Too posh to Push ???

[michel]

There is a theory that many women are 'demanding' that their babies be delivered by caesarian section; (hence the title of this thread)

Is there any evidence of this in the States ? The only article related to this is the following one:- http://news.bbc.co.uk/1/hi/health/751177.stm

Complications of labour

Sometimes surgical intervention is required

The majority of babies are born vaginally, but an increasing number are born by Caesarian section.
The government has ordered research into the reasons for the recent increase in the use of Caesarians.
The National Childbirth Trust fears that part of the reason is doctors' lack of confidence in women's ability to deliver naturally and their fear of being sued if something goes wrong. But doctors argue that medical advances and better technology mean that they can intervene at earlier stages and save babies which would otherwise have died.
Induction:
About 10% of babies are currently delivered prematurely - before the 37th week of pregnancy.
In some cases, doctors have to induce the birth because of a risk to the baby or the mother, for example, if the blood supply to the baby is not adequate or the mother's blood pressure is high.
Induction involves either inserting a pessary or gel into the vagina and/or a hormone-type drug into the arm or breaking the bag of membranes and releasing the amniotic fluid around the baby.
The pessary or gel softens the cervix, encouraging labour to start.
The hormone-type drug sets off contractions. These usually begin quite soon after the procedure is undertaken and there is no gradual build-up as with natural childbirth.
Caesarian section:
This involves making an incision in the mother's abdomen and into the womb.
The cut is usually below the bikini line and is not very visible afterwards.
Women can choose to go for a Caesarian, but they have to have a sound medical reason, such as complications during a previous delivery or high blood pressure.
However, some develop complications during natural childbirth and have to undergo an emergency Caesarian.
Usually the mother can have an epidural and stay awake during a Caesarian, but, if there is an immediate danger to the baby or mother, she may have to have a general anaesthetic.
With an epidural, the pelvic area is numb and the woman does not feel any pain.
Her partner is usually allowed to be present at the birth.
Mothers who have Caesarians generally have to stay in hospital for at least four days after the operation so that they can be monitored for blood clots, high blood pressure or other possible complications.
Since a Caesarian involves major surgery, they are not allowed to drive for six weeks or lift heavy objects.
Forceps/Ventouse:
Some women who give birth vaginally can develop problems during labour, requiring extra help to get the baby out.
For example, the baby can become stuck in an awkward position and become distressed or the woman may get so tired during the labour that she cannot push hard enough.
Babies born in the breech position - where the bottom comes out first - will usually be delivered by Caesarian if the doctor cannot turn the baby around beforehand, but if they are born naturally forceps are likely to be used.
The woman may then be given a local anaesthetic and forceps inserted around the baby's head or a suction cap or Ventouse fitted to the baby's head.
The doctor will then try to pull the baby out.
Both these methods of delivery may leave marks on the baby's head, but these fade soon after birth. Women who undergo forceps delivery will almost certainly require stitches in the vaginal area, known as an episiotomy.

 

[mrscardero]

There is a theory that many women are 'demanding' that their babies be delivered by caesarian section; (hence the title of this thread)

Is there any evidence of this in the States ? The only article related to this is the following one:- http://news.bbc.co.uk/1/hi/health/751177.stm

Not that I am aware of. The only time that they would do a caesarian is for medical reasons or if the mother had previous pregnancies that will only allow her to deliver caesarian way. But if the women are demanding not to have normal deliveries, it also implies with epidoral. That's not having a normal birth.

Back in the days, you know, there were no pain reliever. Take the pain as it is. Hot water and towels. Now it's a shot in the spine to help with the pain or we will put you out since you are having difficulties and deliver the baby without you even knowing what's going on until the drug wears off. When I delivered, I was knocked out cold. They induced my labor by giving me a drug. Talk about lights out. I woke up 12 hours later I think. Didn't get a chance to see anything. I always told myself that I would like to have it video taped. But I don't think they allow that when you are having a caesarian.

If women want to deliver caesarian and they don't need it, why do it? Don't you want the experience? Don't you want to be able to tell your child when they grow up and they are giving you a hard time, "You know, I went through a lottttt of pain when you were born. The least you could do is wash the dishes."

