From Kelby:
This is Kelby. I've been banned from the site. I am using a computer at my local library to let you all know that my information has been SILENCED due to extreme censorship. So, you will not be hearing from me anymore. Typical from allopaths. Hope you all had a great holiday.
Kelby
From Lee Passman:
Yes, we've known for a long time that Amy has issues. Perhaps she has some repressed guilt about the botched C-sections she has performed. This most recent post is yet another example of that. Amy's posts are very much one-sided, and she's the only one who gets to start a post.
Amy likes to pretend she has some critical distance on the issues, creating this site just to make money from Google Adwords. Good gracious, what a lark!
The USA has the most expensive health care system in the world, but still neonatal mortality and infant mortality are much higher than Japan, Singapore, and many countries in Europe. A 30% C-section is a joke. It's as if these doctors believed there was something wrong with a normal pregnancy.
From flim flam:
so how do you propose to reduce the c-section rate? magic? or do you have some super duper prediction machine that only picks out the high risk, 100percent necessary sections?. what do you consider an acceptable c-section rate? on what evidence do you base this on?. or do you just think they are unnatural and yucky and "something should be done!". how about you actually read some of the papers amy discusses. a lot of the stuff you are parrotting is highly inaccurate , to say the least, and demonstrates your lack of knowledge,as does your resorting to ad hom attacks.
From Liz1:
so how do you propose to reduce the c-section rate?
Well, as far as I can see, there are a variety of strategies: 1) publicise and propogate widely bad research; frighten women out of their wits by dwelling on the "side effects", making no attempt to distinguish between, say, those that are serious but not likely, and those that are likely but not serious; increase a natural fear of surgery/hospitals so that it becomes pathological; encourage the use of birth centres, homebirth and UC so that CS isn't available. So far, this campaign hasn't had a noticeable effect on the CS rate, but if Dr. Amy is correct, it has caused the death of a few babies. How they weigh in the balance against all those "empowered" women, is, of course, a matter of opinion.
From sarahz:
Did people think they increased NEONATAL mortality?
I believe they increase MATERNAL mortality. Orphaned children don't always fare that well, kwim? They also just decrease your overall rate of health for the rest of your life. Morbidity?
Perhaps the perfect primary cesarean does not decease the rest of your life's health, but my mother had four classical incisions and her entire GI area has not been right since. She also had to have a hysterectomy young for something directly related to the sections.
From Leelee:
The problem isn't c-sections themselves. C-sections can and do save lives in the appropriate context. The problem is stories like the following, reported to me firsthand by a (male) friendly acquaintance. It came up because he asked me where I had my son, and it is the same hospital where his wife is about to have their second, presumably by scheduled repeat cesarean (I didn't ask). He asked if I liked them and I said not really, and gave my reasons, but also gave my standard caveat that my priorities might not be someone else's, and I'm glad my baby was OK etc. etc. He said their experience was totally different because they "planned the whole thing." At first I thought this meant planned primary cesarean, but he explained:
At 41 weeks, his wife decided she wanted to be induced though her practice (not the practice I saw) was willing to go to 42 weeks. So she went in and, as is more common in primip's, the induction wasn't really progressing rapidly at about 12 hours in. Baby and mother were fine. It was about 6pm. Her doctor comes in and says in a joking voice (per my friend, not my embellishment), "well, we don't think this is going anywhere. We could wait longer, you and your baby are both fine...or we could just go down to the OR, you have your baby, and we all go home."
She readily consented.
Hey - if they're happy, they're happy, and if they're indifferent to a non-medically-indicated c-section, that's their right as (hopefully) informed patients. But I just use the story to illustrate the cavalier attitude, more than anything. I suppose it shouldn't seem shocking at all coming from this particular hospital, and it's *not* shocking I guess, but I sure hope this young mother knows the full scoop and doesn't plan on more than two children, etc. On the one hand I am glad that c-section has become *relatively* safe enough, and much safer compared to how it used to be, that people can afford to feel this nonchalant. On the other hand...I guess I will never understand the mindset that is indifferent when one's doctor proposes major surgery basically for convenience reasons (his own, in addition to the mother's.)
From Leelee:
I recently read a paper that stated that prophylactic c-section at 39 weeks would virtually obliterate stillbirths due to complications associated with postdates....however, 5000 sections would have to be performed to save one baby from hypoxic brain damage.
Worth it? I don't want to be the one to consign that one baby to hypoxic brain damage, but on the other hand, 5000 is a large number of non-medically-indicated major surgeries.
And unfortunately, what can ensue is an insidious concept which, if taken to its extreme, connotes that failure to consent to a c-section at 39 weeks, or a desire to even *attempt* a vaginal birth, means "you don't care about your baby / you value your experience over your baby's life."
The same paper (which fair-mindedly examines the role of cesarean delivery in preventing pelvic floor injuries) also cites a dramatic increase in placenta accreta:
"Previously estimated at about 1:2500 deliveries, the incidence of placenta accreta appears to be rising coincident with higher cesarean rates as a recent study reported 1:533 pregnancies complicated by accreta over a 20-year period from 1982 to 2002. Although rare, this condition is clinically significant as accreta has become the leading indication for cesarean-hysterectomy in many centers and can lead to massive obstetric hemorrhage with subsequent disseminated introvascular coagulopathy, surgical visceral injury, adult respiratory distress syndrome, renal failure, or death. Placenta accreta occurs most frequently in women with a prior cesarean who have placenta previa. Studies estimate the risk for placenta accreta to be 11% to 24% in such women."
from "Cesarean Delivery on Maternal Request: the Impact on Mother and Newborn" by Young Mi Lee, MD, and Mary E. D'Alton, MD.
From Leelee:
Liz 1: "frighten women out of their wits by dwelling on the "side effects", making no attempt to distinguish between, say, those that are serious but not likely, and those that are likely but not serious"
This is the nature of informed consent though. I can cite the list of counseling points for CDMR (cesarean delivery on maternal request) in the paper I cite above. Its primary author performed my section herself; the hospital and practice group at which she practices are not exactly known as a bunch of NCB propagandists. She (rightly, I believe) posits that truly informed consent *must* be obtained for CDMR, that CDMR should never be offered upfront, and the list of potential sequelae (mostly for the mother) is pretty sobering stuff.
Have we come to the point that any bad press about c-sections at all is considered to be rot? It's not even "bad," really, it's just a list of physical sequelae that can and do occur, albeit rarely, which are starting to concern doctors. Also, doctors are faced with this entirely new concept of maternal request cesarean (well, it's probably not new, but seriously entertaining it is relatively new). They are trying to come up with a policy for dealing with it responsibly, that doesn't mean denying all requests entirely.
From I am so wise:
"Amy likes to pretend she has some critical distance on the issues, creating this site just to make money from Google Adwords. Good gracious, what a lark!"
Here's some economic conspiracy mongering (something that I detest) from someone who actually studies history. If childbirth was as safe and easy as the alternative birthing proponents claim, obstetricians would go the way of the syphologist (sic?).
Syphologists were specialists that treated syphilis back when syphilis was treated with arsenic-laden drugs that year’s worth of courses to work.
Then antibiotics were invented. Syphilis was then treated by regular doctors, with a single shot of penicillin in the butt to cure it. You could do this out patient if you had the stomach. There was no need for syphologists. As a cursory look through your telephone book will tell you, they disappeared.
You can also repeat this argument for oncologists and cancer, psychologists and psychiatrist and mental illness, and even for the pharmaceutical industry and illness in general.
IASW- (Otherwise known as yet another man teaching the gals how childbirth works.)
From Liz1:
Leelee, I understand perfectly well your point of view, and I do not particularly want to quarrel with it. However, I do not share it. I can understand that there are people who value being fully informed. For some reason, I am not one of them. Like anyone else, I like to have useful information. There are some pieces of information that I would consider vital, and would feel very put out if they were kept from me. But I cannot for the life of me understand how knowing that a CS "might" lead to a future miscarriage or stillbirth would have helped me feel better. What does one do with such "information"? Expressions like "and can lead to ..." give me a headache, much like the leaflets that come with OTC medicines. Yes, I understand it is necessary to warn of rare complications, but do people really have to be informed to the point of neurosis or paralysis? I think I would value education over information, so that people could get rather better at calculating risk versus benefit. I don't think I am particularly good at it. I think when it comes down to it people do what they want to do for all sorts of irrational reasons, and often being informed means selecting the evidence that suits your prejudices.
From sarahz:
I don't know that so many people share your point of view, Liz1, but it doesn't not at all erase the responsiblity of the provider who intends to collect $$$ for his/her work to provide all the necessary information on the consequences. How wrong is it that I felt WAY more informed about my wisdom tooth extraction than for any OB procedures?
Some of use refuse to have a paternalistic relationship with our medical providers. No college degree will ever make someone 'better' than me or less human and apt (as all humans are) to make mistakes. So therefore, before I open my entire system up to surgical assault, I am going to have every last bit of informed consent out there. And that STARTS with stats on hospitals. How wrong is it that I just found out recently (from a CNM employed there) that a hospital I was actually considering has a section rate over 50%??? Until STATS are made public, there IS no informed consent, and Obstetrics will still involve some level of assault. I am sorry but if your section rate is over 50%, some of those are unnessecary, some of the women getting unnessecary sections are unawary of their unnessecity and that combination equals medical assault and battery, IMHO. And the fact that around here it is mostly men doing this to mostly women adds a creepy subtext IMO.
The city nearby with more women OBs has a lower section rate. Coincidence?
From sarahz:
Also, it isn't like someone could neccessarily audit this hospital and say oh well C-sections A, B, and M were not necessary, but the OB knows in their heart which ones are not necessary. And of course there will always be ducking and weaving (otherwise known as creative charting) to avoid an outsider being able to PROVE anything, but again, a good OB definitely KNOWS if they are performing too many. Do they then have a moral obligation to disclose their high individual rate compared to thier peers to new clients? Again we can expect more ducking and weaving, but should this be the way it is with people we as women trust our bodies with?
