C-section or natural after 3rd degree tear?

[Anonymous]

Anonymous wrote:

Anonymous wrote:You guys realize CS have serious risks to them? Not just now but in the future? Recovering from a bad tear isn't easy but how do you think they get the baby out in a CS? They cut open your abdomen and uterus. That's a much bigger and more serious wound.

I'm a midwife and I see women who've had serious tears not even need repairing the second time. I'd choose a vaginal birth and ask that my provider do good perineal support and let me lead pushing rather than direct it themselves.

Just about everyone recovers from a C-section, especially a scheduled C-section after a routine pregnancy, without incident. I've had a third-degree tear, and I've had a C-section, and I'd choose the latter again in a heartbeat.

There's no gold medal for vaginal birth, OP. Despite what midwives might claim.

This is nonsense. First off, more women die, almost die, and have major complications from c-sections than they do from vaginal birth (in this country, not in less developed areas where the c-section rates are still too low). So yeah if the surgery goes well, super, you've saved your pelvic floor (I guess, although many women with c-sections still have painful sex and incontinence because of pregnancy and hormonal changes). And if you only need one, the first c-section is usually simple and straightforward. They get more and more dangerous the more of them you have. For you and your baby.

I could post data and stats but this makes a much better case I think.
https://www.washingtonpost.com/posteverything/wp/2015/06/05/im-an-ob-gyn-i-dont-think-most-babies-should-be-born-in-the-hopsital

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You guys realize CS have serious risks to them? Not just now but in the future? Recovering from a bad tear isn't easy but how do you think they get the baby out in a CS? They cut open your abdomen and uterus. That's a much bigger and more serious wound.

I'm a midwife and I see women who've had serious tears not even need repairing the second time. I'd choose a vaginal birth and ask that my provider do good perineal support and let me lead pushing rather than direct it themselves.

Just about everyone recovers from a C-section, especially a scheduled C-section after a routine pregnancy, without incident. I've had a third-degree tear, and I've had a C-section, and I'd choose the latter again in a heartbeat.

There's no gold medal for vaginal birth, OP. Despite what midwives might claim.

This is nonsense. First off, more women die, almost die, and have major complications from c-sections than they do from vaginal birth (in this country, not in less developed areas where the c-section rates are still too low). So yeah if the surgery goes well, super, you've saved your pelvic floor (I guess, although many women with c-sections still have painful sex and incontinence because of pregnancy and hormonal changes). And if you only need one, the first c-section is usually simple and straightforward. They get more and more dangerous the more of them you have. For you and your baby.

I could post data and stats but this makes a much better case I think.
https://www.washingtonpost.com/posteverything/wp/2015/06/05/im-an-ob-gyn-i-dont-think-most-babies-should-be-born-in-the-hopsital

Right, but OP is having a first C-section, and thus it will likely be "simple and straightforward."

And again: you don't get a gold star for vaginal birth, especially if you've had significant tearing in the past.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Whenever I see these posts about how easy the recovery is from a scheduled Csection, I feel the need to chime in and just say that you can't count on that. My csection was planned well in advance (breach baby), I had an otherwise healthy and uneventful pregnancy. I was not AMA, I was fit, with really strong core, did the yoga, etc. The surgery went well, and my baby was healthy, and I even got a lot of compliments on my scar (as if I had anything to do with it, but I still liked hearing them). I left the hospital a day early even.

BUT, you will be unable move properly for weeks. You will not be able to pace the floor with your new born like you need/want to. It will be months later, and you will still feel weak in your abs, and will not be able to get up off the floor. This is a very serious surgery, and it will take months to recover. And last time, I didn't even have a toddler. Look, I haven't ever recovered from a 3rd degree tear, but I don't know any mom who did a vaginal birth who was physically recovering as long as I was. I just don't want this thread to give anyone an overly rosy view of csection recovery!

Hi, I am a mom who is still physically recovering from a traumatic vaginal delivery-- so know you know someone. I could not sit down comfortably for months and brought my hospital donut everywhere. I could hardly walk for weeks. I Couldn't have sex without pain for over a year and I spent 6 months in pelvic floor PT because of nerve damage and pain. Nothing is rosy about childbirth, but my 3 friends who had uncomplicated scheduled Caesareans all were back to exercising well before I could even walk without discomfort. I know people will say that my experience is an outlier but the more I talk to women the more I realize how common these issues are in the post partum period. They just are not talked about. All recoveries suck, and some are harder than others.

