More caesareans mean more illness, death, study finds [Archive]

KBecks

06-01-2006, 10:04 AM

I'm afraid I'm feeling this topic and the way this was posted is controversial and/or inappropriate. (I already emailed the OP privately about my concerns.) What I see is a person who works as a doula posting a story that causes fear and concern about c-sections, on a board that has a lot of pregnant women as participants. What's the point of posting, other than to make women second-guess themselves? That's my read, and it makes me very uncomfortable.

As far as what is the appropriate surgical birth rate, do you know exactly what % of surgical births is "right" if the current % is so "wrong"? I don't, and as I've said, I think it's a decision that needs to be made by the person who is having the baby, along with her doctor, and along with any research she chooses to make on her own.

Just ETA: I'll admit I'm feeling sensitive about this, and I imagine that the OP was simply posting an article that supports her point of view, which is a perfectly human thing to do, and not intentionally trying to create a stir or get folks like me worked up about it :)

m448

06-01-2006, 10:48 AM

The point is to educate and inform. Not everyone knows everything and those who think they do know even less.

Yes, Latia is a doula but I've never seen her disguise that despite many other professionals being on this board who provide opinions, studies and research material to support their own views. Shall we prevent liberals from posting research regarding the war? (for the record I'm a conservative).

Marielle

Ian - born 10/03
&
Ryan - born 01/06

tarahsolazy

06-01-2006, 10:55 AM

Actually, WHO has stated that no country in the world should have a c-section rate higher than 10-15%

In most Scandanavian countries, the rates are around 12%. These countries have the same level of medical care as we do, in terms of advanced technology and excellent outcomes for preterm and sick newborns. They just have an entirely different medical culture surrounding pregancy and birth.

The US hit 29% last year.

(Personal disclosure for transparency: had one c-section, necessary, but would prefer to avoid another.)

brittone2

06-01-2006, 11:45 AM

Thanks for posting that Tarah. I was going to look up the WHO's recommendations...I thought I remembered them essentially saying the rate should be half of what it is.

Again, I also think it comes down to informed consent, and I'm not sure that the full 29% of women are getting all of the facts about risks/benefits, etc. from their doctors. Certainly some are, but not all.

pb&j

06-01-2006, 11:52 AM

>The point is to educate and inform. Not everyone knows
>everything and those who think they do know even less.
>
>Yes, Latia is a doula but I've never seen her disguise that
>despite many other professionals being on this board who
>provide opinions, studies and research material to support
>their own views. Shall we prevent liberals from posting
>research regarding the war? (for the record I'm a
>conservative).
>
>Marielle
>
>
>Ian - born 10/03
>&
>Ryan - born 01/06

I think the point was not that the article about the study was posted, but that the article has an inflammatory, fear-mongering title, and was posted entirely without explanation by a person whose profession it is to support women during childbirth. Rabble-rousing, whenther intentional or not, does not fall into the category of educating and informing.

I'm not sure I follow what you mean about preventing "liberals from posting research regarding the war" and how that relates to an article about C-sections.

-Ry,
mom to Emma, stillborn 11/04/04
and Max, 01/05/06

http://www.windsorpeak.com/dc/user_files/32812.gif
http://b1.lilypie.com/aKGqm5/.png[/img] ([img)

octmom

06-01-2006, 12:01 PM

>I think the point was not that the article about the study was
>posted, but that the article has an inflammatory,
>fear-mongering title, and was posted entirely without
>explanation by a person whose profession it is to support
>women during childbirth. Rabble-rousing, whenther intentional
>or not, does not fall into the category of educating and
>informing.
>

Thank you for being better with words this morning than me, Ry.

Jerilyn
DS, Sean 10/03
DD, Katie 3/06

"Baby makes days shorter, nights longer, home happier, and love stronger."

brittone2

06-01-2006, 12:03 PM

Maybe I'm just confused here, but Latia didn't give the article its title...it appears to be from a newspaper. She's also not responsible for the article's "fear mongering"...the second paragraph says the WHO study found an increased incidence of death. That's what they found, and I guess I don't understand how Latia did anything improper in linking to the study. She didn't make up the title or the findings, kwim?

bubbaray

06-01-2006, 12:10 PM

I have to say that when I see a doula post an article like this, it makes me very angry. I'm probably going to get flamed for my opinion, but really -- this is me being restrained. :(

I really find that there is a sentiment on this board that if you have a c-section, you aren't worthy, you didn't try hard enough, or you are less of a mother than someone who had a vaginal birth.

If you are lucky enough to have a vaginal birth, great. That does NOT make you a better person. NOT all mothers are able to, for a variety of reasons.

How often do doula's and midwives congratulate a mother who had a birth via c-section? I've actually had some say they were "sorry" to hear I had a c-section. UH, why? Isn't the point to have a healthy mother and child? If a c-section hadn't been done in my case, it is unlikely that DD would have survived the birth, ditto for me.

Just really extremely tired of the condescending tone of proponents of natural birth....

Melissa

http://b3.lilypie.com/rppJm7/.png[/img][/url]

octmom

06-01-2006, 12:13 PM

I think the point is that there was no explanation or message along with the link and the title of the article was the title of the post. In my opinion, the title of the article, and more importantly, of the post is rather inflammatory. I think we would have lots of folks here PO'd if the title of a post was something equally inflammatory about other sensitive subjects.

Maybe I am wrong about this, but it has always seemed to me that members of this board are generally pretty sensitive about feeding choices (I'm sure there are have been exceptions), but not as much about choices re: vaccinations and childbirth. I guess I just wish that members would consider how their words or the way they pass along information might be perceived by other members, such as those who have had a C/S for whatever reason, those who have trouble conceiving, those who make different feeding choices, those who make different vax choices, etc.

