labor for some time now. It's disconcerting to hear that it's happening after only nine hours in the cases you've been privy to.

[gkhouston]

72. that is truly appalling.

when I had my daughter five years ago, I did not want to have a C-section unless it was truly necessary. I have a sister who'd had two, back in the eighties (the first due to fetal distress and a breech presentation and the second because her incision was vertical), and I'd seen first-hand how long it takes to recover from a C-section.

We were living in the DC area at the time and you could actually get information about the percentages of C-sections performed by various physicians and I considered that when choosing the physician/midwife practice I used. Those statistics weren't invented, either -- I had a vaginal birth two days after my water broke and no, it wasn't unending agony. Mostly, it was a lot of waiting and not much sleeping as I was only comfortable on my feet.

The thing that bothers me most about the "elective C-section" for women who apparently lack a medical indication for the procedure is that doctors are apparently willing to perform such an invasive surgery with the attendant greater risk of infection. I guess they're afraid of losing their patients to someone else but what's going to happen to them when one of those patients gets one of those superbug infections?

[knitter4democracy]

76. I think it is a lack of education.

I've known too many who just didn't want to research their options or know as much as they could about labor and delivery. They went into it very much like victims: they did whatever the doctor or nurse told them and no more and then ended up getting C-Sections because of it (the system encourages the surgery, that's for sure). What got me was how they praised their doctors later and complained about how much weight they gained during pregnancy. :eyes:

[SemperEadem]

74. 22 years ago

I went through a 42 hour labor, which didn't get eased by an epidural until 8 hours before I delivered vaginally. I thank God that epidurals were invented but the experience of getting the tube in my spine was enough for me to stop at one baby. I lost all romanticism about delivery in that one moment forever.

My doctor was old school---even though my labor had gone on a long time, he was reluctant to do a C-section because in his opinion, it wasn't warranted. The baby was in place, my pelvis was wide enough and there was no need to go in. Because the suction machine was broken, she was delivered by forceps. Owch, sort of--epidural, don'tcha know!

And it was back in the day where you could recover for a week in the hospital. Ten years ago, my sister was released the day after she had her daughter--that was barbaric to me.

[whatever4]

11. wellllllllllllllll

I'm not so sure. The recovery from a c-section is nothing like it is from natural birth, and I've seen very stoic ladies bent over in pain. Apparently, we use stomach muscles for everything...just everything. According to her, Trudy.

That doesn't speak to how some women never fully recover from it, though the surgery is better than the bellybutton-to-pubic that it used to be.

And also, the c-section scar, smaller than it used to be, is still a scar, rather more of a stigma than just the stretch marks. I'm not sure what you're talking about there, in terms of stigma.

I wasn't aware the c-section rates had continued to rise like this. And me, thinking I'm informed on womans issues. Sad. So glad my child bearing years are over. I had no idea how easy I got through the whole ordeal. Me, one who delivered a 10'6" baby. And likely I should have had a c-section actually, lord knows it was awful enough. The doctor who said my pelvic bones are shaped/angled correctly was right, said it about my first child, not the second one. Thank god he was right. The second doctor thought I was delivering a 8.5 or 9 pound baby. He wasn't even looking to see if the baby would "fit"

I honestly expect health care for women to see a heavy decline. Things are going to get tough. We are NOT the priority. Not now, not ever.

Did anyone hear the story that birth control pills may cause a permanent decrease in woman sex drive, and that it can last for the rest of her life, a permanent change in hormone levels? yeah. And we've been using the damn things for HOW long? It was a study, in another country, and I don't have the link handy, but it was this year and can probably be found on the internet. And it's a life-long issue. That you've probably never even heard of.

Yeah, our health. It won't be a priority.

[MountainLaurel]

20. Right on

I had my gallbladder removed a few months ago laparoscopically (just four smaller incisions instead of a 6-inch gash) and I was amazed at how much and for how long it affected me. I needed help getting out of bed for a week, driving for more than 10 minutes made me sore, and being at work drained all my energy for more than a month. The idea of a c-section makes me shudder. I remember when my brother's GF had a c-section, she wasn't allowed to drive for more than two months, and her wound opened because she lifted the baby too often. And I would think that breastfeeding would be almost impossible between the painkillers and the fact the child can't rest on the abdomen.