Sorry--I shouldn't have compared the two--and I don't mean to imply that recovering vaginal child birth is anything rosy at all! Just the vibe I got from some PPs (maybe this was their experience--if so I'm jealous--or maybe the details just faded into the memory hole that is the postpartum months) was that the recovery from a cs is no big deal. I just wanted to clarify that this is not the case. And my experience is not an outlier--this is what it is to recover from having your abs cut open and a baby yanked through them.

I'm a NP here. I don't doubt or contest your experience at all, but wanted to add that some do truly have different experiences and not just faulty memories. I'm currently 9 weeks postpartum after my second c section, so my memories of this healing process haven't faded into memory yet. The first 2 weeks were really rough and I agree it was super hard to get up and walk/pace with the newborn. I also needed a lot of help with my toddler. But, I felt markedly better after 2 weeks, and almost 100% back to normal at 6 weeks. Since then, I've been doing yoga and Pilates regularly and going on long walks with no pain. I have no difficulty getting up off the floor and have regularly been playing on the floor with the toddler for at least a month. I will say that I remembered recovering really well and quickly from my first, emergency c section, so I was surprised and disappointed at how hard the first two weeks were this time, but I can say without the fog of memory that it took weeks and not months to feel back to normal this time around.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You guys realize CS have serious risks to them? Not just now but in the future? Recovering from a bad tear isn't easy but how do you think they get the baby out in a CS? They cut open your abdomen and uterus. That's a much bigger and more serious wound.

I'm a midwife and I see women who've had serious tears not even need repairing the second time. I'd choose a vaginal birth and ask that my provider do good perineal support and let me lead pushing rather than direct it themselves.

Just about everyone recovers from a C-section, especially a scheduled C-section after a routine pregnancy, without incident. I've had a third-degree tear, and I've had a C-section, and I'd choose the latter again in a heartbeat.

There's no gold medal for vaginal birth, OP. Despite what midwives might claim.

This is nonsense. First off, more women die, almost die, and have major complications from c-sections than they do from vaginal birth (in this country, not in less developed areas where the c-section rates are still too low). So yeah if the surgery goes well, super, you've saved your pelvic floor (I guess, although many women with c-sections still have painful sex and incontinence because of pregnancy and hormonal changes). And if you only need one, the first c-section is usually simple and straightforward. They get more and more dangerous the more of them you have. For you and your baby.

I could post data and stats but this makes a much better case I think.
https://www.washingtonpost.com/posteverything/wp/2015/06/05/im-an-ob-gyn-i-dont-think-most-babies-should-be-born-in-the-hopsital

Right, but OP is having a first C-section, and thus it will likely be "simple and straightforward."

And again: you don't get a gold star for vaginal birth, especially if you've had significant tearing in the past.

It's a straightforward procedure for the surgeon, yes. Very routine. You can still have organ damage and your risk of infection and severe hemorrhage is higher. And if she has another baby later on? Both of them are at higher risk just by virtue of the first procedure.

That's great advice about gold medals or stars, if that's what drives you in life I guess.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You guys realize CS have serious risks to them? Not just now but in the future? Recovering from a bad tear isn't easy but how do you think they get the baby out in a CS? They cut open your abdomen and uterus. That's a much bigger and more serious wound.

I'm a midwife and I see women who've had serious tears not even need repairing the second time. I'd choose a vaginal birth and ask that my provider do good perineal support and let me lead pushing rather than direct it themselves.

Just about everyone recovers from a C-section, especially a scheduled C-section after a routine pregnancy, without incident. I've had a third-degree tear, and I've had a C-section, and I'd choose the latter again in a heartbeat.

There's no gold medal for vaginal birth, OP. Despite what midwives might claim.

This is nonsense. First off, more women die, almost die, and have major complications from c-sections than they do from vaginal birth (in this country, not in less developed areas where the c-section rates are still too low). So yeah if the surgery goes well, super, you've saved your pelvic floor (I guess, although many women with c-sections still have painful sex and incontinence because of pregnancy and hormonal changes). And if you only need one, the first c-section is usually simple and straightforward. They get more and more dangerous the more of them you have. For you and your baby.

I could post data and stats but this makes a much better case I think.
https://www.washingtonpost.com/posteverything/wp/2015/06/05/im-an-ob-gyn-i-dont-think-most-babies-should-be-born-in-the-hopsital

Let's talk PP because you clearly have an agenda to push and you're not doing it very well. So let's strip away the dogma and ideology and focus on facts. First of all, there is a HUGE difference in risks, mortality rate, etc. between an EMERGENCY Cesarean and a SCHEDULED one. And the reality is that the risks are significantly lower for a scheduled Cesarean. The natural birth community won't acknowledge this. In fact, they love to scare women about the risks of Cesarean while not acknowledging at all that there are any risks to a vaginal delivery. See below.

