C-sections 'a rational choice'

[AtheneNoctua]

I couldn't agree more.

news.bbc.co.uk/1/hi/health/8057785.stm

That's no say everyone should have one. Just those who want to.

BBB - sometimes I find the focus on the very basic issue of how vb vs cs in terms of pain experienced and recovery time a bit narrow. For some of us it's not just about how much pain you experience or how quickly you recover from the birth.

For me personally birth is a rite of passage. I found that going through three difficult labours increased my confidence in myself (in the sense that I went through some really difficult experiences and came out the other end feeling positive) and bonded DH and I in a way that I don't think anything else could have done. Maybe that's down to the sort of care I had (well - in my second and third birth anyway). It definitely improved my self esteem - I feel proud that I was able to cope with the challenges of three difficult labours. When I feel weak now I look back on my births and know that I've got a lot of strength in me somewhere! BTW - this isn't a comment on anyone else's birth, but this is how I feel about my experiences and nobody can take that away from me.

I'm also very interested in the issue of how the physiological experience of birth impacts on the hormonal profiles of newborns and mothers. I feel that our hormones play an important role in priming us for early motherhood. C-sections (and epidurals for that matter) profoundly disrupt the normal hormonal mechanisms of birth - I wonder how much we understand about the subtler aspects of how this impacts on our first experiences with our babies. It makes me a bit sad that when we talk about c-sections and other interventions we never consider these issues as being of any relevance at all.

There was a recent study (a very small one admittedly) which flagged up this issue. The brains of two groups of mothers, one group who'd delivered naturally and one group who'd delivered vaginally, were scanned 3 weeks after birth:

The scans revealed that mothers who delivered naturally had greater activity in certain areas of the brain than mothers who delivered by c-section when hearing their baby?s cry.

These brain areas included cortical regions that regulate emotions and empathy, as well as deeper brain structures that contribute to motivation, and habitual thoughts and behaviors. The responses to their own baby's cry in some of these regions varied according to mood and anxiety.

The researchers were led by Yale Child Study Center Assistant Professor James Swain, M.D.

"I suspect that the parental brain is 'primed' by vaginal delivery and affected by neurohormonal factors such as oxytocin, a hormone linked to emotional connections and feelings of love," said Swain. "C-sections may alter these neurohormonal factors and increase the risk of problematic bonding and postpartum depression."

Now on an individual level the differences aare very subtle and probably not noticable to mothers, but when you think of this at a social level - if very large numbers of people began to deliver by c-section.....
I do appreciate by the way that women having difficult vaginal births may have problems bonding with their babies, despite the normal hormones of birth.

Glad to hear it all went well in the end Cote.

Oh this rite of passage stuff really gets onmy nerves.

So women aren't real women unless they've pushed a sprog out through their vagina.

That is so insulting to the hundreds and hundreds of women on MN who have has CS.

Yes your VB were great and you were pleased with the outcome.

My CS was great and I was pleased with the outcome.

For you to say your experience was better than mine - well you can't possibly say that because you're not me and you didn't have my experience. I don't go around telling people who have had VB that they have missed out for having done so.

You have raised one tiny study that shows that brain activity afterwards may be different. But that no-one knows what the difference is for or why. And it is a very small study. But you have raised it to imply that women who have CS are are not as attuned to the needs of their child as women who have had a CS. Again that is not a fact, it is an extrapolation from a tiny number of women and certainly does not reflect the realities for many women who have CS.

Finally, I have never met anyone who has had a CS though pure choice, as you can't on the NHS. Unless you count people like csectiothistime or cote. And i would say it completely should be their chioce to have their babies through CS if they want, as their previous experiences are so dire.

Many many women have CS, to say they have not experienced some mystical rite of passage and to imply that they will not be primed to care for their babies properly is exactly the sort of stuff that cote has been saying is both unfair and damaging.

I couldn't care less about DD's cries because I was in so much pain for so long after birth. And no, I don't see that as a 'rite of passage', no more than torture at Abu Ghraib would be - just excruciating pain I could do without.

Bonding this time was instantanous and judging by my milk flow just two days post partum, oxytocin is there in abundance.