From Melissa:
Has Kelby really been banned? Does Dr. Amy do that? I was excited when I found this blog (rec'd by a homebirth advocate who is furious w/the site) and found that comments are freely allowed - she had said anyone who can really debate the subject is banned. I figured that wasn't the case after seeing so many comments to each post. ?
From Emma B:
I don't know if Kelby was banned, but she should have been, and a long time before she was at that. Kelby's been our village troll for a couple months now, not because she's an HBA (really, a UCer), but because non sequiturs about the Chutes of Exit don't constitute debate.
We do have HBAs here, including some who have been here for quite a while, such as sarahz above.
From Amanda:
Melissa
There are many frequent commenters who strongly disagree with Dr. Amy, yet have never been banned. If kelby was banned, she had it coming. Read back through a few recent posts and you'll understand why. Even the homebirthers and UCers present called her a troll.
From Tsu Dho Nimh:
Melissa -
Kelby is a troll who does not discuss anything, he/she/it is more interested in being outrageous.
If you want to debate, just be prepared to back up your statements with solid research references and be polite.
From Squillo:
Melissa:
Welcome. I couldn't speculate on who has been banned, other than to say that the ones I know about (and I've been reading here about a year and a half) have been obvious trolls--a la Kelby--or people who are attempting to promote their services or blogs, or who plagiarize and/or are patently unable to keep up a cogent discussion.
I have seen a number of posters here disagree with Amy, and who have made very good points and have not been banned. If you stick around, you'll run across them (of the current crop, Yehudit and Alexis jump to mind, but there have been others.)
This seems to be one of the few places where actual debate occurs; Amy doesn't seem to shut down discussions very often. On many other sites, the moderators will allow only so much back and forth, then declare that they don't want the debate to be "monopolized" or some such, then shut down comments. Here, it seems to me that discussions are generally allowed to run a full course, and peter out naturally.
With all due respect to Amy, I think one of the best things about this site is the peanut gallery. They are a diverse group of people, and as a rule, are very, very smart and interesting on a whole host of subjects beyond the ostensible topic at hand (birth, home and otherwise.) I am in awe of many of them (including those with whom I often disagree), and have found a lot to challenge me intellectually and spur me on to investigate topics way beyond my normal scope of interests.
This is a long-winded way of saying thanks to Amy and the others here, and inviting you, Melissa, to stick around and lurk or contribute to the discussion, and then decide if your friend is right or wrong about this site.
From Liz1:
I don't know that so many people share your point of view,
Well, possibly not, but I can't say that bothers me too much. I do slightly object to the idea that because I did not particularly want a doctor dutifully reciting to me all the side effect of the CS which was essential to give my child any chance of surviving, that means I am an unthinking sheeple in thrall to the establishment. I didn't see the surgeon as Daddy - I saw him as a mechanic, and assumed he knew his job. Given the circumstances, reading the small print seemed like an exercise in futility.
Yes, generally speaking I think it is a good idea to do research, and if you feel strongly that you want to minimise the risk of surgery, then by all means choose a surgeon who shares your views - or scream blue murder till you get your own way. In any situation where there is a real choice, I am capable of making that choice, I believe, as rationally, or irrationally, as any one else.
From Indy:
Kelby's last comment before this thread was under the "So Much for Intuition" post. Take a look if you want to see why he/she is not welcome.
There are many vocal dissenters here. Tasha is a dyed in the wool UCer, and adds a great deal to the discussion. Yehudit and Sharon also are very eloquent posters. Even sarahz with her "surgical assault for profit" nonsense above has a place here.
None of them (or the others) are ever silenced or banned. It's because they add to the discussion. They add perspective. Kelby did not and is the equivalent of a streaker running across the stage at a debate.
I have noticed in my time here, alot of people come with a "shocked" first post, like Lee's. But if they stick around, they realize that this is not simply Dr.Amy calling people bad names.
This is not MDC, if you say something that is false, expect to get called out on it and asked for legitimate scientific proof. If you want someone to blow sunshine up your ass over some bizarre theory you fished out of Google or the Bible, then you are in the wrong place. If you enjoy a good debate though, you will find this place interesting.
From Pharmacist:
--Amy likes to pretend she has some critical distance on the issues, creating this site just to make money from Google Adwords. Good gracious, what a lark!--
Dr Amy's motives for this site is a totally separate issue from whether or not what she says is true. She generally backs up her statements with hard research. It doesn't matter why she has this site, what is important is the truth that she is presenting on this site.
From Nicole:
"How wrong is it that I felt WAY more informed about my wisdom tooth extraction than for any OB procedures?"
I have long argued the point that labor and delivery is the only area of the hospital that you can cut without consent. Doctors do episiotomies with no consent forms and often without telling patients. I don't understand how they get away with this when you need a consent form for anything else that necessitates cutting a patient. I would guess that if men were the ones getting there genitals cut, there would probably be 10 pages of consents that must be signed before a doc could make such an incision.
From sarahz:
This site is okay, in terms of tolerating debate. I would give it a 5 of 10. If everything has to come from PubMed, you shut out any idea not currently accepted by the medical establishment and any establishment will tend to produce papers that support itself. Univiersities, researchers, AND medical students are funded.
Also, Amy doesn't at all recognize the relationship between Herbals and Pharmaceuticals at all, or the relationship between money and Pharmaceuticals, or Patent Law and Pharmaceuticals. And these relationships very demonstrably exist, so, yk, this weakens the argument.
****Yes, generally speaking I think it is a good idea to do research, and if you feel strongly that you want to minimise the risk of surgery, then by all means choose a surgeon who shares your views - or scream blue murder till you get your own way.****
I think the corrolarry to the sentiment: if you get an unnescarian you are a sheeple who didn't do their homework is: if you want to minimize your risk of surgery by say getting stats and having a Birth Advanced Directive you are a giant baby who is not a real woman, because if she was, she would just bravely lay back and get cut. And you are selfish and obnoxious for bucking the system, you should just shut the h**k up and let the nice people do their jobs. :roll:
And that is nicely demonstrated here. Hell yes I will be getting 'my way' in a medical establishment, because 'my way' is great medicine with little invasion and great restraint. I just found a HOSPITAL that will let me use herbs first and only resort to pharmacueticals as a last resort. It may be the only one in the nation, so yk, some people do understand where pharmies come from.
From Liz1:
You misunderstand me, SarahZ. I don't think there is anything at all wrong with women making a noisy fuss to get what they want. Often, it is the only way to be heeded. One can not, of course be certain, but if I seriously believed that the ONLY reason a CS was proposed was for the benefit of the doctor, then I hope I would stick to my guns. In the real world, I am not known for being excessively accommodating if a course of action clashes with my beliefs. On the other hand, I do try to keep those beliefs rooted in some kind of reality, probably not always successfully, and find the "I read a book and know what you are up to" approach not to my taste.
You have found an establishment staffed by people of like mind. Good for you.
From Antigonos:
sarahz: but my mother had four classical incisions and her entire GI area has not been right since. She also had to have a hysterectomy young for something directly related to the sections.
~~~That's why classical incisions are almost never done any more. We've got a better procedure and better suture materials than even 20 years ago.
BTW, since we're being anecdotal, I had 3 C/Ss [all LSCS] between the years of 1980-1983. My reproductive tract has never given me any trouble at all.
From Antigonos:
sarahz: How wrong is it that I just found out recently (from a CNM employed there) that a hospital I was actually considering has a section rate over 50%???
~~~~My first question is, what kind of L&D unit does this hospital have? For example, the UNC Medical Center's unit is 100% EXTREMELY high risk, being in a university teaching hospital. I'm sure the C/S rate is well above 50%.
The number of C/Ss is irrelevant unless it is related to the kind of population using the hospital.
And then you need to know which doctors have a high repeat C/S rate and which do not. It is not the hospital which chooses to do C/Ss; it is the attending doctors. What sort of practices do they have? Low or high risk? Two of my three C/Ss were "elective", after all.
From Antigonos:
I don't understand how they get away with this when you need a consent form for anything else that necessitates cutting a patient.
~~~I can just see myself handing a woman who's in extreme discomfort, at least, at the moment the head is crowning, a pen and consent form, while I also struggle to control the delivery of the head so she doesn't lacerate right through the rectum.
Episiotomy is not performed by sadistic males who hate women, bent on doing something illegal just for the thrill of it, really. [Sadists would really just let a woman lacerate. Much more traumatic for the woman]
I presume episiotomy is covered in the admission consent form.
From Antigonos:
relationship between Herbals and Pharmaceuticals
~~~Is there one, beyond the obvious one that nearly all pharmaceuticals are herbal in origin, but more effective.
From Antigonos:
You have found an establishment staffed by people of like mind. Good for you.
~~~~I hope you still feel that way after getting the treatment you want instead of the treatment you may need.
My guess is you'll be looking to sue someone.
From vonnegut:
ROTFL at Kelby being banned from the site and logging in through the library. Guess the Chutes of Exit struck one too many times.
*goes back to lurking*
Oh-- and in terms of c-section... I think that "elective" c-sections are silly, just as some people think my desire to birth without an epidural is silly. *shrug* But opinions are like chutes of exit, everyone's got one. If the technology is there and available, there will be people who take advantage of it despite risks.
The thing that confuses me on hearing stats about how there is a higher death rate for c-sections, is that while I know there are some "elective" c-sections (which, in my head, isn't things like a repeat c-section, but one that is truly for no medical reason whatsoever) and some that are medically inclined but not emergency (doing it early for risk factors, I guess "preventative" c-section), so many sections are for emergencies and/or health problems, right? You'd almost expect to hear more bad stories about it, because for the most part if there isn't already a problem, the delivery will be vaginal.
These are, of course, unresearched and uninformed thoughts.
*NOW goes back to lurking*
From Susanne:
Leelee (relaying the story of her friend): "It was about 6pm. Her doctor comes in and says in a joking voice (per my friend, not my embellishment), "well, we don't think this is going anywhere. We could wait longer, you and your baby are both fine...or we could just go down to the OR, you have your baby, and we all go home."
She readily consented."