."..Most studies looking at the risks of cesarean section may have been biased, as women with medical or obstetric problems were more likely to have been selected for an elective cesarean section. Thus, the occurrence of poor maternal or neonatal outcomes may have been due to the problem necessitating the cesarean delivery rather than to the procedure itself. The only way to avoid this selection bias is to conduct a trial in which women would be randomly assigned to undergo a planned cesarean section or a planned vaginal birth. When this was done in the international randomized Term Breech Trial involving 2088 women with a singleton fetus in breech presentation at term, the risk of perinatal or neonatal death or of serious neonatal morbidity was significantly lower in the planned cesarean group, with no significant increase in the risk of maternal death or serious maternal morbidity.1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC343856/


And thanks for your awesome WaPo story, but if you were following maternal health news in the UK more closely you would know that they had ended their Campaign for Normal birth, that women in the UK are sustaining record levels of injury because of increased use of forceps and vacuum and pressure to delivery vaginally above all else, and they have launched a Birth Trauma Association because so many women are dealing with life-long physical injuries and emotional trauma from their deliveries.

https://www.theguardian.com/society/2017/aug/12/midwives-to-stop-using-term-normal-birth
https://www.ncbi.nlm.nih.gov/pubmed/27131590

You would also know that the new guidelines published by ACOG and Soc. for Maternal-Fetal Medicine that promote a permissive approach to managing second stage labor and longer pushing rates fly in the fact of 50 years of obstetric practice. Furthermore, there is a growing number of OBs saying--to their own colleagues in the journal of ACOG--that these guidelines are not supported by robust evidence and warning that our country is going to start seeing far more maternal injuries in our dogmatic pursuit of reducing the Cesarean rate while ignoring all other outcomes, such as perineal lacerations, hemorrhage, maternal mortality, infection, somatic trauma, infant cephelahematoma, etc. which are all important outcomes. Not to mention the long term costs to our health care system and to women who have had traumatic births and now are dealing with emotional trauma, prolapse, incontinence, etc. and then have subsequent surgeries, sometimes years or decades alter, with high failure rates, and then have to deal with things like mesh complications, etc.

https://www.ncbi.nlm.nih.gov/pubmed/27131590
http://www.ajog.org/article/S0002-9378(15)02231-0/fulltext

All of this is not to say that Cesarean delivery is not without risk, as it certainly is. But you need to stop with this "natural birth" dogma and ideology, Cesarean fear mongering, and medical paternalism. Women need to have all the information they deserve without bias so they can make the best decisions for themselves and their families and supported no matter what decision they make and whatever outcome they have.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You guys realize CS have serious risks to them? Not just now but in the future? Recovering from a bad tear isn't easy but how do you think they get the baby out in a CS? They cut open your abdomen and uterus. That's a much bigger and more serious wound.

I'm a midwife and I see women who've had serious tears not even need repairing the second time. I'd choose a vaginal birth and ask that my provider do good perineal support and let me lead pushing rather than direct it themselves.

Just about everyone recovers from a C-section, especially a scheduled C-section after a routine pregnancy, without incident. I've had a third-degree tear, and I've had a C-section, and I'd choose the latter again in a heartbeat.

There's no gold medal for vaginal birth, OP. Despite what midwives might claim.

This is nonsense. First off, more women die, almost die, and have major complications from c-sections than they do from vaginal birth (in this country, not in less developed areas where the c-section rates are still too low). So yeah if the surgery goes well, super, you've saved your pelvic floor (I guess, although many women with c-sections still have painful sex and incontinence because of pregnancy and hormonal changes). And if you only need one, the first c-section is usually simple and straightforward. They get more and more dangerous the more of them you have. For you and your baby.

I could post data and stats but this makes a much better case I think.
https://www.washingtonpost.com/posteverything/wp/2015/06/05/im-an-ob-gyn-i-dont-think-most-babies-should-be-born-in-the-hopsital

Let's talk PP because you clearly have an agenda to push and you're not doing it very well. So let's strip away the dogma and ideology and focus on facts. First of all, there is a HUGE difference in risks, mortality rate, etc. between an EMERGENCY Cesarean and a SCHEDULED one. And the reality is that the risks are significantly lower for a scheduled Cesarean. The natural birth community won't acknowledge this. In fact, they love to scare women about the risks of Cesarean while not acknowledging at all that there are any risks to a vaginal delivery. See below.

