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Author Topic: Caesarean or vaginal birth  (Read 8780 times)
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2010BEBES
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« on: July 24, 2010, 12:11:52 AM »

Excuse me if it is not express correctly. I had to use a translator since this is not a topic I would normally use academically. yes  yes
What i would like to comment and know others opinions or experience in other cultures is about Caesarean birth.
In Peru lately a huge % of birth are done by caesarea. Doctors usuarlly say that it is because the baby is trap in his cord or is not turnin around as it should or any other reason. Years ago (aprox 1975) normally there where more vaginal birth.
I think the reason now is :
a) doctors want to take their time and plan their activities. That is much better than being called as 2 am in the morning to assist a birth (as was with my two boys).
b) doctors charge more for caesarea than vaginal birth (usually they charge the insurance company)
c) mothers nowadays prefer somewhat also that kind of planification and to choose (as close as possible) the date of birth.
d) some people say that it is better for the baby that does not have 'TO SUFFER' trying to open his way to the world.

So I would aprreciate if you can share how is it in your culture or where you live now. Are there TOO MANY caesareas?


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« Reply #1 on: July 24, 2010, 10:48:19 AM »

Hi 2010 Bebes.  This is a topic close to my heart as I am involved as a committee member in my local area for a non-profit organisation that provides education and support for women to have the best birth possible.

I live in Western Australia and here the caesarian rate is 30%.  This is incredibly high.  I believe that 10% is the expected number of caesarians that are medically necessary.

In my experience all of those reasons are reasons for the increase.  I also believe that the culture of birth as a normal, natural part of being a mother has disappeared and many first time mothers do not hear reassuring stories about how empowering birth can be and it is no longer seen as a rite of passage but as something we need to endure to get a baby and that if we can numb the pain or bypass the messy business of giving birth althogether then we should.

Unfortunately the medical profession feeds off this fear and the lack of knowledge that is given to women in their first pregnancy and scares women half to death by painting a worse case scenario.  So when a dr tells you that your baby could die if you don't have a caesarian of course you will book in the caesarian.  Unfortunately they don't explain the risks so well to you either and then if you have another child and want a vaginal birth they put up all sorts of policy barriers that mean it is very, very difficult for you to avoid a caesarian. 

Then if you go past 40 weeks which is really arbitrary number they talk induction and say they will induce at 40+10 when most first time mothers will gestate on average to 41 weeks or more.  Then you end up with drugs that make you contract very painfully, you want an epidural for the pain, you are on a time limit and your labour stalls so you end up with a caesarian.

There is also the fear factor when you walk into the hospital which is so far out of your comfort zone.  Like any other mammal if you feel threatened your labour will stall because you do not feel safe enough to birth your baby.  So again you end up with a caesarian because neither you or your baby are tolerating extended labour.

There really are so many things wrong with our culture around birth.  When my mum birthed in the 70's she said that babies were rarely induced and you didn't have an exact estimated delivery date or ultrasounds to go by so if you were "over" people didn't worry and left you alone to go into labour naturally.  So much better for Mum and Bub to do this.

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« Reply #2 on: July 24, 2010, 01:10:05 PM »

Having had a caesarian (my son was wedged sideways, there really wasn't an option) I can't see why anyone would choose to have one! I was 'lucky' in that my son spent six weeks in special care so I could recouperate from major surgery without having to care for a baby all day. I don't know how I would have coped, since the first week I could barely lift a pint of milk.

People talk of surgery as the 'easy option' and don't discuss the pain and difficulty that comes *after* a caesarian birth. For weeks I shuffled rather than walked and had trouble with many daily tasks. Coughing and laughing *hurt*. It is something you can cope with, if you have to, but why people choose this route is beyond me. Sure, natural labour may hurt more, but you have a couple of days of pain and recovery, not weeks. And you don't have a scar that itches and rubs against your underwear for months (if not years - I really don't know that yet).

In the UK there is actually quite a lot of encouragement for vaginal birth after caesarian. As long as the pregnancy and labour progress normally. I am determined to do so when I have my next child.



