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'?

I was only saying it was a bad thing to clamp the cord immediately when it continues to pulsate an provide oxygenated blood if this is not done. It has the function of normalising blood volume and inflating the lungs so respiration can begin. Of course there is a switch over to the baby's circulation, when the baby starts breathing. My baby's cord continued to pulsate for 20 minutes.

Read the research and come to your own conclusions.

This article is interesting:

hcp.obgyn.net/fetal-monitoring/content/article/1760982/1911275

People are very judgy aren't they? Birth is a very emotive subject. We should all be more supportive of each other at this time.

I disagree with what you say sleepyspaniel - PROVIDED they do the right research, there is a possibility of being able to make VB a more predictable artform. A lot will depend on who does research and who is prepared to fund that research. I don't think its a forgone conclusion.

The research will follow the money.

To put it bluntly, there is a lot of financial interest in pursuing ways to make VB more predictable For example a swedish firm are currently doing trials in Europe using a lactic acid test to predict women who will need a c-section. They think its related to hormones - rather than simply pushing women into a c-s, they are aiming at looking beyond that into the possibility of research into balancing hormones to be more favourable to a natural birth. So two financially motivated interests there.

There isn't so much money to be made in research favouring CS. The money is in private practice performing them and not much else beyond that. Drugs is where the money is made, especially in a public health care system (and most of Europe is a mixture of the two rather than purely private).

I'm not sure that its favourable towards a 'natural VB' though.

Its worth also looking at where the political pressure lies, as again this will influence where the government money into research will go. Sadly it does tend to make for a bias. There is a much bigger pro-VB lobby in the uk both from the public and politicians than there is for pro-CS. Pro-CS tends to come under pro-choice instead, but despite this being a key to Conservative (and Labour) policy due to prejudices in the press isn't as supported as it might otherwise be.

If there was more interest in CS, then there would have been more progress made into looking at reasons behind maternal requests since a 2003 government review that highlighted the lack of information. The fact there hasn't been suggests a huge lack of interest, and indeed financial reward, to do so.

I had an ELCS with DD2 after an EMCS with DD1 due to her being breach but not diagnosed till she was in labour. I had no problems getting the ELCS I wanted, and had done a lot of research into the pros and cons of both. However I was surprised that in all the literature from the midwife and hospital and all the discussions they only give you the cons of a CS not the cons of a VB: such as the incontinence, tearing, damage to baby as mentioned in the OP.

I do think researching it thoroughly, and probably scaring myself in the process about all that can go wrong with a VB, helped me make the decision.

My initial reasons for having an ELCS a second time was a lack of faith in midwives who couldn't even work out which way round she was when I was pregnant so why on earth would I trust them to deliver a baby after that.

The idea of letting the doctors and midwives decide what's best is understandable. However, the woman's state of mind is absolutely key to labour going well. If she has been refused a C-section, a epidural, access to waterbirth facilities, or anything else she was expecting and relying on to get her through it, then it's predictable that labour will not progress well, resulting in complications, interventions and birth injuries. It is absolutely imperative to listen to the woman's needs and desires around and during childbirth and to accommodate them as far as reasonable.

I'd be interested to know of women who are refused an elective C-section because it is judged by medical professionals that they are 'physically and mentally capable' of giving birth vaginally, what the stats are then for an instrumental or emcs delivery.

I have absolutely no issues with women that have C sections. I certainly don't think it's an easy option like the media make out - and I would have hated to have had one because of all the aftercare involved. However, DD was transverse lie until mid 30 weeks and I had a low lying placenta. Had those problems not resolved themselves naturally I would have had no issue in having a CS. Birth is a means to a beginning, not an end.

What I do have issues with is the readiness of HCPs to get women in for CS but above all I hate the climate of fear that is around Western births. Birth is portrayed as a hideous, terrifying experience and this was not the experience I had. I heard the usual horror stories of how I would be torn in two, I would never be continent again, I would never manage the pain and that I would feel as if I was dying. I didn't have any of that. The portrayal of birth on film and TV does nothing to dispel this, every birth is a drama. IMO this is leading women to fear birth to such an extent that apparently 1 in 10 women have tokophobia and feel their only way to deliver is via CS.

I would be really interested to see tokophobia rates in countries where birth is not given the horror treatment it is here. I'm not saying that it doesn't exist, just that might be considerably fewer women labelling themselves as tokophobic in a country where birth is not turned into such a hideous trial

PS. Not saying that everyone is lucky enough to have a decent birth just because I did.

Following this thread with interest; Widow there's no need to be rude! I hate to quote Wikipedia but even that has the cord ceasing to pulse from 5-20 minutes after birth, so the 20 mins quoted above seems reasonable. en.wikipedia.org/wiki/Umbilical_cord

Jchocchip

I totally agree with you that there should be a wait to clamp a healthy cord until it has stopped pulsating as long as the baby has been delivered in good condition. It is the foetal blood after all that is being returned.