[Ratty]

24. Yup, hernia here

Laparoscopy for me too. I was out of work for a week. Couldn't get out of bed to go to the bathroom for two days. I was surprised what such tiny cuts in your abdomen do to your whole body. I'll never take "minor" surgery for granted again!

[Ilsa]

31. Actually, I breastfed both of my boys after two C-Sections.

And I didn't use the football hold, either. ANd they were big babies: 10-4 and 9-4. I cradled them on a pillow. I used no supplements, either. It can be done. But yes, the CS was very painful the first time around. Not as bad the second.

The first CS was a lifesaving procedure for me. I was developing pre-eclampsia rapidly. Even after delivery, my bp was 220+/120 the next morning. I even think I might have had a minor stroke. I was in the hospital for a week, but it wasn't for the CS. I was trying to recover from a mild case of HELLP syndrome (My platelets also fell sharply, and at one point my potassium level was in the danger zone.)

The second cs was because I wasn't progressing, but my water had broken much earlier. Since I had had a CS before and I was trying a VBAC, I couldn't get pitocin. It was time to deliver before risk of infection set in, so we did the cs.

[whatever4]

41. Thanks, glad you're feeling better too :) nm

[Arkansas Granny]

68. As I mentioned in an earlier post on this thread

my daughter has had one child via C-section and one vaginally, without pain medication. She states that she had a much quicker and easier recovery with the vaginal delivery.

As far as the pain factor, I believe that the amount of pain and the perception thereof varies from one woman to another. I had two deliveries with a saddle block, one with an epidural and the last one natural. The epidural was great, but if I had another I would probably opt for natural. Yes, there is pain, but it's not more than you can endure.

That being said, it's all about a woman's choice.

[Liberaler]

10. Idiotic US laws

makes this a fad among doctors. Where I come from, c-section is only used on medical grounds. The wast majority give birth the normal way. I'm happy that my daughter was born naturally and that I was there to experience it.

The only reason for a 27+% c-sections are the antiquated legal system this country has and on top of it the insane amount of money that can be made from this. The whole legal system in this country is disgusting and medival and need a total overhaul. Name for instance another country that has close to 2% of it's population incarcerated...

[lastliberalintexas]

52. No, the problem is Big Insurance

Even though Texas has some of the most draconian laws in place supposedly to protect doctors from frivolous lawsuits, their malpractice premiums have continued to increase, while their coverage has been cut. Meanwhile, studies that even the insurance industry admits are pretty accurate show that lawsuit costs still only account for about 5% of healthcare costs in this country.

The legal profession isn't the problem any more than the doctors are.

[knitter4democracy]

59. Amen.

That's all true.

[elehhhhna]

15. The shocker for ME is the good number of C-sect's done

voluntarily by the Mother for scheduling's sake. My sisters OB says it's a big trend.

[HuckleB]

28. Indeed.

I would have thought that was going to other way, but apparently not!

[Dover]

16. Hysterectomies are epidemic too. Is that also due to liability issues?

I wouldn't be surprised.

Not sure what the answer is here.....

[Pastiche423]

22. Hysterectomies are epidemic ?

That most be a recent epidemic. While going through repeated procedures in '97/'98 to find the cause of my symptoms, I begged my doctor for a hysterectomy.

I had my tubes tied in 1984 and had been paralyzed since 1986. Why not take out my indoor plumbing? I surely din't need it. He claimed hysterectomies could only be performed if the woman's life was in danger.

As it turned out, I eventually had surgery for perineum cancer.

[Ilsa]

32. Actually, it is believed that ovaries are still useful for many years

beyond childbearing years as they still secrete hormones that help prevent osteoporosis, etc. They may eventually get my uterus, but they are not getting my ovaries unless I am very old and the research indicates they are no longer producing hormones.

[knitter4democracy]

60. The uterus does too.

There still are doctors who are too quick to take everything out, though, thinking that pills can make up for missing organs. :eyes:

Hysterectomies used to be standard treatment for my disease until they found that they don't actually treat it most of the time. There still are docs out there doing them for it, though, who refuse to believe the current research.

[Sgent]

17. I just wanted to reiterate hear

that MOST doctors did VBAC's regularly until 3 years ago.