."..Most studies looking at the risks of cesarean section may have been biased, as women with medical or obstetric problems were more likely to have been selected for an elective cesarean section. Thus, the occurrence of poor maternal or neonatal outcomes may have been due to the problem necessitating the cesarean delivery rather than to the procedure itself. The only way to avoid this selection bias is to conduct a trial in which women would be randomly assigned to undergo a planned cesarean section or a planned vaginal birth. When this was done in the international randomized Term Breech Trial involving 2088 women with a singleton fetus in breech presentation at term, the risk of perinatal or neonatal death or of serious neonatal morbidity was significantly lower in the planned cesarean group, with no significant increase in the risk of maternal death or serious maternal morbidity.1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC343856/


And thanks for your awesome WaPo story, but if you were following maternal health news in the UK more closely you would know that they had ended their Campaign for Normal birth, that women in the UK are sustaining record levels of injury because of increased use of forceps and vacuum and pressure to delivery vaginally above all else, and they have launched a Birth Trauma Association because so many women are dealing with life-long physical injuries and emotional trauma from their deliveries.

https://www.theguardian.com/society/2017/aug/12/midwives-to-stop-using-term-normal-birth
https://www.ncbi.nlm.nih.gov/pubmed/27131590

You would also know that the new guidelines published by ACOG and Soc. for Maternal-Fetal Medicine that promote a permissive approach to managing second stage labor and longer pushing rates fly in the fact of 50 years of obstetric practice. Furthermore, there is a growing number of OBs saying--to their own colleagues in the journal of ACOG--that these guidelines are not supported by robust evidence and warning that our country is going to start seeing far more maternal injuries in our dogmatic pursuit of reducing the Cesarean rate while ignoring all other outcomes, such as perineal lacerations, hemorrhage, maternal mortality, infection, somatic trauma, infant cephelahematoma, etc. which are all important outcomes. Not to mention the long term costs to our health care system and to women who have had traumatic births and now are dealing with emotional trauma, prolapse, incontinence, etc. and then have subsequent surgeries, sometimes years or decades alter, with high failure rates, and then have to deal with things like mesh complications, etc.

https://www.ncbi.nlm.nih.gov/pubmed/27131590
http://www.ajog.org/article/S0002-9378(15)02231-0/fulltext

All of this is not to say that Cesarean delivery is not without risk, as it certainly is. But you need to stop with this "natural birth" dogma and ideology, Cesarean fear mongering, and medical paternalism. Women need to have all the information they deserve without bias so they can make the best decisions for themselves and their families and supported no matter what decision they make and whatever outcome they have.

I don't have a dog in this fight, but am one of the posters battling this decision and I just want to clap for you. Thank you for this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You guys realize CS have serious risks to them? Not just now but in the future? Recovering from a bad tear isn't easy but how do you think they get the baby out in a CS? They cut open your abdomen and uterus. That's a much bigger and more serious wound.

I'm a midwife and I see women who've had serious tears not even need repairing the second time. I'd choose a vaginal birth and ask that my provider do good perineal support and let me lead pushing rather than direct it themselves.

Just about everyone recovers from a C-section, especially a scheduled C-section after a routine pregnancy, without incident. I've had a third-degree tear, and I've had a C-section, and I'd choose the latter again in a heartbeat.

There's no gold medal for vaginal birth, OP. Despite what midwives might claim.

This is nonsense. First off, more women die, almost die, and have major complications from c-sections than they do from vaginal birth (in this country, not in less developed areas where the c-section rates are still too low). So yeah if the surgery goes well, super, you've saved your pelvic floor (I guess, although many women with c-sections still have painful sex and incontinence because of pregnancy and hormonal changes). And if you only need one, the first c-section is usually simple and straightforward. They get more and more dangerous the more of them you have. For you and your baby.

I could post data and stats but this makes a much better case I think.
https://www.washingtonpost.com/posteverything/wp/2015/06/05/im-an-ob-gyn-i-dont-think-most-babies-should-be-born-in-the-hopsital

Let's talk PP because you clearly have an agenda to push and you're not doing it very well. So let's strip away the dogma and ideology and focus on facts. First of all, there is a HUGE difference in risks, mortality rate, etc. between an EMERGENCY Cesarean and a SCHEDULED one. And the reality is that the risks are significantly lower for a scheduled Cesarean. The natural birth community won't acknowledge this. In fact, they love to scare women about the risks of Cesarean while not acknowledging at all that there are any risks to a vaginal delivery. See below.