 

[michel]

Not that I am aware of. The only time that they would do a caesarian is for medical reasons or if the mother had previous pregnancies that will only allow her to deliver caesarian way. But if the women are demanding not to have normal deliveries, it also implies with epidoral. That's not having a normal birth.

Back in the days, you know, there were no pain reliever. Take the pain as it is. Hot water and towels. Now it's a shot in the spine to help with the pain or we will put you out since you are having difficulties and deliver the baby without you even knowing what's going on until the drug wears off. When I delivered, I was knocked out cold. They induced my labor by giving me a drug. Talk about lights out. I woke up 12 hours later I think. Didn't get a chance to see anything. I always told myself that I would like to have it video taped. But I don't think they allow that when you are having a caesarian.

If women want to deliver caesarian and they don't need it, why do it? Don't you want the experience? Don't you want to be able to tell your child when they grow up and they are giving you a hard time, "You know, I went through a lottttt of pain when you were born. The least you could do is wash the dishes."

Yep.
My wife was induced and had an epidural with our older boy; she had alrseady been in labour 24 hours, and her waters had long broken; the medics were worrying for the baby. She just had gas and air for the second.

I'll never forget it, because she was qute distressed, and I was saying 'Breathe like you were taught'...........she got fed up, and shoved the gas and air mask at me and said "If you know so much about it, why don't you B*****y do it":biglaugh:

 

[dawny0826]

I've had two C-sections, one emergency and one elective...epidurals both go arounds.

I wouldn't even try to attempt a natural delivery with my third...God willing we have a third...

In the US...C-section is a very hot topic amongst women.

Women who are anti-elective C-section do have the tendency to make a fuss and bash the opinions of those who choose surgery over attempting a VBAC (vaginal birth after cesarean delivery) or simply choose surgery over a vaginal delivery.

This is one of my personal hot topics...

 

[dawny0826]

Further...to state that one would be too "posh" to push kind of gives me the giggles.

There's nothing "posh" about C-section recovery.

 

[Bishka]

I wouldn't want a C-Section unless it is necessary.

 

[dawny0826]

I wouldn't want a C-Section unless it is necessary.

Many wouldn't. And that's certainly their right.

I'm just not one to bash the woman who decides that shy wants to bypass labor and a vaginal delivery. If she's aware of the pros and cons of surgery on both her body and baby's...I think that's her right.

 

[michel]

It wasn't my 'terminology'

http://www.netdoctor.co.uk/health_advice/facts/pregnancy_too_posh_003739.htm

Too posh to push?Written by Hilary Jones GP


Many Pregnant women are increasingly choosing to have their babies by Caesarean section. Statistics reveal that as many as one in ten of these surgical procedures performed in NHS hospitals are done not so much for medical reasons as simply for the mother's convenience.

This preference for voluntary Caesareans reflects a similar trend sweeping across the United States. In America, Caesareans are generally included as part of the list of 'birth choices'.

'Honeymoon fresh' for years to come

Many obstetricians favor the method because it is safer from a medico-legal point of view. Women are advised that because they are protected from danger to their pelvic floor, they will be kept 'honeymoon fresh' for many more years to come.

In Britain obstetric care is still considered to be somewhat more conservative. The so-called 'elective Caesarean' is usually only proposed as an option if a woman has already had an emergency Caesarean section in a previous labour, or if there are concrete medical reasons why it might be difficult or dangerous for her to delivery naturally.

In recent years word has got around that you can ask your obstetrician for a Caesarean section whether or not there are any medical indications. Many obstetricians are willing to agree to these requests, as they are generally sympathetic to the reasons behind them. But there could be disadvantages, as the National Childbirth trust and others are only too aware. These may become even more apparent as increasing numbers of women opt for Caesarean deliveries.

The figures show the proportion of British women giving birth by Caesarean section has increased threefold over the past three decades.

The rate in England in 1970 was 4.5 per cent, now it is nearer 16 per cent and still rising.