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2010BEBES
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« Reply #3 on: July 24, 2010, 03:22:39 PM »

Hi 2010 Bebes.  This is a topic close to my heart as I am involved as a committee member in my local area for a non-profit organisation that provides education and support for women to have the best birth possible.
.......I also believe that the culture of birth as a normal, natural part of being a mother has disappeared and many first time mothers do not hear reassuring stories about how empowering birth can be and it is no longer seen as a rite of passage but as something we need to endure to get a baby and that if we can numb the pain or bypass the messy business of giving birth althogether then we should.
.....There really are so many things wrong with our culture around birth.  When my mum birthed in the 70's she said that babies were rarely induced and you didn't have an exact estimated delivery date or ultrasounds to go by so if you were "over" people didn't worry and left you alone to go into labour naturally.  So much better for Mum and Bub to do this.
Dear Marmee, you really have a word on this topic. How reconforting should it be to help women make the best decision.
I do not have the numbers in Peru but from the people around me i would say here almost 80% are caesarean at least not counting moms with less resources but those that can afford to pay or have insurance. I agree that women nowadays to not realize what a miracle when you feel your child coming. I remember that even though i receive epidural (maybe a little late), i was awake and when ask while being in labor from oldesd kid I answer: 'FIRST baby and the LAST one' becasu it hurt a lot. Of course soon after I forgot this and 2 yrs late i was giving birth to my wonderfull daughter and 6 yrs later to another boy (now 26 yrs).
You are right, with the pass of time we see that Technology (ecografias and all) brings a lot of good things (you can almost see your baby's face while in the womb) but is taking away the natural part of child birth.

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« Reply #4 on: July 24, 2010, 05:48:21 PM »

A few issues back, in "Mothering" magazine that I subscribe to was a good article, for some reason I was not able to get a link to it on line, so I would post some parts of it here, cause it was directly on the subject that was brought up...

in a nut shell, there is a place for a c-section in an emergency medicine, and I saw a few C- sections that were indeed a life-saving solutions, usually  one of the very few times when C- section is justified is in the case of cord prolapse.  However in 98% of instances, they are unjustified an pose more danger, the sad thing though is misinformation, lack of informed consent given to woman and putting mommies in situations and under interventions that will directly lead them to C-section.

OK, here are some of the excerps from the article:

Dangers of Elective C-sections
Cesarean Birth in a Culture of Fear By Wendy Ponte
Issue 144, September/October 2007


When I tell someone I am working on a story about the escalating rate of cesarean sections in the US, it often leads to a conversation that goes something like this:

"C-section rates are up to 50 percent or higher in some hospitals," I say. "Doctors often feel they must do a C-section to protect themselves from a malpractice suit. And many of them seem to feel that a C-section is actually better than vaginal birth. A lot of women are being given unnecessary surgery."

"I had a C-section," my acquaintance will say. "But in my case, it was necessary."

"Tell me about it."

"Well, the baby's heart rate started to drop on the fetal monitor, and the doctor was worried that she wasn't handling labor very well. So he said a C-section was the safe thing to do."

It's an awkward conversation, to say the least. I would never want to make any woman feel bad about the birth of her child. Women need to be honored for their birth stories, no matter how those stories go. And having been told by both a doctor and a reliable-looking and expensive piece of machinery that her baby could be in trouble, my acquaintance probably made the best decision she could make in that moment. By the time she reached the point when that decision was made, it could, in fact—after hours of beeping noises on the fetal monitor, the suspense of the hospital atmosphere, and loads of chemicals pumping into her body—have been the only choice available.

And yet I also know what hundreds of other birth activists know. Some percentage of women who think their C-sections were necessary—because of fluctuating heart rates, large babies, failure to progress, previous C-sections, difficult birth positions, and on and on—have actually had unnecessary C-sections.

I know this because the World Health Organization (WHO) says that any time a country's cesarean-section rate rises above 15 percent, the dangers of C-section surgery outweigh the lifesaving benefits it is supposed to provide. 1In the US, the overall C-section rate has now reached 30.2 percent.2

That conversation, which I have had all too many times with various women, boils down to this: There are too many C-sections being done—unless it is your C-section. Then, it just isn't so clear. That conversation parallels the one that seems to be happening on a national scale. Although the arguments against the use of C-sections, except when there is no other choice, are clear, and although these arguments are supported by plenty of evidence and statistics, doctors and patients do not seem to be using that information to change birth practices. It doesn't seem to matter that, in the US:

