"Vaginal birth versus cesarean section"
The discussion of vaginal birth versus cesarean section can be very complex. There will always be respectful differences with regards to this subject. Most studies fail to take into account the multiple variables involved in each patient: the size of the patient (weight/height), the size of the infant, the number of infants, the weeks of gestation, the cervical exam (dilation/effacement/station), underlying medical conditions (hypertension/diabetes/toxemia/etc.), uterine anomalies, fetal heart rate tracing, presence of meconium, and chorioamnionitis.
I believe that vaginal birth is better than cesarean section, but that cesarean section is a safe and excellent option for women. Incorrect surgical technique is the reason for many negative comments about cesarean section. Classic surgical techniques that minimize blood loss, reestablish smooth surfaces ( placing the peritoneum together), gently handling the tissues, reapproximating the rectus muscles, and closing dead space greatly reduce the problems encountered with most cesarean sections.
I have seen firsthand the destructive properties of of vaginal births and cesarean sections. Laparoscopy will sometimes show extensive scar tissue (adhesions) in women whose only surgery has been cesarean sections. The focus of this controversial subject should return to the important goal of doing what is in the best interest of the mother and child. Most women do not understand the long term complications of vaginal delivery: urinary leakage, painful intercourse, rectal issues, and prolapse (bladder/uterus/rectum dropping).
The route of delivery should be discussed with the patient and husband so that all of the variables specific to her particular pregnancy can be addressed. Pregnancy should be one of the happiest times in a woman's life. Each decision has risks and benefits. Patients should try to determine which mode of delivery is best for her and her baby.
Dr. Joe Edwards III
I just copied the whole letter that was posted on Savannahnow.com. There are just too many gems in here to paste mere excerpts. The author's message is that if doctors would stop using improper surgical techniques (and discuss the benefits of Cesareans with the happy pregnant woman's husband to make a decision about mode of delivery), the ladies will love their "safe and excellent" c-sections because it will prevent their ass from falling off. Also, if you're pregnant and not happy, why not? You should be, says the second generation OB/GYN.
This is a perfect example of a doctor that truly believes that his prophylactic intervention near the end of a woman's pregnancy will spare her from the perils of childbirth, i.e., the "long term complications of vaginal delivery." Childbirth Connection conducted a systematic review of the risks of both Cesarean sections and vaginal birth and identified 33 areas where cesarean section was found to involve more risk than vaginal birth, and a mere 4 areas where vaginal birth was found to involve more risk than cesarean section.
Dr. Edwards might not be aware that aggressive management of birth á la obstetrician might have actually caused some of the long term complications of vaginal delivery that he mentions:
Relationship between care during birth and pelvic floor problems: More and more research finds that some practices used at the time of pushing increase the likelihood of pelvic floor injury. Many women experience one or more of these during vaginal birth. You can lower your risk by choosing a caregiver and birth setting with low rates of intervention. These practices include:
- cutting an episiotomy
- using vacuum extraction or forceps to help bring the baby out
- having women give birth while lying on their backs
- using caregiver-directed pushing, which is often more forceful than having the woman and her own reflexes guide pushing
- pressing on the woman's abdomen to help move the baby out
Of hundreds of studies examined to compare vaginal and cesarean birth, not one attempted to avoid or limit the use of practices that can injure a woman's pelvic floor to try to determine whether vaginal birth itself is responsible. It is wrong to conclude at this time that the cause of pelvic floor problems is giving birth through the vagina.
Nice try, though, Doctor Edwards.
Here is Dr. Joe Edwards III's e-mail: firstname.lastname@example.org.
Edited February 11, 2009