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'?

nursenic

I'm not planning on anymore sprogs! so I think that's me done (with babies).

I did have post-op staph infection with the first c-section, no idea if first baby was engaged but second definitely was before the c-section I was told, I was once told by an ob-gyn doctor on an examination I have a "good childbearing pelvis" (haha!).

I did request to see the notes but just read them myself, never had anyone explain it to me. Couldn't find anything about the reason for the induction with my first, but did find some other enlightening notes/info!

Maybe I will request them again and ask them to explain. I mean, I'm of the opinion that as long as the mother is OK and the baby OK the route is not that important, but I have always wanted to know why I was induced for seemingly no reason. Maybe there was a reason though, I will ask x

I don't understand birth snobbery at all, either way. I once read an article where a doctor was quoted as saying a c-section is "the civilised way to have a baby"

Drs always seem to look at the external pelvic appearance which has nothing to do with it as it is the internal pelvic brim shape/size which matters isn't it?

CS wound infection after my 1st necessary CS was probably the main reason why |I suffered a ruptured uterus/urinary bladder during my 2nd delivery. Infections affect the integrity of the healing and because the nature of uterine suturing post CS is that the stitches are holding an organ which rapidly 'shrinks' straight afterwards, these stitches tend to be more vulnerable.

My OB friends laugh at the urban myth of tummy tuck/CS combi. Because the abdominal tissues are so stretched from pregnancy, tummy tucks are non viable. How on earth would you do it? No matter how 'tight' you tucked that tummy, the uterine post pregnancy return to its normal size would mean that the abdomen would look 'loose' again very soon and you would have very ugly 'tissue paper bagging around the tuck stitches.

A surgeon needs to see a woman's abdomen in its 'usual' state to ascertain what needs to be done.

Stay123- What horrid things to say to you! What in god's name is wrong with these women? Judgemental Cows.

I don't think people are particularly judgemental of individuals who decide to go for a c-section.

And it's completely reasonable to have misgivings about medical treatments which involve major surgery.

My big problem with the way this whole issue is discussed is the failure to acknowledge that substandard care in labour, rather than mode of delivery itself, is responsible for so many of the poor outcomes associated with vaginal births ending in emergency c/s or in serious perineal damage.

Elective c-s cost the NHS about 7K. If that much money was spent on the care of every woman attempting a vaginal birth I've no doubt whatsoever that we'd have vastly fewer emergency c/s. And then of course planned c/s wouldn't look like such a comparatively safe option. It's only comparatively safe in a system where labouring women are often given such shit care that they are having record levels of intervention to get their babies born safely.

I had a EMCS with my first and quite a traumatic labour; placental abruption. Personally I find that the Mums that are judgmental about C/S vs V/B are judgmental in life and I try not to spend too much time around these types of people....they're not good to be around in general!

The only thing that I would say that has upset me in the past is that the media in particular and some people who tar everyone with the 'to posh to push label' which I do find offensive. Anyone who has had a CS will know that it's not an easy way out, it's ruddy painful and takes a long time to get over both physically and mentally.

I'mnow expecting number 2 and despite the issues I had the first time, am hoping to have a VBAC - but if it doesn't work out and I end up having a CS then so be it. I certainly won't feel like any less of a Mum having not managed a VB...you can't control everything in life after all!

Brilliant. A 'wonderful' article by the BBC One show on the new NICE guidelines due out tomorrow. Not a single mention of psychological reasons. Not ONE.

So disappointed. Bracing myself for more crap reporting tomorrow...

I have had 2 ELCS (by choice). I have never experienced any judgemental comments about my choices. Likewise I'm glad that my friends who had VBs got thebth experience they wanted.

Anyone care for a game of NICE c -section guideline bingo?

The idea of this game is to score as many points as possible based on a report of the new NICE guidelines on c-section on maternal request which are due out today (23rd November) and to see which journalists have ACTUALLY read it. Lets see how much negative c-section stuff there is out there shall we?

When the last draft was done, reporting was so bad that the ROCG felt the need to put out a statement about it. I'm not expecting it to be any different.

So folks, here is your point system:

-1000points for any article suggesting that women are "too posh to posh"
-500points for any article starting that women will now have a RIGHT to a c-section on demand.
-400 points for mentioning Victoria Beckham in any context
-300points for stating that a c-section is more expensive than a VB (without mentioning possible downstream costs).
-200points for using an example of a woman who have had an Emergency C-Section, without using an example of a woman who has had an Elective
-100points for mentioning any other celeb.

