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 had a wonderful elcs with a very quick recovery. I had no problems with b/f and am still b/f 6 months on.

My friends were all supportive - those who hadn't given birth were interested and non-judgemental. My friends who have been through labour were not judgmental either, and quite a few of them opened up about the traumas and birth injuries they had suffered, and said how lucky I was to have avoided all that.

The one and only judgemental person I can think of was a post-natal midwife who had been very involved in getting birth pools installed in the local hospital. All the other midwives and my health visitor were great.

Two C sections- the first due to deep transverse arrest, the last one because i suffered uterine and urinary bladder rupture during labour. Luckily had epi in place so was awake during my 3 and half hrs of surgery and repair and had complete epi pain relief left in place but it damn near did for us both and i had a 7 unit transfusion and 3 units plasma.

However- up and about the next day, breastfed skin to skin straight upon my return to post natal, walked older DD to school 6 days later. Community Midwife appalled I was on my feet but I was honestly fine.

And although anecdotal, i don't piss myself every time i laugh, trampoline or jump up and down unlike many of my friends/colleagues. Whether it is a small urinary 'leak' or larger volumes I am continually amazed that so many women just 'live with it' and do not seek any resolution. Almost as though some women accept it as a 'normal or inevitable' part of post pregnant life.

During the 'midwifery' placement of my nurse training, the women in our class were asked how many of them suffered any degree of urinary incontinence. Out of my class of 92, 50 women had had children and out of those, 38 admitted to experiencing this. Out of the 12 who did not, 3 had had VB, the rest C section. Oh, and of the 14 men on the course, i think it was 9 of them who saif their wives suffered this still.

I don't give a damn about how people give birth; what concerns me is how many women accept or live with urinary problems that should be considered totally unacceptable.

Forgot-
breastfed DD for a year and a half, DS for two years. No problem at all because i ensured i was taught how to position my baby. I probably pissed midwives off but it IS part of their job and women need to be more insistent upon this.

OP, a lot of women's atttitude towards Csections is a HUGE can of worms, IME. Often contradictory, it's a mess of fact, rumour, emotion and cultural prejudice.

One huge problem is that info about EMCS's and planned CS's has always been mixed up together - so getting an accurate picture of the risks and benefits of planned CS is well nigh impossible.

You've also got cultural and religious background - remember that up until yesterday, historically speaking, the out and out assumption was that the pain and risk of childbirth was something we had to endure as punishment for Eve - suffering was seen as women's 'lot'. That sort of inheritance doesn't disappear overnight, and a lot of hostility towards C sections (and epidurals) comes from a sense that women are somehow 'getting out' of birth.

That's part of that weird attitude you get where women who choose CS's are often accused of being vain, or 'chickening out' of labour (a la Frederick Leboyer) - at the same time as they are being told that a CS is so much worse and more painful than a VB. And so on.

I also think some women who have had tough VB's can have a 'if I had to go through it, you do too' attitude. They are the worst, IME - they'll be the ones arguing that no woman should be able to choose a CS. A lot of the time they'll have rationalised their experience partly by telling themselves they had no choice, that's just how you have a baby, so just get on with it etc etc. (and trying, sensibly enough, to find the positives in their experience). For them, the possiblity that a planned C section might actually have been a better experience, and caused them fewer long term problems just isn't something they want to hear. I think they have a real need to believe that a C section under any circumstances would be worse, otherwise it leaves them in a very difficult place.

I agree too that women who have had very straightforward VB's sometimes struggle to understand what it means to have been through a bad experience, and to find a C section preferable. I also think that some women who have had traumatic EMCS's find it impossible to imagine why anyone would want a planned CS, or that it could be a very different and much more positive CS experience than theirs.

For the posters who are telling you you aren't being judged, and it's only your own anxieties etc that are a problem - no, there IS a lot of judgement around about CS, and a lot of has a very muddy motivation.

Hmm - up to you of course - had an EMCS and then a VBAC - vaginal birth was my preference and was a better experience for me - and much better recovery
Planned CS of course different from emergency in emotional terms
and in terms of pain there was a lot after the CS
However other downside of CS are risk of infection - met someone in hospital with a really bad one and more difficult to convience subsquent babies
however I would think it is worth exploring with someone why you feel so strongly - which I think is in the NICE guideline

With your history nobody can blame you, seriously.
I chose a ELCS just because I didn't fancy trying for a VBAC. I've researched risks and benefits of either, made my mind up, discussed it with the consultant who was quite satisfied that I looked at it very thoroughly and got my CS.