."..Most studies looking at the risks of cesarean section may have been biased, as women with medical or obstetric problems were more likely to have been selected for an elective cesarean section. Thus, the occurrence of poor maternal or neonatal outcomes may have been due to the problem necessitating the cesarean delivery rather than to the procedure itself. The only way to avoid this selection bias is to conduct a trial in which women would be randomly assigned to undergo a planned cesarean section or a planned vaginal birth. When this was done in the international randomized Term Breech Trial involving 2088 women with a singleton fetus in breech presentation at term, the risk of perinatal or neonatal death or of serious neonatal morbidity was significantly lower in the planned cesarean group, with no significant increase in the risk of maternal death or serious maternal morbidity.1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC343856/


And thanks for your awesome WaPo story, but if you were following maternal health news in the UK more closely you would know that they had ended their Campaign for Normal birth, that women in the UK are sustaining record levels of injury because of increased use of forceps and vacuum and pressure to delivery vaginally above all else, and they have launched a Birth Trauma Association because so many women are dealing with life-long physical injuries and emotional trauma from their deliveries.

https://www.theguardian.com/society/2017/aug/12/midwives-to-stop-using-term-normal-birth
https://www.ncbi.nlm.nih.gov/pubmed/27131590

You would also know that the new guidelines published by ACOG and Soc. for Maternal-Fetal Medicine that promote a permissive approach to managing second stage labor and longer pushing rates fly in the fact of 50 years of obstetric practice. Furthermore, there is a growing number of OBs saying--to their own colleagues in the journal of ACOG--that these guidelines are not supported by robust evidence and warning that our country is going to start seeing far more maternal injuries in our dogmatic pursuit of reducing the Cesarean rate while ignoring all other outcomes, such as perineal lacerations, hemorrhage, maternal mortality, infection, somatic trauma, infant cephelahematoma, etc. which are all important outcomes. Not to mention the long term costs to our health care system and to women who have had traumatic births and now are dealing with emotional trauma, prolapse, incontinence, etc. and then have subsequent surgeries, sometimes years or decades alter, with high failure rates, and then have to deal with things like mesh complications, etc.

https://www.ncbi.nlm.nih.gov/pubmed/27131590
http://www.ajog.org/article/S0002-9378(15)02231-0/fulltext

All of this is not to say that Cesarean delivery is not without risk, as it certainly is. But you need to stop with this "natural birth" dogma and ideology, Cesarean fear mongering, and medical paternalism. Women need to have all the information they deserve without bias so they can make the best decisions for themselves and their families and supported no matter what decision they make and whatever outcome they have.

You’re painting with really broad strokes here. I might be convinced by the natural birth movement "dogma" having the effect you’re describing if the c-section rate had actually gone down. It hasn’t in this country. So that theory doesn’t hold water, because we’re doing just as many c-sections as ever and according to you, women are experiencing unprecedented levels of birth trauma because there aren’t enough c-sections being done anymore.

I’m confused too about why forceps are causing so much trauma. I get that they went out of vogue due to the routine use of c-section for obstructed labor, but surely back in the 60s and 70s when c-sections only made up 5-10% of all births, OBs had to use forceps from time to time. Is the argument that women back then were having alarming rates of birth trauma as well (they should have been astronomical by this logic)? Are OBs botching women because they’re no longer properly trained on technique? Or are more labors obstructed? Or is something wrong with women’s pelvic floor and vaginal tissues in the new millenium? In other less developed areas the lack of nutrition combined with child marriage leads to high rates of obstructed labor, and unskilled attendants frequently botch women and kill babies.

I mean, I can see why OBs don't want to go back to having to botch women or -gulp- fight for better training protocols, but that doesn't have to be in conflict with safely reducing c-section rates which, like it or not, do have considerable downstream effects including a higher mortality rate.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You guys realize CS have serious risks to them? Not just now but in the future? Recovering from a bad tear isn't easy but how do you think they get the baby out in a CS? They cut open your abdomen and uterus. That's a much bigger and more serious wound.

I'm a midwife and I see women who've had serious tears not even need repairing the second time. I'd choose a vaginal birth and ask that my provider do good perineal support and let me lead pushing rather than direct it themselves.

Just about everyone recovers from a C-section, especially a scheduled C-section after a routine pregnancy, without incident. I've had a third-degree tear, and I've had a C-section, and I'd choose the latter again in a heartbeat.