Gaby I agree with your last post. Also you can not recover as quickly from a section as quickly as you can from a vb I was up and walking straight after placenta was delivered and I have never heard of woman having a section recovering that quick. But that is our view and we have no right to force them onto another. I would never advise a women as to whether she should have a c section as I have no experience of a section.

Just saw this. Congrats Cote!!!! Elective seems to have worked a treat. Really happy for you after all you have been through.

Another one with quick and easy recovery from cs, both emergency and elective.

I got an elective on the NHS to get proper care and attention at birth. And I did, with a full surgical team, a health assistant for my dh and lovely lovely midwife too.

I barely saw the midwife after I went onto the post-natal ward because she was so busy with other labouring women. She kept apologising, popping in and out and did not get to go home until 6 hours after her shift ended. . Women were delivering 4 to a room screened off from each other. Absolute mayhem.

Vaginal birth? No thanks, I'll stick with elective, thank you.

I don't want to push a sprog out of my vagina if I had a choice. I'd still die happy.

slushy06, surely you accept though that many many women have recoveries from vaginal delivery that are much longer and harder than a lot of CS recoveries.

Best case scenario can't be held up as the norm, as for many women it simply isn't. Again, it's down to luck.

"Oh this rite of passage stuff really gets onmy nerves."

Why should it? Many women feel this way. Aren't they allowed to admit to the feeling that going through labour helped prepare them for the challenges of being a parent?

"So women aren't real women unless they've pushed a sprog out through their vagina."

Have I touched a nerve or something? Why do you feel the use language in a way that trivialises and mocks something that is emotionally very significant to me and to many other women?

"That is so insulting to the hundreds and hundreds of women on MN who have has CS."

No it's not. It's expressing a view about the psychological and social signficance of labour. This is how many women feel about their births. Why should they have to pretend it doesn't matter how they had their babies in order that people who haven't experienced it don't feel bad about their own births? It reminds me of the whole bf vs ff thing. You're not allowed to talk about the emotional signficance of bf to you and your baby because someone who didn't bf might take it as a personal slight...

"Yes your VB were great and you were pleased with the outcome."

"For you to say your experience was better than mine - well you can't possibly say that because you're not me and you didn't have my experience."

Go back through my post. I didn't say that my experience was 'better' than yours. I didn't even infer it! And my births weren't 'great' - they were bloody tough, but I think going through the labours had emotional benefits for me.

"You have raised one tiny study that shows that brain activity afterwards may be different. But that no-one knows what the difference is for or why. And it is a very small study. But you have raised it to imply that women who have CS are are not as attuned to the needs of their child as women who have had a CS. Again that is not a fact, it is an extrapolation from a tiny number of women and certainly does not reflect the realities for many women who have CS."

The point I made is that for some of us the issues are wider than those of maternal pain and recovery times. That's a perfectly valid point. I also acknowledged the fact that the study was small and that at an individual level these things wouldn't necessarily be noticable. Never the less - it is a FACT that mothers meeting their babies after a c-section will have a fundamentally different hormonal profile than mothers meeting their babies for the first time after an unmedicated vaginal birth. I didn't suggest that it was a fact that women who have CS are less well attuned to their baby's needs than women who have had a VB; I said that I am interested in the subtleties of this issue and wonder what significance it might have at a social level.

You should ask yourself why you have felt the need to interpret my words in the way you have.

"to imply that they will not be primed to care for their babies properly"

I didn't infer this. Are we not even allowed to raise the issue of how mode of birth might impact on early relationships for fear of being jumped on by people who are defensive about their birth choices? Again - it's like the whole bf vs ff thing again...

If I am defensive it is because I am sick to the back teeth of hearing how awful CS is, how mothers don't bond with babies properly, how BF is harder to establish, how difficult recovery is etc etc.

For many women these things are simply not true. We have had wonderful birth experiences and come out of them cheerful, healthy and with bouncing happy babies.

That is why it gets on my tits so much.

And I do think it is offensive to say that anyone who hasn't given birth vaginally has missed out on a "rite of passage". presumably the rite of passage to motherhood? So women who have had CS are not real mothers? TBH i know stacks of women who had VB and could well well have done without it, they are damaged psychologically and I know of 3 people who decided not to have any more children due to their birth experiences with their first. But at least they got their rite of passage, eh.