Right. Because having a vaginal birth simply isn't a priority for many mainstream women; their goal is to get that baby out, and get it out post-haste; they don't want to be pregnant anymore, they're tired, and they're not interested in an "experience," they're interested in baby being out. So if things aren't progressing ... well, there's no point being stuck in traffic when you can jump out of the car and take a nearby subway to your destination already. Maybe the subway isn't as nice as your car, but the goal isn't the journey, it's the destination.
I recognize that you think that there was drama in putting "She readily consented" in another paragraph, as if to say such a momentous decision was made despite it not being a Medical Crisis in the making, but I think that just demonstrates that you operate from a different paradigm from most mainstream women, who would indeed say let's get on with the show here, and if it takes a CS, well so be it.
From Liz1:
Are there really women who go in for a straightforward elective CS and come out with a dead baby who died for no other reason than the CS? Anyone know one? Are the Courts full of parents suing on those grounds? What would it be about a CS that would cause a healthy baby's death?
I can see that surgery - any surgery - might result in unexpected adverse consequences for the mother. Even the most uninformed of us knows that GA can be dangerous and even simple surgeries carry risks, but what is the risk to the baby? Not vague "it could happen" risks, but real, seen frequently, never would have happened in a vaginal birth risks? And are we seriously supposed to believe that doctors would take known risks so that they could get home for dinner, or that the medical establishment, supposedly paranoid about litigation, are so dim they haven't noticed them?
From Tasha:
doing the no more Kelby dance...anyone care to join me?
From sarahz:
Antigionos: The hospital I am speaking of (50% section rate) is most adamantly NOT one of the two large 'high risk' hospitals in town. I suspect these hospitals have rates higher than 50% but the most I have been able to get is that one has an epi rate of 98%. The hospital is a satellite (well staffed albeit) sort of suburban hospital affiliated with a large regional chain. Most women with truly high risk pregnancies would go downtown, instead of going regional, so there is really no excuse for this rate.
Also, your opinion is that Herbs are less effective than Pharmaceuticals, my opinion is that if Herbs were studied in the same way (which they won't be because no one stands to profit from something you can't patent, so there wouldn't be anyone to fund the study, pay the participants, etc.) they would prove to be MORE effective and safer because they are 'whole medicines'. The same way that eating an orange is more effective and more pleasing and less subject to error than popping vitamin c tabs. I view the relationship more as 'theft'.
Scientists take herbs, which were created by God to help man for free or low cost, isolate or synthesize what is thought to be the only effective compound (although later we find that sometimes there are a few effective compounds working synergistically), put it through some tests, patent it, and make $$$$$$$$$$ and also make it unaffordable to 90% of the population. To me it is just theft, and that is the relationship. I know we will agree to disagree on this one, but IMO it is a valuable way to look at the relationship, if only for a moment.
From Leelee:
Liz1: "I do slightly object to the idea that because I did not particularly want a doctor dutifully reciting to me all the side effect of the CS which was essential to give my child any chance of surviving, that means I am an unthinking sheeple in thrall to the establishment."
Liz, I think this is a bit more understandable, because when and where a c-section is the best option, it's pointless to dwell on the side effects. They should be stated at some point (preferably earlier in the pregnancy as the expectant mother is presented with information about different modes of delivery), but the paper I cited, and the concept I'm discussing, deal with NON-medically indicated sections. Not medically-indicated ones.
From Leelee:
But Susanne - do you think my friends' wife's doctor is practicing safe medicine? THAT is the issue here, not my friend's wife's decision. Puh-leez, the hospital I speak of is on the Upper East Side of Manhattan, land of the scheduled social induction and maternal-request section. It's not surprising at all, nor is is surprising that a certain subset of women are indifferent. Nor should any onus really fall on the mothers, other than that they should be fully informed. The question is whether, in the long run, it is safe - so safe that it merits a joke from the attending doctor.
If that makes me "non-mainstream," whatever. You constantly try to paint total indifference to mode of delivery, mode of infant feeding, and any host of other things as "mainstream," meaning that if someone GAS about any of it, they are non-mainstream. Of course from where you're sitting, probably among like-minded women, it seems mainstream. But I think what is concerning part of the Total Indifference Is Mainstream crowd is that some of the literature, and *definitely* some of the public attitude, is starting to shift away from this particular mindset. Case in point, in the L&D brochure for my hospital, they boast that "all our nurses are schooled in the Lamaze technique of labor breathing" (hah, I would dispute that, and Lamaze isn't really my bag anyway, but why would they advertise it?) I mean, if my hospital were truly mainstream in your eyes, I suppose it would be more in line with what Desiree's tour nurse bragged about ("hear that?" [silence] That's the sound of a labor ward with a 95% epidural rate.") So now there's debate. Nothing wrong with that.
From Leelee:
And I also must clarify that it's not about the individual or the individual's decision. It's about the big picture of public health, about sheer numbers. 1:2500 vs 1:533 both look like pretty good odds, but as the numbers mount, suddenly 1:533 pregnancies dealing with placenta accreta is going to come to a lot. But who cares in the moment, when the mother is tired and wants the baby out? Please take note I'm not saying she should be denied - indeed I don't see any way TO deny her in our fiercely individualistic culture. I also don't have the full story, because I wasn't in the labor suite with them. My friend seemed very jocular about the whole thing and said his wife was, too. he didn't say "my poor wife was exhausted," or anything like that.
If we're really and truly saying it should be considered both safe and reasonable for a mother to decide in the middle of labor, either at her doctor's suggestion or on her own steam, that she should have a non-medically-indicated section for any reason at all (not just for exhaustion)...well, it's a new era in medicine, is all I can say. But of course that's blatantly apparent anyway. hey, if I'm wrong, I'm wrong. Maybe the prophylactic section at 39 weeks is the way of the future, maybe they will make c-section so safe that no one will consider it reasonable to attempt birth in the usual biological way anymore.
I'm just saying that it's not about her and her individual decision, which are a drop in the ocean much like an individual vote doesn't count in the election. I once had a former lobbyist tell me that you'd be better off giving $50 to your candidate of choice, than voting on election day. Well that's all well and good, but what about the aggregate? What happens if 50 people think that, and abstain from voting? And another 50? And after that another hundred, another thousand? Individual decisions may seem random or insignificant, but eventually they add up to a trend.
From Leelee:
Liz1: "Are there really women who go in for a straightforward elective CS and come out with a dead baby who died for no other reason than the CS? Anyone know one? Are the Courts full of parents suing on those grounds? What would it be about a CS that would cause a healthy baby's death?"
Nothing. If we didn't have NICUs, TTN and complications of late prematurity would commonly result in babies' deaths, but we have the technology now to deal with the complications from c-section, which is part of why everyone has decided it's so safe. I imagine there's an odd case here or there, but you're generally trading frequent morbidity for rarer mortality.
The scary thing to me (prolly not so scary to others) is that, as far as I can tell in medical literature, the mother and baby do end up having a sort of adversarial relationship by the time labor rolls around, so you take that to its farthest conclusion and you get "vaginal birth kills babies." I've seen someone actually post that on Urbanbaby - a NICU nurse who had seen one too many damaged babies after rough vaginal deliveries. It's an exaggeration, of course, but it's easy to see why her experience would lead her to feel this way. Easy vaginal birth is the safest thing of all for everyone concerned, but no one knows who will have that.
And since few women nowadays have more than two or three children, major complications from c/s and repeat c/s remain rare. Until the numbers mount up, that is.
I hope people on this board don't see me as *anti* c/s. I'm not. I question the readiness with which it's commonly decided to move to surgery, and I question the safety of non-medically indicated major surgery. I've moved away from trying to think that I can decide where something was an "unnecessarean" where a doctor gave indication for it. If an individual bad practitioner decided to write "FTP" when everything was fine but they just wanted to go home, that is on their head, and there's no real way to prosecute for that. No one dares sue for "wrongful c-section" if mother and baby came out alive. Perhaps if a complication in a subsequent pregnancy is directly attributable to prior section, then maybe....JUST maybe. But we're in too deep now with the c/s as the gold standard of "we did all we could" from a legal standpoint. We're on the road and won't turn off it until something better comes along, so it's pointless to argue.
However, when I do see mindset start to creep *away* from vaginal birth as "the norm" (there is no judgment inherent in calling something the norm when it is the default), yeah, it concerns me. Perhaps needlessly.
From Jolene:
"Are there really women who go in for a straightforward elective CS and come out with a dead baby who died for no other reason than the CS? Anyone know one? Are the Courts full of parents suing on those grounds? What would it be about a CS that would cause a healthy baby's death?"
I don't think the worry is about the baby's death. I think it's about the mothers death. Cesearean is risky for the mother. Amy has said a number of times that choosing a C over a V is the mother choosing to take the risk onto herself, and off her baby.
From Leelee:
Sorry for the serial posting, I just reread the thread and wanted to address Antigonos' assertion that her 3 sections have resulted in no problems for her.
That's fantastic - and after all, the odds are in your favor. Even with rough odds, the odds are still usually in favor of everything being OK. But your being OK isn't the metric. It's how many women with 3 (or more) prior c/s have complications overall, at any point in their life.
From Susanne:
Leelee, I see where you're heading ... and really, I don't think "it's 9 pm, why not do a CS" falls under "good" medicine. I think the right, ethical thing to do is keep going vaginally until or unless there is something that manifests itself as trouble in which a CS is a reasonable and appropriate next step. And I for one think that if the patient says "But doc, can I just have a CS now?" the doc can indeed say "no, it's not an appropriate move at this point."
But here's the thing. I think the same thing can be said of the patient who doesn't want a heplock, who doesn't want fetal monitoring, who wants to keep eating, who doesn't want vag exams per appropriate protocol, etc. I think that the doctor who acquiesces to all of those isn't practicing good medicine either.But if I were to say that, I'd have a chorus of "But it's her body! and her baby! and SHE decides, no one else!" And it's the inconsistency that drives me batty. If you (not you specifically) want to play It's the Woman's Choice, then the long-term public health sequelae of woman-is-tired-at-9-pm-and-requests-a-CS don't *matter, because the end game isn't public health, it's women's desires.
Put another way, what if the aggregate of What Women Want isn't at all consistent with What The Optimal Public Health Outcome is? Which value overrides the other?