There's no gold medal for vaginal birth, OP. Despite what midwives might claim.

This is nonsense. First off, more women die, almost die, and have major complications from c-sections than they do from vaginal birth (in this country, not in less developed areas where the c-section rates are still too low). So yeah if the surgery goes well, super, you've saved your pelvic floor (I guess, although many women with c-sections still have painful sex and incontinence because of pregnancy and hormonal changes). And if you only need one, the first c-section is usually simple and straightforward. They get more and more dangerous the more of them you have. For you and your baby.

I could post data and stats but this makes a much better case I think.
https://www.washingtonpost.com/posteverything/wp/2015/06/05/im-an-ob-gyn-i-dont-think-most-babies-should-be-born-in-the-hopsital

Let's talk PP because you clearly have an agenda to push and you're not doing it very well. So let's strip away the dogma and ideology and focus on facts. First of all, there is a HUGE difference in risks, mortality rate, etc. between an EMERGENCY Cesarean and a SCHEDULED one. And the reality is that the risks are significantly lower for a scheduled Cesarean. The natural birth community won't acknowledge this. In fact, they love to scare women about the risks of Cesarean while not acknowledging at all that there are any risks to a vaginal delivery. See below.

."..Most studies looking at the risks of cesarean section may have been biased, as women with medical or obstetric problems were more likely to have been selected for an elective cesarean section. Thus, the occurrence of poor maternal or neonatal outcomes may have been due to the problem necessitating the cesarean delivery rather than to the procedure itself. The only way to avoid this selection bias is to conduct a trial in which women would be randomly assigned to undergo a planned cesarean section or a planned vaginal birth. When this was done in the international randomized Term Breech Trial involving 2088 women with a singleton fetus in breech presentation at term, the risk of perinatal or neonatal death or of serious neonatal morbidity was significantly lower in the planned cesarean group, with no significant increase in the risk of maternal death or serious maternal morbidity.1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC343856/


And thanks for your awesome WaPo story, but if you were following maternal health news in the UK more closely you would know that they had ended their Campaign for Normal birth, that women in the UK are sustaining record levels of injury because of increased use of forceps and vacuum and pressure to delivery vaginally above all else, and they have launched a Birth Trauma Association because so many women are dealing with life-long physical injuries and emotional trauma from their deliveries.

https://www.theguardian.com/society/2017/aug/12/midwives-to-stop-using-term-normal-birth
https://www.ncbi.nlm.nih.gov/pubmed/27131590

You would also know that the new guidelines published by ACOG and Soc. for Maternal-Fetal Medicine that promote a permissive approach to managing second stage labor and longer pushing rates fly in the fact of 50 years of obstetric practice. Furthermore, there is a growing number of OBs saying--to their own colleagues in the journal of ACOG--that these guidelines are not supported by robust evidence and warning that our country is going to start seeing far more maternal injuries in our dogmatic pursuit of reducing the Cesarean rate while ignoring all other outcomes, such as perineal lacerations, hemorrhage, maternal mortality, infection, somatic trauma, infant cephelahematoma, etc. which are all important outcomes. Not to mention the long term costs to our health care system and to women who have had traumatic births and now are dealing with emotional trauma, prolapse, incontinence, etc. and then have subsequent surgeries, sometimes years or decades alter, with high failure rates, and then have to deal with things like mesh complications, etc.

https://www.ncbi.nlm.nih.gov/pubmed/27131590
http://www.ajog.org/article/S0002-9378(15)02231-0/fulltext

All of this is not to say that Cesarean delivery is not without risk, as it certainly is. But you need to stop with this "natural birth" dogma and ideology, Cesarean fear mongering, and medical paternalism. Women need to have all the information they deserve without bias so they can make the best decisions for themselves and their families and supported no matter what decision they make and whatever outcome they have.

You’re painting with really broad strokes here. I might be convinced by the natural birth movement "dogma" having the effect you’re describing if the c-section rate had actually gone down. It hasn’t in this country. So that theory doesn’t hold water, because we’re doing just as many c-sections as ever and according to you, women are experiencing unprecedented levels of birth trauma because there aren’t enough c-sections being done anymore.

I’m confused too about why forceps are causing so much trauma. I get that they went out of vogue due to the routine use of c-section for obstructed labor, but surely back in the 60s and 70s when c-sections only made up 5-10% of all births, OBs had to use forceps from time to time. Is the argument that women back then were having alarming rates of birth trauma as well (they should have been astronomical by this logic)? Are OBs botching women because they’re no longer properly trained on technique? Or are more labors obstructed? Or is something wrong with women’s pelvic floor and vaginal tissues in the new millenium? In other less developed areas the lack of nutrition combined with child marriage leads to high rates of obstructed labor, and unskilled attendants frequently botch women and kill babies.

