AIBU to ask this about c sections...

[pizzafrenchfries]

So I have another post on here related to a yoga teacher and a debate on c sections and bonding but after speaking to a few other mums in real life I would really like to know...

My son was born by an emergency c section. I was conscious but it all happened very quickly... anyway.... after the birth people constantly asked: 'were you ok with that?' (Having the c section) as if it was an option... my ex yoga teacher implied it would restrict on bonding, and now a few of the mums at one of the mums groups i go to have said a few times about how if you give birth bu c section you miss out on the birth/ it's harder to heal from a birth/ birth is a beautiful experience you can't share if you're having a c section etc etc.

So basically my question is am I being unreasonable to think that most of the time a c section isn't an option and so asking if you minded having one is a redundant question?! Why do people feel if it's not a vaginal birth it's not a 'proper' one or you haven't suffered enough? And do people really think (like my ex yoga teacher) that vaginal birth is the only way and are actually 'against' c sections?! If so what happens if labor doesn't progress do they honestly believe you should die?

I've had both. No.1 emergency section. No. 2 vaginal. Recovered from c-section much faster than the so called "natural" birth. Just tell enquirers that you are so delighted to have a beautiful healthy baby and shut down the conversation. Congratulations!

I had a vaginal birth with twins. I don't remember meeting DT1 because the poor bugger got taken to SCBU to have her lungs suctioned, and by the time she got back 45 minutes later I'd passed out from exhaustion.
The chances of getting that sort of optimum bonding experience at the moment the baby is placed in your arms is pretty small I think, and that drive to perfection anyway has no place in parenting. Kids aren't perfect, parents aren't perfect, and to place the expectation of perfection on the birth experience just causes unnecessary stress and devalues the actual thing that is happening.

It makes me so sad that women put such pressure on themselves and each other.

In my NCT group, four had C sections. Then two of us had vaginal births but ended up in surgery immediately anyway due to placenta issues and haemorrhage.

The final one had a vaginal birth and did not end up in surgery but desperately wanted to breastfeed - her baby simply refused to do it and never latched.

So we're all failures I suppose

In reality I know very few people who had a beautiful birth experience. That's just not how it works for most, especially first time around. That's fine. I think it's healthier to view it as a means to an end and accept that much of it is out of your control.

Your yoga teacher sounds like a bit of a twat.

Well said Mouse

maggiecate, from what I have read since posting, the "obstetrical dilemma" is an unproven hypothesis. This an intresting article (I posted it upthread) which suggests that changes in human diet (with the introduction of farming and a carbohydrate-heavy diet) may also have played a part.

www.bbc.com/earth/story/20161221-the-real-reasons-why-childbirth-is-so-painful-and-dangerous

Interesting article, Mimi, but I am not quite sure about the underlying premiss that triggered the research:

"Wells agrees. "It's impossible to imagine the problem has been this bad over the long term." "

Why is it impossible? As long as the species survives (which it evidently has), why would it matter in evolutionary terms if the problem is bad for individuals?

Female squid die after laying eggs, every single one of them. A female squid professor might well look at this situation and call it impossible, but the species still keeps going.

I am always at any attempts to portray evolution as some kind of benevolent fairly godmother. Possibly because I know that both my dc have a genetic disorder which would have died out (through their early demise) if I had not fought like mad to keep them alive. Because I kind of like having them around. In fact, I care more about that than about evolution proceeding on its merry way unhampered. Not to put to fine a point on it, you could say that evolution and I are at cross-purposes.

As for the dietary aspect, that may well be true. But as we could not now return to a pre-farming economy/diet/lifestyle without killing off most of the human race, that seems pretty irrelevant. We have to make the most of the situation we have.

mouseclogs interesting post. The labouring body will squeeze out the child or die trying.

Yy. This is how I felt about it all. My body took over and did everything and I was bloody luck that baby came out with no intervention needed. It was bugger all to do with me. Which is why I can't understand the evangelical pushing that how you birth is something to do with with you mentally and spiritualally. Sp. It had as much to do with me and who I am as when I push out a shit. It's wicked to imply anything else.

And because we are being strangled by this background ideology women are afraid to speak to out!! Which is why I do and I like my personal example because my labor was textbook perfect six hours established labour no major tear. But the small tear I did have caused me more upset, pain than my section wound.

corythatwas, baby squid obviously don't need a mother to nurture them, otherwise it wouldn't be very good for their species at all that they all die after giving birth.
Human babies obviously do need a "mother" (and more so in times gone by when the father's role was to be out hunting/working).....so losing a mother during childbirth is far from ideal for our species, which is why it doesn't make sense that childbirth was always as dangerous as it seems to be these days....unless perhaps as a natural form of population control. I'm going to do a bit more digging and see what I can find out!

www.nice.org.uk/guidance/cg132/chapter/1-Guidance#planned-cs

NICE guidance. At 1.2.9.5, you'll see that women who want ELCS should be offered one. The fact that other support and counselling should be offered first doesn't mean they don't think women should be given ELCS. Nothing in their guidance suggests they think there should be a limitation placed on this numerically, that there's anything dangerous about us opting to do it.