Bad analogy, but let's take nose jobs. Aside from a few that correct deviated septums, the majority are cosmetic in nature. The optimal public health outcome would be no rhinoplasty except for corrective / medical considerations. But we as a society have said we don't much care, do we? as long as people get the nose jobs they want (and are willing to pay for them) As long as said surgeries are being performed within whatever clinical guidelines there are for rhinoplasty (doctors are properly trained, the right techniques are used, etc), we as a society don't spend a lot of time angsting about the public health sequelae of X number of "unnecessary" operations a year. So why do we when it comes to the public health sequelae of X number of "unnecessary" CS operations a year?
From JJ:
[Sadists would really just let a woman lacerate. Much more traumatic for the woman]
I don't think this is supported by current research. Current research, as I understand it, shows that tearing is superior to cutting. An episiotomy is more likely to extend into a 3rd or 4th degree injury, whereas a tear is more likely to be 1st or 2nd degree. A 4th degree tear in the absence of an episiotomy is extremely rare, and much more common if an episiotomy is performed (though in all cases, 4th degree tears aren't very common).
OBs now being taught in the U.S. are taught not to cut an episiotomy; they're almost never done and certainly not done routinely just because it looks like a woman's going to tear - since it's now known that tearing is better for the woman - less traumatic.
I've had two births and two second degree tears. I didn't feel either of them happen, the births were unmedicated, and the healing was complete and uncomplicated (though not immediate, obviously). Anecdotally, when the subject comes up (usually from an expectant first-time mom), I've never heard/read a woman comment that she could feel herself tearing or that it was especially traumatic.
But maybe I misunderstood your comment. How is tearing more traumatic for the woman than an episiotomy that is more likely to extend into a deeper and more severe injury?
(Of course, episiotomies are indicated sometimes, for example if necessitated by instrumental delivery.)
From Dianne:
do you think my friends' wife's doctor is practicing safe medicine?
That could depend on a lot of things. How far along was your friend's wife and how long had she been in active labor? If she had been in labor for the last (say) 12 hours and was 3 cm dilated then she was a clear failure to progress and surgery was quite reasonable. If she was only in labor 6 hours and at 6 cm...not so much. Also were there "soft signs" that the baby might be experiencing stress (i.e. variable decelarations)? It really depends on a lot of details that we don't have (and shouldn't have really...it's none of my business certainly.)
What I do think is that the consent process (assuming you gave it in full) was extremely inadequate. She should have had a fuller discussion of the risks and benefits of doing c-section versus continuing to wait. This sounds like an extremely non-emergent section so there is no good reason to not give every detail and make sure that the patient's questions are completely answered before jumping in to the surgery.
From Yehudit:
Sadists would really just let a woman lacerate. Much more traumatic for the woman
++++++++++
Do you have research evidence comparing outcomes of the two policies: "avoid a tear" and "avoid an episiotomy", please!
From Kat:
Susanne, I think practicing good medicine and listening to a patient are one of those difficult situations that seem to be more common in OB/GYN. Of course a woman should be able to choose a c-section. I know of a woman who only had more children because she finally found a doctor who would allow her to have one.
Or of a relative with enough problems with her uterus that all she wanted was for it to be removed. It took years before a doctor would consent.
I think there are enough examples to fill several books.
The problems arise when you run into a patient who is choosing something based on lies and half-truths. Is there time to convince the woman? Is the danger so great that it is unethical to allow her the choice? Are doctors still held responsible when they don't tie a woman down and perform x,y,z?
Hopefully these situations are rare.
Now is it really mainstream to not care at all what happens in L&D? I don't think so. I think that is similar to saying that mainstream women are appropriately zen (or full of valium).
Of course they won't dwell for years on a VE that went a little rough, or a c-section that may or may not have been necessary, but your conclusion that they just want baby out and no matter is stretching it. That is to say, that if thier only goal is baby on the outside of the belly, then why do they care about an epidural?
Without one, baby still comes out. Is it more painful? Is that something to be avoided by mainstream women? If so, then why would a mainstream woman choose the more painful option of a c-section with higher rates of morbidity, all things being equal?
She either cares or she doesn't. My guess is she does care. She wants baby out, fast as possible (no woman wants a 24 hour labor) and as painless as possible with everyone healthy and happy. Labor followed by a c-section for the heck of it, because who cares, doesn't follow the MO of mainstream woman. An appropriately zen woman perhaps....
I am betting there is much more to LeeLee's friends story. I would bet that she was stalled and could choose two choices and she probably chose correctly. The reality is that she was stalled, and that usually doesn't change. It was c-section then, or c-section later with a small chance of things changing. She chose c-section and I am sure she is simply happy to have her baby and cuddling it. Normal reaction I would think....
From Kat:
"Sadists would really just let a woman lacerate. Much more traumatic for the woman"
How would it be more traumatic?
From Leelee:
Susanne: "Bad analogy, but let's take nose jobs. Aside from a few that correct deviated septums, the majority are cosmetic in nature. The optimal public health outcome would be no rhinoplasty except for corrective / medical considerations. But we as a society have said we don't much care, do we? as long as people get the nose jobs they want (and are willing to pay for them) As long as said surgeries are being performed within whatever clinical guidelines there are for rhinoplasty (doctors are properly trained, the right techniques are used, etc), we as a society don't spend a lot of time angsting about the public health sequelae of X number of "unnecessary" operations a year. So why do we when it comes to the public health sequelae of X number of "unnecessary" CS operations a year?"
Susanne, that's an interesting analogy, but I see two flaws in it:
- a nose job doesn't involve two living beings, one of whom is inside the other, and the other of whom must make decisions for the former, weighing her own outcome both against and with the outcome of her "passenger." It's a unique situation. Really if you break it down philosophically it's rather mind-boggling (or I find it so, at least.)
- a nose job doesn't have an unavoidable biological alternative like c/s does. If a person doesn't have a nose job, their nose is not going to, on its own, change in some way for better or worse or be destroyed (except in some reconstructive cases). In birth, there will always be a change resulting in the baby - alive or dead, healthy or not - being outside the mother. If a c/s is not performed, the body will go into labor at some point. Whether the labor will be successful is another matter, but there is a necessary biological process of getting the baby out that will happen (or one's body will attempt to make it happen) with or without surgical intervention.
There's also the fact that c-section opens the peritoneal cavity, and c-section does carry more risk of morbidity for the baby than an *uncomplicated* vaginal birth (with the caveat that no one knows who will be uncomplicated, but most practitioners would still prefer to try).
That's my opinion on why the maternal-request c-section debate carries more weight than nose job vs. no nose job.
And FWIW, I personally *do* care about unnecessary surgery any time I see someone lose the odds and suffering because of it, whether because of a post-op infection in a nose job, a botched job that results in cartilege collapse, or accreta because of c-section. But to speak out against elective surgery - *particularly* where there's only one individual involved, no one will be hurt but themselves if it goes awry and one can rest assured that the surgeon counseled the patient appropriately - well, it comes across as rather un-American, for better or worse as one perceives that term.
From desiree:
leelee, do you know any more details about your friend's delivery? like, was she at 3 cm after 12 hours of pit and really, really likely to end up with a c/s for fetal distress in the next 12 hours? or was she at 6 after 12 hours and just puttering along slowly? i think in the first scenario, a c/s would be medically indicated. maybe the casualness was just the kind of relationship she had with her OB? if she had really wanted a vaginal birth, would she have said no, let's wait longer for the c/s?
From Leelee:
Also, Susanne, I'm laughing now because I'm stuck with this image of my nose spontaneously going into labor. What would it give birth to? A chunk of brain? Wait, let's not answer that.
From desiree:
oh and leelee, don't forget the other line:
me: do you have jacuzzis for laboring?
tour nurse: no, jacuzzis are too crunchy for us here. if you want a water birth, you'll have to go to NJ.
From Leelee:
Desiree - I don't know any more, and I won't press for details because these are not close friends and it's none of my business. He's a friendly acquaintance from work. We just happened to end up talking about birth and about the hospital because his wife is about to have their 2nd. I tried as hard as I could not to relay that I had any opinions about birth at all, because I think that would be rude. I did give an honest answer when he asked me why I didn't like the hospital.
It's funny because I'd never actually met in person someone who was that indifferent about it. Everyone else with whom I've ended up "talking birth," *none* of whom have been birth activists, really hoped for a vaginal birth (or in one case, VBAC, and she got it with the help of a midwife, doula and supervising OB who were all on board) and expressed some level of displeasure with the state of American obstetric care, *completely unprompted* by anything I said. In each instance, it was their reaction which made me feel comfortable discussing my own experience. Unless I know how someone feels about it or they specifically ask, I keep my mouth shut.
From Tasha:
http://www.nbclosangeles.com/new...guna-
Hills.html
and I thought Deg came big at 9#12oz.
good thing for c/s, this babe never would have been born vaginally
From Leelee:
Um, wow. That baby is HUGE. He looks like a sumo wrestler!
From Leelee:
I just noticed his oxygen tube. I hope he's alright?
From Tsu Dho Nimh:
Dianne ... It is quite possible that the CS vs vaginal discussion had taken place earlier.
From Antigonos:
LeeLee, I said "anecdotal". You cannot extrapolate from individual anecdotes. Sarahz is against C/S because her mother had sequellae--a worthless assertion as to the safety or otherwise of C/S, so I countered with an equally worthless anecdote "demonstrating" the exact opposite.
From Antigonos:
JJ: An episiotomy is more likely to extend into a 3rd or 4th degree injury, whereas a tear is more likely to be 1st or 2nd degree. A 4th degree tear in the absence of an episiotomy is extremely rare,
~~~A MEDIAN episiotomy can extend into a 3rd or 4th degree tear; MEDIOLATERAL almost never does. Tears DO frequently extend into the rectum, and in my experience, the recovery from a tear is much more painful than a properly done episiotomy.
From Antigonos:
At the moment of the episiotomy/tear, the perineum is usually numb and the contraction is so overwhelming the woman doesn't feel it. But later she does. And her entire sexual life can be affected if the repair is poorly done, or if the tear is jagged and cannot be repaired neatly. Dyspareunia [painful intercourse] can last for years and require revision of the scar.