This trend has occurred without any evidence of a corresponding rise in obstetric needs for women to have Caesarean sections. It looks as if the criteria for performing Caesareans has been reduced without any increase in genuine medical need. This seems to be a situation that suits many women and their medical advisers.

Increasingly popular method

Devotees of elective Caesarean sections are happy to explain why they are such fans of this increasingly popular method of childbirth.

First of all, the vast majority of operations are now performed using an epidural or spinal anesthetic rather than a general anesthetic.

The mother is fully conscious throughout and does not have to miss out on that wonderful moment when the baby utters its first cry and is placed warm and kicking in her arms for that precious first cuddle. The mother is also more ready to offer that cuddle, as she is likely to feel far less exhausted and tortured having been protected from hours of labor pain and pelvic floor muscle trauma by the effect of the epidural anesthetic and the surgery she has just had.

Most anesthetists now leave the tiny catheter that administers the epidural anesthetic in place after the Caesarean, so that pain relief can be reinforced for a day or two after the operation without the need for further tablets or medication.

Protecting the pelvic floor

Many women want to protect their pelvic floor muscles from damage by opting for a Caesarean. Stress urinary incontinence caused by stretching of these muscles during natural childbirth is common and can be difficult to overcome. Causing inconvenient and embarrassing leakage of urine when coughing, sneezing, laughing or crying, its treatment can be arduous and disappointing once the condition is established. 'Kegel' - pelvic floor exercises, weighted Vaginal cones and Bladder Surgery are all very well, but given the choice, many women would not wish to make such a sacrifice merely to be able to boast that she had her baby by the natural route.

Natural childbirth can lead to tearing of the vaginal lining and perineal tissues that may need stitching and cause considerable pain and discomfort afterwards. Women may have spoken to their friends and shared experiences about how their sex lives can be ruined by the trauma of vaginal delivery, and how post-natal blues or even depression, can be triggered or made worse by it. Recurrent pain when going to the loo, haemorrhoids and episiotomy stitches are not really conducive to the unbounded joys of new motherhood, as many women will testify.

On another front, Caesareans offer the advantages of social convenience par excellence. Surgeons can work out when the baby is due so that a delivery date can be arranged to suit both parents and doctors alike. This means that the procedure can be expertly planned, that work and social life can be managed and manipulated, childcare arrangements for existing children can be made and the mother-to-be can then prepare herself fully for what is to come.

A Caesarean section takes less than an hour in the operating theatre. The woman's partner can be there too, or observing through the window if squeamish, to offer support and to be included in the proceedings. Many women are up and about and going home within three days of the operation. The horizontal wound soon heals to leave a neat, barely-visible bikini line scar within a matter of weeks.

What's the downside?

It all sounds a little too good to be true, doesn't it? According to the NCT and others who feel that the trend has gone more than a little too far, it is. So what is the downside of elective Caesarean section?

Some women may feel deprived of the miracle of natural birth and of an intangible feeling of achievement. Others regard the process of vaginal delivery as central to the bonding of mother and baby that can never quite be equalled by Caesarean delivery.

More objectively, Caesarean section is now the most commonly performed operation on women in the UK with 100,000 such operations being carried out every year. Critics say that is far too many. Forty two per cent of these were elective, despite the fact that countries with higher Caesarean rates do not have lower perinatal mortality rates.

Caesareans are not as safe as vaginal birth, contrary to popular belief, even when the baby is premature or in the breech position. In fact a woman is four times more likely to die as a result of a Caesarean than from a vaginal birth and it may take longer to recover psychologically and establish breastfeeding too.

The NCT points out that since a Caesarean birth costs the NHS about £760 more than a normal delivery, a mere one per cent rise in the annual rate in the UK means an expenditure of £5 million that could be better spent on improving maternity care for all new mothers.

The NCT says lack of information, loss of confidence in giving birth without medical intervention, fear of pain and pelvic floor damage and the false perception that a Caesarean section is an easy way out are not valid reasons for allowing the upward spiral of optional Caesareans to continue.

Caesarean on demand?

So armed with the facts and a resume of the relative pros and cons, where do you stand? Can you opt for a Caesarean on demand, even if it is only for reasons of convenience and personal preference?

