Anonymous wrote:

Anonymous wrote:Curious why C-Sections are seen as such a bad thing. I delivered vaginally for my first and it was awful. My care team was great, I just hated everything about the entire process. Seemed like a whole lot of waiting around and being in pain. And I ended up needing an episiotomy and extraction anyway, which then resulted in a bunch of scar tissue that caused problems.

Now that I'm pregnant with my second, a C section sounds pretty darn good. No labor, just go in and get the whole thing done and over with in 15 minutes. I know there's recovery, but recovery from vaginal birth sucked, too. And I know it's surgery, so there are risks associated with that, but from talking with my OB it sounds like it's a very, very small increase of risk.

So why exactly are c-sections seen as so horrible?

Ummm I’m sorry but …unless you’ve had a c section you don’t get to say it’s easy. I’m 4 weeks postpartum still can’t walk right or bend or go up the stairs and get gas pains. Oh and I can’t lift my toddler and I can’t nurse right or sneeze or cough right. So they’re not bad, they’re just incredibly freaking difficult on the mom. And only when you’ve had one do you know what a shit show it is.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Vaginal breech delivery is considered risky and extreme because of the higher rate of infant death. I guess if getting the baby out vaginally matters more to you than minimizing the risks you baby will be born dead, you’re free to make that choice but there’s a reason precious few providers do this when we have a safe alternative.

https://www.skepticalob.com/2011/06/no-breech-is-not-variation-of-normal.html

Cool. One very pro c-section blog says it’s not normal (fine, that’s a reasonable assessment in a 5% situation) I notice she doesn’t say that well respected OBs in the DC area—albeit few— are giving a subpar standard of care or are “extreme”. That’s just anonymous internet poster vs. ACOG again.

There are a handful in the DMV doing it and they are all at GW. Madkoir got his training on them in counties where C sections aren’t readily available. Most practicing OBs consider it risky and my JHU OB told me GW has a reputation for being too extreme with regards to vaginal birth. So there’s that.

Anonymous wrote:

Anonymous wrote:Vaginal breech delivery is considered risky and extreme because of the higher rate of infant death. I guess if getting the baby out vaginally matters more to you than minimizing the risks you baby will be born dead, you’re free to make that choice but there’s a reason precious few providers do this when we have a safe alternative.

https://www.skepticalob.com/2011/06/no-breech-is-not-variation-of-normal.html

Cool. One very pro c-section blog says it’s not normal (fine, that’s a reasonable assessment in a 5% situation) I notice she doesn’t say that well respected OBs in the DC area—albeit few— are giving a subpar standard of care or are “extreme”. That’s just anonymous internet poster vs. ACOG again.

Anonymous wrote:Vaginal breech delivery is considered risky and extreme because of the higher rate of infant death. I guess if getting the baby out vaginally matters more to you than minimizing the risks you baby will be born dead, you’re free to make that choice but there’s a reason precious few providers do this when we have a safe alternative.

https://www.skepticalob.com/2011/06/no-breech-is-not-variation-of-normal.html

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
My theory is that WOC have a higher maternal mortality rate because they have a higher c-section rate, which is itself correlated with a higher mortality rate. Why doctors perform more c-sections on Black women than white women probably has to do with the overall lower standard of medical and particularly obstetric care Black women receive in the U.S (not just poor— read about Serena Williams, a wealthy athlete in fantastic health, being ignored by her medical providers) and the belief among medical practitioners that everyone— but especially women and ESPECIALLY WOC should just blindly do as they say— even if that’s just to get that medical student his first surgery.

Interesting. So you think that C-sections have a higher mortality rate, and a higher C-section rate in a given population is an indicator of lower quality of care.

Wouldn't that point toward the need for the obgyns to have tools and tricks OTHER than a C-section in their repertoire?

I don’t “think” anything, the data is pretty cut and dried on the subject.

But forceps and vacuums in the hands of people who are ignoring what their patients are telling them (again, read about Serena Williams’ birth and how long she had to wait for correct care) are just as potentially dangerous as a scalpel, just not as lucrative. I think the problems arise before the forceps or the scalpel. OBs for sure need more training, but on issues like collaborative decision making and perverse incentives. Forceps are not going to solve that, although if you said something like, OBs should be trained on uncomplicated breech presentation, I might be more inclined to agree .

Your arguing for uncomplicated breech delivery? Omfg. Have you ever read about head entrapment and what happens? There’s a reason the standard of care is C section. Breech deliveries done vaginally will always result in a level of infant mortality that is frankly unacceptable.

Also you think the patients are the ones who should make the call about vacuum and forceps? Like we all somehow are medically trained in indications for their use and in the midst of labor should be informing the care team that it’s time for forceps?

