Why is there so much judgement directed at c sections?

[DanceLikeTheWind]

I honestly don't want to start another endless VB v/s CS debate. I am just eager to read any insight that people may have on this topic- Why are other women so judgemental towards women who opt for c sections, whether elective primary c sections or repeat c sections?

There are several reasons why I will opt for a c section: a prior (minor) uterine prolapse, anxiety issues, and a family history of erb's palsy and incontinence.
I have faced nothing but judgement, ridicule and even hatred from other women :(:(

I am well aware that this is a major surgery with a longer recovery. I'm well aware it shouldn't be done prior to 39 weeks (unless of course I go into spontaneous labour). I'm well aware of the increased risk of complications in future pregnancies, however I don't plan on more than two babies.
I'm also aware of the risk of staph infection.

However, by opting for a c section I'm reducing my chances of developing
incontinence and prolapse. I have a zero chance of suffering an obstetric fistula, a third or fourth degree tear and perineal trauma.
My baby will be at a reduced risk of cerebral palsy, erb's palsy, brachial plexus nerve injuries and trauma caused by a possible assisted birth.

I'm not hard-selling c sections here, just pointing out that there are some benefits to a c section as well.
Why then do people only focus on the negatives? And why are the varied risks of a VB ignored simply because it's 'natural'?

If medical professionals were properly factoring in the mental as well as physical aspects, the long term as well as the short, they are far more qualified than mothers (with no medical training) to judge the risks and select the appropriate birthing method.

I think this whole recent trend of giving over important decisions to utterly untrained individuals who often have an extremely shaky grasp of statistics is crazy. For one thing I already have a day job and I dont need the responsibility of having to get a medical degree and keep constantly on top of the research literature in order to make truly informed decisions about my health care. Thats what doctors are for!

jchoccip so you reckon it wouldn't have been a stillbirth at home? Because a baby has a better chance of surviving emergencies at home? Seriously? I don't think anyone was to blame for that particular death, I just used it to counter the "a midwife could solve any problem" bollocks.

I agree with you about informed choice. I just think it's important that information shows as little bias as possible.

ps. I realise thats a big IF at the start there and that doctors do not always look enough at the individual circumstances atm.

Or rather I think that 'your body your choice' was the rule that was applied when you chose to conceive and bring the baby to full term. Having made that decision you are now committed to act in the babies best interests (who didnt get a choice and will be stuck with the consequences).

On the basis of what's best for the baby alone, I'd have an ELCS every time, no two ways about it. It's worry and fear about my good self that prevented me from asking for an elective CS in the first place, although I ended up having a CS anyway because it was deemed best for the baby.

entropygirl - that's utterly utterly patronising.

Yes, the HCP involved should help the women understanding the stats involved. I agree with you, as someone who's only left to google for themselves and doesn't have a sound understanding of how to interpret stats, can easily fall for very biased information.

However, once the HCP has explained the risks (and stats behind them), the decision should be down to the individual, and not dictated. Patient choice should be paramount.

It's the same in any other healthcare situation, (unless they're sectioned), that a patient has the right to choose which treatment he wants to accept or decline. Why should it be different when it comes to birth?

I know nothing of the circumstances of that stillbirth in hospital so can't comment. It is sad, it happens. Midwives are highly trained professionals its not b*ks as you put it. It's been my choice to trust them to take care of me and my children. I'd rather have a physiological third stage. It's evidence based. Ie there is no evidence for clamping the cord immediately and cutting off the babies blood supply before they start breathing. But that is what happens in hospitals all the time.

It should be different when it comes to birth because it is not just your life on the line. The personal choice of the mother should not outweigh the safety of the baby. I just cannot imagine a justification for that!

NICEyNice - sorry again I wasn't clear. My point was more that these women were comparing a private system here with the NHS and not understanding why they weren't immediately given more choice. It is impossible to compare the 2 systems...I also wouldn't be able to afford to go private in the UK and am sure the majority couldn't either.

