C-section or natural after 3rd degree tear?

[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.

Wow PP. And I thought I had it bad.... I just had it bad for a short period of time and now I'm fine. Do you mind sharing more of your story?

[Anonymous]

Anonymous wrote:

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.

Thanks for sharing that, PP. I'm the poster you replied to. I'm only about 4-5 weeks away from giving birth so I need to make my decision and my OBGYN said either is an ok choice based on the size of my baby etc. My choices are however, an induction or a c-section. Induction doesn't seem that appealing to me hence why I think I'm leaning towards as c-section. I, however, don't have the concerns about death and recovery time because my recovery time from from first vaginal birth was long and hard.

[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.

Thanks, PP. I think we should be BFFs. I am another casualty of a well known DC midwifery group. I also have multi organ prolapse, loss of bowel control, and a damaged sex life. I used to be a marathoner but I can't even walk without prolapse pain and discomfort now and I live a very sedentary life. I only know all this stuff now that it's too late for me, but I'll be damned if I let other women continue on in sheer ignorance when they can still educate themselves about the risks before irreparable damage is done. My quality of life sucks now in many of the ways you have described, and I wish daily for my old life back.

Those who are battling this decision would be well served to read the work of Dietz and Handa. But no matter what you decide, avoid forceps at all costs. The rate of damage with them--even when used properly--is incredibly high. There are several countries who have stopped using them entirely, but the resurgence in the US is frightening. I love this video, as it explains why and has excellent info.


https://m.youtube.com/watch?v=7V5mcAqItDw


I dearly wish I knew this stuff before I had my baby.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Thanks for sharing that, PP. I'm the poster you replied to. I'm only about 4-5 weeks away from giving birth so I need to make my decision and my OBGYN said either is an ok choice based on the size of my baby etc. My choices are however, an induction or a c-section. Induction doesn't seem that appealing to me hence why I think I'm leaning towards as c-section. I, however, don't have the concerns about death and recovery time because my recovery time from from first vaginal birth was long and hard.

I think my experience was a little unusual in that I had basically NO (productive) reaction to pitocin until they broke my water but by that point I have been on it for 4 non consecutive days and my uterus was DONE. Hence: long third stage. Hence: foreceps. Hence: tearing. So, since I have no reason to think my relationship to pitocin will have evolved, it is just not an option for me.

[Anonymous]

Anonymous wrote:

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.

Thanks, PP. I think we should be BFFs. I am another casualty of a well known DC midwifery group. I also have multi organ prolapse, loss of bowel control, and a damaged sex life. I used to be a marathoner but I can't even walk without prolapse pain and discomfort now and I live a very sedentary life. I only know all this stuff now that it's too late for me, but I'll be damned if I let other women continue on in sheer ignorance when they can still educate themselves about the risks before irreparable damage is done. My quality of life sucks now in many of the ways you have described, and I wish daily for my old life back.

Those who are battling this decision would be well served to read the work of Dietz and Handa. But no matter what you decide, avoid forceps at all costs. The rate of damage with them--even when used properly--is incredibly high. There are several countries who have stopped using them entirely, but the resurgence in the US is frightening. I love this video, as it explains why and has excellent info.


https://m.youtube.com/watch?v=7V5mcAqItDw


I dearly wish I knew this stuff before I had my baby.

NP here. I'm sorry you went through such a traumatic experience. Can I ask, what decisions would you have made differently due to this knowledge? Were there signs or risk factors for these potential issues before you went into labor so that, armed with this knowledge, you could have chosen an elective c/s instead?

[Anonymous]

I had horrific tearing with my first. Almost 4th degree. It was brutal. My recovery was slow and painful. But I healed completely.

Had a vaginal birth with my 2nd. Less tearing, though still a slower recovery. I think because I also had a toddler at home.

Over all, if I had a 3rd, I'd also go with a vaginal birth. Mainly because I healed well both times.

[Anonymous]

The PPs who had an anal sphincter tear or fistula/rectocele etc., were you induced or did you go into spontaneous labor? It seems like a fair number of posters who had bad tears are saying their labor was induced, and that is in fact associated with severe tearing in the literature. It's unclear whether induction drugs prolong labor intro obstruction, or increase the need for an epidural which prolongs/obstructs, or maybe makes it worse if the baby is in a tricky position to begin with.

[Anonymous]

Anonymous wrote:The PPs who had an anal sphincter tear or fistula/rectocele etc., were you induced or did you go into spontaneous labor? It seems like a fair number of posters who had bad tears are saying their labor was induced, and that is in fact associated with severe tearing in the literature. It's unclear whether induction drugs prolong labor intro obstruction, or increase the need for an epidural which prolongs/obstructs, or maybe makes it worse if the baby is in a tricky position to begin with.

Severe rectocele and uterine prolapse and moderate cystocele here. I went into spontaneous labor but was extremely slow to progress after 6 cm. Baby was malpositioned but I did not find this out until after. In hindsight, I should have gotten an epi and pit far earlier when labor was not progressing, pushed for 3 hours and no more, and then had a Cesarean or vacuum. Forceps and a long pushing phase (including hours and hours breath-holding valsalva pushes) and tons of aggressive vaginal stretching seemed to seal my fate.