JACHO, which is the certification that hospitals have to have to accept Medicare, Medicaid, and most private insurance, changed their requirements.

To have a VBAC, you must have a OB/Gyn and Anesthesia available immediately. This essentially means that you have to have your VBAC in the Operating Room, with physicians no further than the next room over. Previously it was within 10 minutes, which is much easier to maintain.

[Southpaw Bookworm]

18. While we're on the subject of childbirth

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=104x4456684

[knitter4democracy]

53. Now, I'm sorry, but that's just men being stupid.

Seriously. :eyes: I don't get that one at all. Thank goodness my husband wasn't so silly after helping me with both of my natural births or I'd have had to smack him. ;)

[CoffeeCat]

23. I've had two c-sections...

...the first one happened because my daughter was in distress. Her heart rate was dropping and they needed to get her out. She had ingested meuconium and it was a dangerous situation.

My second c-section was scheduled. The doctor who delivered our first, said that I had a very narrow pelvis and that delivering a baby would be extremely difficult.

So we scheduled the second c-section and it was such a wonderful experience. The doctors and the anesthesiologist were relaxed because it wasn't an emergency situation. It was like a party atmosphere in the operating room. We joked around, talked a lot. It was like a big celebration. When they opened me up and took my child out of me, the anesthesiologist said, "Do you want to see?". I said yes. He titled my head forward and I saw them take my daughter out of me. It was just....remarkable.

I recovered pretty quickly from both c-sections. I went home less than 48 hours after each surgery and I was at the grocery store only a day after being home. The first 24 hours are the most difficult. It hurts to get out of bed or to walk. However, I forced myself to walk the halls and get moving several hours after the surgery and that helped.

I guess these choices are very personal, and each woman must do her own research and make her own decision. You really have to be your own advocate and ask a lot of questions.

[HuckleB]

25. Cesarean Fact Sheet

http://www.childbirth.org/section/CSFact.html

[WildClarySage]

30. Ironic, that at the top of the page is an ad for a lawyer

who is advertising he will take malpractice cases related to vbac injuries.

[HuckleB]

26. Could You Be Forced To Have A C-Section?

http://advocatesforpregnantwomen.org/articles/forced_c-section.htm

[WildClarySage]

29. Yes, goddamnit, you can be.

I'm pregnant right now with my second. My physician has told me that I will almost certainly have a repeat c, he will not allow an induction, and doesn't believe that I'll go into labor on my own. I'm looking into finding another doctor who'll support my efforts to have the healthiest outcome for my baby.

When my son was born, I was told that my c-birth didn't keep me from having a vbac in the future. Zip forward 11 years and it looks like it will. I'm really unhappy about that because I've done the research and the risks of a uterine rupture (the reason my doc says no vbac) are far slighter than the risks associated with a c! My son couldn't breathe at birth on his own partly because he didn't have any contractions to stimulate the breathing response or to squeeze the fluids out of his lungs naturally. He was in the NICU for several days after birth because of his tendency to stop breathing and turn blue. Fortunately he's perfectly healthy today.

He also couldn't breastfeed at birth, and never got the hang of it, which is associated with epidural meds and a c-birth, and I really think that if he'd been allowed a more natural birth, we would have had a much better start in life. Also, the nurses in the NICU went behind my back to feed him from a bottle after I specified that I did not want him to do so.

A c-birth is a very violent way to come into this world, and babies born that way reflect that. The transition isn't made as nature intended. Instead of a peaceful entry, they are yanked out by the feet, exposed to bright OR lights, and immediately 'treated' with heel sticks, eyedrops or ointments that sting and blur vision, and all that's done while mom's surgery is being completed, so that when you finally get your baby, after you're done and have been through the recovery room, you're shivering and shaking from anaesthesia and blood & body heat loss, the baby has been traumatized excessively by the birth experience, and you're both exhausted. No wonder infants born by c-birth don't smile as soon as infants born vaginally do.

I'm definitely healthy enough to try for a VBAC, and I know I can handle the pain of a natural birth far easier than the pain of recovering from major abdominal surgery. It's a matter now of finding a supportive physician to help me bring my new little boy into the world peacefully and healthfully.

And now I'll hop down OFF the soapbox...