I am in no way judging anyone for choosing CS over VB or viceversa my point is is that, should every woman be given the choice and CS rates increased (they seem to be very high in countries where a less expensive private system is in place so I am not sure why mothers in the UK would all still opt for VB given the choice - many women on this thread have said having looked at the pros and cons they may well opt for a CS) the NHS in it's current state will not cope and mothers and babies will be neglected even more so than is happening now..

I do not have preconceived ideas about this. The choice is a reality here and the reality is that the vast majority choose CS over VB for whatever reason. We won't know if this will be the case in the UK until the choice is provided on the NHS....interestingly there are a number of threads about this very subject on another popular UK mums website and a lot of 1st time mums say they will opt for a CS.

Widow How is that patronising? I have a PhD in physics but I don't find it patronising that an obstetrics expert told me what was best for me and baby during labour. Sure he might have been wrong but his best guess is better than my best guess....

jchoccips Of course they're highly trained professionals, I never denied that.

But they can't work magic. Being highly trained is not always enough, especially if you don't have every tool imaginable at your disposable. And even if you have, sometimes that's not enough if the shit hits the fan.

Also, the nonclamping of the cord is no magic solution to all breathing problems. If the baby doesn't start breathing pdq the cord can be attached as long as you like, the brain will still be deprived of oxygen. That's simple physiology. (Please note that I'm not arguing early clamping, only saying that late clamping doesn't make up for not breathing.)

Tinsie I had the opposite experience...I would have had a CS if it were just me but the babies position etc. meant that VB was the safer choice on the day as it were.

But thats my point - either can be the safest on the day but there IS a safest method and that is what should happen, regardless of the womans choice.

I had an emergency c-section with my non-ID twins at 38 weeks (full term for twins) when my induction wasn't working. I say emergency, as it's how it was referred to, but my twins or myself weren't in a any difficulty (if that makes any difference) I was in agony during, and after- I felt far too much during the operation, and lost quite alot of blood. I felt unable to hold my babies properly the following day as I felt on the verge of blacking out at any moment. I felt out of control and exposed. I could go on, but I won't. It was just an awful experience for me in general, and I am fairly certain I will never have children again for the fear of having to go through similar. BUT I do realise that many people have far better experiences than me, including two of my friends who recovered fully and quickly and generally feel alot more positve than I do.

What angers me is how many people seem to think that C sections are an easy option- they are anything but in my experience. I have had people say "ooh, at least you had the easy option, no painful birth for you!" I know I've had a negative experience, and I am firstly eternally grateful for the safe delivery of my children, but I cannot buy in to this 'too posh to push' notion. Surely people are not this naive? It is a major operation, with sometimes long lasting effects. I do think women should have as many options as to what happens to their bodies and how they give birth, wherever possible, and not be judged for this.

entropygirl - I'm not saying you shouldn't trust your obstetrician -but they're capable of presenting information in the way of "in case of x, possibilities are y, in case of a possibilites are c", not just saying "right we're gonna do z, because that's what's best for you in my opinion". That's not happening in any other healthcare situation either.

As to that there are two individuals concerned, I partly agree with you, if the risk-benefit balance is very strongly weighted against something, a HCP should be free to say that he wouldn't want to take responsibility if something went wrong and refuse to attend. But that's simply not the case in a ELCS situation.

Safest? Safest for who? If childbirth was predictable maybe. If women didn't vary so hugely in psychical and mental needs. It has to be assessed on a individual basis - 'women centred care" I believe is the buzz phrase - using generalised risk as a background to a patient doctor dialogue. Choice has its place in this as a result.

Left alone, the cord will continue to pulsate and circulate oxygenated blood into the baby for about 20 minutes in my limited experience. You therefore have the luxury of time to get baby to breathe before brain damage sets in. My son had the cord a couple of times around his neck and was blue. Immediate cord clamping would not have done him any favours. I read research, I made my choice and I'm glad I did... You can still ask for dcc if you have a section and recent evidence suggests a couple of minutes delay in clamping is to be preferred.