In a risk/benefit calculation you should assess both likelihood of occurence plus severity of outcome. It doesn;t help you if something is very rare, if you end up being one of the rare cases, at least that's my take on it.

I don't tell anybody who wants to give birth vaginally at home, in a MW led centre or at hospital that they're wrong and should have a CS

I don't tell anybody who doesn't want painkillers ever that they're wrong and definitely should get an epidural at 37+0 just in case it starts.

Everybody needs to choose for themselves what they want to go for. (But are best of keeping an open mind if their prefererred way doesn't work out)

I really don't get why some NCB advocates feel the need to dictate other women which risks they should take and which they shouldn't.

I'm really surprised (as with most judginess based on ignorance) that so many of you have had such horrid comments directed at you, regardless of how you choose to birth. I had my first at home and am planning the same for DC2 (due any day) and while I've had a few comments of "wow, you're brave" I've only had one person being outwardly hostile(my delightful aunt telling me I was selfish and putting my babies' lives in danger) but regardless, my utmost belief is women should have access to the information they need to make an informed decision about where they feel safest to give birth. So much is left to fate at the end of the day that least if you start out with minimal fear, and faith in the people assisting you then the outcome is more likely to be good .

But OP I have to agree with the posters saying your post is a bit disingenous, it's one thing to ask for support when you've come against hostility and even though I have my reasons for wanting to avoid a c-section as much as possible, I would support you in your choice, you have created a bit of scaremongering for those choosing or wanting VB, especially those attempting VBAC, which to be honest makes you loose a bit of my support because you're coming across a little bit as judgey as those you claim who judge you.....

DanceLikeTheWind I'm going to take a wild stab in the dark here, based on this post and a couple of others you've made and say that I reckon you've got a case of full blown tocophobia going on... fear combined with a obsession with finding facts and data...

You've been doing all the research as you are terrified and are pretty desperate to get an ELCS and the press, the NHS and his dog all seem dead set against it. You need something to back you up and support how you feel.

The trouble is not that women are against ELCS. They are mixed up with EMCS and people are being spoon-fed a lie about why women want them. As they have been taught by the press that women are weak, too lazy to push and don't want any pain. In short they think women choosing ELCS think they are an 'easy option'.

I find the tone of your post very defensive and quite agressive in tone as a result - I think you are more likely to get hostile responses because of that, rather than the reasons underlying your argument. I've not seen much of an anti-cs feeling on MN - ONCE your reasons have been explained. I think women here are openminded enough to accept psychological (and physical) reasons for an ELCS. Its just lifestyle choices that are frowned on (and the reality is, virtually no women have ELCS for those reasons) Sometimes you don't want to have to explain or justify yourself. Hence the being defensive...

I also think you are reluctant because of your own personal view to be able to look at VB in any way as being a positive thing. They are for some women, and I think for most women they ARE the way to go. Its just that for 6% of women with severe tocophobia, the idea of childbirth just doesn't compute in the 'correct' way. Its a huge barrier that other people don't get. But as much as sufferers struggle to be understood, the opposite is true - sufferers need to also need to try and understand why going natural is right for other people. Respect has to go BOTH ways, and I don't get much of a sense of that from you. You need to be careful in the way YOU come across. You ARE judged for wanting a CS. But if your attitude is coming across as hostile and negative then that has an impact on how others perceive women who want ELCS too.

I also think you are slightly burying your head in the sand with regard to ELCS and the risks they have. NONE of the research out there is for women who have more than one ELCS. So two ELCS rather than just one is still taking a gamble. Your baby IS more likely to end up in NICU. You ARE more likely to end up needing a hysterectomy. You ARE much less likely to manage to BF.
And you are neglecting the fact that incontinence is STILL an issue for women who have an ELCS, it only reduces the risk. (I'm fairly sure your mistaken about the stat of 35% of women - i believe that figure is for ALL women not just a VB).

NICE has made recommendations for research on ELCS - particularly for medium to long term risks as they simply are not known now. You ARE taking a gamble on a lot of things if you have an ELCS as there are huge gapping holes in research we still need to address. I have little doubt in your case an ELCS is for you, however you still need to make sure you aren't being blinkered due to your fears.

