So what exactly is the problem with C-Sections?
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Anonymous
But you DO have that option since all obs are trained to give C-sections, and if you ask for one, you could get one with little difficulty. The issue is for those who would like a different option - as the non-C-section skills are becoming rarer and rarer. I've had both a forceps-assisted delivery and a C-section and I'd take forceps any day. If I chanced into a younger doctor, that option would not have been available to me, and neither would other midwifery maneuvers. I am not against C-sections at all. I am for a full toolbox. |
Anonymous
Your argument seems to be that whatever birth happens more frequently, that is the birth doctors are skilled in. But despite the fact that c sections only account for 1 in 3 births now you don't seem concerned that doctors don't have adequate skills to perform them. Even if it became 50/50 (which I do not think it will be) that would mean doctors would see vaginal births just as frequently as c sections and would of course be skilled in managing them. You have no idea if those options would have been available to you with a younger doctor, that is purely hypothetical. And you seem to be extracting logical conclusions based on no real evidence. |
Anonymous
Yeah. This is why #2 will be a scheduled c if I get pregnant. No way in hell I'm having a shitty vaginal birth again. No way in hell. Surgery terrifies me, like, completely terrifies me, but recovering from a shitty vaginal birth was the worst experience of my life and I refuse to repeat it. |
Anonymous
Every C-section is the same. It's a standardized procedure. Every vaginal birth is different, and there are dozens of maneuvers that exist to deliver the baby. Even if vaginal births may constitute two-thirds of an ob's workload, he or she may not encounter the same technique more than once or twice a month. In that same month, he or she would have performed dozens of C-sections that differ little from each other. That forceps may not have been offered to me with a younger doctor who isn't skilled in using them is what my 50+ yr old ob said, and I have no reason to doubt her. But it's OK if you don't trust the opinion of the doctor you've never met. Let's look at an authority no one doubts. https://www.newyorker.com/magazine/2006/10/09/the-score ".....Forceps have virtually disappeared from the delivery wards, even though several studies have compared forceps delivery to Cesarean section and found no advantage for Cesarean section. (A few found that mothers actually did better with forceps.)... ....The question facing obstetrics was this: Is medicine a craft or an industry? If medicine is a craft, then you focus on teaching obstetricians to acquire a set of artisanal skills—the Woods corkscrew maneuver for the baby with a shoulder stuck, the Lovset maneuver for the breech baby, the feel of a forceps for a baby whose head is too big. You do research to find new techniques. You accept that things will not always work out in everyone’s hands. But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts. You seek reliability. You begin to wonder whether forty-two thousand obstetricians in the U.S. could really master all these techniques. You notice the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received. After Apgar, obstetricians decided that they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble. They found it in the Cesarean section. ....This procedure, once a rarity, is now commonplace. Whereas before obstetricians learned one technique for a foot dangling out, another for a breech with its arms above its head, yet another for a baby with its head jammed inside the pelvis, all tricky in their own individual ways, now the solution is the same almost regardless of the problem: the C-section. Every obstetrician today is comfortable doing a C-section. The procedure is performed with impressive consistency. ....We have reached the point that, when there’s any question of delivery risk, the Cesarean is what clinicians turn to—it’s simply the most reliable option. If a mother is carrying a baby more than ten pounds in size, if she’s had a C-section before, if the baby is lying sideways or in a breech position, if she has twins, if any number of potentially difficult situations for delivery arise, the standard of care requires that a midwife or an obstetrician at least offer a Cesarean section. Clinicians are increasingly reluctant to take a risk, however small, with natural childbirth. I asked Dr. Bowes how he would have handled obstructed deliveries like Rourke’s back in the sixties. His first recourse, as you’d expect, would have included forceps. He had delivered more than a thousand babies with forceps, he said, with a rate of neonatal injury as good as or better than with Cesarean sections, and a far faster recovery for the mothers. Had Rourke been under his care, the odds are excellent that she could have delivered safely without surgery. But Bowes is a virtuoso of a difficult instrument. When the protocols of his profession changed, so did he. “As a professor, you have to be a role model. You don’t want to