Unpopular opinion - elective c-sections

[Anonymous]

I've seen both sides of this coin, a "successful" vaginal birth that resulted in a blue baby that need to be resuscitated, and a C-section that resulted in severe C-section isthmocele, and a second C-section that resulted in a 100% dehisced uterine scar AND endometritis and laparoscopic repair. I am team patient autonomy. If someone only wants 1 or 2 kids I think elective C is perfectly viable. If you want a mini van of kids, avoid C sections at almost any cost.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I can't believe anyone would opt for a c-section if it wasn't necessary. Cutting through several layers, including muscle, to deliver the baby. The recovery is difficult and painful.

They don’t cut through muscle anymore. Have you had a c-section?

The rectus muscle and lower segment of the uterus (which is muscle) are cut. Maybe you should not be speaking on matters of which you know nothing.

[Anonymous]

Anonymous wrote:I can't believe anyone would opt for a c-section if it wasn't necessary. Cutting through several layers, including muscle, to deliver the baby. The recovery is difficult and painful.

I've had an unmediated vaginal birth and 2 C-sections. The unmediated vaginal birth was 1000x more painful than both Cs combined.

[Anonymous]

Anonymous wrote:I had no trouble with insurance paying for my maternal choice c-section. There's all this conventional wisdom around them being expensive, but think about how many hours you spend in L&D at the hospital for a vaginal delivery (which can still end in c-section) to say nothing of birth complications. Insurance is happy to pay for it.

The real cost comes from a brain damaged baby, which is way less likely with a C.

[Anonymous]

Anonymous wrote:This article explains in great detail how common maternal birth injuries are and the impact on women. Should be required reading for every expectant mom so she’s aware of what’s at stake in the delivery room and can make an informed decision about her delivery type. https://www.nzdoctor.co.nz/educate/MBI

Also, I had a maternal request C section and had no issues with insurance covering it. It was only a touch more expensive than my vaginal birth was, and cheaper in total compared with the years of physical therapy and urogynecologist consults and trauma therapy from my bad vaginal birth. That one bad birth injured me and still cost me over 15K out of pocket for treatment over a number of years. I still need pelvic floor reconstruction which will likely cost 50-100K. So the C section was far cheaper, when considering big picture costs.

My OB said it’s fear mongering that insurance won’t pay for a maternal choice C section. He laughed at me when I asked if they would
Cover it and told me that he’s never had an issue with insurance paying for one. He’s been in practice for over 25 years and said it’s a bunch of NCB fear mongering.

That is *really* eye opening! I had a laparoscopic revision of a severe C-section isthmocele and it was 15k. This was Dr. Puthoff in St. Louis. Another doctor in Atlanta said $50k. Also, the C-section isthmocele repair has a better success rate, to my knowledge.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I can't believe anyone would opt for a c-section if it wasn't necessary. Cutting through several layers, including muscle, to deliver the baby. The recovery is difficult and painful.

They don’t cut through muscle anymore. Have you had a c-section?

The rectus muscle and lower segment of the uterus (which is muscle) are cut. Maybe you should not be speaking on matters of which you know nothing.

Sorry, let me correct myself:
"aponeurosis from the external oblique rectus muscle, and the other is a fused layer which contains the aponeuroses of the transverse abdominis and internal oblique muscles"

[Anonymous]

Anonymous wrote:I can't comment on how often elective c sections are refused (I've never had nor wanted one) but I totally agree that it should be up to the patient and all this arguing about whether c sections are good or bad are completely irrelevant.

However, C-sections are hardly unique in terms of denying patients autonomy. Just look at the prescription drug system (which I also oppose). The medical field is (unethically) all about gate keeping.

The gate keeping and bullying happens both ways. I was bullied into a horrifically dangerous TOLAC with residual myometrium under 1mm.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Aren't C-sections generally more expensive? That's a reason to avoid them. I mean insurance will cover it, and then we all have continued rising insurance costs.