If you want to argue the case for ELCS you HAVE to be balanced and you HAVE to say both sides of the argument - and that includes the points AGAINST it. You can't neglect them. You need to do your research with more of an open mind if you are going to try and persuade others of your argument without annoying them in the process with your approach, which I have to say is getting close to bordering on 'militant' in tone. You do need to listen to pro-VB arguments, whether you like it or not. (Then choose to ignore it).

You need to also remember that there are natural birth lobby groups but not really any pro-ELCS groups to even up the balance. Not to forget that, midwives in this country have a lot more power and influence than in other countries as they are better organised. Its not that people are necessarily anti-cs, but more that they just have been taught things in a certain way.

Its a press and cultural thing though. It doesn't really exist outside the UK or US. And a lot of it is backup up with the way ELCS are recorded (or more to the point, are badly recorded). "Too posh to push" shifts newspapers - the press has no interest in changing attitudes if it can make money off a myth.

I agree with fruity on a great many of her points too. A VB goes hand in hand with ideas of feminity and the right of passage into motherhood. Far too often, in terms of failures in the NHS I'm seeing an attitude that we should just accept this or that problem as theres no money, rather than a fighting attitude to kick the bloody doors off Downing St for it. Any suggestion for changes in maternity comes with a hostile "we can't have that!". The same goes for a weird acceptance of pain, suffering or complications... Its a woman's burden and she must accept that as part of her role as a female. 'Failure' is a word that is used too commonly with a CS - right down to the medical term 'failure to progress'.

Girlwiththemouseyhair-

My partner's three children were all home births born in the eighties and early nineties; all of them smooth and how birth should be.

I was Little Miss Medical Model in contrast; through necessity.

All birth is amazing; unsolicited criticism about anything always says more about the motives, emotional or whatever of the person criticizing. They do reveal their inadequacy/insecurity by crapping on somebody else's choices or beliefs.

Good luck with your birth!

And my comment 'smooth and how birth should be' does not relate to cultural values but rather with regards to how nature intended it.

No woman should be blamed for any deviation from this.

The issues I have with VB relate to the overuse of episiotomy and the statistical incidences of pelvic floor problems and urinary incontinence left unaddressed afterwards.

In the UK incontinence is a huge issue because there is no systematic provision for pelvic floor physio afterwards. The rate of incontinence in other countries is far, far lower. Those are the ones with physio.

Fraktious_

yes yes yes! France for example. Physio prescribed afterwards. Japan- I have several friends who have given birth there who all describe how birth attendants apply warm compresses and oil to the perineum during labour, helping it to become more pliable and 'stretchy'. As uncomfortable as some said it got, the perineum around the crowning head was massaged, pressed with warm sterilised gel pads and the babies head delivered with minimal tissue trauma.

Thanks nursenic (assuming you're referring to what my aunt said to me?), I'm fine with it, I have made my decisions based on what I know is right for me and through making those choices have realised how personal a thing it is - I'm just surprised by how many people come across such hostility because I would never judge another woman's decision - it's just horrid, and makes me a bit sad - but then I suppose nobody will really understand it until they go through it themselves?

Yes, I was referring to what your aunt said.

I don't know why I still get so surprised by the level of venom and judgement women regularly direct towards each other.

But sadly some of the most judgemental seem to be those women who have gone through it which seems to switch on the self righteous and self centred gland.

What's the evidence base for the oil compresses making it more stretchy though? Just because it's done, doesn't mean that it neccessarily changes the outcome.

In Germany they do so called "Rueckbildungskurse" starting from about 6 weeks post partum, I always thought that was just typical German OTT-ness. I was quite happy to just do the exercises the physio had explained to me after my CS - they even gave me a leaflet with a reminder how to do it. (Plus I kept doing kegels all through pregnancy anyway)

I would have to look for the evidence base and will ask my OB/GYN Japanese friend who gave birth there.

But there is certainly plenty of physio evidence that if you warm and gently massage soft tissues, then there is a concurrent relaxing of the muscle fibres which may or may not be psychologically initiated. In addition, tissues under stress and pain will be flooded with histamine which triggers bio chemical stress response.

You only have to look at what happens to the tensor muscles surrounding hair follicles to see the effects of warmth, relaxation and cold. And there are plenty of those in the perineal region. And that's just one type of tissue.

Certainly more emphasis on pre natal pelvic floor health is needed. Not enough to hand out leaflets and merely tell women about them.