In my experience, about 40% to half of primips need episiotomies or they will tear, often badly. Fewer multips do, but many simply do not have stretchy perinea, and the tissues first buttonhole, then shred. In order to prevent tearing, I prefer to deliver patients in the left lateral position; squatting often produces the worst tearing because of the difficulty of controlling the birth of the head, and of course lithotomy predisposes to the necessity of performing an episiotomy because the perineum is already stretched to the limit.
From Yehudit:
in my experience, the recovery from a tear is much more painful than a properly done episiotomy.
+++++++++++
When large numbers of women are asked their opinion of postpartum pain, in the context of controlled trials, they collectively give the completely opposite opinion.
From Yehudit:
p.s. I thought you only had CS? (Since we are using the "in my experience" gambit).
p.p.s What kind of postpartum follow-up does the Israeli system allow a hospital midwife to have?
From Yehudit:
In my experience, about 40% to half of primips need episiotomies or they will tear, often badly.
+++++++++++
This is not reflected by the outcomes in UK hospitals following the universal abandonment of liberal episiotomy, on the basis of research evidence.
From Leelee:
Susanne: "Put another way, what if the aggregate of What Women Want isn't at all consistent with What The Optimal Public Health Outcome is? Which value overrides the other?"
In my opinion, a good practitioner will first try to counsel the patient *towards* the optimal care practice from a health standpoint. If the patient won't budge, either give them what they want, or refer them to someone else (in a non-emergent situations).
It would seem that the authors of the CDMR paper agree with me.
In other words, the public health value *should* outweigh personal preferences, but you can't force it.
From Susanne:
"In my opinion, a good practitioner will first try to counsel the patient *towards* the optimal care practice from a health standpoint. If the patient won't budge, either give them what they want, or refer them to someone else (in a non-emergent situations)."
I don't disagree, Leelee. I'd also hazard a guess that what to one patient is "being counseled towards an optimal care practice" is another person's "disempowerment of me and ignorance of the importance of my birth experience / being treated as an assembly line." How far does one counsel a patient? Whether it's counseling or badgering depends on what side of the line you're on.
From Ericacrochets:
"It's funny because I'd never actually met in person someone who was that indifferent about it. Everyone else with whom I've ended up "talking birth," *none* of whom have been birth activists, really hoped for a vaginal birth (or in one case, VBAC, and she got it with the help of a midwife, doula and supervising OB who were all on board) and expressed some level of displeasure with the state of American obstetric care"
Well, what with the media constantly whining and shouting alarms about the rising c-section rate, I think people have a lot of mistaken notions about the issues involved in the c-section rate.
Whether the c-section rate is too high or not, the information that the media prints about it makes it seem like a very straightforward issue when it is not. Just from reading this blog, I will notice so many issues that are left out of any article on the topic that you read from the mainstream media. If you just read your daily newspaper or CNN, why wouldn't you think that the c-section rate is just too darn high because of those women who are "too posh to push" and those doctors who are "afraid of lawsuits"?
Whether you think the c-section rate is too high or not, I think most of us who read this blog are aware that the issue is much more complicated than that.
From Ericacrochets:
I think that in a country where 3-4 children is considered a large family, it does not make sense to set public healthy policy based on a small minority of women who want a huge family.
Placenta accreta can rarely, rarely lead to maternal death, but from what I can understand the concern is emergency hysterectomy.
So, if I have 4 children, on my 4th c-section it looks like I face about a 2.5% chance of having my uterus out with the baby. This means I'll probably never have as many kids as the Duggars.
From Leelee:
"I think that in a country where 3-4 children is considered a large family, it does not make sense to set public healthy policy based on a small minority of women who want a huge family.
Placenta accreta can rarely, rarely lead to maternal death, but from what I can understand the concern is emergency hysterectomy.
So, if I have 4 children, on my 4th c-section it looks like I face about a 2.5% chance of having my uterus out with the baby. This means I'll probably never have as many kids as the Duggars."
As I posted above, the concern is from a public health standpoint - all those c-section/hysterectomies adding up, and the point from the CDMR paper that frequently, pregnancies are unplanned. You see "I'll just have my uterus out with the baby;" I see a situation which, repeated enough times, results in not only tremendous cost to public health (and our loony for-profit healthcare system, which is another matter), but potentially serious complications for women's health.
I reiterate, I'm not talking about medical indication. I'm talking about whether truly elective and/or maternal-request c-sections are ethically and medically sound practice. It's not like every woman who has a c-section is going to wind up with accreta, but if enough women either (a) see c-sections as risk free or (b) have physicians willing to accommodate a request, it will start to add up by dint of sheer numbers. One individual's experience won't, and can't, reflect the total picture. So while I don't think policy should be set based on the public health projections alone, not to take it into account would be silly.
From sarahz:
I don't want a huge family at all, but I am incredibly committed to keeping all my organs. Very much so. I definitely believe that organ removal of any type leads to health problems and only should be in cases of life or death. I believe the body is a WHOLE system, not with disposable parts like tonsils, adeniods, gall bladders, appendices and uteri.
Also, just throwing it out there that it wouldn't be just FINE with me if my baby was taken by CS and had to spend a mere couple of days in the NICU as a result. In fact, it would BREAK my family financially. And we have insurance. Our bill would not be a penny less than 10K with Section and NICU.
I sort of feel like L&D should be flat fee, because after all, I could need a C-section for ANY reason, my baby could need NICU for any reason, even hospital politics or general hospital section rate could play in here, why should I be broken financially while someone who has an easy vaginal birth or a more supportive care team is not? Doesn't this economically disadvantage C-section moms? I seriously find L&D billing objectionable. All the upcharges! There should be a package price, and take away the economic incentive to do interventions!
From Susanne:
There is a package price in many circumstances, sarahz.
From Susanne:
Leelee: "I reiterate, I'm not talking about medical indication. I'm talking about whether truly elective and/or maternal-request c-sections are ethically and medically sound practice."
One could say the same about an elective refusal of, say, fetal monitoring or vaginal exams. Yet women think their desires along those lines should be indulged, too, even though it's not sound medical practice. I keep asking (and not getting an answer to) ... what is more important? Sound medical practice, or what the mother wants?
From Susanne:
sarahz, are you seriously suggesting that NICU care should come for free, that the neonatalogists / neonatal nurses / all that equipment should come at no cost to the family who needs it?
From Emma B:
I sort of feel like L&D should be flat fee, because after all, I could need a C-section for ANY reason, my baby could need NICU for any reason, even hospital politics or general hospital section rate could play in here, why should I be broken financially while someone who has an easy vaginal birth or a more supportive care team is not?
You are of course aware that any such flat fee would be substantially higher than the cost of an easy vaginal birth, since those births must subsidize the much more costly births? Remember, some of the posters on this thread have had birth expenses in the hundreds of thousands of dollars.
Also, you generally wouldn't need NICU care just because you wound up needing a CS after going into labor. It's relatively uncommon for term infants whose mothers labored to have RDS after CS delivery, although the risk is higher than that of vaginal deliveries. Transient tachypnea ("wet lungs") is more common, but that doesn't require NICU care, just a few hours of observation in the regular nursery.
From Indy:
I'm just wondering how sarahz's "one price, inexpensive L&D" plan compares to her "make epidurals expensive so they will be less desired" plan?
I thought she said earlier that interventions shouldn't be cheap and readily available because it would encourage their demand? Sounds like her insurance is discouraging her from those scary interventions just like she wanted.
From Fiona:
Suzanne: sarahz, are you seriously suggesting that NICU care should come for free, that the neonatalogists / neonatal nurses / all that equipment should come at no cost to the family who needs it?
My first two sons' NICU care came free at the point of need for our family via the NHS.
OTOH, at the PF there have been more than one family bankrupted by an unforseen micro-preemie birth in the US.
From Susanne:
This is just another example of sarahz just spouting off and not really thinking through her points. She doesn't *really* think that NICU care should be free.
From Fiona:
Ah - apologies, then. I have been largely absent recently - because I couldn't bear the Kelby trollings - and was tempted back by signs she had been banished.
Didn't read the thread through properly, though.
From Susanne:
"You see "I'll just have my uterus out with the baby;" I see a situation which, repeated enough times, results in not only tremendous cost to public health (and our loony for-profit healthcare system, which is another matter), but potentially serious complications for women's health."
And again - I reiterate. Isn't there a cost to public health and potential for serious complications for cosmetic rhinoplasty? Breast augmentation (not related to reconstruction)? Liposuction? LASIK surgery? All for things that are cosmetic in nature and don't even HAVE the potential (if not done) to become serious or life-threatening? I'm asking a very serious question. Why is there public health concern about women's bodies vis-a-vis CS but not about rhinoplasty, breast augmentation or (shudder) labiaplasty? I'll leave it to A Sarah to draw the line about ornamentation vs function on that one 
From vonnegut:
sarahz[quote]
I don't want a huge family at all, but I am incredibly committed to keeping all my organs. Very much so. I definitely believe that organ removal of any type leads to health problems and only should be in cases of life or death. I believe the body is a WHOLE system, not with disposable parts like tonsils, adeniods, gall bladders, appendices and uteri.
[endquote]
Yeah, I want to keep all my organs, too, but when my appendix ruptured, I decided to go ahead and let them take it out, rotfl.
I get that it's a totally different deal, but your mention of it made me giggle...
I suppose it's more "natural" for my appendix to not rupture, just as it's more "natural" for the baby to not need a c-section...
but shit happens.
I'd rather have the surgery than die for ruptured appendix... just as I'd rather have a c-section than have the baby or myself come to harm.
From Emma B:
I definitely believe that organ removal of any type leads to health problems and only should be in cases of life or death. I believe the body is a WHOLE system, not with disposable parts like tonsils, adeniods, gall bladders, appendices and uteri.
I've had tonsils/adenoids and one fallopian tube removed, and both improved my overall health. Infection and scarring aren't cases of life and death, but they sure make your life unpleasant. If you found yourself living with chronic pain, I think you might well change your tune.