Look at the lifetime of healthcare costs that a delivery can have on a woman’s health. My vaginal was 40K and my scheduled C section a few years later was a bit over 50K. The hospitals take the negotiated rate from insurers and no one pays that much out of pocket. You are arguing over peanuts - the insurers don’t care that much, the likelihood of a C section is high anyway even for someone planning a vaginal delivery and those births also get very expensive because of all the time/costs for labor then costs of a C section on top - those actually are the most expensive (vaginal
Turned emergency C section).

Pelvic floor PT costs 200 dollars a session. So does therapy for birth trauma. Incontinence supplies are expensive, and incontinence in later life is a leading cause of nursing home admissions. Urogynecologists charge around 500 for a visit, hundreds on top of that for a pessary fitting, etc. Imaging prior to pelvic floor surgery costs thousands - MRI, U/S, defecography, urodynamics, etc. And costs for surgeries like bladder sling for incontinence, rectopexy for rectal prolapse, sacrocolpopexy for bladder/uterine prolapse, etc. are major abdominal surgery and cost likely 10-20K or much, much more.

Consider this:

Between 2016 and 2018, there were 140,762 POP surgical cases annually with an annual national cost estimated at $1.523 billion per year.

pregnancy and birth damage our bodies in many ways, some much more than others, and sometimes the impacts don’t show up
Until menopause

This is all peanuts compared to a brain damaged baby. A brain damaged baby is an automatic multi million dollar payout and way more likely with a vaginal birth. Most common reason to sue in a vaginal birth gone wrong is for not calling an emergency C in time.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I can't believe anyone would opt for a c-section if it wasn't necessary. Cutting through several layers, including muscle, to deliver the baby. The recovery is difficult and painful.

They don’t cut through muscle anymore. Have you had a c-section?

The rectus muscle and lower segment of the uterus (which is muscle) are cut. Maybe you should not be speaking on matters of which you know nothing.

Sorry, let me correct myself:
"aponeurosis from the external oblique rectus muscle, and the other is a fused layer which contains the aponeuroses of the transverse abdominis and internal oblique muscles"

That’s all connective tissue. You don’t want it cut of possible. It’s in part what stabilizes your core.

[Anonymous]

Anonymous wrote:I've seen both sides of this coin, a "successful" vaginal birth that resulted in a blue baby that need to be resuscitated, and a C-section that resulted in severe C-section isthmocele, and a second C-section that resulted in a 100% dehisced uterine scar AND endometritis and laparoscopic repair. I am team patient autonomy. If someone only wants 1 or 2 kids I think elective C is perfectly viable. If you want a mini van of kids, avoid C sections at almost any cost.

Patient autonomy would be ideal! On every level.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

You can choose to spend an extra night in the hospital but most women don't.

Is it really only one extra night? It’s been a while but I recall it was two days for vaginal and 5 days for a c-section.

Legally insurance companies cant restrict payment/coverage for less than 48 hours for vaginal or 96 for csection.

Regardless womens healthcare is always underwhelming. You can stay for 4 days but theres no one to help you get out of bed or bring the baby to you etc unless you have family or friends staying with you. From my understanding only the women are considered the patient of the nurse not women plus baby and the ratios for post-op for any other surgery are way less than with postpartum moms. Nurses can correct me if I am wrong.

My DH was at Hopkins at had nurses constantly at his bedside, checking in, helping him, etc with no surgery. Post op csection after 2 days labor....it was deserted and wild wild west. You get poked and stabbed and massaged but thats about it.

This.

I avoided C-Section because it’s contraindicated for my medical history other than a life or death emergency. But if I knew how absolutely appalling postpartum care is, I would have been even more adamant. In what other possible universe is a patient responsible for the feeding and toileting of another patient hours or minutes after surgery/birth???

I will never ever forget being in tears waiting for the nurses to come to bring me to the bathroom after I fainted the first time unaccompanied and they put me on a fall warning (had they read the chart I would have been on the fall warning to begin with…). The idea that I’d have been waiting that long pushing a button for a post-surgical complication gives me chills.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

You can choose to spend an extra night in the hospital but most women don't.