A woman is five to seven times more likely to die from a cesarean delivery than from a vaginal delivery.
A woman having a repeat C-section is twice as likely to die during delivery.
Twice as many women require rehospitalization after a C-section than after a vaginal birth.
Having a C-section means higher rates of infertility, ectopic pregnancy, and potentially severe placental problems in future pregnancies.
Babies born after an elective cesarean delivery (i.e., when labor has not yet begun) are four times more likely to develop persistent pulmonary hypertension, a potentially life-threatening condition.
Between one and two babies of every hundred delivered by C-section will be accidentally cut during the surgery.3
The US is tied for second-to-last place with Hungary, Malta, Poland, and Slovakia for neonatal mortality in the industrialized world.4
Babies born via C-section are at high risk for not receiving the benefits of breastfeeding.5
The risk of death to a newborn delivered by C-section to a low-risk woman is 1.77 deaths to 1,000 live births. The risk of death to a newborn delivered vaginally to a low-risk woman is only 0.62 per 1,000 live births.6


Despite these statistics—which are just drops in the bucket of information available about the dangers of cesarean surgery—the procedure keeps being done. Women are not well enough informed, say birth activists. Medical schools are not teaching doctors how to create optimal scenarios in which successful vaginal birth can happen. Doctors are making decisions based on fear of malpractice suits rather than medical necessity. But even though we know all of this, and even though the statistics are compelling, high-tech birth practices continue, and the C-section rate keeps climbing, with every indication that it will climb higher. Why? "In another century, these birth plans will be perfect time capsules of postmodern maternity," says Tina Cassidy in her recently published book, Birth: The Surprising History of How We Are Born, "for if there is one thing that writing this book has taught me, it is that birth always reflects the culture in which it happens."7 Which made me wonder: In examining the way we give birth today, what would an anthropologist a hundred years from now learn about our culture?

The Mantra of Fear
If an imaginary future anthropologist took a look at our current birth practices, she or he might conclude that we were a very frightened people indeed. In her book, Cassidy reports that many women have a deep feeling that birth is inherently dangerous. "Deliveries at home and in birth centers have been statistically proven to be as safe as those in hospitals, where, not incidentally, one's chances of having a cesarean soar just because you walk through the door. . . . There are, and always have been, trade-offs in decisions about where a child should be born. . . . Weighing those options, women still want to give birth where they feel most safe. And for all but a fraction of those pregnant today, that place is on a bed that can—if necessary—be wheeled into the operating room, surrounded by machines, and attached to electrodes and a catheter that drips anesthetic directly to the spine."8

Just look at the statistics in the 2006 survey "Listening to Mothers II." Only one in four women surveyed had attended a class in childbirth education—however, 68 percent of these women had watched one or more television "reality" shows that depict childbirth.9 With few exceptions, these shows portray births that follow a strictly medical model, usually problem pregnancies in which women and their babies are rescued by heroic medical procedures. Machines beep wildly in the background, and the atmosphere is fraught with tension.

Maureen P. Corry, executive director of Childbirth Connection, which sponsored the "Listening to Mothers" surveys, feels that such shows make women believe that this type of birth is completely normal for all women.10 In the 2006 survey, 72 percent of first-time mothers felt that watching these shows "helped me understand what it would be like to give birth." In other words, being rescued from a dangerous situation by medical technology now seems to them to be a normal part of the birth experience. Even more striking is that 32 percent of first-time mothers felt, on the other hand, that the shows "caused me to worry about my upcoming birth."

Neither position seems likely to prepare a woman for the idea of birth as a normal life process that might actually go well on its own, with little or no intervention—a process that is, in fact, biologically more likely to go well. "Our culture has an 'accident waiting to happen' mentality," says Corry of the survey's findings. "It makes birth go from a normal physiological process to something that resembles intensive care. I think it is indicative of the larger culture in general."

Indeed, we seem to be a people who are just waiting for something to go wrong. You have only to turn on the evening news to get a good dose of what there is to be fearful about. On any given day, you can hear that the supplement you were told last month would add years to your life has now been proven to be toxic. Your chances of developing such-and-such disease have been increased by your living in the town or neighborhood you moved to last year. If you don't send your children to get extra tutoring right now, they will never succeed in their chosen careers.

Certainly, the events of September 11, 2001, and fears of terrorism have increased this tendency—or perhaps it is our fear-filled response to these threats that has caused our lives to become even more anxiety-ridden. For many, it has become impossible to sort out the difference between sensationalism and valuable information. And this very uncertainty itself provokes more anxiety, adding yet another layer of fear.

Our fear-based culture shows up in another birth-related way: the overriding fear of most doctors—even many midwives—of being sued for malpractice. This fear is based on grim reality. Being sued for malpractice can be life-changing and devastating: Doctors can lose their practices, their homes, their life savings. And so, as the normal ebb and flow of labor unfolds, physicians all too quickly resort to responding as if to a worst-case scenario. If a woman is not progressing quickly enough, or if the fetal monitor she is attached to indicates a change in the baby's heart rate, the physician feels the safest route is to use every medical tool available, to show that all the bases have been covered. To protect themselves from the expense of a major, career-destroying lawsuit, doctors pay for malpractice insurance at increasingly outrageous rates—some as much as $200,000 per year.