Jerilyn
DS, Sean 10/03
DD, Katie 3/06

"Baby makes days shorter, nights longer, home happier, and love stronger."

pb&j

06-01-2006, 12:16 PM

That's true, but she chose to post an article with a controversial title, without any comment whatsoever. As a doula, I'd hope she would be able to provide some enlightening comments about this article, rather than sending it out into the ether and not looking back. Childbirth comes in all kinds of forms, and there are plenty of educated and informed mamas who have C-sections. The article touched a nerve here, and it's entirely understandable that there are BBB'ers who would see the OP as inflammatory.

-Ry,
mom to Emma, stillborn 11/04/04
and Max, 01/05/06

http://www.windsorpeak.com/dc/user_files/32812.gif
http://b1.lilypie.com/aKGqm5/.png[/img] ([img)

bubbaray

06-01-2006, 12:20 PM

Thank you -- you said it FAR better than I did in my post below.

STILL fuming....

Melissa

http://b3.lilypie.com/rppJm7/.png[/img][/url]

brittone2

06-01-2006, 12:25 PM

This is my last comment, but I think we all read into certain things with our own sensitivities (myself included).

Tarah is a neonatologist and has had a C-section, and has posted her professional opinion and experiences in the past that c-sections can lead to serious complications for mother and baby. There are numerous studies saying the same thing.

The midwives and doulas I know certainly don't look down upon someone for having a c-section (???). I think they express they are sorry when things don't turn out the way a woman wanted...as in, if she was really wanting a vaginal birth and that didn't happen, some women grieve that, and I guess that's why they sometimes say they are sorry (?). Of course, there are women who are fine w/ the fact that they had a c-section as they know it was needed for them to have a healthy baby. ETA: and in a case like that, I'm sure it would be irritating to hear "i'm sorry" if you were feeling satisfied with the outcome.

I don't think anyone is saying there aren't a *LOT* of c-sections that are medically necessary for mom or baby's health or that those are "wrong" in any way. I think the concern is that there is an apparent overuse of c-sections in this country without great reason. There are certainly a huge percentage of those cesareans that are totally necessary, and I'd never judge what was or wasn't. I think that the problem is in the fact that there are many doctors who don't fully inform women of the risks (and they are from legitimate studies) of elective cesareans, elective inductions, etc.

IMO in certain instances there are also hospital/physician policies that are partial contributers to the high rates, such as when they deem a woman has been laboring "too long" but the baby nor mother appears to be in distress. Women get rushed in for a c-section that might not be totally necessary, but the parents may not be advised of that (in my understanding provided mom and baby are doing fine, there shouldn't be an arbitrary limit on how long a woman can labor).

Hospital/physician policies that are more supportive of women and backed by better evidence-based decision making would IMO lead to a lower c-section rate. That doesn't mean it is the fault of any woman having a c-section, I think it is just a reflection on our medical system.

Without a doubt there are tons of women and babies who need and benefit from c-sections and while I guess I'm an evil proponent of natural birth (if a woman wants it), I don't for a second think there is a single thing wrong with women having c-sections, provided they were given full disclosure of risks/benefits in advance (ETA: when possible! Obviously an emergency is an emergency end of story). The problem IMO is with the medical system and the way birth is viewed, not with individual mothers and their decisions and births.

Thank goodness c-sections *are* available for cases like yours and cases involving many, many other women!! ETA: IMO the problem is when c-sections are being done without a clear, evidence-based reason backing up why it is necessary, and in a case like that, the benefits may be overshadowed by some serious risks that may not be fully disclosed.

I don't think anyone here is being condescending??

trumansmom

06-01-2006, 12:35 PM

I'm going to be honest in that I don't exactly understand the concern here, but I'm very sensitive to the fact that people are feeling this was insensitive.

No rules have been broken so far, but please, out of consideration for all members of our community, please take an extra moment to think about language choice, and about possible perceptions of your words by others.

Thank you,
Jeanne
Mom to Truman 11/01 and Eleanor 4/04

buddyleebaby

06-01-2006, 12:37 PM

I just have to jump in here to defend Latia.
She has posted many articles in the past on women's health/baby's health issues that she finds interesting. Some relate to childbirth and some do not. Some I have read and found to have merit, others I have disagreed with intensely, and others I have chosen to not read at all.
I am sorry you feel that moms who had c-sections are looked down upon, and I agree with you tha the end result of a healthy mom and baby is most important. However, I do not believe that Latia had any motive in posting this article other than sharing something she found interesting. Please do not take it as a personal comment on the choice that some mamas here made to have a c-section, or on the necessity that some mamas here had to have a c-section.
You can hate the article, trash the article, dispute the article if you are so inclined, but attacking someone simply for posting is IMO unfair.

ETC typos.

Rachels

06-01-2006, 12:38 PM

What I don't get is women's total reluctance to learn the facts about risks and benefits about such a major life decision. Here an article was posted and the overwhelming sentiment was, "We don't like those study results and so we shouldn't have to know about them, and you suck for making it possible for us to read them!" Beyond the part where you're welcome to skip any post that bothers you, it's unfair to trash the OP for providing a research link regardless of your feelings about the research.

As for the issue of appropriate percentages of cesarean births, it's evidence-based medicine. There is a tremendous amount of research about this. The WHO does not pull recommendations out of its butt, kwim? It cites a kazillion studies that suggest the safest approaches to birth for women and babies.