Is it really only one extra night? It’s been a while but I recall it was two days for vaginal and 5 days for a c-section.

Legally insurance companies cant restrict payment/coverage for less than 48 hours for vaginal or 96 for csection.

Regardless womens healthcare is always underwhelming. You can stay for 4 days but theres no one to help you get out of bed or bring the baby to you etc unless you have family or friends staying with you. From my understanding only the women are considered the patient of the nurse not women plus baby and the ratios for post-op for any other surgery are way less than with postpartum moms. Nurses can correct me if I am wrong.

My DH was at Hopkins at had nurses constantly at his bedside, checking in, helping him, etc with no surgery. Post op csection after 2 days labor....it was deserted and wild wild west. You get poked and stabbed and massaged but thats about it.

I’m sorry you had a bad experience.
I had elective section at sibley pre pandemic. I felt very well cared for and was able to send baby to the nursery overnight to get some rest. The nurses were angels. I was there 4 nights and almost didn’t want to leave lol

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

You can choose to spend an extra night in the hospital but most women don't.

Is it really only one extra night? It’s been a while but I recall it was two days for vaginal and 5 days for a c-section.

Legally insurance companies cant restrict payment/coverage for less than 48 hours for vaginal or 96 for csection.

Regardless womens healthcare is always underwhelming. You can stay for 4 days but theres no one to help you get out of bed or bring the baby to you etc unless you have family or friends staying with you. From my understanding only the women are considered the patient of the nurse not women plus baby and the ratios for post-op for any other surgery are way less than with postpartum moms. Nurses can correct me if I am wrong.

My DH was at Hopkins at had nurses constantly at his bedside, checking in, helping him, etc with no surgery. Post op csection after 2 days labor....it was deserted and wild wild west. You get poked and stabbed and massaged but thats about it.

I’m sorry you had a bad experience.
I had elective section at sibley pre pandemic. I felt very well cared for and was able to send baby to the nursery overnight to get some rest. The nurses were angels. I was there 4 nights and almost didn’t want to leave lol

Sibley is the only hospital in the area to have a baby nursery from my understanding but its an hour drive for me.

I actually dont want the baby out of my room as a personal choice since I nurse (my choice doesnt have to be anyone elses). I want PP women to be covered at the same ratio as other post op patients- regardless of their mode of birth- and for the infants to be included in their patient ratio. It would be very difficult to establish supply without pumping or nursing overnight (i.e >4hours) in those first few days. But again, the choice kind of feels like no help at all due to "nursing-friendly" or a baby nursery which isnt supportive of how nursing works.

Again there's these binary choices in womens healthcare instead of expansion of choices just like you either have a non-bonding C section or vaginal birth.

I was told the hospital wont do a golden hour with a csection even though its evidence based. Obviously if contraindicated it wouldnt be done. But if you have a vaginal birth, you get it (outside of contraindications).

[Anonymous]

Anonymous wrote:I can't believe anyone would opt for a c-section if it wasn't necessary. Cutting through several layers, including muscle, to deliver the baby. The recovery is difficult and painful.

+1

I have no strong opinion on women being able to elect a C section without any medical indication, but I find it an odd choice. I had 3 babies vaginally and even with needing some pelvic floor therapy at one point, my recovery was remarkably easier than my friends who had C sections (esp multiple times). I’m a bit softer in the middle, but mostly things are back to normal (I also lucked out with no stretch marks or anything). No c section shelf or scar. I was able to get up and shower/walk around within a few hours of giving birth each time.

I think women are strong an amazing for literally having their bodies cut open to bring their children into this world, but let’s not downplay that it is major surgery.

[Anonymous]

Anonymous wrote:Our docs need to offer more options than lie in your back and push or those crappy squat bars. Poorly guided pushing and improper postures are a HUGE part of why we are sustaining injuries during birth. It’s not all if it but man….there is a better way.

I birthed 3 babies with midwives in a hospital and was able to roll around with a peanut ball.