Is Pushing Really for Suckers?
By Glinda
I’m going to do something I’m probably going to regret and jump into the Caesarean Section vs. Natural Childbirth debate.
First, I’m going to say that I’m not for scheduling C-sections because it’s “easier” for either the doctor or the mother than going through labor. It especially makes no sense to me, as recovery times for C-sections are significantly longer and more painful than for natural childbirths.
C-Sections, although having a low mortality rate, are just not as safe as having a child naturally.
But, no one should be looked down upon because they wanted an epidural.
No woman should feel guilty, “less of a woman,” or grief because she had to have a necessary C-section instead of natural childbirth. And other women shouldn’t necessarily feel superior for having a natural childbirth, either. Neither one makes you a better or worse mother.
I think that we perform too many medically unnecessary C-sections in the US.
Yet at the same time, we cannot forget that dying during childbirth was not uncommon all that long ago.
I think there is a distinct lack of true dialogue between mothers-to-be and their healthcare providers. I don’t know if it can be traced to a bottom-line driven healthcare system, lack of knowledge, malpractice fears, or what. But either doctors need to listen more, or women have to be more aggressive in questioning their doctors.
Or, better yet, how about both of those?
And yes, this is coming from a woman who had a scheduled, medically necessary C-section.
August 7th, 2008 at 12:21 pm
Ok, I’m not really going to take any sides here, especially since I don’t have kids myself, but I read in Newsweek that more children are developing allergies now than they used to in the past. While this is hardly big news, I was surprised and interested when I read that researchers believe that this may be correlated to the number of C-sections being performed. The researchers hypothesize that natural birth enables the babies to pick up some more antibodies in their mothers’ birth canals that they otherwise would miss in a C-section.
August 7th, 2008 at 1:17 pm
I agree with you Glinda. I had intended to have a natural child birth, but ended up having multiple medical necessities such as uterine flush, fetal monitor, analgesic, epidural and finally, a C-section anyway. I felt nothing but guilt for having “failed” at child birth, which in my irrational state was a right of passage to motherhood. I know it’s not rational but that badge of honor was denied me (in my head). The second time I had to have a scheduled C-section because the first birth was labelled “failure to progress.” I feel no guilt whatsoever for the second C-Section, but 10 years later, I still feel inadequate for not having a “natural birth.” Wrong, yes, real nonetheless.
August 7th, 2008 at 2:01 pm
My son was breech. They tried turning him with no luck. I had a C-section that was “not bad”, but still … the recovery and all. Ick!
My daughter, almost 10 years later, came by way of VBAC. And let me tell you! SOOOOOO much better! 5 minutes and 8 pushes and she was out. It was so easy compared to the C-section that I don’t know WHY anyone would intentionally want one.
August 7th, 2008 at 5:23 pm
Seana, for whatever comfort I can offer you:
It’s not a competition.
As I understand it, the object of the exercise is to have a child at the end of it, with, optimally, a live mother to look after it.
This is what we call “success.” Unhappily, even in this day and age, sometimes the end result is not always a “success,” but, fortunately, the vast majority of these endeavors are “successes.”
It does not matter how you get there. You are not being marked. You are not “better” or “lesser” for having reached your goal using one way over another. It’s not a competition. Nor, in fact, is it anybody else’s G.D. business except the participants. If you have Mother Nature sprinkling you with pixie dust, and you then go out and find your child under a cabbage leaf:
a. You have succeeded; and
b. Cool!
But otherwise, it’s no one else’s business, and it’s no one else’s concern. Moreover, it’s no one else’s concern how you feed the end result of your successful endeavor, either. No one else is in charge of your breasts. No one else is entitled to know what you do with them. Your new little person couldn’t care less, either, in fact; he or she – or they! – just want the food. The container doesn’t concern them.
I absolutely cannot understand why so very many people seem to make what other people do with their bodies, their business. Sadly enough, yes, ladies, I’m talking to you. Not, of course, the ones here; but there are plenty out there.
The ladies here, however, at least now can feel better, and have a response, if they should be harrassed or bullied:
“Please don’t worry yourself about it.”
“You needn’t concern yourself.”
And there’s always:
“I fail to see how it is any of your business.”
August 7th, 2008 at 5:35 pm
“Yet at the same time, we cannot forget that dying during childbirth was not uncommon all that long ago.”
Thank you, Glinda, for the balanced reminder. I have trouble understanding why anyone would deliberately choose a C-section or a doctor agree to perform one for the sake of convenience alone. However, as a very short person who attempted long and hard to deliver two babies with pumpkin-sized craniums–and physically could not–had C-sections not been available, I and my two babies quite simply would have died.
Seana, no one should feel inadequate because they and their doctor made a decision that saved both their baby’s life and their own as well. Just consider it the first of many wise maternal decisions made for the well being of your child.
