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 have no problem with that research. I want more. Which does show cause/effect etc. And I want it reported PROPERLY, so I know what the risks really are.

What I have a problem with is directly linking that research to an unrelated document on CS on request, which clearly defines the area of concern and why they have chosen that line. (namely fear) WITHOUT mentioning the logic behind the decision and WITHOUT saying that actually its not necessarily going to make it easier to get a CS.

Its completely the context and use of the two things TOGETHER that is the issue. It changes the meaning and the message that is being communicated.

Its selective and doesn't report what EITHER study is really saying. They are being used to create another story.

Yes, its the DM, but in the context of OP's comment about why do CS get a hostile reaction, then its a highly relevant one.

Well I think the OP didn't do herself any favours by spouting a selection of VB risk statistics which came across as "why would you go for a VB".

That is different to how CSs are reported in the press. But you can say that about anything vaguely medical. Why don't you complain to the DM?

Oh, Odent. Yep, that well-known biochemist. I kind of expected you to quote him.

Iggly, with regard to the OP's attitude, I've covered that on another post... She's got a few issues there I think.... which she needs to look at which will affect the reaction she gets and how much support she has.

As for complaining to the DM?! Are you fucking kidding me? They aren't interested in reporting 'the truth'. They are interested in selling papers. The two are not one and the same! I think we have a little thing called the Leveson Enquiry going on about that one atm...

skepticalob.blogspot.com/2011/10/why-lie-about-childbirth-pain-and.html

I had a ELCS for my first baby, my choice.
I didn't tell anyone apart from my mum and husband.
I didn't need people telling me about my choices that I had already made were wrong or they disagreed.
The less people knew the better as far as I was concerned.
It's of course up to you to decide to tell people, I don't think I would have told people if I was having an induction on that day either,but that's me.

The biggest controversy about a C-section is the cost to the NHS. At a time when the NHS is struggling and the Tories are very keen to justify handing it over into private hands, it does not make sense to encourage women to have C-sections that are 10 times more costly than natural childbirth. It's also helps cover up the huge midwife crisis. There are not enough midwives to attend to every labouring woman so of course if more women have C-sections, less midwives are needed.

I also don't think the NHS ante-natal classes help. Certainly not the one I went to anway. I was terrified into thinking that labour would be intensely painful and last up to 12 hours. And it was. But with my second I had enlisted the help of the NCT and with their support I gave birth at home, quickly and without any pain-relief.

Did anyone hear on the radio some guy saying that a new mother, in his opinion, would be more worried about the prospect of motherhood than about giving birth (he was denying the idea that more women would ask for C-sections on the basis that they would be too scared to give birth). How the hell does he know what mums-to-be are thinking? And since when did they start taking notice of mother's opinions on these things anyway? From my experience your birth plan is just tossed in a wastepaper bin whilst they tell you what they are going to do and you just have to agree.

With the shocking shortage of midwives and lack of consideration for labouring mums, it's no wonder so many want to opt for C-sections.

I posted a similar post to the OP about 10 months ago. What I learnt from that is that some people genuinely think that a cs is worse for the baby (in the same that formula is), and don't understand that a cs is potentially safer or as safe for the baby. So they are being judgemental because they think you are choosing something worse for the baby because you don't want your fanjo stretched.

Some also just feel that if they have been through the pain of childbirth, other people shouldn't be let off lightly.

Additionally there is a myth that you can't breastfeed properly if you've had a cs or that you won't bond with your baby. This is pure bs.

ELCS do carry risks though. I've had just about every complication since my second one. I still feel it was the right choice for me and my baby, but I think I will be suffering long term physical consequences unfortunately.

Iggly - but what is wrong with talking about the risks of VB? You don't do anyone any favours if these are not talked about, nothing is risk free, and you can't make an informed choice, if you don't know about all the risks.

Not talking about the risks hinders informed choice, hinders looking at different ways of mitigating risks and is patronising to say the least.

Women should know what they can expect, saying "oh, but that doesn't occurr very often, I'm sure you'll be fine dear" is just wrong.

Rhubarb But the new NICE guidelines suggest that cost actually is not as big a factor as previously assumed so your argument doesn't stack up.

I had a planned c-section for medical reasons (privately and abroad). It wasn't the greatest experience but not bad enough not to fall pregnant a second time (am due in May). I have been told I have to have another c-section as they refuse to do a VBAC in spite of the fact that the medical reason for the 1st birth is not something that will necessarily be repeated...and I'm paying for this!

I have friends both in the UK and abroad who have had both VBs and CS - some positive and some negative on both sides. The more serious/life-threatening issues both to baby and mother have been during/after CS. However it does seem as though the mother is generally much more aware durng a VB so mentally the experience is probably more traumatic when things go wrong..