I mean, I can see why OBs don't want to go back to having to botch women or -gulp- fight for better training protocols, but that doesn't have to be in conflict with safely reducing c-section rates which, like it or not, do have considerable downstream effects including a higher mortality rate.

I’m not going to bother engaging you, PP if you won’t directly address my points. You seem obsessed with our nation’s high Cesarean delivery rate—why? Yes emergency Cesarean sections have risks but scheduled ones far less so. So why do you care about arbitrary percentages so much. I promise if you look into the literature on Cesarean delivery you will be surprised at what you read, especially when comparing outcomes of planned Cesarean with planned vaginal birth.

What you seem to be failing to understand is that obsession with Cesarean delivery rate on our nation is just that—obsessive. It ignores many other important outcomes that really really matter. I am not usually a skeptical OB fan but read what Amy Tuteur says about the WHO target goal for Cesarean delivery rate. She has some extremely valid critiques.

And for forceps, if you don’t recognize that there are major, large studies now showing how bad they are, you really need to get with the program. Look up the work of Victoria Handa at JHU and Hans Peter Dietz in Sydney. Once you stop getting your advice from Ina May and start looking at evidence based research you will find a very different reality from what you seem to believe.

[Anonymous]

Also, you seem largely ignorant of the risks of pelvic floor disorders among older women. It’s not talked about but they effect one in 4 women so yes, very common. Aren’t you aware of the mesh surgery litigation? And also the fact that advanced maternal age at first delivery and larger babies are Factors in these complicated labors. The reality is that we were not designed to have our first children in our 30s and 40s.

[Anonymous]

Anonymous wrote:Also, you seem largely ignorant of the risks of pelvic floor disorders among older women. It’s not talked about but they effect one in 4 women so yes, very common. Aren’t you aware of the mesh surgery litigation? And also the fact that advanced maternal age at first delivery and larger babies are Factors in these complicated labors. The reality is that we were not designed to have our first children in our 30s and 40s.

Thank you for all of this PP. People like the other PP need to be shut down. I just left an OB appointment trying to figure out which way is best for my second birth (I'm in my late 30s and have big babies) and a planned one may be best based on my previous birth and history for shoulder dislocia (I know I spelled that incorrectly).

That said I still don't know what I'm going to do!!!

[Anonymous]

God, who is this person who also knows about Handa and Dietz!!! Wonderful!!! When I had my child in 2014, I was so badly mangled and I felt like the only person, in the subsequent months of trying to put myself back together, who knew who they were. Thank you for highlighting their work. To the adamant vaginal birth person who has posted previously: You can sing your song after you have walked in my shoes. I cannot hold gas, or soft stools. Constipation pushes my rectum into my vagina. Evacuation has to happen edigitally because all the hard stool goes to where my levator ani used to be, and guess what, there is no anus there. My sexual enjoyment - what's that? I am a giant hole with three prolapsed organs (uterus, bladder and rectum) hanging in it, and no levator on my right side to contract for any sort of pleasure. Did I forget to tell you about my intussception? I really notice that when I am constipated, because when I can finally evacuate the stool, part of my colon emerges from my body. Thankfully it goes back in. But I dont know if it will when I have menopause someday. And did I mention my nerve damage (again, sexual enjoyment), enterocele and general daily pelvic pain? Or what it was like to not be able to life anything over ten pounds after my son, or how it feels inside when I have to tell him i cant carry him or pick him up? FWIW, arguably the most prominent midwife practicing in the district was in the room when I delivered. So, fuck your sanctimony. You try being me first. For the rest of your fucking life.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Also, you seem largely ignorant of the risks of pelvic floor disorders among older women. It’s not talked about but they effect one in 4 women so yes, very common. Aren’t you aware of the mesh surgery litigation? And also the fact that advanced maternal age at first delivery and larger babies are Factors in these complicated labors. The reality is that we were not designed to have our first children in our 30s and 40s.

Thank you for all of this PP. People like the other PP need to be shut down. I just left an OB appointment trying to figure out which way is best for my second birth (I'm in my late 30s and have big babies) and a planned one may be best based on my previous birth and history for shoulder dislocia (I know I spelled that incorrectly).

That said I still don't know what I'm going to do!!!