August 7th, 2008 at 7:32 pm
No decent physician will unnecessarily risk the life of mother or baby with a difficult delivery when a C/S will grant both healthy moms and babies. OBs convert from vaginal deliveries to C/S to prevent immediate harm to mom or baby. (always easier to ensure a good outcome, from a doctor’s perspective, by controlling the events, and C/S are much more controllable than vaginal deliveries).
Unfortunately, at a population level, I think also that there are too many C/S due to fear of malpractice lawsuits.
One of the most interesting ethical/technological/medical discussions I’ve heard was a lecture about how those little scalp baby heart monitors altered OB/Gyn practice in the 1980s. Although advertised as enabling OBs to monitor the health of the baby during vaginal delivery, there was very little evidence at the time backing up the appropriate interpretation of the baby’s heart rate. There was also a widespread belief–though never proved, and is highly debatable–that cerebral palsy was due to birth trauma during vaginal delivery. Sometimes it might be, but often no one really knows. ALL to say, there was a flurry of high-priced lawsuits against OBs when moms went through difficult vaginal deliveries, the OB was accused of improperly interpreting the baby scalp heart monitor (though remember, there were NO “gold-standard” studies established guidelines for such interpretations) and the baby came out with cerebral palsy. Result: OBs are quick to stop a vaginal delivery and convert to C/S, because they a) don’t want to risk hurting the mom or baby and b) they don’t want to get sued if the baby comes out with a problem.
An interesting history of the judicial and medical issues surrounding those heart monitors can be found in this article:
http://www.warriorsfortruth.com/john-edwards-vice-president.html
(I do NOT include this in any way, shape or form as a comment on John Edwards or politics or elections or anything. It’s just his history in the legal profession and the cases he won for his clients are highly publicized and good examples of the 1980s lawsuits that have now led to increased C/S rates.)
On a more personal note, I think the whole C/S vs vaginal delivery thing is sort of like the whole formula vs. breast-feeding thing. If you’re blessed enough that everything goes well, do it naturally. But if things aren’t working, there’s no shame in taking advantage of medical and social progress TO SURVIVE. Check out the graphs here:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm#fig1
I’m so glad we live in a time when we expect–no, demand– that all moms and babies live through childbirth. It’s such a gift, even it it comes with C/S.
August 8th, 2008 at 9:27 am
I don’t have any children, so I don’t have a dog in this fight, but of course I still have an opinion, which is that as long as you end up with a baby, who cares?
If I ever had a baby, I would ask to be knocked out because I’ve had menstrual cramps that have made me pass out, so why would I want to have even worse pain in labor?
And amen to the statement that women used to die in labor. The corollary to that is that children used to die from diptheria and whooping cough (my great-something grandmother lost all six of her children in seven days to diptheria, then had more kids), which is why we vaccinate now. The same women who want to have their babies at home in the bathtub because “it’s so safe! what could go wrong?” are probably the same ones who think vaccinating is a bad idea.
Sorry. I got off track there. I just get so annoyed with people who ignore the role of modern medicine in maternal and child health and want to be “natural,” when it’s nature, and not medicine, that has tried to kill them.
August 8th, 2008 at 4:26 pm
I took a class when we were preparing for our little guy to get us ready for labor. The teacher went on and on about how “women have been giving birth naturally since the beginning of time” and it’s the way things ought to be. I heard “You can do it. Every woman can do it. Just tell yourself you can and you will.”
The teacher took a poll at the end of the last session, asking who would be brave enough to push through natural childbirth and who would wuss out and have medication. Everyone in the room, but me, agreed (very nervously) to get through their labors unassisted. I raised my hand fearlessly and said “epidural all the way!”
Well, I ended up having to be induced and I got my epidural, but I ended up letting the epidural stop because the nurses said it would slow down the pushing. Well, ladies, I pushed through two hours of medicine free labor. By the end of it I knew why some women have planned c-sections. I was so bitter about the experience, I wouldn’t look at my baby for days. I feel differently now and I don’t think I would do a planned c-section. I would just keep the epidural going!
However, honestly, it’s your own body and if you would rather be cut open then tear open, don’t let anyone try to tell you you’re wrong! It’s your body, your baby, and it should be between you and your doctor. The only thing I feel really strongly about here is that I DON’T like people, like my child-prep teacher, pushing their agenda on first-time moms.
August 8th, 2008 at 11:06 pm
When my son and daughter-in-law had their first child, my son asked me if I wanted to be in the delivery room during the birth. I said “Honey, I didn’t even want to be in the delivery room when you were born.” So yeah, I went for the drugs and I also ended up needing a c-section, after 12 hours of induced labor produced no movement on my son’s part. He clearly wasn’t sticking to his end of the bargain. The recovery was a b**ch.