You also seem to think that complex births are the fault of moms (for not doing all the right things) or doctors (for wanting to go play golf and being too intervention happy) which means you know nothing about the history of obstetrics. Midwifery care was the standard for hundred and thousands of years and resulted in high levels of infant and maternal mortality. Interventions and obstetrics reduce mortality and injury. It’s not something to dismiss.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Vaginal delivery plays an important role in developing a babies microbiome which we are still learning to understand the importance of. “The development of the microbiome begins in utero, however factors related to the labor and birth environment have been shown to influence the initial colonization process of the newborn microbiome. This “seeding” or transfer of microbes from the mother to newborn may serve as an early inoculation process with implications for the long-term health outcomes of newborns. Studies have shown that there are distinct differences in the microbiome profiles of newborns born vaginally compared to those born by cesarean.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648605/

“Children born via cesarean compared to those born vaginally are more likely to develop immune-related disorders like asthma/allergies, inflammatory bowel disease, and obesity”.

For these reasons, I’m hoping to deliver vaginally. If there’s a medical reason preventing me from doing this, c-section is a great alternative available to modern women.

Saying c sections cause allergies/IBS/obesity is the 2020s version of the 1950s theory that autism was caused by mothers who didn’t love their kids enough.

+1000 But I feel like it's become a FTM rite of passage that you have to buy way too deeply into having the crunchiest birth possible, so that a couple of years later you can read posts like this and the lady who provided a bogus photo and feel second-hand embarrassment trying to remember what you posted when you were pregnant with your first.

Next stop: babies that aren't breastfed all turn out to be sickly and obese with ADHD.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
My theory is that WOC have a higher maternal mortality rate because they have a higher c-section rate, which is itself correlated with a higher mortality rate. Why doctors perform more c-sections on Black women than white women probably has to do with the overall lower standard of medical and particularly obstetric care Black women receive in the U.S (not just poor— read about Serena Williams, a wealthy athlete in fantastic health, being ignored by her medical providers) and the belief among medical practitioners that everyone— but especially women and ESPECIALLY WOC should just blindly do as they say— even if that’s just to get that medical student his first surgery.

Interesting. So you think that C-sections have a higher mortality rate, and a higher C-section rate in a given population is an indicator of lower quality of care.

Wouldn't that point toward the need for the obgyns to have tools and tricks OTHER than a C-section in their repertoire?

I don’t “think” anything, the data is pretty cut and dried on the subject.

But forceps and vacuums in the hands of people who are ignoring what their patients are telling them (again, read about Serena Williams’ birth and how long she had to wait for correct care) are just as potentially dangerous as a scalpel, just not as lucrative. I think the problems arise before the forceps or the scalpel. OBs for sure need more training, but on issues like collaborative decision making and perverse incentives. Forceps are not going to solve that, although if you said something like, OBs should be trained on uncomplicated breech presentation, I might be more inclined to agree .

Anonymous wrote:

Anonymous wrote:
It’s separate, but I don’t see “more training on other risky interventions” as the thing to do before it is addressed. Because the same outcome of people who have unnecessary c-sections and therefore complications is going to be the case for this one doctor who always uses forceps. Look at episiotomy for a reasonable parallel, the evidence is clearly against it but there are still some doctors who do it as a matter of routine due to habit. Those doctors don’t need training in using forceps, they need training in *not* intervening.

I don't think any doctor should use forceps as a matter of habit. I think doctors should have a full toolbox of non-surgical tricks and tools they can try before they escalate to C-sections for women who would like to avoid unnecessary surgery. Of course those who would like a C-section should be able to get one. But those who'd like to try in other ways should have qualified medical help that goes beyond "not intervening". If a woman has a kind of birth that can unfold well without intervening, that's great! But if she needs an assist, the doctor should know ways to help her beyond getting a OR ready.

Anonymous wrote:

Anonymous wrote:
It’s separate, but I don’t see “more training on other risky interventions” as the thing to do before it is addressed. Because the same outcome of people who have unnecessary c-sections and therefore complications is going to be the case for this one doctor who always uses forceps. Look at episiotomy for a reasonable parallel, the evidence is clearly against it but there are still some doctors who do it as a matter of routine due to habit. Those doctors don’t need training in using forceps, they need training in *not* intervening.

I don't think any doctor should use forceps as a matter of habit. I think doctors should have a full toolbox of non-surgical tricks and tools they can try before they escalate to C-sections for women who would like to avoid unnecessary surgery. Of course those who would like a C-section should be able to get one. But those who'd like to try in other ways should have qualified medical help that goes beyond "not intervening". If a woman has a kind of birth that can unfold well without intervening, that's great! But if she needs an assist, the doctor should know ways to help her beyond getting a OR ready.

