Reply to C-section or natural after 3rd degree tear?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]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. [/quote]

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.[/quote]
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
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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.

."..[b]Most studies looking at the risks of cesarean section may have been biased[/b], 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, [b]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[/b]

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.

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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.[/quote]

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.

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