It just that waiting as long as the other poster suggested would be of little use as the cord will only function optimally regarding veinous and arterial return for a short while due to the necessary biochemical changes occurring within the placenta/cord which initiate placental detachment (and help lactation/bonding hormone too|).

Not so sure about Wikipaedia as a totally reliable source. I stick to the medical/nursing journals which are peer reviewed and subject to proper sanction.

I really hope you are wrong SleepySpaniel! Though if, as is predicted, antibiotics fail in the next fifty years and we can no longer control infection, we might well see a return to a much more basic form of medicine. I had an awful VB but I totally agree with OhdearNigel, its this climate of fear, women on their backs strapped to monitors, tensed up with terror and begging for epidurals that makes women feel that a CS is the safer option. Birth doesn't have to and shouldn't be like this.

I seem to be in the minority, in that I had an elective caesarean that didn't go very well.

I had done a lot of reading before making the choice to have a csection, and been on tons of threads on mumsnet, but nothing prepared me for just how awful I felt. My blood pressure plummeted, I lost tons of blood (borderline transfusion at 1700 ml), throughout the op I felt woozy and sick, and after the op I was too shaky to hold ds, then started vomiting uncontrollably. Ds had low blood sugar, and couldn't feed, they tried him with a bottle, cup and syringe, but ds wouldn't suck, and then it was noticed that he was grunting badly and so he was taken to NICU where he was put on cpap. I spent the first night in a room on my own, vomiting and shaking, with pains in my chest, whilst ds was in an incubator in NICU. I was able to hold him 2 days later when he was able to be taken out of the incubator. Ds was in SCBU for 8 days, whilst I switched from the postnatal ward to SCBU and expressed like a crazy woman for his tube feeds. I was in agony after the section, despite being on morphine and paracetemol and codeine, the gas in my chest was horrendous, and I developed phlebitis in the veins of my leg (which was the size of a small tree trunk!) from having to push ds's crib around scbu. When we finally got home I was wrecked for weeks, ds was ill and I developed mastitis and in infection in my wound which left me delirious.

I suffered PND and PTSD following ds's birth and ended up on anti depressants. I was referred for counselling, but when I turned up the consultant in charge of my care when I was pregnant and the surgeon who did the section were there and the whole thing came across as an arse covering session (ds has global developmental delay, and problems with his muscles which are under investigation). I don't know whether ds's problems are a result of something that happened during the birth, there is a chance we will never get a diagnosis let alone a cause.

I think that there is an impression that with a section everything will be under control, but I found that not to be the case. I found the whole thing brutal, and have nightmares about ds being pulled out when he isn't ready to be here.

I know that vaginal births can be horrendous, and there is no black and white when it comes to the unpredictable world of giving birth, but it angers me when i see elective sections portrayed as the easy way to give birth.

The more I read on here, the more I think we REALLY need to separate out the experiences of the ELCS and the EMCS. The EMCS by its very definition is a last minute emergency, rushed, and there is already a medical predisposition to something potentially going wrong.

On the other hand, an ELCS is a major operation, but surely the outcome is as predictable as any other type of serious op? Gall bladder removal, for example. Yes, very occasionally something goes wrong, but overwhelmingly they just go according to plan...

hazey what a x-post! So sorry to hear that you had such an awful experience, and hope that you are able to find some answer and get some closure for you and your DS. And yes, even though you are in the minority, it doesn't make it any easier when it you that it's happened to.

I don't know from personal experience, but of course CS isn't the easy option - don't listen to anyone who says it is.

Ultimately, it's about weighing up risks for yourself and your child, and making the best, informed decision. However, I still agree that giving ELCS as one of those options is fundamental to being able to allow women to choose the best option for them.

As an example of how consultants weigh risks - I was pressured to VBAC and told there was no medical reason why I couldn't. When I pushed back a consultant reluctantly agreed that, yes, I did have about a 60% risk of emergency csection (there is a calculation for this) and about a 30% chance of instrumental delivery. So about a 10% chance of "normal" delivery.

My attitude was that those weren't good odds given the increased risks inherent in an emergency csection and the fact that I didn't want forceps. His attitude was "forceps get a bad press and we'll just give you an operation at a later date to sort out the damage". I am not kidding or exaggerating.

And we all agreed that the risk to my baby was less if I had a planned csection.

I think that's a really good example of why women need to inform themselves and to exercise choice. It wasn't a big deal to him if I suffered the complications of an emergency cs or if I suffered pelvic damage. It was to me.

Incidentally I did have a bad planned section in the end. Under private care (paid for by insurance company) with a leading consultant. It's the worst case scenario but at least I know that I did my best to avoid the risks.