OTOH, I thought for a while that the uterine infection might culminate in a hysterectomy, which I found to be a disturbing prospect even though I didn't want any more children. I'd have done it if that's what it took to get things sorted out, but I wouldn't have been happy about it, either. There's more at stake there than just not having any more children -- the possibility of pelvic floor damage, sexual dysfunction, earlier menopause even if you keep your ovaries.
I still think that the health of the current baby takes precedence over the possibility of accreta and hysterectomy in a future pregnancy. However, it's a bigger deal than an appendix removal, for sure.
From Emma B:
Completely OT, I note that Sarah Palin's daughter has just had her baby. I know Amy was firmly convinced that a teen pregnancy coverup had taken place, but the timing makes it extremely unlikely. Time for a retraction, perhaps?
From Ericacrochets:
First of all, I think that a person who wants a large family and requests a primary c-section for no medical reason is making a poor choice. The last I looked it seemed that for a woman who knows she only wants 2 children, maternal request c-section is a reasonable choice, and the risks are comparable to that of 2 attempted vaginal births.
I'm not saying that a hysterectomy isn't a big deal. I would prefer not to have one while I'm under the age of 50. But I don't see it becoming a public health crisis. The c-section rate is already over 30%, and there is no "crisis" of hysterectomies. And the trend is for smaller families.
There seems to be a lot of doctors trying to avoid the emergency c-sction. Being rushed down the hall, put under GA, and having the baby out in a couple of minutes is NOT good for the mother's immediate recovery, and there seems to not be much information about the long-term effects of elective c-section versus emergency c-section.
That's what I would like to know. Is there a difference between my risk for accreta if I had a vertical incision, a postoperative infection, or had a rupture? If all c-sections are elective and uncomplicated is that woman at lower risk for accreta? If there is any information on this topic, I would be very interested to know about it.
From Harmony:
Listen to this argument...it is ridiculous.
Is a C-section 200% worse than nature or 59% worse?
Obstetrics can be likened to curing an ingrown toenail by amputating the leg...
oh yes it surely works...
that toenail will never trouble you again....
you can rid a house of flies with a shotgun too....a tad overkill... and oh what damage you do in the process.
From Nicole:
"And again - I reiterate. Isn't there a cost to public health and potential for serious complications for cosmetic rhinoplasty? Breast augmentation (not related to reconstruction)? Liposuction? LASIK surgery? All for things that are cosmetic in nature and don't even HAVE the potential (if not done) to become serious or life-threatening? I'm asking a very serious question. Why is there public health concern about women's bodies vis-a-vis CS but not about rhinoplasty, breast augmentation or (shudder) labiaplasty? I'll leave it to A Sarah to draw the line about ornamentation vs function on that one"
For me, the scary issue here is not the overall cost of unnecessary procedures. My concern is that I walk into the hospital with a nosebleed and they could apply a med and stop the bleeding, but instead they perform a rhinoplasty. They tell me it was necessary, but really it was just because the doc was in a hurry and figured the surgery would be faster than waiting on the med to kick in.
Okay... that's probably a poor analogy, but hopefully you get what I mean. I want a healthy baby with the minimum interventions necessary. I don't want anybody cutting me open and putting me at risk for infection and a longer recovery if it's not critically necessary. Someone who signs up for elective surgery knows what they're signing up for. Unfortunately, lots of moms see docs with section rates through the roof and think that they won't get a section unless it is medically indicated. They walk into a hospital not wanting surgery and walk out with an elective c/section. They just didn't realize it was elective...
From Emma B:
Is there a difference between my risk for accreta if I had a vertical incision, a postoperative infection, or had a rupture?
I don't know about accreta, but I do know from firsthand experience that infection can produce uterine and tubal scarring and thereby cause infertility. That's how I lost my fallopian tube, after an uncomplicated elective repeat CS in my second pregnancy.
From flim flam:
is losing a baby during a homebirth 200% worse than having a live baby and a caeser, or only 69% worse?. is the mothers "experience" worth more than the babys life?". is not getting the fantasy MDC homebirth but having a healthy baby in hospital better or worse than having the dream birth but getting a dead baby?. are homebirth advocates 75% or 100% full of crap?
From Leelee:
Susanne: " keep asking (and not getting an answer to) ... what is more important? Sound medical practice, or what the mother wants?"
My answer to this is the same as my answer regarding non-indicated c-sections: sound medical practice should always have top priority where it can, but the line is drawn at forcing. So I guess in practice, informed consent/refusal has to trump medical advice. It's an unfortunate situation, but to do otherwise amounts to the Angela Carder case.
There is very little spirit of compromise between the two "camps" these days. One side rejects what modern science has to offer because they don't like the complete package. Medical practice is naturally bound by the preferences of individual practitioners, who doubtless have their reasons. Even "Hurrican Hardt," the aggressive obstetrician Rural Doc described in a recent post about her residency days, must have her reasons for doubting that stage II can happen normally without her intervening with the vacuum at the slightest delay. But the end result of that is that women who do have a preference don't know who they can trust or who they should believe. And most women do have a preference one way or the other, since there's also a proliferation of new mothers who rant about not being able to get their epidurals quickly enough.
Why is no one working on a better, more mobile form of continuous EFM? Telemmetry for all rooms, or for anyone who wants it? I reread my hospital's maternity services brochure - right in it, it says "telemmetry monitoring is available for those who want to be mobile during their labor." Yet this was not true in practice and we were flat-out told that "we don't just give that out," and "you shouldn't have been told you can have that." I did report this to my former OB, but don't expect a reply.
If the staff necessary for IA to work well simply can't be trained and paid for, or legal constraints demand an EFM strip, surely a compromise can be reached? Yet I myself dealt with a situation where the compromise was said to exist and offered in advertisement, yet denied during the time when it was needed. I can only conclude that *someone doesn't care*, because someone doesn't think it's important in reality. Yet it was important to advertise it - why?
From Leelee:
Susanne: "Why is there public health concern about women's bodies vis-a-vis CS but not about rhinoplasty, breast augmentation or (shudder) labiaplasty?"
There should be, but I think the situation is different because cosmetic surgery is *purely* elective and doesn't involve the unique but unavoidable process of one person's body producing and yielding up a new human being. There's only one person potentially affected in rhinoplasty, labiaplasty etc, and nature also furnishes us with a birth process which *usually* works, and works even better with the safety of emergency services available as backup. Nature doesn't furnish us with a natural method of reshaping our noses or other body parts. Any kind of birth is a "necessary" function, and one that some 80% of women will experience in their lifetime - cosmetic modification is not. I think that's why people don't care as much about cosmetic surgery, though I don't doubt it has public health costs on a smaller scale. Whatever one's opinion of purely cosmetic surgery, it's perceived as a person's right, which hurts no one else if it goes wrong.
I do find it curious that public health officials, including MDs (and naturally including those OBs whose focus is on public health), are generally more apt to be concerned about the sequelae of the massive increase in c/s, while many private practice OBs are much less so. I think it is because one deals with the forest while the other deals with the individual trees.
From A Sarah:
Susanne: Why is there public health concern about women's bodies vis-a-vis CS but not about rhinoplasty, breast augmentation or (shudder) labiaplasty?
Because society doesn't give a crap about WOMEN'S health. We only give a crap about women-as-potential-bearers-of-offspring-because-
that's-why-they-were-put-on-this-earth-and-don't-
you-forget-it-missy's health.
Sorry, I'm grouchy today.
From A Sarah:
Though I do suppose we give a crap about breast cancer. After all, look at how taking some existing product and turning it pink helps to increase sales.
Grrr.
From Leelee:
A Sarah: "Because society doesn't give a crap about WOMEN'S health. We only give a crap about women-as-potential-bearers-of-offspring-because- that's-why-they-were-put-on-this-earth-and-don't- you-forget-it-missy's health."
...and thats the darker side of it I couldn't quite bring myself to say. Birth is seen as something of a public process, the gestating woman as public property, no matter how we try to structure our laws to stop it. Some see modern medicine as part of "the establishment" that tells women what to do with their bodies. It may be misplaced and misguided, but a few super unpleasant hospital experiences, just a few incidents of iatrogenic complications, and voila. But from any viewpoint you can see the tendency to treat pregnant women's bodies as public property. To the degree that I once had some little old lady grab me at a bus stop and pull me farther away from the curb, scolding me that I ought to be more careful (careful of what? I want to get on the damn bus first so I have a chance of getting a seat, because I'm not always offered one, you annoying harpy!)
From Caryn:
Why is no one working on a better, more mobile form of continuous EFM?
I suspect someone is, but on the public health scale this is a *far* lower priority than, say, getting translation into place for non-English speakers or for people who cannot understand the health care decisions they are being asked to make. It is also a much lower priority than things like getting laboratory facilities into countries without them, or getting essential drugs into countries without them, or malaria nets, or vaccines.
From Leelee:
Caryn: "I suspect someone is, but on the public health scale this is a *far* lower priority"
And this is appropriate....but why say you have it officially, on the record, and then refuse to give it and basically totally contradict the official statement?
Even where it's supposedly available, it's not available!
From Susanne:
"Why is no one working on a better, more mobile form of continuous EFM?"
So let's say this more mobile form of continuous EFM were invented so now women can bounce and walk around to their heart's content without intrusive leads. What will change, though? Bad tracings will still be investigated, and CS'ed if necessary. What's the public health point of it?
From Leelee:
Susanne: "So let's say this more mobile form of continuous EFM were invented so now women can bounce and walk around to their heart's content without intrusive leads. What will change, though? Bad tracings will still be investigated, and CS'ed if necessary. What's the public health point of it?"
There is no public health point to it. But it carries the same importance as women being able to get epidurals promptly - for their experience. If they teach methods of non-medication pain management, and then do not provide the means to employ those methods, there's a problem.
There are also those doctors and institutions which actually believe that movement helps early labor (from my hospital's L&D brochure):
"If you arrive in early labor, you may be sent home, *or told to walk the halls to increase your contractions.*" (emphasis mine)
(And of course, the quote about telemmetry monitoring being available for those who want to be mobile)
If having these amenities available cuts down on the use of more expensive or risky interventions....then I suppose there would be a public health aspect after all. For those who want unmedicated labor, of course, it shouldn't be forced on anyone.