NHS is so short term focused; just think of the monetary savings from reduced pelvic floor surgical repair ad nauseum

Actually dance the more i have thought about this the more irritated i have got. I was on your other thread about your DH not supporting your choice for ELCS and myself and nearly all of the other posters were quite supportive of your choice. I have to say that i think your at war with yourself and your OP is actually just as offensive as other "people" being against your ELCS. As others have said who are these "people" your dh's issue seemed to be that he didn't want you spending money.

Your facts that you have pulled up are not complete, there are risks both sides, incontinence can be temporary and fixed with surgery there are some risks of a cs that are the same. Make your decision stick by it and then move on, that's the thing about becoming a mum, everybody has an opinion about how you do things you need a thicker skin and perhaps a shotgun but running other peoples choices down won't do you any favours.

I would sooner risk incontinence than have a cs without trying first.

No point in trying for VB when it is impossible. That's called being in denial.

I think it is so hard to make a sensible comment as everyone's experience is so different - I had an EMCS (I was delighted - I had asked for a ELCS but been refused ) - I was completely knocked out so I had 'no feelings' at all about what went on - and personally that didn't bother me - I seem to have no scar - not sure why - recovery was really, really quick - I am amazed that people call it 'major surgery'. A friend had a VB after an EMCS and bitterly regrets it.

I personally can't understand why anyone would choose a VB - but that's because my experience of a CS was brilliant and my expectation of what a VB would be like is so horrendous. Needless to say, I never, ever got pregnant again !

I had 2 c-sections and was also told (by my own sister!) that I "didn't really have a baby,did you?" .

I do believe there are risks and benefits to both c-section and VB. All of this has been well documented. I don't think there is any point in being judgey about other's choices, although I would feel sadness if c-sections became the "done thing" for purely cosmetic or convenience reasons. .

The first time I gave birth I was 18 and terrified, with no partner or family around. I was admitted to antenatal at 38+2 because I'd had a tiny bit of fresh bleeding. The baby and me were found to be fine and healthy although the baby looked 'big' for my tiny frame. For some reason (I still don't know after having read my notes!), they decided to induce labour. God knows why because I now know an induction of a 38 week woman who has never given birth before is unlikely to work. They tried 3 times and my cervix was still clamped shut (!) So I was taken down for a c-section as soon as I hit 39+0. I still don't know the reason I wasn't just sent home as all the notes say everything was fine and healthy and the reason for c-section was 'failed induction' ???? puzzled....

The second time at 21 I opted for a repeat c-section mainly just because it was what I'd had before, and because I was more bloody scared of the possible interventions like forceps etc and also of labouring for ages only to be told I'd need c-section anyway. I didn't actually find the c-sections all that traumatic or painful afterwards and I only took paracetamol after the 2nd one. My midwife was determined to encourage me to have a VBAC because of my age (higher chance of having more pregnancies I guess) and she told me I looked as if I'd 'labour well' (no idea if that was just persuasion!).

I do feel a little sad that I knew very young that I would never experience a vaginal birth (after 2 sections I believe you are advised against VBAC), but I am happy with my births and would probably choose the same outcome if I had the chance to again. Still need to go back and ask them why the first induction though . Anyone any ideas?

"although I would feel sadness if c-sections became the "done thing" for purely cosmetic or convenience reasons. sad."

I'm not sure what cosmetic reason there would be for a C-Section (you can't have a tummy tuck at the same time, that's a myth), but even if - what's the issue? I don't think there are "good ELCS" and "bad ELCS", and a woman should be free to choose whether she wants a VB or a CS for whatever reason, as long as she knows the risks and benefits of either.

Oh Alias- I have mental image of you at 18, scared and alone. Bless you.

VBAC would need to be supervised carefully but if you had no wound infection post CS, have reasonable assurance of a good sized pelvic brim and your first baby fully engaged six weeks or so prior to 40 weeks, then it's not out of the question.

Please ask to see all your hospital notes and ask for an appointment with OB/GYN department to go through them.

good luck.

I had an emergency c-section for my first boy. I was put on the synotocin drip at 42 weeks and I only dilated 2 cm in 18 hours. My baby's heart stopped and he had to be cut out and helped with breathing. When I went back to work a colleague asked how the birth had gone and I said emergency c-section and she just snorted and said "oh, couldn't take the pain, eh?" There was a bit more sniggering from other women too. Most women have been nice but I must agree with you that I definitely do feel judged usually by women who have short, less painful births.