HugosGoatee, in answer to what you say it seems that fear/anxiety has a HUGE part in how labour progresses. This is what home birth advocates say, and this is what scientific research into child birth fear seems to say.

Have a read of this summary of an research paper done in sweden. Its not the stats you are after, but its connected and reveals some interesting figures. The article is a fairly decent summary of the full report:
healthland.time.com/2011/09/23/women-who-are-terrified-of-childbirth-are-more-likely-to-have-c-sections/

It seems to suggest that if you are more anxious, you are more likely to end up with a prolonged, difficult labour potentially with a greater chance of instrumental delivery or a EMCS.

I don't necessarily think the research needs to promote ELCS. What it does is promote the idea that fear in itself is a risk factor that should be dealt with during pregnancy. And there are many ways in which you can do this (for example the homebirth route might be more suitable for some women than an ELCS).

HazeyJane-

Sorry to hear that. Were you nil by mouth for a long time as sounds like you were hypoglycaemic and hence, so was your baby? A glucose drip is not always enough to keep one from feeling like this.

You should have been given drugs to bring your pressure up as that sickness and shakiness comes from a plummeting BP common during epidural-CS in combination with blood loss.

The pain in your shoulders and chest was caused by changes in abdominal pressure and is called 'referred pain'. Were you told what it was and how to help it? it can also be triggered by muscular spasms that occur during induction of anaesthesia but you had a epidural didn't you?

I agree-nobody should portray CS as an 'easy way'. i think what many who have had 'good' Cs experiences are trying to say is that compared to the alternative, their CS did seem easy and that when it goes well, it is a good experience.
Same as with VB.

That's the point though isn't it? In the case of ELCS it's an unnecessary major op. Doctors don't routinely remove appendixes to prevent appendicitis because surgery carries major risks.

If there are medical (including psychological) reasons for an elective then that's great but leaving the decision up to women who don't have the experience/capacity to understand and weigh up risks doesn't make sense.

nursenic I think that it is when the baby has been delivered in poor condition that it is imperrative that the cord should remain intact while resus takes place. The link I posted above cites numerous research papers.

PS I'm not saying that women are incapable of doing these things but that not everyone will look at the decision in the same way. And that women who are already labouring are in a pressurised situation making it difficult to think clearly about it. Doctors make decisions on the spot, taking all of the risks into account every day.

Thanks for that link Jchocchip-

I'll have a good read of it.

hazey I cross posted with you as well. You'll see in my post that I had a bad experience with my csection - sorry to hear about your experience and I hope your baby is ok now.

merielandmatt - the point I was trying to make in my post is that the doctors don't always have the same attitude to risk as the patient. Things that for them may not be important can be lifechanging and devastating to the patient. There is often no clear cut right or wrong which is why it is supposed to be a discussion about attitudes towards risk when agreeing on birth options.

meriel at what point is an ELCS an unnecessary op? As it stands in the UK at the moment, ELCS is only performed if there are medical reasons for it, or if there has been a previous traumatic VB.

Comparing it to removing a healthy appendix to prevent appendicitis is a faulty metaphor. The baby needs to come out one way or the other, and this is about the mother weighing up the risks between two different ways of having it. Again, I'd like to reiterate that VB most certainly carries risks too, even if it isn't a major operation.

leaving the decision up to women who don't have the experience/capacity to understand and weigh up risks doesn't make sense.

Except its not that is it? Its a dialogue between a patient and a doctor. And in very few circumstances are women lacking in capacity that. Otherwise, doctors wouldn't even bother asking for consent on any other operation. It would just be deemed to be in your best interests...

The point of 'choice' is to allow a two way question/answer session to assess what is most appropriate for an individual based on her needs. A doctor can strongly advise one way or another on any medical procedure. It doesn't mean a patient has to agree to it. We should question things and be involved in decisions about our care.

Its interesting that in other areas of medicine, doctors often make decisions about their own care that they wouldn't necessarily advise their patients to take as they use different priorities to decide their own care. A less risky procedure for example, may have more life limiting side effects than a more risky one. A doctor might advise a patient to take the less risky route, but themselves be more inclines to take the more risky one as the side effects were deemed unacceptable to them personally.

And of course theres the whole obstetricians being more likely to opt for a c-section argument as part of that...

Sorry, I should clarify, I mean weighing up the risks as told to them by a medical professional. I do NOT believe that HCP should be making the decisions for the individuals, but should be simply informing them fully about what the pros and cons are of every option.

Like a previous poster said - the Dr or midwife really probably doesn't give a crap about what you may have to go through post birth, and (certainly in my VERY limited experience, admittedly) couldn't give a rats' whether there are hundreds of complications down the line, as long as they can't make their lives easier, hit their targets, and keep the PCT mildly happy.