Most of my friends have CS here, but we pay for it and it costs significantly more and the aftercare in hospital is so much more...that is what worries me as the NHS is already underfunded and understaffed....for CS mothers and babies not to receive the proper post-birth care would be potentially lethal...

I have nothing against CS at all and understand that someone who has had a very traumatic previous VB/EMCS might wish to request a ELCS (referring to NHS) if they are counselled and still think an ELCS is the best thing for them then they should be given their preference.

I do have some friends though who were so "traumatized" by their 1st births they said that they had constant panic attacks however they still planned a 2nd pregnancy with a 18 month age gap and then a 3rd and now planning a 4th...I'm not saying women should not have subsequent children but do find it strange that they have Tokophobia but still keep on having children...Surely they would be questioning their decision if there is doubt as to whether they will get their elcs..??

What I fear is that those who really do have Tokophobia will suffer as a result of those who would just prefer to have a CS..

Good luck to everyone whatever birth you have - all carry risks but many are beautiful experiences so particularly for 1st time mums try and focus on the positives because they do exist!

I don't have a problem with talking about te risks of VB. I do have a problem when it's not done in a balanced way instead of "I'm having a super safe CS because a VB is so risky because of x/y/z". It's just the same as someone saying I'm having a VB because a CS is risky because of x/y/z - no mention of risk on both sides.

Also the problem is this is so emotive. Even if we knew all the risks of methods of delivery, people would still take it the wrong way.

I think there is judgement, like there is about all elements of mothering - vb vs. section, breast vs bottle, baby led weaning vs traditional, crying it out vs picking them up, SAHM vs WOHM

However I think the only women who judge are the ones who feel insecure and feel the need to denigrate others to make themselves feel better. They are not very nice people so therefore I am not friends with women like that.

Life is tough enough so why not support each other in our choices.

For what its worth I had two VB's both of which were fine.

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

When I talk about the purpose of the research I'm not referring to the way it may eventually used by outside agencies. I'm referring to the brief that health researchers set themselves.

Much of the research into infant feeding done in the past 40 years, which compared outcomes for ff and bf babies, failed spectacularly to adjust for 'dose' or exclusivity. This is a massive problem, given what we now know about the health differences associated with partial and exclusive breastfeeding.

"Surely, the developers of formula's main research target will be to create formula which gets closest to breastmilk as possible."

You'd hope that wouldn't you?

"As for suggesting that mode of birth actually MATTERS to babies - that's your personal belief"

I think you'll find it's also the belief of most of the 1000's of midwives practising in the UK and around the world.

"although there's from what I can see not much sound scientific evidence around this, but a lot of philosophical theorising and romanticising"

Or we could turn it around and say there's no evidence that medical interventions in birth AREN'T associated with subtle disturbances in the mother/infant relationship. And that would be because it's almost impossible to design research which could adequately address this issue. Personally I start from the position that those arguing for wider use of surgical or medical intervention into natural processes like birth or breastfeeding are responsible for finding proof of the efficacy and harmlessness of the intervention. And absence of proof of harm is not proof of lack of harm.

And sometimes the right questions aren't asked - this is particularly the case when research is driven by commercial interests.

One example - a recent study finding cognitive impairment in children fed iron-fortified formula in infancy. (see below). BTW - the study is a large, double blind RCT...... The research into the value of iron supplementation of infant formula didn't ask the question: do all children, even those with high iron levels, benefit equally from iron supplementation in infancy?

Makes you look at the Cow and Gate 'giant cup of milk' advert in a different light....

"Iron-Fortified vs Low-Iron Infant Formula: Developmental Outcome at 10 Years
This study enrolled 835 healthy, full-term infants in Santiago, Chile. From 6-12 months infants were fed iron-fortified (mean 12.7mg/L) or low-iron (mean 2.3mg/L) formula milk. At 10 years of age 473 (56.6%) of the children were assessed for IQ, spatial memory, arithmetic achievement, visual-motor integration, visual perception, and motor functioning.
Compared with the low-iron group, the iron fortified group scored lower on every 10 year outcome.
Betsy Lozoff, MD; Marcela Castillo, PhD; Katy M. Clark, MA; Julia B. Smith, EdD. Iron-Fortified vs Low-Iron Infant Formula: Developmental Outcome at 10 Years. Arch Pediatr Adolesc Med. Published online November 7, 2011. doi:10.1001/archpediatrics.2011.197"

A CS costs hospitals an average £1,701 while a vaginal
delivery costs an average £749. The Audit Commission
has estimated that a 1% rise in CS rates costs the NHS
an extra £5million/year4. Some have suggested that,
where women choose CS for non-clinical reasons, they
should be charged the difference. However, any costs
associated with long-term complications are potentially
more significant and there is concern that the long-term
effects of CS on mothers are not fully taken account of
when decisions about CS are made.