There is SO much defensiveness about c-sections; every post about the overuse or risks of them is met with a certain number of "But mine was really necessary!" responses. NOBODY -- not me, not pps, not the WHO -- is saying that all c-sections are unnecessary. NOBODY IS SAYING THAT. If you had a necessary c-section, thank heavens that technology was available to you. You don't need to justify your experience or your medical history to anybody. But to suggest that we shouldn't ever trouble our pretty heads about birth research on the off chance that we might learn things that make us uncomfortable is doing ourselves a disservice. Informed consent involves being informed. If you don't want to know, don't read the link. But don't shoot the messenger.

-Rachel
Mama to Abigail Rose
5/18/02
http://www.gynosaur.com/assets/ribbons/ribbon_amethyst_36m.gif
Nursed for three years!

and Ethan James
10/19/05
http://www.mothering.com/discussions/images/smilies/bf.jpg

"When you know better, you do better."
Maya Angelou

HoneymoonBaby

06-01-2006, 12:46 PM

I think the problem here is the title. When I saw it, I opened the thread with every intention of posting why it bothered me, only to find that many mamas had beaten me to the punch.

A lot of us here had C-Sections, needed or not (it's hard to tell the difference when you're in the middle of a difficult labor, IMO). Now we have to grapple with the issue of VBAC vs. elective C, and come to terms with the loss of the births we'd hoped for, and articles with scary titles like this one put a lot of extra pressure and fear onto us as we're trying to work through those issues.

We KNOW C-Sections are not as good as vaginal births. We're not ignorant. Telling us over and over again that our babies' lives are at risk isn't helpful. WE KNOW. But frankly, from our perspective, there's a part of us (well, a part of me, at least) that's afraid EITHER choice is risky for baby now, and we're trying to deal with our anger over the 1st C-Section that forced this awful lesser-of-two-evils choice on us in the first place.

So really, please, PLEASE stop reminding me that there's an increased chance my next birth will end very, very badly. I am all too aware of it already, I don't need anyone's pity or judgment on top of my own jumbled emotions.

bubbaray

06-01-2006, 12:47 PM

Like the OP above (who worded it much better than I did), I do think it was insensitive to post such a thread without comment. It would have been easy to post a neutral comment, or something like food for thought or whatever.

I *did* try to word my post as MY feelings, NOT attacking Latia. I said it made ME angry, which it does. I DO feel judged by proponents of natural birth (not just here). I have had NUMEROUS negative, condescending comments made to me by doulas (including my own) and midwives and other moms. I even had a male coworker make a negative crack. I don't discuss the reasons for my c-section with these people (other than my own doula), so they are making comments without knowing whether my situation was elective, scheduled for medical reason or emergency.

So, yes, to say that this article hit a nerve with me would be a definite understatement.

I do apologize if I appear to be attacking Latia personally. That is not my intent. I'd like to think that her intent wasn't critical of those moms who end up with c-sections. However, I don't know her well enough and the lack of a comment within her original post leaves me wondering, KWIM?

Anyway, that's enough from me on this subject. I'm just going to go slink off into a corner and look at DD's birth photos from the OR and be VERY thankful that a c-section was available to me!

Melissa

http://b3.lilypie.com/rppJm7/.png[/img][/url]

trumansmom

06-01-2006, 12:57 PM

I really don't want to jump in the mix on this, but Latia didn't show pity, judgement or anything else about c-sections. In fact, she didn't say anything, which has apparently upset folks. Neither has any other poster made this sort of comment, as far as I can tell.

I know many topics push people's buttons. This is one of them. (And trust me, there are several topics that send me over the edge.) But just as I've asked people to take a minute and really think about their word choices, I'd also like to ask readers to take a minute and think about their perceptions. Perhaps a poster's intent is very different from the reader's perception. It happens.

All in all, I'm hoping this thread calms down.

Jeanne
Mom to Truman 11/01 and Eleanor 4/04

s_gosney

06-01-2006, 12:59 PM

I usually don't join in on these threads (I guess I'm a little non-confrontational), but something in your post struck a note with me. I certainly am sensitive to your (and other posters') reaction to this article, and I think the difficult decision of VBAC vs 2nd c/s is a good point and further explains some of the intense reactions here. However, I can't help but think if I had had a medically necessitated c/s, but then later found out that it wasn't actually medically necessary, and now here I am having gone through the more difficult recovery from a c, and having to grapple with the decision about what to do with future births...I really think I would have wanted to know before I had the c in the first place. AND, I would want any other mothers-to-be to be informed about such things so they could spare themselves from the things I had endured.
Now, certainly I know nothing about your situation (or that of anyone else here), and I am not at all implying that anyone's c here wasn't truly medically necessary. This is all just hypothetical.
I really do think though that we need to keep in mind the same thing that often comes up in gripes about our mothers' reactions to our parenting choices. I know that my mom feels sensitive (and possibly even criticized) when I explain to her why we don't spank dd (my sibs and I were spanked). But, the reality is it's not that I think she made a bad decision or that she's less of a mom or anything like that. I just have different information than was available to her at the time. I hope that the same will be true for my dd if/when she becomes a mother. There will be new and improved info for her to base her parenting choices on that will hopefully allow her to be a better mother than I will ever be.
I really think that this information was intended to be helpful, and hopefully it will in-fact help some mother-to-be here be more knowledgable and look into this issue, so that maybe just maybe someone can be spared the pain you've described.

ETC: typos

buddyleebaby

06-01-2006, 01:01 PM

Melissa,
I understand your feelings completely.
I just wanted to point out that Latia often posts the title or summary of a health related article and a link with no further comment with no objection, and so I do not think she anticipated this being a problem.
To my memory she has done so regarding vaxes and autism, the "cancer vaccine" for women, U.S. infant mortality rate, SIDS, etc.
Hugs, mama. Enjoy your pictures and remembering the miracle of your dd's birth.

bubbaray

06-01-2006, 01:03 PM

:) .