+100 points for pointing out that these are guidelines and NHS Trusts do not have to follow them.
+200 points for using an example of a women who has had an Elective.
+300 points for mentioning counselling as being part of the process to support a choice
+400 points for mentioning downstream costs in any way shape or form.
+500points for mentioning the words "birth trauma", PSTD or similar or mental health reasons.
+1000points for using the word Tocophobia

Bonus points may be awardable for selective and misleading quoting of professionals or other 'artist' forms of reporting.

Lets see how many newspapers can actually report this document and show they have actually bothered to read it, and aren't obsessed with tabloid sensationalism.

So far, I have four articles prior to publication, so are based on draft still (which hopefully is unlikely to alter hugely):

The BBC One Show, tonight scored -900 tonight.
(-400 for Beckham, -300 for costs, -200 for EMCS example, -100 for other celebs +100 for pointing out they are guidelines and trusts don't have to follow.)

The Guardian have scored an excellent +2000.
www.guardian.co.uk/society/2011/nov/23/nhs-caesarian-nice-guidelines
Well done them!
(+1000 for Tokophobia, +500 for birth trauma/mental health being mentioned several times, +200 for an example of a woman who had an elective, for mentioning counselling)

The Independent a rather short article but not horrendous. -300
www.independent.co.uk/life-style/health-and-families/health-news/midwife-shortage-linked-to-rise-in-caesarean-births-6266367.html
(-300 for cost)

The Daily Fail don't actually score anything for this article as they didn't actually say anything about the guidelines at all, though I think they deserve -1500 for inventiveness for linking two stories.
www.dailymail.co.uk/health/article-2064653/Women-elect-Caesarean-risk-having-fatter-babies.html
I'm impressed at their ability to make C-sections look bad by saying that a study of 62 babies shows that c-sections make your children fat! (whilst also not mentioning whether these are EMCS or ELCS or what the BMI of the mother was in the first place which would be quite helpful to understand what the study ACTUALLY found)

I watch with interest to see what the final guidelines will actually be and who reports whats in the document best... and worst...

The Graun is running a story about this

MICE I read about the c-sections=fat babies elsewhere. It said it's an issue for ELCS not EMCS and they had considered BMI of the mothers (made no difference). But it said further research needed to see if there was a causal link ie ELCS caused babies to be fatter.

What is the proposed mechanism of how a Caesarean is making babies fat then?

They think that certain genes might be triggered by labour - hence more research as they're not sure - but it's a possibility as it's not an issued for EMCS as babies would have gone through part of the labour process.

Iggly, even if its ELCS, we could easily get into the debate over reasons for that ELCS in the first place and medical reasons for them. How many are 'without clinical need' and how many are? Etc etc.

A study with 62 babies is a start, and yeah agreed definitely more research needs doing. But to try and spin a negative angle on the NICE guidelines based on that study is bad science and biased. It potentially is comparing apples and oranges. Its scaremongering.

That said, I have seen another Daily Fail article on the guidelines this morning, which is decent and a pleasant surprise. Same with the Telegraph.

Wonder if it has anything to do with immune function? My understanding is that babies born by c/s are more likely to develop atopic disease because of lack of exposure to vaginal flora during birth. Wonder if there is a link between immunity and obesity in later life?

Actually I think that health reporting in UK newspapers is generally pretty shit, and often shit to the point of being shameful.

Sad to see there is so little reporting which starts by acknowledging that the key concern when it comes to UK maternity services should really be our stupidly high rates of emergency c/s as this is the only thing which makes higher rates of planned c/s for low risk women a sensible or humane option at a population level.

Is there anywhere a link to the original study, as all I can find is journalist's take on them.

It would be interesting to know what the reasons where why the ELCS have been scheduled, and how it was controlled for other factors.

I've heard that thing about the lack of exposure to vaginal flora a few times, surely if it really was an issue, couldn't the exposure be artificially be done after the CS, with a swab or whatever?

Or does the exposure have to happen through being passed through the vagina, in the same way that synthetic oxytocine allegedly isn't as oxytocinish as the proper natural one?

Genuine question.

"couldn't the exposure be artificially be done after the CS, with a swab or whatever?"

I take it you've missed the mumsnet threads about .... ahem... 'finger dipping' and 'swiping baby with it', following c/s.

"in the same way that synthetic oxytocine allegedly isn't as oxytocinish as the proper natural one?"

Syntocinon isn't oxytocin. It's a synthetic substitute which mimics SOME of its functions.

Actually this is something I really interested in. Two of my children(one of who has ADHD and autism) had prolonged exposure to syntocinon in labour. I've stumbled across articles recently about possible links between syntocinon and autism. But also across links between c/s and autism.

