So what exactly is the problem with C-Sections?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:More bluntly: which groups of women pay the health price for training new physicians in the art of delivery, since PP seems to think preservation of that knowledge is so critical? Exactly which babies and delivering mothers get to be the training grounds? I would like to know from the PPs lamenting the loss of training in forceps births.

Who is paying the price for the new surgeons now? Where are they training to operate? Are they born with that knowledge?

You didn’t answer the question.

You didn't, either. No one has to be the training ground. If they figured out how to train people in surgery, they can surely figure out how to train them in midwifery techniques.

[Anonymous]

Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

[Anonymous]

Anonymous wrote:Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

One of the misogynist natural birth proponents. It is absurd.

[Anonymous]

Anonymous wrote:Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

I've had forceps too and they were fine - barely felt a thing. And before you dump on the middle ages, no, MIDDLE AGES, you need to remember what C stands for in Cesarean.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

One of the misogynist natural birth proponents. It is absurd.

I've had a forceps birth, and I've had a C-section birth. I don't want to be denied either option. Calling people names weakens your position. I'm a proponent of a full toolbox.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

I've had forceps too and they were fine - barely felt a thing. And before you dump on the middle ages, no, MIDDLE AGES, you need to remember what C stands for in Cesarean.

Statistically far more women have op’s experience and when gambling between her bad outcomes and a c section almost any rational person would choose ac section

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The article noted many things - you only picked the parts that you like. But thanks for telling me what I believe.

It seemed you missed a very simple message of the essay: the doctor's bag is getting lighter. It used to be full of all kinds of tricks and tools, including the scalpel. Now, it's just the scalpel. Not because they believe the other tools won't work; it's because they don't know how to use them. They simply never learned. And that's why women with any deviations from the "uncomplicated vaginal birth" pathway find themselves with fewer options. Not because physicians believe these options aren't suitable, but mostly because they don't know how to use them. It's a very simplified picture, for sure, with lots of gray and nuanced parts, but that's the direction of travel. We should be able to acknowledge this as reality.

DP. Sure, but what is the point.of this acknowledgement if countering this, or as PP so eloquently said, "preserving artisanship," comes at such a high price to laboring mother's? I don't see the point of any acknowledgement when it would be unethical to take steps to preserve that artisanship.

On the contrary. It would be highly ethical to take steps to preserve these skills because they do work, and educate physicians on how to practice them safely, and when to progress to a C-section. At its most reduced, this line of thinking says: unless a vaginal birth is progressing perfectly, do a C-section. Don't learn to manage complications in any other way. At the tiniest sign of any variation, get the operating room ready. Not because you think a C-section is the best way to manage these complications, but because, simply, you don't know any other way. Truly, when all you have is a hammer...

So you want to return to the days when poorer women of color in labor were used as training grounds for inexperienced delivering doctors. You know that is how it used to work, don’t you? How and where do you think all those physicians got their training before they were experienced enough to run their own private practices? How can you remotely think that is an ethical model?

This is kind of true now though. Look at the rate of c-section among non-white mothers and look at the mortality rates. I don’t think this is an argument in either direction I would just point out they poorer women of color in labor are absolutely being exploited as a training grounds now, it’s just surgical training.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

I've had forceps too and they were fine - barely felt a thing. And before you dump on the middle ages, no, MIDDLE AGES, you need to remember what C stands for in Cesarean.

Statistically far more women have op’s experience and when gambling between her bad outcomes and a c section almost any rational person would choose ac section

When choosing between treatments, it's helpful to know that your doctor is proposing what's the best course for your specific situation, not what's the only thing they've been trained to do.

I've had a forceps assist, and I've had a C-section. The latter was 100% indicated and there was no other way. Choosing between the two, a forceps go was much easier.

[Anonymous]

Anonymous wrote:It's major abdominal surgery, with all the attendant risks (especially infection, limitations on activities, etc.). Plus, if you have multiple pregnancies, the scar tissue from the C-section can cause issues, because it doesn't stretch like unscarred tissue. Likely not a big deal for one more, but can become an issue with multiple.

All this, plus possibility of blood loss/transfusion, painful recovery and may not be able to carry your newborn at first, etc

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The article noted many things - you only picked the parts that you like. But thanks for telling me what I believe.

It seemed you missed a very simple message of the essay: the doctor's bag is getting lighter. It used to be full of all kinds of tricks and tools, including the scalpel. Now, it's just the scalpel. Not because they believe the other tools won't work; it's because they don't know how to use them. They simply never learned. And that's why women with any deviations from the "uncomplicated vaginal birth" pathway find themselves with fewer options. Not because physicians believe these options aren't suitable, but mostly because they don't know how to use them. It's a very simplified picture, for sure, with lots of gray and nuanced parts, but that's the direction of travel. We should be able to acknowledge this as reality.