Melissa

http://b3.lilypie.com/rppJm7/.png[/img][/url]

o_mom

06-01-2006, 01:06 PM

I don't think there is anything wrong with the title - it was just the title of the article.

Yes some people have had c-sections, probably a good number, but there are also people here who have not given birth yet, who may not know this. They may not have thought about it in detail because they think it won't happen to them. They don't know how to avoid them and why it is important. I would hope that you would want for those moms to be educated to try and avoid what you went through.

megs4413

06-01-2006, 01:59 PM

I would like to steer this topic in a different direction if possible....

I am currently TTC and while it's never bothered me before (i wasn't worried about it with #1), I'm getting increasingly apprehensive about the birth...I think it's mostly because I had such a good experience with DD that I'm afraid I've used up all my good labor and delivery luck! Adding to my nervousness is the fact that my last three friends to have kids all required c-sections (yes actually medically necessary in each case)! I'm so terrified of having one and it's actually making me wonder if I want to try to have another child at all. I know that must seem silly to all of you who have had and survived c-sections, but i am one of those "afraid of the unknowns".

My question is, is there anything one can do to contribute to avoiding a c-section? When would a doc suggest a c-section when it wouldn't be necessary? Specifically I'm wondering if there would be a circumstance where a doc would suggest it and I would have a reasonable belief that I could refuse it safely....KWIM? I know i'm getting way ahead of myself since i'm not even preggers yet, but it is definitely a concern for me....i am such a chicken!

brittone2

06-01-2006, 02:06 PM

I know you are trying to steer this in a different direction, but what one can do/not do to avoid a C-section etc. is probably going to be very controversial. If someone here suggests things that may reduce the incidence of c-sections, someone may see that as "blame" that they didn't do xyz, etc. and ended up w/ a c-section, kwim?

There are some great books and online resources that are available that you might be interested in but I hesistate to post anything here for fear of fanning the flames.

jennifer_r

06-01-2006, 02:07 PM

O.K., I'm going to jump in. I usually don't post in controversial threads but I feel I should defend Latia.

Some people are offended because she posted an article WITHOUT making comments about it. I feel she is in a Catch-22 situation, damned if you do, damned if you don't. Personally, I think she did the most neutral thing by just posting the article and not commenting. If she had commented, I think people would get upset because she was biased. I also think there is nothing wrong about posting an article related to pregnancy, childbirth, babies, etc. if it is from a legitimate source. People do it all the time here.

So, just defending Latia's actions. That said, I think there is a time and place for c-sections and many lives have been saved because of c-sections but the rate is too high - I think most of us on this board would have to agree with that statement.

Jennifer

Mom to:
Christopher 12/29/89
Adelaide 8/23/04
Bronwyn 11/9/05

http://www.gynosaur.com/assets/ribbons/ribbon_garnet_6m.gif[/img][/url]

m448

06-01-2006, 02:09 PM

I'd highly suggest you read books like:

The Thinking Woman's Guide to a Better Birth - Henci Goer

Silent Knife (can't recall the author right now)

Active Birth - Janet Balaskas and google for her site as well

Spinning Babies www.spinningbabies.com

THIS is the purpose of such an article and thread. To get women to ask, "Why is this happening? How can it be prevented (unecessary c-sections, not warranted ones)?"

A good friend of mine made the comment that a lot of what is the standard of care in the OB arena sometimes CAUSES the need for c-sections (having women labor on their backs, depriving them of water and food, negating all evidence that a malpositioned baby prevents dilation).

Marielle

Ian - born 10/03
&
Ryan - born 01/06

m448

06-01-2006, 02:13 PM

Oops, apparently I had no such forethought. LOL Nevertheless everyone please note that my suggestions were posted in the spirit of helping a mom and not berating anyone who may have had a c-section.

Marielle

Ian - born 10/03
&
Ryan - born 01/06

megs4413

06-01-2006, 02:16 PM

useful information, thank you, and now i will make a hasty exit from this difficult thread!!!

kijip

06-01-2006, 02:23 PM

Latia,

I can't help but point out that you often post links to articles. Off the top of my head I recall SIDS and mattresses, HPV Vaccine and home births in recent memory and I don't even read the boards daily. Most of the times the articles are informative. It is clear that you care a lot about these issues are are working hard in your new profession. I have found that some of the articles are from sources with a stated bias but such is the nature of journalism in general, no? So I factor that in to my reading and draw my own conclusions, which I am sure all of the mamas here can and do. I do agree that the USA's C-section rate is unnecessarily high but I also know that there are many times when one is medically necessary or personally necessary and that each mother and care provider can weigh the risks of the various options. I also know that the 40% increase since the mid-1990s is baffling. My non-expert hunch is that medical malpractice claims may be playing a role. This is a huge legislative issue that interests me a great deal. There is certainly no one way to look at the issue.

What bothers me is that sometimes I wonder what you are trying to accomplish when you post these articles. While no rules are being broken, it seems sometimes to be close to baiting. There are long threads on most of the issues you have posted on and on some of these topics, one could say that "battle lines" have been drawn in that many who post here know where other posters stand.

If the articles were posted in response to a question on the topic asked by a mother seeking advice, it would seem different to me. But the fact that they are posted as links with little to no other content has always puzzled me. I do appriciate your expertise and viewpoints, I just think that this thread will hopefully call your attention to how your posts can come off to those here who do not share the same beliefs. I am all for diversity and disscussion on the boards, as my posts reveal LOL! So I am not saying you should stop posting these links (you should do whatever you want) I just think that you might find that they help more mothers when given in the context of a spontaneous discussion.