Anonymous wrote:
It’s separate, but I don’t see “more training on other risky interventions” as the thing to do before it is addressed. Because the same outcome of people who have unnecessary c-sections and therefore complications is going to be the case for this one doctor who always uses forceps. Look at episiotomy for a reasonable parallel, the evidence is clearly against it but there are still some doctors who do it as a matter of routine due to habit. Those doctors don’t need training in using forceps, they need training in *not* intervening.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
My theory is that WOC have a higher maternal mortality rate because they have a higher c-section rate, which is itself correlated with a higher mortality rate. Why doctors perform more c-sections on Black women than white women probably has to do with the overall lower standard of medical and particularly obstetric care Black women receive in the U.S (not just poor— read about Serena Williams, a wealthy athlete in fantastic health, being ignored by her medical providers) and the belief among medical practitioners that everyone— but especially women and ESPECIALLY WOC should just blindly do as they say— even if that’s just to get that medical student his first surgery.

Interesting. So you think that C-sections have a higher mortality rate, and a higher C-section rate in a given population is an indicator of lower quality of care.

Wouldn't that point toward the need for the obgyns to have tools and tricks OTHER than a C-section in their repertoire?

I don’t “think” anything, the data is pretty cut and dried on the subject.

But forceps and vacuums in the hands of people who are ignoring what their patients are telling them (again, read about Serena Williams’ birth and how long she had to wait for correct care) are just as potentially dangerous as a scalpel, just not as lucrative. I think the problems arise before the forceps or the scalpel. OBs for sure need more training, but on issues like collaborative decision making and perverse incentives. Forceps are not going to solve that, although if you said something like, OBs should be trained on uncomplicated breech presentation, I might be more inclined to agree .

Doctors not listening is a big problem for sure. But it's a separate problem from "the doctors don't know how to do anything other than drink tea or do a C-section."

Anonymous wrote:I had two vaginal births and all my friends and both my SILs had c-sections.

Cons: 1) it's real, serious surgery and it hurts like h*ll after and the recovery is a PITA. I went for a 2 miles walk probably 3 days after I had my second and they couldn't even move. If you have a ton of help and someone talking care of the baby 24/7 while you recover, it's not bad. If you don't, it's hard. 2) All of them ended up with funky looking stomachs, even my brother's wife, who is rail thin. 3) scars 4) babies are more prone to autoimmune issues 5) one SIL ended up with some uterine scarring. Statistically, this could be why some have a harder time conceiving after.

"Previous peer-reviewed research, by multiple authors, has identified links between C-section and negative health outcomes in children, including obesity, asthma and autism. For example, studies have shown that delivery by C-section increases a child's risk for obesity by age 5 by an astounding 55%." IMO, his could be that the moms are already sicker and obese and therefore requiring a c-section, so the offspring are not that healthy, so it might not be the surgery itself, but who knows.

Pros (HUGE): pelvic floor health and stress urinary incontinence



https://www.webmd.com/baby/news/20130211/c-section-formula-may-disrupt-good-gut-bacteria-in-babies#1

https://www.sciencedaily.com/releases/2020/07/200709141545.htm

https://www.sciencedaily.com/releases/2020/11/201104131520.htm

https://www.sciencedaily.com/releases/2018/12/181219093903.htm

https://www.sciencedaily.com/releases/2016/02/160223074738.htm

Anonymous wrote:I had two vaginal births and all my friends and both my SILs had c-sections.

Cons: 1) it's real, serious surgery and it hurts like h*ll after and the recovery is a PITA. I went for a 2 miles walk probably 3 days after I had my second and they couldn't even move. If you have a ton of help and someone talking care of the baby 24/7 while you recover, it's not bad. If you don't, it's hard. 2) All of them ended up with funky looking stomachs, even my brother's wife, who is rail thin. 3) scars 4) babies are more prone to autoimmune issues 5) one SIL ended up with some uterine scarring. Statistically, this could be why some have a harder time conceiving after.

"Previous peer-reviewed research, by multiple authors, has identified links between C-section and negative health outcomes in children, including obesity, asthma and autism. For example, studies have shown that delivery by C-section increases a child's risk for obesity by age 5 by an astounding 55%." IMO, his could be that the moms are already sicker and obese and therefore requiring a c-section, so the offspring are not that healthy, so it might not be the surgery itself, but who knows.

Pros (HUGE): pelvic floor health and stress urinary incontinence



https://www.webmd.com/baby/news/20130211/c-section-formula-may-disrupt-good-gut-bacteria-in-babies#1

https://www.sciencedaily.com/releases/2020/07/200709141545.htm

https://www.sciencedaily.com/releases/2020/11/201104131520.htm

https://www.sciencedaily.com/releases/2018/12/181219093903.htm

https://www.sciencedaily.com/releases/2016/02/160223074738.htm