I can remember hearing of another learned study back then, 30+ years ago, saying too many c-sections were being performed unnecessarily, and that researchers had found a potential link to kidney disease later in life for children born via c-section.
BTW, I did end up in the delivery room when my grandchildwas born, and child birth definitely improves as a spectator sport. And once you get beyond the “I can’t believe what I’m looking at” phase and get to the “oh my God, that’s the most perfect child I’ve ever seen” phase, it’s a highly moving experience.
August 9th, 2008 at 9:02 am
“The teacher went on and on about how ‘women have been giving birth naturally since the beginning of time'”
Did she mention the part of how women have been dying in childbirth since the beginning of time, too? Or, at the least, been in a lot of pain? Maybe she really believes that labor pains are our punishment for Eve’s transgressions.
August 9th, 2008 at 1:04 pm
Apparently she felt that the pain was all part of the wonderful experience.
She kept telling the husbands “women look forward to childbirth. We’ve planned and looked forward to the experience since we were little girls. I gave birth to both my children at home, against my husband’s wishes, and it was everything I hoped for!”
I just kept thinking, “I planned and looked forward to my wedding since I was a girl. The only plan I had for childbirth was to avoid the pain as much as possible!”
She also admitted that she almost lost her first baby because they were not in a hospital, and her husband wanted to call 911, but she held her ground and it all ended up okay. I’m sorry, but I just don’t understand why anyone would WANT that kind of experience.
August 9th, 2008 at 2:22 pm
Speaking as someone who is currently recovering from a c-section (on Tuesday), I don’t understand why anyone would plan this intentionally. I tried induction for a vaginal deliver and made absolutely no progress in over 8 hrs so they decided to do a c-section while we were all doing well. As it turned out , my darling little girl has the shoulders of a linebacker and would likely have been difficult to deliver vaginally anyway. But for now, it hurts to stand, walk, get in and out of bed, and I can’t really do anything but sit with my feet up. Would I have another c-section? I’m not sure.
I think that there are too many doctors who are willing to do things like induce at 38 weeks because the mom doesn’t want to be pregnant any more (which is likely to fail and lead to c-section) or do a c-section just for convenience sake.
August 9th, 2008 at 4:50 pm
Bellamama, a childbirth professional (and I use that term lightly) who knows all the horrible things that can go wrong at the last minute wanted to have her baby at home? Even if you aren’t worried that the cord will wrap itself around the baby’s neck and need expert intervention, why would you want that mess on your own sheets?
I think the “against her husband’s wishes” is also a key part of this woman’s psychology, along with her refusal to call 911 when HER BABY’S LIFE WAS AT RISK.
I’m with you. My motto is no pain, no pain.
August 9th, 2008 at 7:38 pm
Dr Nic,
Congratulations on your baby girl!
I wonder if OB practice patterns are different in private vs academic? All the academic OBs I’ve worked with would not deliver at 38 wks, as that is not technically full term. In fact none of them would induce a normal healthy pregnancy before the mom was post-dates (42 wks). And no OB would schedule a C/S “just for convenience” if a mom didn’t have to undergo a C/S or wanted to try a VBAC. Scheduling C/S is a different story if it’s a second or later pregnancy and the first delivery was a C/S. If the mom HAS to have a C/S (which, if you’ve already had 2 or more C/S, you’ll continue to have C/S, as no OB would allow an attempted VBAC, as risk of uterine rupture is too high). If you have to have a C/S anyway because of medical history, I don’t see why not schedule for convenience, during week 39 or later.
There _is_ a flurry of C/S scheduled the last week of December–expectant moms trying to get the baby out before the next calendar year–but those are all women who have to have C/S for medical reasons anyway.
Bellamomma and class-factotum, can you imagine the guilt a mom would carry if she chose a home-birth and things went wrong and her child was injured for life? I can’t imagine taking that risk.
The best model I’ve seen for allowing women a full range of choices and safety for childbirth was in one of the Boston hospitals, where the OBs partnered with area midwives. Women with normal healthy pregnancies could have a midwife-attended, natural childbirth in a private hospital suite (I think with the bathtubs and everything). If anything went wrong, medical attention was immediately available. It was a great model, though difficult to duplicate because OBs and midwives don’t always get along!
August 10th, 2008 at 4:03 pm
I had planned to have my daughter naturally. No drugs, no c-section. However, my daughter wasn’t descending properly and was having some erratic vital signs. The doctor’s gave me an option to try pushing for a bit longer or to have a c-section. For me there wasn’t even a question I said start prepping me for the c-section. For number two, I’m pretty sure that I would have a scheduled c-section.
As an older first time mom and being a breech baby myself I’d pretty much come into the pregnancy with the attitude that ‘Hey, I’ll try the natural childbirth thing but my main goal is a healthy baby.’ So I was pretty much ok with either outcome. The thing I had really wanted to avoid was the epidural needle and I ended up with a spinal anyway!