KimberleyDawn

06-01-2006, 02:25 PM

I didn't see a problem with the way it was posted but then again I didn't have a section so it isn't a touchy subject to me. I will admit I instantly thought of all the elective preplanned c/s that are performed simply because the mom didn't want a "painful" birth....what a joke! I have a few friends that have had sections and while they all recovered nicely they couldn't say it was pain free.

kijip

06-01-2006, 02:26 PM

Well the flip side of a 29% section rate is a 71% vaginal delivery rate. That is almost 3 in 4. And I beleive that having had 1 vaginal delivery increases the probability that you will have another. I guess I am telling you to plan, talk to your care provider and not worry too much.

psophia17

06-01-2006, 02:45 PM

Well said, Katie. Where is the applause smiley when you need it?

m448

06-01-2006, 02:49 PM

nm - not productive.

Marielle

Ian - born 10/03
&
Ryan - born 01/06

kijip

06-01-2006, 03:04 PM

> Shall we prevent liberals from posting
>research regarding the war? (for the record I'm a
>conservative).

Well, actually BBB kind of does. LOL. So much so that we liberals have, as you likely know, our own board. ;)

essnce629

06-01-2006, 03:15 PM

I'm sorry that many people were offended by me posting this article without any further comment. Also, I don't see the big deal about the title-- I didn't make up the title, I just copied and pasted it from the article (like I always do). I have been posting on the BB boards for 3 years now and have always posted articles related to childbirth topics. I always just post the links, because I don't have time to post a bunch of other stuff. If you look back, I've posted several links before without adding any discussion. I came across that article at like 1am last night and just wanted to post it before going to bed. The c-section rate in the U.S. and other countries is skyrocketing right now and even though many c-sections are medically necessary, unfortunately almost 80% are not. As a doula, it is part of my job to make sure women are fully educated regarding their choices and are completely informed before consenting to any procedure. Fully informed means being told all the risks, benefits, alternatives, and what would happen if they did nothing before consenting to any procedure. And unfortunately, most doctors are not getting completely informed consent from most women when it comes to childbirth choices. In fact, it just announced on my local news five minutes ago a study that just came out stating that repeat c-sections lead to increased risks to the mother and that women should think twice before scheduling ELECTIVE c-sections or if they plan to have large families. If I find an article on that I'll post it as well. Now if your c-section is medically necessary then yes, it is the safest option for you and your baby, but the truth is, an elective c-section or one that is not medically necessary is not the safest thing for mom and baby and there are plenty of studies to back that up-- it has nothing to do with my opinion.

Oh, and I came across this article on another board I post on, found it interesting, and decided to post it here and on several other boards that I post on. Almost all the articles I end up posting here are found on other boards I frequent-- it's not like I stay up all night searching for articles to cause controversy.

***Latia
Birth and Postpartum Doula

Conner 8/19/03 (homebirthed water baby)
http://www.babiesonline.com/babies/a/aug2003angel
http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Self-weaned at 24 months!

pb&j

06-01-2006, 03:24 PM

>Probably hiding behind the list of "approved by the majority
>topics of discussion" list.
>

Eh? I don't follow...

-Ry,
mom to Emma, stillborn 11/04/04
and Max, 01/05/06

http://www.windsorpeak.com/dc/user_files/32812.gif
http://b1.lilypie.com/aKGqm5/.png[/img] ([img)

kijip

06-01-2006, 03:34 PM

Which was, after all a joke ;)?

If I posted a link to information on the possible safety of elective c-sections I would expect some disagreement to arise. I think it is reasonable for you to expect the same when making your posts. If I posted a link about the safety of vaccines, I would expect some disagreement to arise and so forth and so on. I don't think that disagreement is bad but I do think that you know full well that there are dissenting voices that will speak up.

I am not saying that your link posts should be prohibited, just that they are not the most effective way to help/educate in MY opinion. You are free, as we are all, to think and say otherwise.

mamicka

06-01-2006, 04:14 PM

I'm not sure why it's such a problem to post a link to an article without comment. Isn't it implied that the comment would be "Food for thought" or "Thought you might be interested". Does that change the perception if that had been posted? I just don't get it. I can see thinking that it's weird to post links without comment, but offensive?

I had a c/s that was an emergency at the time, but was the result of a mismanaged labor, for lack of a better phrase. I could have done more to prevent the c/s had I taken the time to educate myself beforehand. I don't understand the resistance to education.

C-sections are not bad. Having had a c/s, whatever the reason (elective or emergency), does not make you a bad mother. Why can't we all at least appreciate the value of becoming more informed?

Allison

KBecks

06-01-2006, 04:25 PM

Rachels said:
Here an article was posted and the overwhelming sentiment was, "We don't like those study results and so we shouldn't have to know about them, and you suck for making it possible for us to read them!"
------------
I just want to say, I don't think that's what was said here AT ALL. My concern is that there are a lot of pregnant women here who are concerned and sensitive to and scared about how their births will go. Having an article presented with a dramatic title that potentially generates greater fear about -- what if I have to have a c-section, is in my opinion, not so great a thing to do. And I don't think anyone implied that the OP sucks. Perhaps the OP has some conflict-of-interest, is it not OK to suggest it as a possibility? To the OP's credit, the disclosure is great, it helps to know where someone is coming from.

Also, no one is saying here that pregnant women shouldn't research. By all means they should, and they should talk with their doctors, and they should be their own medical advocates.