DP. Sure, but what is the point.of this acknowledgement if countering this, or as PP so eloquently said, "preserving artisanship," comes at such a high price to laboring mother's? I don't see the point of any acknowledgement when it would be unethical to take steps to preserve that artisanship.

On the contrary. It would be highly ethical to take steps to preserve these skills because they do work, and educate physicians on how to practice them safely, and when to progress to a C-section. At its most reduced, this line of thinking says: unless a vaginal birth is progressing perfectly, do a C-section. Don't learn to manage complications in any other way. At the tiniest sign of any variation, get the operating room ready. Not because you think a C-section is the best way to manage these complications, but because, simply, you don't know any other way. Truly, when all you have is a hammer...

So you want to return to the days when poorer women of color in labor were used as training grounds for inexperienced delivering doctors. You know that is how it used to work, don’t you? How and where do you think all those physicians got their training before they were experienced enough to run their own private practices? How can you remotely think that is an ethical model?

This is kind of true now though. Look at the rate of c-section among non-white mothers and look at the mortality rates. I don’t think this is an argument in either direction I would just point out they poorer women of color in labor are absolutely being exploited as a training grounds now, it’s just surgical training.

Where do you think Norwegian surgeons train? You think they import secret pools of nonwhite women to train on?

The bigger issue to think of is our particular intolerance for any imperfect outcomes in medicine. It's almost as if we expect there to be no learning curve for physicians; we want them to hatch with a perfect set of skills. Yet every dentist will one day pull his or her first tooth, and her 100th extraction will be much better than her 1st. You think surgeons hatch fully trained? Someone, somewhere is doing their first C-section as we speak. Who are they supposed to train on? Are they not supposed to train?

That's a different discussion, though.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

I've had forceps too and they were fine - barely felt a thing. And before you dump on the middle ages, no, MIDDLE AGES, you need to remember what C stands for in Cesarean.

If you knew your obstetric history better you’d know that the C in C section is actually a misnomer. The first recorded successful case was in 1500 done in Switzerland by a man who was a sow gelder on his wife. And I’m doubtful you had forceps if you say you didn’t feel them and suffer no ill effects. Very doubtful.

You seem to be the same poster with the Gawande article, which ironically points out how using forceps is an extremely difficult art form to teach as it involves complex angles and pressure and the right “touch” and at the end of residency some doctors have “the touch” and some people don’t. And that is versus a C section which is a straightforward surgery that is easy to teach and for doctors to perform successfully over and over again. Personally given the fact that your urinary and anal continence, your child’s health and brain and skull, and the structure of your pelvic floor and vagina are all at stake (as well as your ability to retain tampons, your vagina’s laxity, and your sexual function) when you give birth, I would much rather choose the skill that is much easier for doctors to learn and perform successfully as the downsides of having a forceps delivery with a doctor who doesn’t have “the right touch” can ruin your quality of life and damage your body in ways that aren’t easily remedied, and significantly harm your child (up to decapitation, as horrifying as that is).

[Anonymous]

Anonymous wrote:

Anonymous wrote:Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

One of the misogynist natural birth proponents. It is absurd.

Funny you think I’m a natural birth proponent. I’m a proponent for informed women giving birth and getting full information about risks and benefits for their health for the rest of their life. I don’t believe in one size fits all medicine or birth and I am not a proponent of natural birth by any stretch. But I do think forceps are an antiquated tool that has shown through much evidence statistically significant rates of maternal injury that to me, mean alternatives should be used or women need to be completely and totally informed of the many downsides of a forceps birth.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The article noted many things - you only picked the parts that you like. But thanks for telling me what I believe.

It seemed you missed a very simple message of the essay: the doctor's bag is getting lighter. It used to be full of all kinds of tricks and tools, including the scalpel. Now, it's just the scalpel. Not because they believe the other tools won't work; it's because they don't know how to use them. They simply never learned. And that's why women with any deviations from the "uncomplicated vaginal birth" pathway find themselves with fewer options. Not because physicians believe these options aren't suitable, but mostly because they don't know how to use them. It's a very simplified picture, for sure, with lots of gray and nuanced parts, but that's the direction of travel. We should be able to acknowledge this as reality.

DP. Sure, but what is the point.of this acknowledgement if countering this, or as PP so eloquently said, "preserving artisanship," comes at such a high price to laboring mother's? I don't see the point of any acknowledgement when it would be unethical to take steps to preserve that artisanship.

On the contrary. It would be highly ethical to take steps to preserve these skills because they do work, and educate physicians on how to practice them safely, and when to progress to a C-section. At its most reduced, this line of thinking says: unless a vaginal birth is progressing perfectly, do a C-section. Don't learn to manage complications in any other way. At the tiniest sign of any variation, get the operating room ready. Not because you think a C-section is the best way to manage these complications, but because, simply, you don't know any other way. Truly, when all you have is a hammer...