be the cowboy who goes in to do something that your residents are not going to be able to do,” he told me. “And there was always uncertainty.” Even he had to worry that, someday, his judgment and skill would fail him. These were the rules of the factory floor. To discourage the inexpert from using forceps—along with all those eponymous maneuvers—obstetrics had to discourage everyone from using them. When Bowes finished his career, in 1999, he had a twenty-four-per-cent Cesarean rate, just like the rest of his colleagues. He has little doubt that he’d be approaching thirty per cent, like his colleagues today, if he were still practicing. ...And yet there’s something disquieting about the fact that childbirth is becoming so readily surgical. Some hospitals are already doing Cesarean sections in more than half of child deliveries. It is not mere nostalgia to find this disturbing. We are losing our connection to yet another natural process of life. And we are seeing the waning of the art of childbirth. The skill required to bring a child in trouble safely through a vaginal delivery, however unevenly distributed, has been nurtured over centuries. In the medical mainstream, it will soon be lost." https://www.newyorker.com/magazine/2006/10/09/the-score |
Anonymous
I'm a NP to this topic and these are two separate issues. Vaginal birth is higher risk for prolapse because it weakens the pelvic muscles. However, the highest risk is the pregnancy itself and the number of children. So, having two easy vaginal deliveries, like I did, is not a huge risk. Having lots of vaginal deliveries of large babies while also being obese is very high risk. Prolapse after menopause happens to women that never gave birth too. It's the lack of estrogen that thins the vagina and the tissues that causes the prolapse. So one weakens the muscle (hence why exercises work) and the other one thins the tissues. So, early menopause and several 9+ lbs. babies, even delivered via C-section while also being overweight is risk risk. Late menopause, 1 to 2 easy vaginal deliveries with normal weight babies and staying in shape is lower risk. |
Anonymous
I'm glad you got the delivery you wanted, and I hope forceps are available to anyone who wants them. But please tell me you know the bolded is not true. Because it's not. |
Anonymous
PP here with the friend group I referenced. FWIW, my anecdotal sense is that post-vaginal-birth prolapse is actually very common, but because the medical system and society in general does not care about the medical problems of older women, it is swept under the rug or just normalized. You see it here too: “oh, women who had c-section also get prolapse.” Well, yes, but not at the same rate, and there is also a question of severity. There is a strong desire to hide or minimize pelvic floor damage to women for deeply misogynist reasons IMO. Natural birth advocates are as guilty of this as the gerontologists who discount the suffering of older women. |
Anonymous
You are not really making an argument that there is as much variation in C-section technique as there is in vaginal birth. |
Anonymous
No, I'm making the statement that "Every C-section is the same" is not true. Because it is a false statement. |
Anonymous
A distinction without a difference if there ever was one. In the meantime, I see you have no comment to offer on Gawande's essay. |
Anonymous
It is a distinction with a big difference. I have no comment to offer on your very long post. I'm not the PP you've been arguing with. I am just trying to figure out if you believe the false statement you made, and it seems you know it is false but think the fact it is false is of no consequence. That's all I needed to know. |
Anonymous
DP. Do you understand the concept of taking basic rhetorical positions in writing for the purposes of clarity ? You are being oddly literal, which is really weakening your position. Obviously compared to the vast variety of vaginal birth techniques, c-sections are “the same.” Now, of course they aren’t actually the same — PP probably didn’t think she had to explain something so basic and obvious — but when you are speaking about techniques across a large population, they are essentially the same. Maybe this is too complicated for you, but it is obvious to most. |
Anonymous
But vaginal birth is almost always performed on your back. Is it the labor position that plays a role in pelvic injury? Is it purple pushing? Is it pushing prior to crowning? Forceps and vacuum assisted may be a correlation with birth position. |
Anonymous
I don't have a "position" other than that the sentence "All C-sections are the same" is false. That position cannot be weakened because it is correct. I do understand rhetorical devices, which is why I asked if PP was using one. She responded that "I couldn't possibly be [taking a position I never took]" and then that the fact her statement was false was a distinction without a difference. You can find those statements rhetorically persuasive, but I'm guessing it's only because you were already feeling a kinship with her based on upthread posts. |
Anonymous
It's odd to get so hung up on one obviously rhetorical statement, that's all. |