Childbirth is scary for a lot of women, and IMO the posted article has the potential to generate even more fear, leading women to second-guess their decisions, distrust their medical providers and feel even more scared about birth. (A couple people have posted about their fears as to whether to even have more children because they're already freaked out and pressured about making the right birth choice.)

That's why I think it's *so* much better for a woman to research on her own, at her own pace, talk to her doc, and find her own comfort level (I think we agree on this). Even to ask questions here, and THEN receive some great research and help from board mamas. No one has said to stick your head in the sand. I'm just saying that a woman should also talk to her doctor, she and her doc are the two most important people in determining the right health care for her specific needs and situation.

ETA: Darn it, I don't want to keep pushing this post up the food chain here...but I had to respond to the idea that anyone is promoting mamas sticking their pretty little heads in the sand. That's so not what anyone at this board is about, IMO.

Now, I'm going to find some better topics to reply to :)

Saccade

06-01-2006, 05:00 PM

>
>A good friend of mine made the comment that a lot of what is
>the standard of care in the OB arena sometimes CAUSES the need
>for c-sections (having women labor on their backs, depriving
>them of water and food, negating all evidence that a
>malpositioned baby prevents dilation).
>

Just an honest question: How many OBs still practice like this? Maybe it's just here where I live, but in our hospital prenatal class (taught by a doula, with the full endorsement of the academic medical center) we were given Henci's book, exhorted to remember to eat and drink during labor, told NOT to sit with out knees above our pelvises and to assume hands and knees position in early labor to help prevent posterior presentation, told that we MUST stay active as much as possible during labor...this was just standard operating procedure.

Granted, when I was in med school (lo these many years ago) many of us students were doing research trying to prove that it was OK for laboring women to eat, because at that point many OBs in the area were still not on that page, but even back then the tide was turning.

I do agree that the C-section numbers are troubling, but I'm not certain that it's not multifactorial. I was a medical anthropologist/sociologist before going to med school, so I am perfectly willing to buy that there are systemic problems. However, as informed women and consumers of obstetric care, I think we need to cast a wider net looking for causes rather than laying the entire blame at a standard of care that is a moving target and that (hopefully) is evolving into something that is fully evidence-based.

ET trim quote

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buddyleebaby

06-01-2006, 05:07 PM

I have no idea on the whole how many Obs still practice like this.
I only know that mine does!

I was induced at 37 weeks for no reason, not allowed to eat for five days before I finally went into labor (they did give me jell-o around day 3), stsrted on pitocin when I was barely dilated, not allowed to even SIT UP during labor, and finally given an epidural (with my consent).
Knowing now what I did not then, it amazes me that I did not end up having a c-section.

o_mom

06-01-2006, 05:17 PM

Pretty standard here - IV on admission (I consented to a heplock), ice chips only, and once the epidural went in CFM and IV is required. I certainly couldn't walk with the epidural. I wish that they had given more advice on pelvic rocks, etc. to help with presentation when I requested the epidural, rather than just saying that was the only option.

I am amazed that I didn't have a c-section, inspite of all this. DS1 was not positioned well at all and I certainly met the Failure to Progress criteria after pushing for 8 hours.

psophia17

06-01-2006, 05:24 PM

The hospital I delivered at (and my OBs) were old school as well - that was just the way it was done. Before we found out DS was breech, we'd gone on the hospital tour, and were told not to expect what they called "special treatment." They had their standard procedures, which included the IV, monitors, and staying in bed, and that was that.

I asked my OB about a birth plan, and was told not to bother, the hospital wouldn't honor it.

I hope this evolution is fast and furious...

essnce629

06-01-2006, 06:09 PM

IV at admission, continuous fetal monitoring (which makes remaining mobile difficult and sometimes impossible), not allowing food, etc are pretty standard in most hospitals around me as well (San Diego, CA). There are a lot of hospitals in San Diego and there's only 2 that I can say are actually natural childbirth friendly (as in a lot of common interventions are not the norm or mandatory there). Pretty much all the hospitals here have c-section rates close to 30%. I was at a birth 3 weeks ago at an in-hospital birthing center run by midwives and when I entered the room (as the on-call volunteer doula) I found the mom laying in bed in a ton of pain and as far as I know she had been that way since she had been admitted 4 1/2 hours before. This was in a birthing center that doesn't even have electric fetal monitoring (they use hand-held dopplers), there are no routine IVs, there's tubs to labor in, and mom can eat whatever she wants. But since the mom was pretty much alone the whole time with only her husband (the midwives only come in periodically to check baby's heartrate), no one suggested she get out of bed. So as soon as I got there I got her up out of bed and we started walking the halls and after only walking for about 30 seconds she said she already felt better. Later I had her on the birthing ball, in the shower, and in the tub. She labored this way (from the time I got there) for 12 hours and went on to have a natural birth without a hitch. So even if a hospital doesn't have a lot of standard interventions (like the hospital I was at), a lot of times the moms will still remain in bed because no one suggests otherwise and they are so used to seeing moms on tv, etc laying in bed with an IV, monitors, etc which they just assume is the norm.

brittone2

06-01-2006, 06:14 PM

Well, I think it is quite common to have outdated hospital policies for lack of a better way to describe it.

The original hospital I planned to deliver at (only because it was 15 mins from home) required an IV hep lock, was not supportive of eating/drinking in labor, no shower/tub at all in labor, etc.

I started asking questions and was uncomfortable w/ these policies. My doula, who has been a doula for a long time (in her 50s), attended births at many, many area hospitals and was able to guide me toward one that was more supportive of the kind of labor I wanted. I ended up driving 45 mins to the midwives I saw, and it was a 45 minute drive to that particular hospital from my home. That hospital did not require routine IVs, hep lock, no "ban" on eating/drinking in labor, could labor (but not birth) in the tub, etc.