At present there is no legal right to the operation, although it is against the law to force a sane woman to have a Caesarean section against her will. As things stand right now, the decision comes down to negotiations with individual consultants. So what are the views of your own obstetrician, and how well do you know him or her?

Yoga is an ancient Indian form of exercise with an holistic approach, meaning it tackles a person's well being as a whole - mind and body - unlike other forms of exercise.

 

[dawny0826]

I know Michel.

There are risks associated with EVERY pregnancy and BIRTH. If a woman is well aware of the risks of C-section (which I was and am)...she should choose accordingly.

A real nasty is the medically unnecessary induction which often results in an unwanted emergency C-section.

 

[Karl R]

Back in the mid-90s, I was working at a major hospital. I processed the paperwork for all elective inpatient surgeries for two years, including all c-sections.

Insurance companies (including medicaid) will not pay for a c-section without a valid medical reason. I'm sure that some obstetricians would be willing to do a completely unnecessary c-section if the patient was willing to foot the entire bill. However, in two years I never saw this happen.

At least 80% of the scheduled c-sections had "previous c-section" listed as the primary medical reason. "Breech presentation" was the second most common reason. While it is possible for a woman to give birth naturally after a c-section, doctors seem to be highly reluctant to try.

I realize that c-sections cost more than natural delivery, but I'm not entirely certain that they're driving overal medical expenses up (even though it would appear obvious that they would). Obstetrics is the field of medical practice that is most prone to large malpractice lawsuits. C-sections reduce the chance of litigation. Less litigation results in cheaper malpractice insurance, which might counterbalance the increased cost from the c-sections.

This data should be obtainable, so it should be possible for someone to determine whether c-sections are driving health costs up, and by what amount.

 

[nutshell]

Once my wife went into labor (for both kids), it was 30 minutes of "real" pushing and they popped right out.

I don't think you can get more posh than that. And she's the envy of all women who know her and have given birth.

 

[michel]

I know Michel.

There are risks associated with EVERY pregnancy and BIRTH. If a woman is well aware of the risks of C-section (which I was and am)...she should choose accordingly.

A real nasty is the medically unnecessary induction which often results in an unwanted emergency C-section.

Of course, Dawny; I wouldn't suggest otherwise; I am talking about the ladies who apparently 'opt' for c-sections.

Back in the mid-90s, I was working at a major hospital. I processed the paperwork for all elective inpatient surgeries for two years, including all c-sections.

Insurance companies (including medicaid) will not pay for a c-section without a valid medical reason. I'm sure that some obstetricians would be willing to do a completely unnecessary c-section if the patient was willing to foot the entire bill. However, in two years I never saw this happen.

At least 80% of the scheduled c-sections had "previous c-section" listed as the primary medical reason. "Breech presentation" was the second most common reason. While it is possible for a woman to give birth naturally after a c-section, doctors seem to be highly reluctant to try.

I realize that c-sections cost more than natural delivery, but I'm not entirely certain that they're driving overal medical expenses up (even though it would appear obvious that they would). Obstetrics is the field of medical practice that is most prone to large malpractice lawsuits. C-sections reduce the chance of litigation. Less litigation results in cheaper malpractice insurance, which might counterbalance the increased cost from the c-sections.

This data should be obtainable, so it should be possible for someone to determine whether c-sections are driving health costs up, and by what amount.

That, of course is not something we have in England. Because we have a National Health Service, we are not used to malpractice lawsuits, though I believe they are beginning to 'creep in'

There is (apparently) indication that 'previous c-sections' are often used as a reason for the option; however, no one checks back.

Breach Births, I agree, are nasty, and there is no other option. James (our second son) had the umbilical cord wrapped around his neck, but was delivered naturally as well.

 

[Quoth The Raven]

Once my wife went into labor (for both kids), it was 30 minutes of "real" pushing and they popped right out.

I don't think you can get more posh than that. And she's the envy of all women who know her and have given birth.

I've had a 30 minute labor...it sucked. The 16 hour one wasn't so hot either, but other than a sudden and very unwelcome bout of lucidity at an inconvenient moment, I have to say the 6 hour one was the best of the three.