But you know what? Something tells me this is mere advertising fluff *to attract the business of those desiring unmedicated birth.* Medicine is, after all, a business. There is another hospital in town that has a reputation for catering to natural birth. I was certainly misled by the advertising material, since when I arrived, it seemed no one cared at all about my secondary desires (secondary to the health of my baby). No one but the final attending who saw me, who apparently erroneously (according to Amy) believed I should sit up to "try to let gravity assist." The same doctor who eventually called for and performed my c-section, and who wrote the paper I quoted on CDMR.
From Caryn:
So you're angry with the marketers. Get in line.
From Leelee:
If the marketers had anything at all to do with my ending up having surgery rather than vaginal birth (not provable, I know), they have a lot more to answer for than my simply being pissed. The fact that there's no way to prove it is no excuse for their not having what they said they would have, *particularly* since they themselves held up these techniques/amenities as being helpful in speeding labor along and coping with pain sans meds. This isn't like advertising that you had chocolate ice cream and someone shows up and all they have is vanilla. But that's typical complacency coming from a viewpoint that views a c-section as absolutely no big deal, and non-availability of optimal labor support to be No Big Deal either, because why in the world wouldn't you just want to lie back with your epi and be 'pit'ted? Next time you get (justifiably) angry reading a comment from some haughty natural-birth advocate poking fun a woman's dismay that she couldn't get her epi fast enough, please remember that.
All they had to do to be honest is say what Desiree's nurse said on her tour, about the labor-support style at my hospital. That nurse had it right. And if she had given my tour, I would have transferred, post-haste.
From Caryn:
The fact that there's no way to prove it is no excuse for their not having what they said they would have, *particularly* since they themselves held up these techniques/amenities as being helpful in speeding labor along and coping with pain sans meds.
Sure. I'd agree, absolutely, that there's no excuse for lying. I'm not attempting to excuse lying. I'm just pointing out that you're not angry with *medical care*. Or *nursing care*. You're angry about *marketing*, i.e. professional liars.
From desiree:
leelee, have you talked to patient affairs? (http://www.nyp.org/patients/patient-
relations.html)
when i wanted to have DD2 with me in recovery after my c/s, i called them to see how to set that up. they've also helped me with some billing issues i had. i think they'd be great to talk to.
and, i DO remember hearing about the telemetry EFM during my tour. i didn't ask for it because i was on pit and at the mercy of DD1's heartrate the whole labor, so it wasn't an option. if you want, i can ask my friend who used to deliver there if they really have them or not. maybe your nurse just didn't know about them because no one uses them?
From Pharmacist:
--So, if I have 4 children, on my 4th c-section it looks like I face about a 2.5% chance of having my uterus out with the baby. This means I'll probably never have as many kids as the Duggars.--
I don't know about that, Mom Duggar has had 3 C-sections (some VBAC's inbetween them). It is possible to have a large family and use medical technology (if that is what one desires.)
From Pharmacist:
--Completely OT, I note that Sarah Palin's daughter has just had her baby. I know Amy was firmly convinced that a teen pregnancy coverup had taken place, but the timing makes it extremely unlikely. Time for a retraction, perhaps?--
It would appear to be that way...all I can say is, it makes S Palin appear to be incredibly stupid and cavalier to have risked her baby's life by delaying seeking immediate medical attention when her water broke in Texas. I had hopes that a state governor (of any political party) would be a little bit more intelligent than that.
From Mama Liberty:
"It would appear to be that way...all I can say is, it makes S Palin appear to be incredibly stupid and cavalier to have risked her baby's life by delaying seeking immediate medical attention when her water broke in Texas."
Oh, pulease! Here we go again... what the hell do you know of her medical history? How do you know what her four earlier labors were like? Don't you think she knew whether or not she was in active labor? Perhaps she felt safer with her own physician. How do you know she didn't consult a doctor? Give me a freakin break.
From Pharmacist:
--Oh, pulease! Here we go again... what the hell do you know of her medical history? How do you know what her four earlier labors were like? Don't you think she knew whether or not she was in active labor? Perhaps she felt safer with her own physician. How do you know she didn't consult a doctor? Give me a freakin break.--
She supposedly consulted with her own doctor over the phone. I have a hard time believing that any doctor would tell a woman who thought her water had broken (or was at least leaking) to FLY FROM TEXAS TO ALASKA! DOUBLE that for a woman who was very high-risk (advanced age + baby with known birth defects including possible cardiac effects.) Flying is generally not recommended for pregnant women in the 3rd trimester under the best of conditions. If Palin honestly didn't know this, her doctor certainly should have. The airline would have known enough to refuse her passage if they had known that her water had broken/was leaking.
From Leelee:
Desiree - thanks for the link, I will visit it. I simply sent a letter directly to my OB. Since I'm not going back (in addition to my being disgruntled, it's actually a wildly inconvenient from where we live now) I didn't do any sort of long term investing in the relationship. But if there's a formal place to report that, it would be helpful.
Multiple nurses in triage (where we were told to place our request for the telemmetry) did not know that the telemmetry was being marketed as generally available. One even told my husband "we don't just give that out. You shouldn't have been told you could have it." So they knew it was there -- they just denied that it was for general use.
I won't be going back, but if I can help ensure that care is consistent with what is advertised, I would be glad.
Caryn - that's a tough one, because the *advertisement* promised a sort of medical care which they did not deliver. So I was unhappy with the medical care (since if I had known how it was going to be, I would have transferred to some place where I was assured to get the care offered, and if denied, given a reason other than "you shouldn't have been told you could have that.") But in general, it is the false advertising that is the big problem.
If it was indeed just individual staff ignorance (somehow all the nurses on that shift responsible for doling out the wireless monitors didn't know they were supposed to give them first-come-first served), on some level that's even worse for me AND the hospital, because I alone received substandard care, am wrongly blaming the hospital, while meanwhile other women are getting their telemmetry monitors, no problem. But it's good for the other women, I guess.
From mamalama:
Antigonos - I work in an "extremely high risk" teaching hospital and our c/sec rate is 25%. The two suburban hospitals nearby full of healthy, (largely)upper-middle class white woman have rates that approach 50%. Failed elective c/sec and low VBAC rates (by choice, not lack of availability) are largely to blame.
From mamalama:
sorry, that should read "failed elective INDUCTION" not "c/sec". I need to go to bed.
From Stop letting her getaway with:
Despite one hundred-plus comments nobody pointed out that Dr Amy is full of shit when she concluded her post with:
“The bottom line is that there is no evidence that C-section increases the risk of neonatal death in this study or in any other study to date.”
Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study (Villar, et al., British Medical Journal, 2007;335:1025, 17 November)
Study Design: Researchers assessed the risks and benefits of cesarean delivery vs. vaginal delivery.
Bottom line: Cesarean carries twice the risk of injury and death for both mother and baby. Women with cesarean experience double the rate of hysterectomy, blood transfusion, admission to intensive care, prolonged hospital stay and death, compared to mother who delivered vaginally. Babies born by cesarean were 45 percent more likely to be in the neonatal intensive care unit for 7 days and 41-82 percent more likely to die than babies born vaginally.
Risk of Uterine Rupture and Adverse Perinatal Outcome at Term After Cesarean Delivery (Spong, et al., Obstetrics and Gynecology 2007; 110: 801-7)
Study Design: Researchers examined the risk of uterine rupture after cesarean and what harms it may have for mothers and babies.
Bottom line: Regardless of how the baby was delivered, the rate of uterine rupture was low and complications from rupture were also low for both mother and baby.
Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. (Declercq, et al. American Journal of Obstetrics and Gynecology. 2007 Mar; 109(3):669-77.)
Study Design: Researcher divided mothers into two groups: women with a planned cesarean after no labor and women who labored and had either a cesarean or vaginal birth and then compared rehospitalization rates.
Bottom Line: Rehospitalizations in the first 30 days after giving birth were 2.3 times more likely in planned cesarean than with planned vaginal births. The leading causes of rehospitalization after a planned cesarean were wound complications and infection. Hospital costs were 76 percent higher for women with planned cesarean, and hospital stays were 77 percent longer.
Previous caesarean or vaginal delivery: Which mode is a greater risk of perinatal death at the second delivery? (Richter, et al., European Journal of Obstetrics & Gynecology and Reproductive Biology 2007; 132: 51-7)
Study Design: Researchers compared mothers who had delivered previously by cesarean vs. vaginally, and examined the number of babies who died in the subsequent pregnancy.
Bottom line: A previous cesarean delivery was associated with a 40 percent increase in perinatal death (the first week after birth) and a 52 percent increase risk of stillbirth. A vaginal or cesarean delivery in the current pregnancy did not impact the death rate.
Postcesarean delivery adhesions associated with delayed delivery of infant (Morales, et al., American Journal of Obstetrics and Gynecology 2007; 196: 461.e1-e6
Study Design: A common complication of any surgery is overgrowth of scar tissue, called “adhesions.” Researchers examined the frequency of adhesions with successive cesareans and whether adhesions caused by cesareans could slow down the delivery of a baby in the next pregnancy.
Bottom line: Researchers concluded that each successive cesarean significantly increases the incidence of adhesions and can slow down the delivery of a baby. One prior cesarean adds 5.6 minutes to the time it takes to deliver the baby, 2 prior cesareans 8.5 minutes, and 3 prior cesareans 18.1 minutes. This delay can compromise the health of the baby, researchers concluded.
Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy. (Yang, et al., British Journal of Obstetrics and Gynecology: 2007 May;114(5):609-13.)
Study Design: Researchers examined the incidence of placenta previa (placenta blocking the cervical opening) and placental abruption (placenta separating from the wall of the uterus prematurely) in women who have had a prior cesarean vs. a prior vaginal delivery.
Bottom line: Compared to vaginal birth, cesarean increased the risk of placenta previa by 47 percent and placental abruption by 40 percent. Both complications carry the risk of death for both mother and baby. Researchers indicated that complications may be due to the cesarean scar on the uterus.