Please also remember that the people you are throwing your scare stories at are extremely likely to have had their CS for medical reasons, so what exactly is the point of telling them how awful it is, when they have no choice in the matter?

bigbella, be a fake woman with me.

Maybe I had less hormones and was less prepared for parenthood than a real woman, perhaps. But I suspect it does not matter since I can no longer push dd or ds out to know the difference. I am still bf-ing ds 2.8 years so I guess something went right. But by all means, have a debate.

I am pleased that I did not get any tears, or fissures or incontinence or be at risk of prolapse later on. So not a total loss.

I asked the surgeon to take care to stitch me up after my elective and she did - it has healed beautifully. I do recommend asking for this - a tip I picked up from mn.

"Why should they have to pretend it doesn't matter how they had their babies in order that people who haven't experienced it don't feel bad about their own births? It reminds me of the whole bf vs ff thing. You're not allowed to talk about the emotional signficance of bf to you and your baby because someone who didn't bf might take it as a personal slight..." Who says you're not? It is a bit much to snipe at BBBB that you have "touched a nerve", and then come out with something super-defensive and tangential like this.

And then this: "I didn't suggest that it was a fact that women who have CS are less well attuned to their baby's needs than women who have had a VB; I said that I am interested in the subtleties of this issue and wonder what significance it might have at a social level" is total hair-splitting. To spend as much time detailing that study as you did, in the context of your remarks here, does indeed carry the implication that BBBB called you on. Either stand by it or apologise, for heavens' sake. Your disingenuous remarks do you no favours.

Personally (as someone whose emergency CS luckily went very well, after a protracted attempt at VB) I found that the fears I'd previously had about the prospect of a section (bonding problems, milk problems, recovery) were totally unfounded. I'm happy to say that the mad rush of love I felt for DS has still not subsided 21 months in.

Bottom line some women will have a section with no adverse effects, some won't.

Some women will have vaginal births without adverse affects, some won't.

Luck of the draw pretty much.

I have had an emergency section and 2VBACs so feel qualified to see both sides tbh.

Apologies if the following comes across as a bit arsey. In my defence I'm 34 weeks pg and feeling rather obstreperous. Summary is that I think everyone should have an informed choice.

Informed both ways that is. DD1 ended up ventouse and forceps delivery. If I had known the incontinence risks I might well have asked for an em c/s instead. But no-one tells you about the risks of anything other than c/s. Anyway.

I have no medical reason to need a c/s this time round. But after last time - where the (crap, as admitted by the hospital this time round) mw failed for 5 hours to notice that DD's head position meant she was never coming out without assistance, where I ended up having an instrumental delivery without epidural/spinal because the (only) anaesthetist was busy elsewhere with a c/s, and where I ended up back at the gynaecologist 6 months after the birth due to internal damage - there's no way I'm putting myself in that kind of unknown situation again. This time round I'm having a c/s because I know I'll have someone vaguely competent right from the start, if only because there will be a team of them, and I know I will have access to pain relief.

Regarding relative risk of VB and CS - I've looked into this A LOT in the run up to no 2's arrival. There is no compelling evidence that elective c/s at 39 weeks has increased/decreased risks for mother or baby other than increased risks for the mother in subsequent pregnancies (and I'm sure this baby will be my last; aware that those are famous last words).

Regarding cost - at DD1's (v. long) 'natural' birth we had at various times 3 midwifes (one supervisor), the head of midwifery, an obstetric registrar, an obstetric consultant, and a paediatric registrar. I don't think my elective c/s will be significantly more expensive than that lot. And as others have said - if we want to deny women birth choices on the basis of cost then lets ban epidurals, home births and birth pools as well.

Some people have easy VBs and are up and about feeling great soon afterwards. Some people have easy c/s and are up and about after a week or two. But there are bad VB and bad CS experiences too, so for anyone to say what someone ELSE should do based on THEIR experience of either is, imo, wrong.