From parliament.uk

Well, but midwives surely have an interest in promoting the idea that vaginal birth is superior to CS, as that's their livelihood. So they're not exactly neutral, are they?

(FWIW, I've met more than one midwife, who found ELCS to be a completely acceptable choice)

"but what is wrong with talking about the risks of VB? You don't do anyone any favours if these are not talked about, nothing is risk free, and you can't make an informed choice, if you don't know about all the risks."

For low risk mums the risks associated with surgery are pretty standard. As long as you have the right surgical team, the mother is in good health and not obese, and her placenta isn't in the way, the risks will be similar for all.

However the risks associated with vaginal birth will differ HUGELY according to the type of care the mother gets.

So for example - if she goes to one hospital she's got a 14% chance of having an emergency c/s and in another it may be 20%. If she has a homebirth she'll halve her risk of ending up in an operating theatre. If she has one to one care her chance of having complications goes down. If she has a consultant involved in her birth (should it become complicated) she'll have a lower risk of a poor outcome.

You can't just say 'if you have a vaginal birth you have 'X' risk of ending up needing a blood transfusion'. It's meaningless. It's about as sensible as saying 'if you go to school you'll have a 20% chance of getting a grade B in your English GCSE, without mentioning that if you go to an outstanding private school, as opposed to a crap comprehensive, the likelihood of you achieving academically is higher.

Surgical care for mothers giving birth is massively better resourced and much more standardised than care for labouring women.

It'd be much more sensible to compare outcomes for vb and cs according to how much is SPENT on the woman's care!

Widow, you could say the same about consultants and obstetricians re CS. You imply that MWs deliberately downplay VB risks to keep CS rates down?

Shagmundfreud

You are exactly the kind of mother I was referring to. No wonder women feel judged.

I had vaginal births, breastfeed, made all my own baby food but in absolutely no way do I think the choices I made are better than someone who had a section, bottle fed and gave jars of food. There are other elements of mothering that they may be far better than me at so why on earth would I list research to try and prove superiority when all it does is point to your own inferiority

Without having read the whole thread who are these women showing you such hatred, OP? I had to elcs-es, for breech, and if other women hated me I was completely unaware of it.

Are you sure you're not winding them up by banging on about this?

"Well, but midwives surely have an interest in promoting the idea that vaginal birth is superior to CS, as that's their livelihood. So they're not exactly neutral, are they?"

Their 'livelihood' is caring for mothers and babies before, during and after pregnancy and birth. And actually when a mum has had a surgical birth their role AFTER the birth is vastly expanded.

Midwives focus is on the health and welfare of mothers and babies. With respect - given that they have more involvement with newly delivered women than any other health professionals, including doctors, I'd say that their understanding of how mode of birth impacts on health is probably pretty well developed. In other words - they have a perspective and knowledge about birth which is pretty unique.

So if midwives as a group are concerned about the recent huge increases in the number of surgical births, I'd say they have good reason to be.

It's about the ideal of what is taught in midwifery training versus what is actually achievable of feasible in the real world of NHS care.

Yes, breastfeeding is advised but the reality is that midwives do not teach or support mothers, fathers and babies adequately enough. Successful breastfeeding is often in spite of rather than because of.

Same with pelvic floor health and integrity. Same with low episiotomy rates. Same with decisions about pain relief and labouring choices. Same with emotional support.

Iggly I didn't imply any deliberate downplaying of risks, but more the overstating of benefits, and that nobody is free of bias.

Of course I'm aware that OB/GYNs are likely to be biased into the opposite direction, especially as they see more complicated births.

I think there is a lot of judgement - and a lack of discussing risks and benefits - for every part and type of birth and pregnancy care. There may be judgement purely because there is no discussion of these things and so people go on what they think is logical even when it isn't backed by the real facts.

Foe example - the afterbirth section of the latest NHS pregnancy guide book is less than half a page long regardless that there are many things that could go wrong and that the after-birth shot has it's own share of risk factors. It's all written in a 'you don't need to think about this, just let the professionals get on with it'. With DD1 there was discussion of c-section and my concerns about it (having had a good friend die during one a few years before that) were only answered with a "we just want you and baby to be healthy, you shouldn't be so concerned". If we aren't educated on it as women going through it, how are the media and wider population suppose to know anything about it?