Risks of adverse outcomes in the next birth after a first cesarean delivery. (Kennare, et al. American Journal of Obstetrics and Gynecology. 2007 Feb; 109(2 Pt 1):270-6.)
Study Design: Researchers examined the complication rate of women who delivered their first baby by cesarean vs. vaginally.
Bottom line: Women who had a prior cesarean delivery were more likely to have complications than women who had a prior vaginal delivery. Women with a prior cesarean were more likely to have a placenta previa (odds ratio [OR] = 1.66), placenta acreta (OR = 18.79), and bleeding during pregnancy (OR = 1.23). During delivery, women with a prior cesarean were also more likely to have a prolonged labor (OR = 5.89), uterine rupture (OR = 84.42), and need an emergency cesarean (OR = 9.37). Babies born to women with a prior cesarean were more likely to be small for their gestational age (OR = 1.12), have a low birth weight (OR = 1.30), and to be still born (OR = 1.56).
Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. (Coassolo, et al., Obstet Gynecol. 2006 Jan;107(1):205)
Study Design: Women who attempted VBAC before the estimated due date (EDD) were compared with those at or beyond 40 weeks of gestation. Researchers assessed the relationship between delivery after the EDD and VBAC failure or complication rate.
Bottom Line: The risk of uterine rupture (1.1 percent compared with 1.0 percent) or overall morbidity (2.7 percent compared with 2.1 percent) was not significantly increased in the women attempting VBAC beyond the EDD. Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.
Caesarean delivery and risk of stillbirth in subsequent pregnancy: a retrospective cohort study in an English population. (Gray, et al., BJOG:2007 March 114(3) 264-270)
Study Design: Researchers compared the incidence of stillbirth following a previous cesarean section with stillbirths following no previous cesarean section.
Bottom Line: Pregnancies in women following a pregnancy delivered by cesarean section are at an increased risk of stillbirth.
Predicting placental abruption and previa in women with a previous cesarean delivery. (Odibo, et al., Am J Perinatol. 2007 May;24(5):299-305.)
Study Design: In women with a previous cesarean section, researchers compared those who had a placental abruption and/or previa with those who did not.
Bottom Line: Three or more previous cesarean sections was a significant risk factor for placental abruption and previa.
From Liz1:
Yes, yes, yes, you are at "increased risk" of those things. They are "more likely" to happen. And if you are a devotee of home birth, or intend to have 10 children, you would be wise to avoid CS in all but the most extreme circumstances. And, no question, CS is less attractive than a dreamy, perfect vaginal birth.
And being informed of all the risks is likely to make even the most stoic hysterical when faced with the need for a CS. Surgery is unpleasant and best avoided. And the doom laden scenario is the dead baby card in a different guise.
For quite a lot of us - me, for instance - it simply isn't that big a deal. Given the choice of vaginal delivery of a dead baby,or two CS, two live babies and a need to think again about the size of my family, it seemed the better option. And no, I didn't have any of the dreadful complications.
From mamalama:
I find it funny that the conclusion amounts to "you can't determine much from birth certificate data" when much of the studies damning homebirth are based on just that!
From Amy Tuteur, MD:
mamalama:
"I find it funny that the conclusion amounts to "you can't determine much from birth certificate data" when much of the studies damning homebirth are based on just that!"
Birth certificates have been studied extensively for reliability. Certain things are very reliable: weight of baby, Apgar score, age and race of mother, etc. These studies have also shown that when complications are mentioned, they are an accurate reflection of what happened, but when no complications are mentioned, it is often because the space was simply not filled in.
From LD:
I work in L and D and have seen my share of moms pushed along the slippery road to a c-section because we determine under the medical model that their bodies are somehow incompetent. Nobobdy in her right mind would advocate for vaginal delivery in the event that a section is necessary. The problem is that the medical model creates the necessity more often than most laymen realize.
Im typing this from an L and D unit. I know what it's all about.
And I gave birth at home.
From Caryn:
we determine under the medical model that their bodies are somehow incompetent
Which model would you rather use?
How would you know if a Caesarean were necessary if you *weren't* using the medical model?
From Susanne:
" ... because we determine under the medical model that their bodies are somehow incompetent."
No, no one determines that women's bodies are "incompetent" (though I do think the term incompetent cervix is a poor one). That's the value judgment YOU'VE put on it. When I go to the orthodontist and they tell me I need to wear a retainer to correct my bite, they didn't find my mouth "incompetent." When I go to the eye doctor and they tell me I don't see 20/20 and need glasses, they didn't find my eyes "incompetent." Likewise, when I go to L&D and I'm not progressing, they didn't find my uterus "incompetent." Just because some people aren't bright enough to figure out the difference between having a health condition / issue / diagnosis, and their bodies / selves being declared "incompetent" is not the medical community's problem.
From Jen:
I agree with Susanne. Why does childbirth hold the special position that when complications happen, it is a reflection of that woman, not just "shit happens"? What other medical complication is viewed that way? Any?
From Liz:
Why does childbirth hold the special position that when complications happen,it is a reflection of that woman?
And not just the why, but the when and the how?
Words have significance. And that until fairly recently women regarded themselves to be "blessed" with children - that Nature was arbitrary, sometimes cruel and that luck played a large part was a more realistic assessment than the present culture of competitiveness and blaming. Even the reviled notion of being "delivered" acknowledged that a baby was helped to come safely into the world instead of some magic contract where the baby "knows". The trouble with NCB is that aspects of it are reassuring and supportive to women, but its disguised origins are in assumptions of superiority and inferiority that should have no place in childbirth.
But why would some women embrace this so readily? Where is the pleasure in undermining other women, or encouraging them to undermine themselves? It does seem to come out of a desperate neediness, or vanity and denial. And women internalise this at their peril. It is a very fragile house of cards.
When I first knew I was "failing" to have the perfect pregnancy, I did feel some grief and confusion that I could not do this simple thing. I was fortunate to come across a group of other women who had also experienced this. I have never fogotten the support and solidarity I got from them. That is how it should be. That is the true strength of women. The competitiveness belongs to a sicker world.
From Liz:
Bored again. Can I bring up another instructive thread on MDC? This is about "pain free" labours. It has, as usual, the I am a Birth Goddess and don't you wish you were me? posts, but it also has others which helpfully explain that the way to have a pain free labour is to refuse to admit that what you are feeling is PAIN. Name it something else, and voila! - it isn't pain. Post birth amnesia no doubt helps with this one. As only inadequate women feel pain, and you can not possibly be (or admit to being) inadequate, your birth was pain free, and therefore superior to anyone who is hampered by honesty.
I get, occasionally, migraine. My husband gets migraine, and I have a friend who is severely restricted by it. My pain is not that bad. It is easily treated, and sometimes can be ignored. Theirs isn't. Does that make me superior? Freaky, lucky, maybe on occasions a bit dumb and insensitive to others?
From Liz:
Stuck in serial mode. On the subject of supportiveness, one of the things that fascinates and grieves me is that you do see this on MDC - both the best and the worst of what women are capable of. Which brings me to the question of being "informed", which I also regard as being a big puzzle. When I went into hospital I "knew" about pre-eclampsia, or thought I did. In those pre-internet days, I had no opportunity to get better informed, and in retrospect I was glad of it. Would it have helped or made any difference to know just how much trouble I was in? Same with CS and its possible complications. If real information is controversial, and mis-information abounds, what to do? The stunningly bad advice on MDC is given in good faith. Maybe the answer has nothing to do with childbirth or attacking home birth but in the education of women, maybe a new strand of feminism which teaches the true value of women not the false values of women's magazines and NCB.
From Squillo:
Liz 1:
"But why would some women embrace this so readily? Where is the pleasure in undermining other women, or encouraging them to undermine themselves? It does seem to come out of a desperate neediness, or vanity and denial. And women internalise this at their peril. It is a very fragile house of cards."
Yes. This is what puzzles me, too. So much of the "natural" childbirth advocacy rhetoric is couched in terms of feminism and the "empowerment" of women--and in some respects, I think the movement has contributed to those things--but then they shoot themselves in the proverbial foot with offensive catchphrases like "incompetent bodies" and "pain with a purpose" and the uber-ridiculous "trust birth/trust your body." Phrases like these end up reducing the whole movement to a version of the "physiology is destiny" philosophy. No, actually it's worse--at least that philosophy acknowledges the capricious nature of Nature. Some NCB rhetoric turns it into "physiology as achievement," as if we can control nature by strength of character. The irony is, of course, that the very people who tout this illusory control over nature often deny the utility of--and even vilify--the only tools we currently have to exercise a small measure of control over nature.
The NCB advocacy movement could take a page from a few of the posters here, who are critical of some current obstetrical practices, and argue based on a consideration of the real questions about risks and benefits, separate from the pseudo-feminist philosophical underpinnings of some of the NCB movement.
From Liz:
So much of the "natural" childbirth advocacy rhetoric is couched in terms of feminism
This is what I find so depressing. It appears to be couched in those terms, but it has merely appropriated them for some very un-feminist, and positively misogynist ends. Don't bother to undermine women in the interests of better controlling them and making them more docile consumers of whatever is being sold, just encourage their natural tendency to undermine themselves. Mothers ARE powerful, they shape the next generation. Keep 'em focused on trivialities, competitive with one another and all shall be well, all manner of things shall be well.
From Caryn:
The NCB advocacy movement could take a page from a few of the posters here, who are critical of some current obstetrical practices, and argue based on a consideration of the real questions about risks and benefits, separate from the pseudo-feminist philosophical underpinnings of some of the NCB movement.
Eh. I was in that wing of the party, for lack of a better term, and the problem there is the focus is on what's wrong with some current obstetrical practices.
It tends to *stop* there. There's very little investigation into other obstetrical practices, why obstetrics might have been adopted, why those particular practices might have been adopted, and if there is investigation into these questions, it frequently devolves into naturalistic fallacy.
Which means people who know about the naturalistic fallacy stop paying attention to NBA there and think something along the lines of, well, *I'm* low-risk, so probably I won't need to worry about that, and if I develop enough risk markers, my care providers will transfer my care.
Which would be fine *if* relying on care providers to actually do that worked. But when they're DEMs and they don't actually know anything about it either...
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