To answer PP's question, what I would have done differently is:

-Gone with an OB practice and not midwives and asked for conservative management
-Asked for OB involvement and/or second opinions far earlier when labor was not progressing and when I had been pushing for 3-4 hours and no one seemed concerned about prolonged pushing
-Gotten an epidural as soon as I arrived at the hospital instead of trying for unmedicated
-Hired a doula who knew spinning babies and was not dogmatic about natural birth
-sought out pelvic floor PT when pregnant for issues I was having during pregnancy that midwives dismisses (leaking urine, back pain)
-gotten chiropractic care in pregnancy to ensure a well stabilized pelvis and well positioned baby
-refused to push longer than 3 hours and refused to do breath holding pushes
-not done impact exercise in pregnancy
-insisted on a vacuum and not forceps, or had an emergency Cesarean
-discussed my risk factors for pelvic floor disorders with my providers in prenatal visits and demand that they take that into account when formulating my care plan
-insisted on a late ultrasound to estimate fetal siZe when it was evident that my baby was big
-not waited past my due date for spontaneous labor when it was evident that baby was gonna be large and I am petite
-asked women in family about our history of pelvic floor issues

I would never recommend that anyone have forceps if you have another choice. I still have nightmares about them.

[Anonymous]

13:36 - yes, we should! I am saddened - and angry - to hear about what you have had to go through, and what you have to live with. For the others asking, I had no induction and a 34 hour labor. I was told to push for 4 hours. I had done birth classes, read out bodies ourselves when I was 13, went to a women's college, and had no idea this could happen to me. Risk factors which they told me afterward (not before!) were - over 40, fair skin (?! - but women in the online support groups have every age and ethnicity), large baby and family history (this is also debatable, although my mother had prolapse, her mother and sisters did not. But I was a large baby and they used forceps on her.) The key things are - large baby and long second stage of labor. Oh, and the midwife screamed at the nurse for not emptying my bladder which had two liters of water in it because after 29 hours I succumbed to an epidural. In sum, use caution if you are over 40 (muscle tears more easily), have a big baby, and if you are laboring long. If you have an epidural make sure they empty your bladder. Honestly, even an enema before delivering is probably a good idea. You want maxium space for baby to slide out. There is good information on positions and pushing in books by Calais-Germain and de gasquet (the latter is only in French) that I found after the fact. There is mounting evidence that you should not push for long and definitely that when you push you do it in a certain way. OP, whoever you are, good luck! I fully agree with 13:36 that every woman should clearly understand the risks and make her own decisions as a fully informed person.

[Anonymous]

And I will add one more thing - in my first trimester I was in a yoga teacher training class. So I was not out of shape, healthy eater, no medical issues.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Thanks, PP. I think we should be BFFs. I am another casualty of a well known DC midwifery group. I also have multi organ prolapse, loss of bowel control, and a damaged sex life. I used to be a marathoner but I can't even walk without prolapse pain and discomfort now and I live a very sedentary life. I only know all this stuff now that it's too late for me, but I'll be damned if I let other women continue on in sheer ignorance when they can still educate themselves about the risks before irreparable damage is done. My quality of life sucks now in many of the ways you have described, and I wish daily for my old life back.

Those who are battling this decision would be well served to read the work of Dietz and Handa. But no matter what you decide, avoid forceps at all costs. The rate of damage with them--even when used properly--is incredibly high. There are several countries who have stopped using them entirely, but the resurgence in the US is frightening. I love this video, as it explains why and has excellent info.


https://m.youtube.com/watch?v=7V5mcAqItDw


I dearly wish I knew this stuff before I had my baby.

NP here. I'm sorry you went through such a traumatic experience. Can I ask, what decisions would you have made differently due to this knowledge? Were there signs or risk factors for these potential issues before you went into labor so that, armed with this knowledge, you could have chosen an elective c/s instead?

Forgot to answer your other question. I had a pretty textbook pregnancy and was extremely healthy. My only risk factors were being almost AMA when I delivered, which is actually a pretty significant risk factor for having complications with delivery. Otherwise I was the picture of good health and had nothing to really indicate Cesarean otherwise.

[Anonymous]

I’d go for vaginal. I had a vaginal the first time with episiotomy and scheduled c the second time. C section recovery was hard (and I had a preemie so I wasn’t even taking care of a baby during the first part of recovery)

[Anonymous]

Anonymous wrote:I’d go for vaginal. I had a vaginal the first time with episiotomy and scheduled c the second time. C section recovery was hard (and I had a preemie so I wasn’t even taking care of a baby during the first part of recovery)

What was your first recovery like though?

[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.
[...]
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.

PP really wasn't pushing an agenda. I'm done childbearing (I just hang out here sometimes for fun) and had section and two vaginal births. C-section is more dangerous in terms of maternal health and life, it just is. There's no sense in denying it.

That doesn't mean OP shouldn't choose it, especially a planned one. I bid you peace and good luck, OP.

[Anonymous]

Anonymous wrote:

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.

Are there any good studies on this you can share? I've mostly just seen this one and it worries me: "The planned cesarean group comprised 46 766 women v. 2 292 420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1800583/