[Ilsa]

33. As long as you don't need pitocin, I think you should try the VBAC

and the doc should allow it. That was the protocol about 6-7 years ago. I attempted a vbac and my doctor said he didn't think I'd go into labor on my own either. But I did have spontaneous labor and I still had a cs for other reasons.

[JNelson6563]

38. Hard to believe

I've had two c-sections and I find it hard to believe that is more violent for a baby than vaginal birth where the child is squeezed through to the point the head is shaped by it. I remember so well the difference between the vag. birth babies and the cs babies and it was very obvious who had gone through the trauma of regular birth. And all the things done to the c-section baby after birth are done to the vaginal birth baby so not sure what that was about. Additionally, both of my kids had no problem nursing and were very responsive.

With that said, unless the mother's health is in danger I believe she should be allowed to make the choice and c-sections should be forced on no one. My first was an emergency, the 21 hours of fruitless labor was wearing me down and my vital were dropping, I was losing it. I was offered VBAC but I knew c-section recovery would be easier without the many hours of labor (flex some muscles for 21 hours and then cut them--ouch!) so I told the doc save your pitch for the VBAC, I only have to touch stove once to know it's hot. ;-) To those confident that a VBAC would work for them due to whatever their circumstances are/were, I say You Go Girl!

Julie

[WildClarySage]

40. What I mean by a violent birth is how they treat the baby

immediately after birth. The heelsticks and ointments in the eyes are often withheld in a vaginal birth until after a few minutes getting to know mom first. It's a very comforting time for a baby that a c-birth doesn't allow for. When the baby meets mom for the first time after a c-birth, he or she is usually visually impaired from the drops or ointment, shell-shocked by the much brighter OR lights and noise, and any other interventions that may become necessary in a c-birth.

The squeezing of a vaginal delivery is hard on a baby, but the baby is moreso prepared by the contractions stimulating hormones such as adrenaline that help them cope. A c-birth without labor (like I had with my son) means that the baby doesn't know what's coming until the bright lights hit them full-force. Also, the breathing problems brought on by many c-births are addressed with things like IV's, respirators, many heelsticks to moniter oxygen and glucose levels, etc. I remember being asked to leave the NICU because the nurse was about to put the IV line in my son's head. He had so many heelsticks that after the first day of his life, he no longer cried when they gave them. I'm determined to give this baby a better start in life, assuming there are no specific indications for a c-birth at the time of delivery. I'm not foolhardy about it, I'm not going to argue in the face of clear need, but my dr's desire to avoid the possibility of an unlikely problem isn't, imho, a reason to deprive my lil' kidlet of the best start possible.

[JNelson6563]

48. Sounds truly awful

it sounds as though your experience included a lot of terrible things mine did not. So sorry to hear of the horrors! I cannot blame you one bit for wanting to try the opposite of what you know.

I want to add though that the idea of holding the baby fresh-out-of-the-womb never appealed to me very much. Maybe I'm just squimish.

I stand with you in your fight to do this your way. Every woman should be allowed to do so.

Best wishes to you and your precious one on the way! :toast:

Julie

[WildClarySage]

51. Thanks!

[all.of.me]

39. bullshit, bullshit, bullshit!!!!!!!!

ugh, this pushes my buttons! i had a vbac, and it all went fine. ugh. they act like your scar is going to rip open. argh. let me at 'em!!!!!

[lastliberalintexas]

44. VBACs can be very dangerous

I know someone who had a VBAC 6 years ago and her child is severely disabled, unable to walk or talk, mentally impaired, very little to no hope of improvement, and requires constant care- all because the stress of the delivery caused her uterus to rupture, and the child was therefore oxygen deprived during the time in which an emergency c-section could be done.

Yes, some doctors might schedule a c-section to fit within their schedule. But a woman should also be fully informed of the options and the risks associated with each type of delivery. A VBAC is much riskier for both the woman and the child than a scheduled c-section, and as long as she knows this, she is entitled to make that decision. But certain natural birth advocates go along with the myth that vaginal birth (and especially without meds) is the best option for everyone, when it isn't. One size most certainly does not fit all.

There is actually a very good reason too that doctors worry about malpractice suits in connection with VBACS- most experts consider it a violation of the standard of care to perform a VBAC, and will testify as such. The doctors know this, and so should the women before choosing one.