But why is it that the very things that cause birth-related morbidity rates to rise are seen as the "safe" way to go? Why aren't women and their doctors terrified of the chemicals that are dripped into their spines and veins—the same substances that have been shown to lead to more C-sections? Why aren't they worried about the harm those drugs might be doing to the future health of their children, as some studies are indicating might be the case?11 Why aren't they afraid of picking up drug-resistant Staphylococcus infections in the hospital? And why, of all things, aren't women terrified of being cut open? Again, the response seems totally irrational.

Our future anthropologist might soon conclude that the answer lies in our culture's biggest fear of all—of letting go and allowing natural processes to carry on—and our fascination with and blind faith in science and technology as the ultimate antidotes.

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« Reply #5 on: July 24, 2010, 06:59:28 PM »

I personally believe that a vaginal birth is the best for the mother and the child. I have known women who have had babies born both ways and the women who gave birth vaginally recovered faster and experienced far less side effects after birth. Also, If one chooses to have their baby C-section the first time they have to have the next one the same way. The c-section cuts through the mother's stomach muscles making it almost impossible to push a future baby through the birth canal.

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« Reply #6 on: July 24, 2010, 09:30:58 PM »

I definately vote for vaginal birth! it is the safest and the easiest for the moms.

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« Reply #7 on: July 25, 2010, 01:00:11 AM »

I remember that even though i receive epidural (maybe a little late), i was awake and when ask while being in labor from oldesd kid I answer: 'FIRST baby and the LAST one' becasu it hurt a lot. Of course soon after I forgot this and 2 yrs late i was giving birth to my wonderfull daughter and 6 yrs later to another boy (now 26 yrs).

I laughed at this 2010BEBES because this was me every time I was in labour and I have 4 children.  I would say to my husband "This is our last baby, I'm not doing it again".

Thanks for posting that article Skylark.  It was exactly what I was trying to say.

In contrast I was hearing about the situation in some African countries where some midwives from our state have traveled to help out the hospitals.  The caesarian rate is about 3% because they do not have the skilled medical staff or even the resources and equipment to perform caesarians when they are needed and the mortality rate of mothers and babies is atrocious.  So we have on the one hand communities where caesarians are overused and on the other hand communities where they are under utilised. It is tragic on both accounts and if only some of the resources we have could be funneled to places where they are really needed.

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« Reply #8 on: July 25, 2010, 04:42:20 AM »

I also believe that a natural birth (whenever possible) is much safer & healthier for both mother & baby.  Not only that, even "completely safe" drugs do cause side effects & even though you make not really notice it, your body has to recover from that as well.

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« Reply #9 on: July 25, 2010, 12:20:52 PM »

I had two friends have c-sections, one emergency because her blood pressure sky rocketed, they said she wouldn't cope and the baby wouldn't cope as the pain would make the blood pressure worse....sounds fairly reasonable, I don't know.

My other friend had one by choice and nearly died. She lost so much blood and her heart slowed down so much they though it was going to stop and she had to have transfusions. It was scary and it was a very, very long time before she recuperated from this (and she had had twins!).

I had a drug free natural birth, and yes it really, really hurt. But what I try to tell friends is that the pain has a foreseeable end. Much like a cramp in your calf times a thousand, excruciating, close to unbearable but not going to kill you. I knew each contraction would end (and I would wait in dread for the next) but I got a rest in between and then once he was out the pain was gone. I was then free to hold my child and walk around with him.


I had a very slight tear, three stitches, and a bit of grazing. So it stung to wee for about a week and I tried to wee in the shower if I could manage it. I was a bit tired and uncomfortable but nothing exceptional. I know I was probably one of the luckier ones.

I sometimes think we have built up a huge fear about the pain of childbirth to the point where women think they can't possibly cope with that amount of pain. I've heard women tell others to ask for the epidural straight away, don't wait or the pain will get too much and it will be too late. I think this sort of thing is really irresponsible.

I had another friend who had an epidural, don't know the whole story but something was quite right, she couldn't feel it and the docs didn't realise she ended up bruising her back muscles or something, it was so severe she couldn't walk for three months after she had the baby.

Drugs and operations are great things for those who need them, but I think the rest of us should let nature run its course.

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