I live in a different state now, but this was not out in the sticks. It was a distant suburb of Philadelphia, and the more local hospital had a good reputation.

ETA: this is slightly off topic, but despite many studies showing routine episiotomy is no longer indicated at all, there are many old school docs that still cut them routinely. There are studies showing that they still happen way more often than they should, even though there's really no hard evidence that they are beneficial at all, kwim? Hopefully the changing of the guard will happen soon, but there are still some really outdated practitioners still practicing outdated medicine, and unfortunately still teaching the younger generation of doctors that kind of misinformation.

Globetrotter

06-01-2006, 06:42 PM

"Just an honest question: How many OBs still practice like this? "

Unfortunately too many, judging from the experiences of my friends and relatives, unless we actively seek out OBs who aren't "old school". My first experience was terrible, resulting in a c/s that could probably have been avoided. It was the classic case of induction/failure to progress - yeah, hook me up to an IV drip/monitors from the beginning and force me to lie on my back with a pitocin induction.. no wonder!

For my second, I somehow found an OB/midwife practice that supported vbac (it wasn't easy!). Despite our best efforts, I did have a scheduled c/s (ETA: at 42 weeks) but at least this time I did my homework
and felt my providers wouldn't rush to a c/s unless it was necessary. In some cases it absolutely is, and I'm glad it's an option.

I think we all need to be well-informed. For the record, I wanted to avoid a repeat c/s to avoid the risks of surgery and the painful recovery, which often makes bonding/rooming in/nursing on demand difficult.

ETA: The c/s was at 42 weeks, not 40!

Kris

Rachels

06-01-2006, 08:14 PM

"What bothers me is that sometimes I wonder what you are trying to accomplish when you post these articles. While no rules are being broken, it seems sometimes to be close to baiting."

What? Think about that. If posting birth research is baiting on a baby board, there's some incredible censorship afoot. Not all research outcomes are going to make us comfortable. If our goal here is never to encounter things that we don't like, then we'd better put a moratorium on new information altogether.

I find birth research illuminating. It is specifically BECAUSE of reading it that I altered my own plans for birth. Knowing the research enabled me to make a truly informed decision about the choices that were right *for me*. I'm beyond grateful to the people who first put the research in front of my face, although it made me squirm terribly for a good while. They weren't baiting; they were making information available. What I did with it was entirely up to me. Same here.

-Rachel
Mama to Abigail Rose
5/18/02
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Nursed for three years!

and Ethan James
10/19/05
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Maya

o_mom

06-01-2006, 08:34 PM

I think it is being posted on it's own because it is new. There have been other smaller studies that went both ways, but this is a very large study confirming what many people suspected. We shouldn't wait around until there is an appropriate discussion, since that may be too late for some people.

I also think it is actually better that it is posted with no comment, rather than a comment that could be taken as an endorsement or bashing. There have been at least two other news stories posted in the last week with little or no comment and no one has questioned the motives of those people.

swampus

06-01-2006, 09:42 PM

I'm curious-- for how many regular posters here, how many lurkers do you think exist?

You seem to imply that the OP knew what the regs here would think of her article, but what of all the lurkers who are newly pregnant or TTC? Don't you think it would be beneficial for them to go to their OB at some random appointment and say, "I read this article online.... what do you think about it?" The discussion can then happen between pt. and doctor.

I realize this is a community and many of the regular names are well-known. But I'm always cognizant of the lurkers and the value of these heated threads to them.

I was induced (cold) with both my pregnancies. The first time, I knew absolutely nothing about it before going in for my first post-date appt. I went with it because the OB was the doctor and what did I know? My second time, I asked a LOT more questions, but still consented to the induction. If I have any more children, I will certainly question it again. I feel confident in my decisions, of course, because I have two healthy babies. I have a close friend who went into a cold induction (actually, it was a successive induction), ended it with an emergency section, and had to have a hysterectomy to save her life (perfectly healthy newborn and baby, btw). She likely has a different perspective than I do.

This board rarely gets heated, that I've seen--compared to other online communities. But I think the discussion has ripples that extend FAR further than the handful of posters involved in any one discussion.

I think we agree on most dynamics of these discussions, but the big difference is that I think it's very healthy for someone to post a "biased" article and for others to vehemently oppose it.

Saccade

06-01-2006, 09:46 PM

OK, thanks for answering my question. I was hoping the change in practice was a result of the years since my med school rotation and not because of the region I live in right now. Sigh. :(

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kijip

06-01-2006, 11:51 PM

>What? Think about that. If posting birth research is baiting
>on a baby board, there's some incredible censorship afoot.
>Not all research outcomes are going to make us comfortable.
>If our goal here is never to encounter things that we don't
>like, then we'd better put a moratorium on new information
>altogether.

My post was on the stream of atricle links, many of them not new information coming from one person on hot button issues, sometimes with tibits of commentary that imply that there is only one way to see the issue and NOT just this one thread. You know I don't care if the posts are here and welcome them (as I stated- I find some quite interesting), I just think that if someone wants to post such links they can reasonably expect that some are going to disagree and that some contraversy is going to arise and that someone who has been posting here for three years like Latia can't pretend to be surprized that some have a hot poing to contention on that particular topic of the day. Heck, I don't disagree with the premise of this one article and I enjoy the discussions and debate...I just see both sides of the coin here and can see why people were offended. What do you suppose would happen if someone posted a stream of articles on the benefits of formula, TV, plastic matresses, growth hormones in cow's milk and nuclear energy, and disposible diapers to prevent diaper rash?

kijip

06-01-2006, 11:55 PM

>OK, thanks for answering my question. I was hoping the
>change in practice was a result of the years since my med
>school rotation and not because of the region I live in right
>now. Sigh. :(

FWIW, Saccade I DO see a huge amount of change. For one people have the ability in many areas to choose hospitals. For another, I too share your impressions from my own labor and delivery. Working with thousands of new mothers over the last three years and leading new parent groups leaves me with the distinct impression that things are more flexible and modern than not in the county that I live and work. We are both on the West Coast though and that may play a role? What does the medical sociologist in you think on the regional issue?