[WildClarySage]

49. Risks of uterine rupture are actually fairly small... 1 or 2% of vbacs

and c-sections carry their own risks, such as, a 6% chance a baby will be cut during the incision. Not usually a life-threatening risk, but certainly one many moms would not want to subject their infants to. I agree that there are certainly occasions when c-births are life-saving and that it's tragic that some babies don't do well from vbac. VBACS must be monitered carefully, and there are criteria that should be met first. Ultrasound measurement of the previous c-birth scar may reveal a vbac is inadvisable, for example. Certainly women should have all the facts available to them. But to claim that all vbacs are dangerous is overlooking the fact that all pregnancies and births are dangerous. Each woman should be encouraged to do the research and figure out what's best for her family, and unfortunately a lot of physicians simply want to tell women what they will do. Even more unfortunately, many women want the physician to do just that, to spare them the trouble of being informed and the responsibility of the decision.

[lastliberalintexas]

54. I agree that it's up to the woman

But I also believe that she should be fully informed of the risks associated with VBACs, and most aren't. And because the problems associated with VBACs are so severe (even if their frequency is not that high), it is even more important that women become fully informed on the issue.

I know women who've gone both ways on this, and most of their VBACs were successful. But the ones that go awry are absolutely tragic.

[knitter4democracy]

57. The risks of rupture are low but freakin' scary.

You're absolutely right on that.

I've found that it depends on the mom. I've had friends who did almost nothing to research labor and delivery--went into it quite clueless, depending on the doctor to tell them what to do. They couldn't have been fully informed at that time (would they even be able to respond or sign something? I remember being quite out of it during labor and birth). That means that the doctors had to make the best decision they could with what they knew. I know that's not how it's supposed to be, but it often is.

If a doctor gets a patient in labor he's never seen before, who hasn't had any or many prenatals, and who seems to be really scared of the whole process, he will give her a C-Section, guaranteed. That's what my hubby saw in med school, and that's what we've heard since.

If he gets one who has taken care of herself and has learned as much as possible, he'll view her as a partner in the process and go with what she wants. I know that's backwards and all, but it's true.

My first Ob who helped me deliver my daughter fully supported my desire for a natural labor, as did my nurse, and it wasn't until afterwards that they admitted that it had been at least a year since they'd each helped with one. They hadn't wanted to jinx my labor by telling me the truth, as in their combined experience, pretty much every patient demanded pain killers or a C-Section after awhile. I still wonder at that.

[RayOfHope]

55. Not necessarily true a VBAC is more dangerous

and as was posted upthread, the incidence of rupture is very small if the mother is allowed to go into labor naturally (ie no induction),and no pitocin is used. The was her uterus was stitched up from her last c-section also makes a difference. The big belly button to pubic bone cuts they used to do are not nearly as strong as the horizontal incisions they now do. Also, in closing the uterus, a double layer stitch heals stronger than a single layer interlocking stitch.

I wanted to VBAC, but ended up with a c-section. Somewhere thee docs forgot to close something up, and I had severe blood loss that resulted in a transfusion and severe anemia 2 days later. That was a treat.

[knitter4democracy]

61. Wow.

That's horrible! How could they forget something that important? Had they slept much lately, or were they high? It happens . . .

I hope all is better now. {{{Hugs}}}

[shimmergal]

64. Women's choices can go both ways.

There's a case to be made for elective Caesareans, and it has nothing to do with schedules (Drs.' or mothers') or insurance/liabililty.

Every hear of uterine prolapse? Probably not; it's one of those women's conditions that's still unmentionable, but increasingly common. Of course it's unmentionable because it mostly happens to older women. It seldom kills you either, but can majorly impact one's quality of life. In my case, I reached the point where I could hardly walk, and had constant pain.

Anyhow, there's some eviodence that having had vaginal deliveries in the past raises the risk of prolapse. It's hard to know for sure, but it _is_ a possibility. Sometime in future, mayber there'll be a study of U.P. rates among Brazilian women--a majority of whom are choosing elective C-sections now--and American women, who've been propagandized for at least two generations that "natural" childbirth is the only way to go.

[knitter4democracy]

77. There are other causes of uterine prolapse.

They're finding, as they study it more, that their original thesis of it being caused by birth isn't necessarily true. If I remember right, I read that in the American College of Internal Medicine's weekly journal, but it might've been in one of the other journals my husband gets.