20 minutes? So in your experience the placenta will not detach and supply sufficient oxygen even if the baby isn't breathing for twenty minutes?

widow I was in unbearable pain and utterly without reason during my labour. It drove me mad that every decision had to be run past me as if I had anything useful to say or could even understand what was being discussed.

The only thing I 'heard' was your baby will be at more risk if we do the CS (because she was positioned awkwardly), which I was just about coherent enough to decide that meant I didnt want it. But how can you possibly expect someone to try and weigh pros and cons rationally in that situation? And what if even though there is a huge risk to the baby, the mum (in extremis) demands the procedure anyway? Or in reverse, someone is adamant that they will VB even though the baby is in distress. Is the doctor supposed to suck it up and let the baby die?

No, I think the baby has the rights to the delivery that provides the best long term outcome, and the choice of the woman has almost nothing to do with it.

Of course I do totally concede that at the moment HCP's dont take enough of the aftermath into account. It is more than just getting the baby out in one piece, and a mum that cant walk for 3 weeks afterwards or ends up with long term depression is a risk that has to be included in the analysis.

It would be different if women had no control over conception or bringing to term, but in this day and age (with a very few possible counter examples) you only end up in labour because you made the active decision to do so. You signed up to the associated risks so you shouldnt get to choose a suboptimal delivery method that puts the baby at unnecessary risk (either VB or CS, which ever that might be in your case.)

yes

Or in reverse, someone is adamant that they will VB even though the baby is in distress. Is the doctor supposed to suck it up and let the baby die?

Actually yes. They have to have consent agreed legally. They are ethically not allowed to intervene unless they have reason to believe the person is mentally incapable of making the decision and understanding the risks involved. So if it has been discussed ahead of time and the woman still maintains the same opinion, then doctors should not involved. They may do, in a crisis situation, if it hadn't previously been discussed and they felt the woman wasn't able to give informed consent properly.

See Jehovahs Witnesses...

entropygirl - hang on we're talking about two different scenarios - discussing my birth options and the relative risks at my 20 week consultant appointment is very different to the emergency situation you describe - and still, it was good, I believe that you've been provided with the reason why they thought a vaginal delivery was the better option than the CS.

When my first birth went wrong I was also presented with the option and a very strong recommendation into one direction - being under time pressure of course changes the situation. And you're still free to say "please go with what you think will be best for me and my baby"

Widow- yes, that's right. The baby's circulation does not start to re-route through the lungs rather than the umbilical artery and placenta until the baby is breathing properly, meaning that while the cord artery is still pulsating, the baby can be sustained in oxygen through the placenta, and the placenta will in theory not start to detach until it is no longer needed. It's all amazing really.

I'd laugh at your delusion if I wasn't so shocked at the utter lack of understanding of biological processes.

duchesse-

The first breath a baby takes causes the re routing of the previous fetal circulation. The heart chambers immediately function and the route bypassing the lungs is sealed.
Very occasionally the baby needs surgery due to this happening incompletely called Patent Ductus Arteriosis.
It is wrong to say the process takes 20 mins approx. It happens immediately, is progressive and importantly incorporates a trigger for the cord to stop pulsing and 'hand over' the job to the CVS. This trigger is the change in air pressure from the internal environment of the uterus to the open air after the umbilical cord emerges, attached to the baby.
The umbilical cord and placenta are not a substitute for the babies own CVS because at the moment of birth, even while the cord still pulsates, hormonal and pressure changes are initiating the sealing and detaching of arteries, veins, capillaries and arterioles. The placenta starts changing on a cellular level immediately. The newly born baby will not be adequately oxygenated after a few minutes-not 20!

I predict that in around 50 years most births will be state of the art CS with minimal recovery time, as it will be decided along the way that VB are too unpredicatable for the health of both the baby and the mother.

In around 100 years we will be surprised at anyone who has a VB through choice.

I have yet to hear personally of a CS gone wrong in ANY way, despite the stats, whereas I have heard of lots and lots of VBs with injuries to the mum and/or baby. A lot of consultants apparently choose to have CSs because they deal with the aftermath of VBs gone wrong which MWs do not, of a regular basis.