Ironic also mimi that you would refer to the obstetrical dilemma as an unproven hypothesis while linking to an article containing so much supposition! Cory has explained it very well: the idea that consistent high maternal and perinatal mortality is incompatible with evolutionary success is totally flawed. The woman who has 11 births with only 3 surviving children is, in evolutionary terms, more successful than the mother who has 2 who both survive. Mother Nature couldn't give a fuck about her broken heart. That is not to say that factors like our diet couldn't have any influence, but when people are simply saying the problem can't possibly always have been this bad, they need to prove it.

Superb post mouseclogs.

Eurus, I didn't link it as evidence. It's not something I know much about, clearly! It was the first article I came across and found it quite interesting, and thought corythatwas might too. However, most references to the obstetrical dilemma do also call it a hypothesis, so I presume it is yet to be proven as fact.

Sure, but if you're saying something is a hypothesis then present something else without also noting the great big massive thread of (unwarranted) supposition running through it, you have to expect someone else to point that out!

Eh? I'm not trying to disprove the hypothesis. A hypothesis, by definition, is unproven. I'm just trying to learn about the whole topic, having never ever pondered it before reading this thread yesterday, and that article was, alongside explaining the original hypothesis, offering alternative/additional explanations.....which is the whole point of a hypothesis really. Test it and challenge it. Sorry if I'm being pedantic. Not trying to argue...just trying to understand the concepts involved.

If someone said no to an emergency section to save their babies life, and they deemed mentally capable of making that decision we would not go ahead. It's actually assault in the eyes of the law to go ahead without consent. Remember rightly or wrongly the baby legally has no right to life until the second it's born so a mother can refuse life saving treatment legally.

If to save the mothers life it's tricky ground. Technically if she has expressly said no and is aware of the risks we shouldn't go ahead but they usually would under the medical duty to preserve life, it's a murky area.

Thankfully I've never been involved in either. I have however been involved in a case where a mother refused monitoring in labour, there were concerns about the baby and we wanted to apply a CTG monitor, she refused all monitoring. We had to comply and deliver the baby not knowing if it was still alive or the condition it would be born in. Thankfully after some extensive resuscitation the baby was ok.

Great post Mouse.

MimiTheWonderGoat Sun 19-Feb-17 11:57:19
"corythatwas, baby squid obviously don't need a mother to nurture them, otherwise it wouldn't be very good for their species at all that they all die after giving birth.
Human babies obviously do need a "mother" (and more so in times gone by when the father's role was to be out hunting/working).....so losing a mother during childbirth is far from ideal for our species,"

Losing a mother during childbirth may well lead to the baby dying- but that does not necessarily affect the species as long as enough of them survive. That is the point I keep trying to make. Evolution isn't some kind of benevolent being that has an interest in individual babies surviving. In some species, the majority of babies die. That doesn't mean evolution has somehow failed.

catching that's interesting. I must have been considered not mentally capable then. I would have consented in the end I'm sure but at the time there wasn't enough time for the long discussion and explanations I would have needed to give proper informed consent. The registrar just did it and then came to see me the next day to apologize for not getting proper consent. It must be very scary for the staff when things like that happen and they have to make quick decisions. Ds5 was born 23 minutes after the registrar shouted "theatre now", floppy and grey but thankfully with minimal lasting damage.

Just to answer some of the responses to my post: I would definitely include mental health conditions as medical reason! All I am saying is that I do not think it is something that should be offered routinely.
It is a major surgery with the risks associated with that. There are some other maybe more minor 'downsides' in relation to the baby's gut flora which is a 'benefit' of a vaginal birth (although nowadays this can try to be countered via swabs etc). And i dont think the potential trauma for mother and baby should be entirely discounted. Again only comparing a (good) c-section with a 'good' vaginal birth. And certainly not suggesting c-section isn't a good option in many cases!

the NICE guidelines are interesting and actually still in line with my thinking: it should not be routinely offered or given however yes if mother does request it it should be explored and only agreed after much discussion on the risks and after the offer of psychological support and guidance.
So ultimately the c-section would still be in a way given for medical reasons ie either the mental health issues prompting the mother to request in the first place or the risk of mental health issues by forcing a vagina birth on a woman (obviously not a good idea!)...