I feel that there are many things we don't understand about how mode of birth might impact on later development. My personal feeling is that inteventions in birth and mode of birth probably does impact on infant and child development in a whole host of subtle ways, which would be impossible to measure or assess. I don't think we know the right questions to ask. I think the same thing in relation to research into breastfeeding - scientists have been very crap at creating good studies on infant feeding, which is why we've been blundering around for decades assuming it doesn't make any difference how a baby is fed.

shagmund maybe my googlefu is not up to scratch, but from all that I can find syntocinon/pitocin and oxytocin are chemically identical

Whilst we are on the subject of DM study I mentioned above... I too would love to see it properly.

The suggestion was to do with hormones. Well if you are doing an elective on request for fear and anxiety... well theres studies showing that these women seem to have their labour affected by that etc etc...

You see where I'm going with this? Cause and effect? Basically we haven't got a effing clue.

My beef with that DM article is it goes to paraphrase it:
Here is a study that says that CS are bad.
Tomorrow NICE are making it easier to have CS when there is no medical reason.

Except thats not necessarily the truth, it makes no comment on what type of CS we are talking about etc... nor does it mention why guidelines are being changed (eg fear)

So its setting people to say ' if you have an emergency cs you are making your child fat'... etc etc..

Its all relevant for pro VB and pro CS in actually getting better care for everyone. Yet the focus is just CS = bad.

"scientists have been very crap at creating good studies on infant feeding, which is why we've been blundering around for decades assuming it doesn't make any difference how a baby is fed."

Science's purpose is not to create something to support a narrative, but to look at real effects, and change the narrative according to their findings.

Now I'm as crunchy as they come, but there's a lot of dismissing of scientific findings which don't fit into one's personal prejudices.

"Science's purpose is not to create something to support a narrative, but to look at real effects, and change the narrative according to their findings."

By 'create' I meant 'construct' - as this is what they do: construct research which is fit for purpose.

And much of the research into infant feeding in the past 20 years hasn't been fit for purpose.

IMO - the purpose of science is simply to uncover the truth about the way the world 'works'. It's the job of politicians and social activists to change society.

"but there's a lot of dismissing of scientific findings which don't fit into one's personal prejudices"

I couldn't agree more. Try posting anything suggesting that mode of birth actually MATTERS to babies and see how far you get.

NICe your "beef" with the DM link doesn't invalidate the research being done on CS. This is why I do not read or take seriously anything the DM has to say quite frankly.
I read the article in the Times originally which was much more sensible (but with the paywall, can't link to it)

I can only find this

Re: syntocinon and oxytocin - oxytocin is the primary hormone associated with 'bonding' behaviours in humans. You produce it during love making, from skin to skin contact, and during breastfeeding as well as in labour. Hence it sometimes being dubbed 'the hormone of love', also 'the mothering hormone', because it's believed to trigger nurturing and altruistic behaviours. A mother who's has a natural delivery will have hugely high levels of oxytocin present in her body at the moment of birth, which helps to promote mother/infant bonding.

According to Michel Odent:

"A drip of synthetic oxytocin (syntocinon or pitocin) is a substitute for the natural pituitary oxytocin a woman is supposed to release when giving birth. It can be used for labour induction, or to make uterine contractions more effective during a labour that started spontaneously. The need for synthetic oxytocin is a symptom of an inappropriate hormonal balance. It is therefore dependent on environmental factors. It is related to the degree of privacy and the feeling of safety. The need for synthetic oxytocin is usually associated with a need for epidural in the context of modern departments of obstetrics.

The long-term consequences of being born after a labour induced or augmented by synthetic oxytocin cannot be easily evaluated among humans, since randomized controlled studies are not feasible.

There are basic differences between the effects of an intravenous injection of oxytocin and the effects of the same hormone released by the pituitary gland. The first difference is that injected oxytocin does not cross the blood-brain barrier and does not reach the brain receptors: it has no behavioural effects. In other words it is not a hormone of love. The second difference is that the natural hormone must be released by pulsations in order to be effective. Intravenous injection is continuous; this is a way to explain why the doses of synthetic oxytocin must be comparatively high to be effective."

shagmundfreud both sides are guilty of cherry picking.

In what way was the research "not fit for purpose", or rather which purpose didn't it fit?

Surely, the developers of formula's main research target will be to create formula which gets closest to breastmilk as possible. That's a good thing for the babies which are formula-fed, surely. So that type of research probably is not fit for the purpose of promoting breastfeeding over formula feeding. But as it wasn't the purpose of the research in the first place, that's not surprising.

As for suggesting that mode of birth actually MATTERS to babies - that's your personal belief, and there's a whole interweb full of people who claim the same, although there's from what I can see not much sound scientific evidence around this, but a lot of philosophical theorising and romanticising.

Maybe the syntocin/oxytocin thing has something to do with the difference in how (or the amount of) oxytocin is released by mum/baby vs getting it via a drip?