And congrats to Cote

Each to his own. My csec almost finished me off through utter medical mismanagement.

i thikn this thread has proved that there is never going to be a one size/ mode of delivery fits all.

i had a horrendous em c.s , i had a wonderulf VBAC. those are my personal experiences.

i support women to have the most positive birth they can, be it a VB, VBAC, em c.s., elective/semi elective c.s..... so that they can look back on the birth and feel good about it

i would not choose a c.s for myself without compelling emdical reasons, nor would i ever choose to give birth again in a hospital, but those are my choices borne out of my experiences and what i have seen and learnt

those are not necessarily the right choices for somoene else

neither c.s nor VB are risk free

you can argue that a planned c.s is the safest or a normal VB is the safest

what the key question is, is why are women so afraid to give birth vaginally? I truly think it is to do with the short staffing of maternity units and the lack of faith in the system. a planned c.s rather than pot luck on the day can seem an inviting option

i think if the NHS was stuffed with money, then every woman should have the birth of her informed choice, be it water home birth, C.s, hospital birth with epidural..

but i doubnt that will happen in my lifetime!

Thank you Anna, blueshoes & lucas

Lying here with 2 day old DS sleeping on me. It is so lovely not to miss out on these early days because of pain & exhaustion.

Snap! on your experience lucas - and am sitting here happily bf'ing 11wk dd after elc/s which was FANTASTIC compared to horrendous VB. The choice you have to make is usually between repeating an experience like the one you have already had, and a c/s. If someone could have guaranteed me a lovely VB without the risks of my dc's having to grow up with a faecally incontinent mummy, I would've taken their hand off!

Don't underestimate the effect on bonding of awful experiences v. hormones...I'm much more blissful this time around.

Congrats again, Cote (said it already earlier in the thread, but just in case you're still here!) Welcome, miniCote!

I just want to defend gabygirl a little: she made it very clear that her births were a rite of passage for her. What she wrote does not preclude the possibility that someone who had a CS could consider their CS to be also a rite of passage. Why not, after all? Having major abdominal surgery in order to bring a lovely child into the world seems like a pretty big deal to me.

Also, there is some evidence that labour initiates the flood of hormones to mother and child. If you don't experience labour, these hormones might not be experienced immediately or so strongly. To say so is no criticism of CS. Earlier in this thread, I said that I recognised that CS was a rational choice. So for gabygirl to discuss this is not VB propaganda.

It has been remarked upon on these threads before that people who have a strong and positive experience of birth, particularly VB, frequently feel ashamed to talk about it. If they do, they must grovel and say how lucky they were (and indeed they were; I know I was!), and play down how they feel about it, in order not to appear "smug" (a particular MN fave, that) or delusional about the fact that it was all luck, etc.

Others have complained that their CS experiences have been dismissed; on this thread already 2 people have jokingly referred to themselves as not being real women because of it, implying that this is how they are perceived by women who have had VBs. It is awful that anybody should be made to feel this way about their CS.

Why? Why this incessant sniping and bitching?

Fabulousbaker - not sure it's luck of the draw but I know what you mean. I think it's crap surgeons vs good ones, elective c/s compared to emerg c/s and low vs high pain threshhold!
I had a similar experience to CoteD - (congrats by the way) Great surgeon, on the NHS, no medical reason, baby put straight on me (albeit under my chin!) but they didn't take him away for quite some time, milk came through fine, breast fed for nearly 6 months, home after 24 hours, off the epidural after 6 hours, only ibuprofen at home, held my baby from the get go, healed up nicely... I also had a really good consultant do it...I'm really glad there are people who would rather have a natural, but I've seen them to get really put off one! there may be a higher chance of problems with a C/S , but to me it's a very low risk, compared to the almost gauranteed chance of prolapse, incontinence, sexual issues later in life... I don't frown on the 'natural birthers (however there's not a lot beautiful about tearing from one end to the other!) so I wish people would stop coming down on a womans choice for C/S. I had such a lot of crap from midwives during my pregnancy - only ever had one 'nice' one who confided she would have a C/S herself! I'll for sure be having another - my preference is to keep my lady bits intact thanks

Blueshoes
"I don't want to push a sprog out of my vagina if I had a choice. I'd still die happy" pmsl!!
Me too

pmk1: "the almost gauranteed chance of prolapse, incontinence, sexual issues later in life"; "my preference is to keep my lady bits intact thanks"

Why the vitriol?

It's these kinds of remarks which I meant when criticising the sniping. Why do you have to suggest that yours in the superior choice by pointing out the negatives of VB? Don't you think it's cruel to women who may have suffered these things?

And incidentally, I read somewhere that it's often pregnancy, not solely childbirth, which damages the pelvic floor, so you may not escape these things.