I personally have no particular view on whether one way of giving birth is a 'success' or a 'failure' and no interest in judging women on that basis as it is quite frankly pointless.

CatchingBabies that's really interesting. I was never even asked for verbal consent (which I would have given) with DD2, which in hindsight I thought unusual as although there was no time to get a form out, I thought they'd have to ask as I was conscious and lucid just about. I'm very glad they just got on with it TBH, more so when I was told in recovery they'd had just 7 minutes (an odd, but very precise timescale?) to get her out from when our readings dropped. It was both of us at risk, not just DD2, so I fell into your 'murky' area I suppose.

The NICE guidelines are not at all in line with your thinking oblada because they are very clear that a woman should be able to choose an ELCS with no medical reason. That's exactly the opposite of what you said upthread.

Saying that a section is surgery with risks is invalid when you don't also acknowledge that giving birth vaginally is also a process with risks, and that a section actually reduces some of these. There is no risk free way to give birth, you just choose the risks you prefer. Some issues are more likely with a vaginal delivery, some with an elective, pre-labour section. And really, the idea that VB delivery benefits a baby's gut flora as against CS is speculative. It has been pretty clearly demonstrated that babies delivered by CS have different gut flora to those delivered vaginally It has not been demonstrated which, if either, is more advantageous.

As for trauma, of course this has to be considered, but presumably you don't think this is more of an risk of maternal request CS then attempted VB?

I've had two c sections. Never actually been asked that but in the case of 'were you ok with that'? I think I would have to answer 'well it was certainly preferable to my son dying, me dying or both, so yeah, I'm good with it thanks '.

skanking - just wondering if maybe you'd signed something earlier agreeing to surgical intervention should it be required - I have a vague recollection of it being in the paperwork somewhere!

With DS2, I was well aware all through the process of getting him out that at any point I might be whisked off for emCS - he was an unstable oblique transverse lie (head up under my ribs, either side, depending on how he felt that day - he had a lot of fluid to swim around in!) and if I'd gone into labour naturally it would have been an immediate CS. I'd signed papers for that prior to the induction just in case, but that's slightly different - with DS1 it was more straightforward but I still think that I signed something about agreeing to surgical intervention if required.

Not to my recollection Thumb. I was in the process of being assessed to go into the MLBU when things first went south so never got to a labour ward or birthing unit as such. I'd had height/weight taken, one lot of monitoring, checked dilation, and was just about to be unhooked from a second lot of monitoring when the shooting pains across my CS scar started (I suffered a uterine rupture). What followed was 3hrs of various medically trained folk making various suggestions as to what was going on (despite my insistence I suspected a rupture), including a few who thought I just wasn't coping with the contraction pain There was a lot of discussion and procrastination, but I don't remember any form signing. Then the monitor readings dropped dramatically and I was raced down the corridor like an extra in Casualty.

Those of you that had c-sections without 'consent". It isn't that they deemed you not mentally fit or anything like that. Sometimes it's just that serious an emergency where every single second counts and so there is no time to get forms out and go through the full consent procedure, which has to include a full list of risks vs benefits etc.

Now legally no matter how serious the situation is a quick verbal consent should at least be obtained or you can be charged for assault, in reality the medical staff are doing 100 things preparing for theatre and ensuring the safety of either mum or baby, reassuring the mother about what is going to happen etc. it's easily overlooked. Especially as it's VERY rare for someone to refuse any medical procedure when their baby's life is at risk so they almost assume consent and ask later.

While it's not technically or legally right to do that, we are human and we do the best we can to ensure a safe outcome and you just act sometimes without thinking. It doesn't make it right but it's easily done.

I had a situation a while ago where a woman I was caring for had a sudden cord prolapse (cord comes out the vagina) and this is seriously life threatening to the baby and requires a crash section. The management is to put your fingers in the vagina and push the baby's head away from the cord (to allow blood flow) while rushing to theatre. This was the first time I had ever dealt with this situation, I was alone and quite panicked really. I quickly followed the management I had been taught and pushed the head away from the cord, ran into theatre etc. thankfully baby ok. It was only sat in recovery I realised I hadn't asked the woman for consent to place my fingers in her vagina. I was truely horrified with myself, couldn't apologise to the woman more (she said it was fine and understood the urgency) and I've been bothered by it to this day because it shouldn't happen.

Oh and skanking - a uterine rupture is exactly one of those dire emergency situations where seconds count! I can certainly believe you were simply rushed off and it does fall under the immediate threat to maternal and fetal life. We call it a category 1 or crash section which is basically get into theatre now!