So you want to return to the days when poorer women of color in labor were used as training grounds for inexperienced delivering doctors. You know that is how it used to work, don’t you? How and where do you think all those physicians got their training before they were experienced enough to run their own private practices? How can you remotely think that is an ethical model?

This is kind of true now though. Look at the rate of c-section among non-white mothers and look at the mortality rates. I don’t think this is an argument in either direction I would just point out they poorer women of color in labor are absolutely being exploited as a training grounds now, it’s just surgical training.

Where do you think Norwegian surgeons train? You think they import secret pools of nonwhite women to train on?

The bigger issue to think of is our particular intolerance for any imperfect outcomes in medicine. It's almost as if we expect there to be no learning curve for physicians; we want them to hatch with a perfect set of skills. Yet every dentist will one day pull his or her first tooth, and her 100th extraction will be much better than her 1st. You think surgeons hatch fully trained? Someone, somewhere is doing their first C-section as we speak. Who are they supposed to train on? Are they not supposed to train?

That's a different discussion, though.

The c-section rate in Norway is between 15-17% so while I’m sure their surgeons train, they have significantly *more* training on vaginal birth. They also have an absolutely minuscule maternal mortality rate compared to the U.S, especially compared to the U.S maternal mortality rate among WOC. I don’t think “dead mother” is an imperfect outcome of which we should be tolerant.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Who is this poster arguing for forceps? I had forceps and they were horrific. Absolutely horrific. A baby getting ripped out of me with BBQ tongs and ripping off my pelvic floor muscles from the bone in the process. Levator ani avulsion is permanent. It’s often caused by forceps, and there are boatloads of evidence about the damage forceps causes - anal incontinence, LAA, injuries to the baby, and prolapse. Literally there are European countries that don’t use them at all anymore and just use ventouse/vacuum. They represent less and 2 percent of US births because they are antiquated and dangerous and need to go away. There are better alternatives than a technology invented in the MIDDLE AGES!

I've had forceps too and they were fine - barely felt a thing. And before you dump on the middle ages, no, MIDDLE AGES, you need to remember what C stands for in Cesarean.

If you knew your obstetric history better you’d know that the C in C section is actually a misnomer. The first recorded successful case was in 1500 done in Switzerland by a man who was a sow gelder on his wife. And I’m doubtful you had forceps if you say you didn’t feel them and suffer no ill effects. Very doubtful.

You seem to be the same poster with the Gawande article, which ironically points out how using forceps is an extremely difficult art form to teach as it involves complex angles and pressure and the right “touch” and at the end of residency some doctors have “the touch” and some people don’t. And that is versus a C section which is a straightforward surgery that is easy to teach and for doctors to perform successfully over and over again. Personally given the fact that your urinary and anal continence, your child’s health and brain and skull, and the structure of your pelvic floor and vagina are all at stake (as well as your ability to retain tampons, your vagina’s laxity, and your sexual function) when you give birth, I would much rather choose the skill that is much easier for doctors to learn and perform successfully as the downsides of having a forceps delivery with a doctor who doesn’t have “the right touch” can ruin your quality of life and damage your body in ways that aren’t easily remedied, and significantly harm your child (up to decapitation, as horrifying as that is).

The thing is you can't really choose because doctors don't know how to use forceps very well any longer. The choice you speak of is imaginary. That's the point. You aren't choosing what's best for your individual case. You are choosing between the tools the doctor knows how to use. If they only have a hammer, the hammer is what you get for everything. Like Windex in the Greek wedding.

Forceps should be but one tool in the ob's bag of tricks. But right now, that bag is headed toward only two things:

a. A teabag for a cup of tea to enjoy during perfectly uncomplicated vaginal deliveries, and

b. A scalpel.

[Anonymous]

Anonymous wrote:
The c-section rate in Norway is between 15-17% so while I’m sure their surgeons train, they have significantly *more* training on vaginal birth. They also have an absolutely minuscule maternal mortality rate compared to the U.S, especially compared to the U.S maternal mortality rate among WOC. I don’t think “dead mother” is an imperfect outcome of which we should be tolerant.

I don't really understand your point. You said we shouldn't teach doctors non-Cesarean tricks and maneuvers because that requires much experience, and they'll just go and train on poor WOC and that's why we shouldn't do it. Did you mean that only for America? So, like, it's OK for foreign obs to learn and practice these skills because they learn and practice in a more ethical manner?

Or, do you believe that 85% of all births in Norway are perfectly uncomplicated vaginal deliveries where all doctors do is drink tea? Or could it be they were taught some midwifery skills and maneuvers to support vaginal birth before grabbing a scalpel?

And that really doesn't answer the question of how they train without a pool of WOC to experiment, as you say, on. Do you think they emerge from womb perfectly skilled in everything? How *do* they train?