Kegels seem to help, as one study author said. I'm working on them more now, personally. They might not, though, as they really don't know what causes it.

I'm so sorry you had that kind of pain. I have endometriosis, and I know my pain can put me right to the floor when it's really bad. The worst I ever had was the same as transition in labor but longer lasting, and that's really hard to handle for hours on end. That kind of pain sucks, and I hope you're doing better.

[Arkansas Granny]

65. My daughter's first child was delivered by C-section, but

her doctor allowed her to have her second child vaginally. Part of the decision was based on which direction the incision had been made during the C-section and her overall good health and physical condition. This was nearly 20 years ago. I don't know how the thinking on this is going now.

[shimmergal]

67. Women's choices aren't all one way.

There's a case to be made for elective Caesareans, and it has nothing to do with schedules (Drs.' or mothers') or insurance/liabililty.

Every hear of uterine prolapse? Probably not; it's one of those women's conditions that's still unmentionable, but increasingly common. Of course it's unmentionable because it mostly happens to older women. It seldom kills you either, but can majorly impact one's quality of life. In my case, I reached the point where I could hardly walk, and had constant pain.

Anyhow, there's some eviodence that having had vaginal deliveries in the past raises the risk of prolapse. It's hard to know for sure, but it _is_ a possibility. Sometime in future, mayber there'll be a study of U.P. rates among Brazilian women--a majority of whom are choosing elective C-sections now--and American women, who've been propagandized for at least two generations that "natural" childbirth is the only way to go.

Oops--sorry for dup. posting--apparently having computer trouble. Mods, feel free to take out the extra one--I don't know how!

[Witchy_Dem]

71. Forced a second section after having one

Still not sure either was necessary but without an advocate or legal presence IN the hospital many patients are subjected to the will of the staff.

I'll never know, really.

[knitter4democracy]

75. I'm sorry. :(

Your birth experiences should've been more powerful and wonderful than that. You're right that we need advocates (birth is soooo not the time to have to make any kind of a real decision) and that some nurses and doctors bully the patients into doing what's best for them, not the patients. It sucks, but it does happen. I've seen it, and my husband has seen it.

[whatelseisnew]

73. Comparisons of national cesarean-section rates

http://www.emedicine.com/med/byname/dystocia.htm

The cesarean delivery rate for the past 20 years in the United States has consistently been 50-75% higher than the rate in Europe. The increase in the cesarean delivery rate in the United States is believed to be partly due to the fear of litigation, influencing physicians to perhaps prematurely diagnose dystocia and other indications. Interestingly, in some European countries, the cesarean delivery rate is rising in response to the increasing incidence of litigation in those countries.
==============

<These are older but the comparison trend is evident.>

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7778651&dopt=Abstract

Cesarean birth: how to reduce the rate.
Paul RH, Miller DA.
Department of Obstetrics and Gynecology, Women's and Children's Hospital, Los Angeles County-University of Southern California Medical Center, USA.
The cesarean section rate, which approached 25%, has stabilized and started a modest decline. A stated United States national goal by the year 2000 is a rate of 15%. Suggested rates are 12% for primary and 3% for repeat cesarean sections. The major indications for cesarean section are prior cesarean delivery (8%), dystocia (7%), breech presentation (4%), fetal distress (2% to 3%), and others. The major areas of reduction must occur in the categories of prior cesarean delivery and dystocia. An expanded use of trial of labor and vaginal birth after a prior cesarean section will produce further reductions. Countries in Europe achieve > 50% vaginal birth after a prior cesarean section compared with 25% in the United States. A heightened awareness must occur regarding the decision to perform the first cesarean section. The residual impact, a scarred uterus, affects 12% to 14% of women seen for delivery. Even if 50% achieve a vaginal birth after a prior cesarean section, the national goals are unachievable. The obstetrician must consciously consider the impact of "once a cesarean, always a scar."
==============
http://content.nejm.org/cgi/content/abstract/316/7/386

PubMed CitationAbstract

Our study of cesarean rates in 19 industrialized countries of Europe, North America, and the Pacific revealed sharp differences in rates, ranging from a low of 5 (Czechoslovakia) to a high of 18 (United States) per 100 hospital deliveries in 1981.