DDowning

06-02-2006, 12:01 AM

"But a new World Health Organization-led study involving more than 97,000 deliveries in Latin America found that hospitals with the highest rates of caesareans had higher rates of maternal death and severe illness and had higher numbers of babies who died or were admitted to intensive care for seven days or more after birth.

The results, published online by the journal The Lancet, "show how a medical intervention or treatment that is effective when applied to sick individuals in emergency situations can do more harm than good when applied to healthy populations."

*******

Does anyone else feel like the study is a bit misleading? I say this because:

(1) The focus is on Latin America hospitals; could it be reasoned that the standards, expertise of medical staff and the degree to which they operated in a sterile environment might be substantially different to that of US, let alone Canada? Would a study conducted in the US produce the same result?

2) Based on the sentence quoted, there is no distinction made between elective and emergent c-sections, which begs us to look at the population used as its sample. Did the study go into detail if the population in question had proper, consistent, prenatal care? Could it be argued that if proper prenatal care was not followed, problems or symptoms might be overlooked or uncovered resulting in the higher fetal or maternal deaths?

Maybe its just the way the article summarized the study and my questions would have been answered if I read the actual study itself. Right now, I can't help but think the article is skewed toward a certain viewpoint to get the result the authors were looking for?

For the record, I've had two c-sections. The first was unplanned, the second was a hopeful Vbac that turned into an elective c-section at the end. While the first was no picnic and pretty unpleasant experience, the second was a dream. In both cases, I delivered a healthy child and at the end of the day, that's what's important.
(Though, it would be nice to have my stomach muscles back! :P)

Saccade

06-02-2006, 12:47 AM

What
>does the medical sociologist in you think on the regional
>issue?

I don't know. My friends in Boston had the same experience as I. Maybe it's being near academic medical centers?

I guess I would also add to my comments above that I do think the most effective way to lower the rate would be to focus on educating other women rather than just railing against the system (since it is slowly but surely changing as evidence amasses to support new birth practices).

To a large extent C-section rates depend on what the market will allow: in other words, what the consumer -- as much as I hate that term as applied to people who use a health care system -- chooses as far as practice style. (Note that I am using the word "chooses" but am quite conscious that without sufficient information, a true choice may not be possible -- if you don't know your options, how can you choose?). Given choice (a big given that is by no means assured to many), women who understand the issues will vote with their feet and this will drive a change in practice.

For example, there is a cushy private hospital in town that has a higher intervention, epidural, and C-section rate. I have friends who knew this and chose to deliver there. I know OBs who practice there and are frustrated by how they are practicing, but who feel that there is a market for a more medical birth and that they are serving that niche. Then again, a few women who were planning to deliver there and listened to a childbirth class given by another doula group in our area decided to switch away from that hospital once they heard about options.

I feel cynical saying this, and it's a bit depressing, but good old market forces continue to drive what is offered to the consumer by the U.S. health care system.

So a good place to focus, I think, would be making sure that women have a choice when it comes to a birth provider, and that they understand the potential implications of choosing one provider over another. I'm not talking about readers here on the BBB, who are generally well-informed on all details (to a fault, sometimes :) -- I'm looking at myself when I say that). If you are upset about C-section rates, try getting the word out in the real world -- though that's hard to do without doing a mommy drive-by or butting in.

I must go sleep now. 'night.

E for typos

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shilo

06-02-2006, 12:53 AM

to your points 1) and 2) above, i have to say that's the first thing i thought of when i read this too... 'gee it would be interesting to look at their cohort groups and see if they took into account things like prenatal care and morbidities going into the delivery (ie my thinking went along the lines of less prenatal care --> things like presenting at hospital with eclampsia --> emerg. section with poor maternal/fetal outcome, etc). well, can't even find the abstract yet on medline (looks like it just went onto the lancet site today?), but other articles written about this study in pre-published interviews lead me to believe maybe they did take this into account?

last 2 paragraphs
http://www.lse.co.uk/ShowStory.asp?story=TO2225383K&news_headline=caesarean_birth_risk_to_mum_and_baby

and
http://www.medicalnewstoday.com/medicalnews.php?newsid=43897

just for the record, i am neutral on this - in so much as i think one can be. had a vag. delivery with ds, but like every mother on these boards, would have made the best decision i could have at the time, with the information i had at the time, presented with the need for a section. we all just want healthy babies when it comes down to it... knowledge is a gift we can share with eachother.

Sam 5/19/05 How lucky I am that you chose me.

essnce629

06-02-2006, 04:54 AM

>Maybe its just the way the article summarized the study and my
>questions would have been answered if I read the actual study
>itself. Right now, I can't help but think the article is
>skewed toward a certain viewpoint to get the result the
>authors were looking for?

Here's the complete full text of the actual study (conducted by the World Health Organization by the way). You'll have to register (it's free) before you can read it though. The study is extremely long and detailed, but very informative.

http://www.thelancet.com/journals/lancet/article/PIIS0140673606687047/fulltext

***Latia
Birth and Postpartum Doula

Conner 8/19/03 (homebirthed water baby)
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