It's really hard. Shoulder dystocia literally makes appearances in my nightmares. My first birth could easily be classified as traumatic, but it's funny -- I survived, with a 3rd degree tear and two units of someone else's blood, but I physically don't seem to have any lasting damage. It seems to be kind of a crapshoot as to how birth #2 could go, and so I'm not eager to deal with the potentially devastating effects of a severe tear, but I'm also not thrilled about the increased risk of death with (even an) elective cesarean, as well as the recovery time. I'll just play it by ear, I guess, and try to make sure I'm comfortable with my provider's communication about why she thinks what she thinks -- right now (in first trimester), she's certainly not pushing the cesarean, but maybe things will evolve.

One thing I don't want? A pitocin induction. That was NOT a good scene for me (pitocin did nothing except exhaust my uterus, leading to a variety of other interventions), so if that is what ends up being suggested, I'm going to stick with the cesarean.

[Anonymous]

Anonymous wrote:God, who is this person who also knows about Handa and Dietz!!! Wonderful!!! When I had my child in 2014, I was so badly mangled and I felt like the only person, in the subsequent months of trying to put myself back together, who knew who they were. Thank you for highlighting their work. To the adamant vaginal birth person who has posted previously: You can sing your song after you have walked in my shoes. I cannot hold gas, or soft stools. Constipation pushes my rectum into my vagina. Evacuation has to happen edigitally because all the hard stool goes to where my levator ani used to be, and guess what, there is no anus there. My sexual enjoyment - what's that? I am a giant hole with three prolapsed organs (uterus, bladder and rectum) hanging in it, and no levator on my right side to contract for any sort of pleasure. Did I forget to tell you about my intussception? I really notice that when I am constipated, because when I can finally evacuate the stool, part of my colon emerges from my body. Thankfully it goes back in. But I dont know if it will when I have menopause someday. And did I mention my nerve damage (again, sexual enjoyment), enterocele and general daily pelvic pain? Or what it was like to not be able to life anything over ten pounds after my son, or how it feels inside when I have to tell him i cant carry him or pick him up? FWIW, arguably the most prominent midwife practicing in the district was in the room when I delivered. So, fuck your sanctimony. You try being me first. For the rest of your fucking life.

(Signs up for elective cesarean immediately).

I'm so sorry, PP.

[Anonymous]

Anonymous wrote:God, who is this person who also knows about Handa and Dietz!!! Wonderful!!! When I had my child in 2014, I was so badly mangled and I felt like the only person, in the subsequent months of trying to put myself back together, who knew who they were. Thank you for highlighting their work. To the adamant vaginal birth person who has posted previously: You can sing your song after you have walked in my shoes. I cannot hold gas, or soft stools. Constipation pushes my rectum into my vagina. Evacuation has to happen edigitally because all the hard stool goes to where my levator ani used to be, and guess what, there is no anus there. My sexual enjoyment - what's that? I am a giant hole with three prolapsed organs (uterus, bladder and rectum) hanging in it, and no levator on my right side to contract for any sort of pleasure. Did I forget to tell you about my intussception? I really notice that when I am constipated, because when I can finally evacuate the stool, part of my colon emerges from my body. Thankfully it goes back in. But I dont know if it will when I have menopause someday. And did I mention my nerve damage (again, sexual enjoyment), enterocele and general daily pelvic pain? Or what it was like to not be able to life anything over ten pounds after my son, or how it feels inside when I have to tell him i cant carry him or pick him up? FWIW, arguably the most prominent midwife practicing in the district was in the room when I delivered. So, fuck your sanctimony. You try being me first. For the rest of your fucking life.

Holy shit. What a nightmare for you pp! What happened during your vaginal birth? I've never heard anyone have any of those problems you mentioned. I'm so sorry for you.

[Anonymous]

Anonymous wrote:Also, you seem largely ignorant of the risks of pelvic floor disorders among older women. It’s not talked about but they effect one in 4 women so yes, very common. Aren’t you aware of the mesh surgery litigation? And also the fact that advanced maternal age at first delivery and larger babies are Factors in these complicated labors. The reality is that we were not designed to have our first children in our 30s and 40s.

It's not really that cut and dry, much as I'm sure everyone will be happy to hear that their bodies are damaged goods by the time they hit 32.

I've read studies that found that c-section was protective of the pelvic floor, and I've read studies that found that protection was lacking by the time women reach middle age, as a significant numbers experience incontinence later on. Obesity is a big risk factor, not age independently. Nowhere is there the definitive consensus that you are hoping for to neatly explain away this problem.