Poll: How Many Maternal Request C-Section Moms Do You Know?
Sunday, March 29, 2009 at 9:04PMI have a question. How many women do you personally know who requested a cesarean? I’m not talking about elective repeat cesareans, nor am I wondering how many women you know who have been scared or coerced into surgery by a doctor.
To frame the question, I know one woman. It was within the last five years and I haven’t seen her since she had her baby, but I remember how she used to talk about having kids. She was so disgusted by the whole process of childbirth that for her it would have been a huge positive to find a doctor who would accommodate her request for a c-section. When I heard that she sought a c-section, I was surprised. “People do that?” I asked our mutual friend who told me about her request.
I find the Listening to Mothers Survey (pdf), which interviewed nearly 1,600 women and found that only one had requested a cesarean, to be accurate based on my life experience. What have you found?
Reader Comments (16)
I voted "none" but I have a qualification. I know several women who had what I consider to be medically unjustifiable C-sections which they "chose" -- I daresay they would be considered "elective" C-sections if they were included in a research study -- but they would consider them to be medically indicated. My husband's cousin had her first baby by C-section in the late pre-term period (I think for suspected preeclampsia); her doctor would have "allowed" her a "Cinderella VBAC" (you know the kind IF she goes into labor prior to her scheduled C-section date, which is at 38 weeks, and IF she does this and IF she doesn't do that); then her latest baby was also born by C-section because her first two were. She could have been a 2VBA1C imo, but she trusted her doctor.
Another friend had some health problems during her first pregnancy (she was overweight to start with, developed high blood pressure and gestational diabetes), was induced which of course failed and ended in a C-section (I think she had general anesthesia, but I don't know if it was because it was a true emergency or some other factor). During her second pregnancy, her health problems were kept under control, but she always had that fear of a repeat of her first labor, which was scary to her and difficult to recover from. Judging from some of what she said during her second pregnancy, and the choice of words she used and her doctor used, I would say that her doctor pushed her to choose a C-section. I don't blame her for doing it, but I think it was medically unnecessary.
Actually -- in typing the above, I forgot my SIL who chose a C-section for her second after her terribly long and difficult labor with her first (planned home birth) which ended in a C-section. When she went into labor the second time, she changed her mind about attempting a VBAC and drove to the hospital for a C-section.
Finally, I have a friend who says she doesn't think she'll get pregnant again, but that if she does, she's thinking about having a C-section. Her first was a planned home birth, and her 9.5lb baby had difficulty fitting under her pubic bone, but she was ultimately successful, without a tear. Her second was a planned hospital birth (she developed heart problems requiring medication that probably would have precluded home birth anyway, but they lived in a different state as well); she had an epidural and a lot of complications (including losing the baby's heartbeat a couple of times and getting an amnio-infusion). Although this baby was about 8lb, she was posterior, and also had difficulty getting under the pubic bone. My friend tore badly towards the front, and had a very difficult recovery. She said that she'd rather have a C-section were she to get pregnant again than go through all that. She doesn't see that the interventions she had during labor may have caused the problems -- the epidural causing low maternal blood pressure and the baby's heart to go weird; the AROM causing the baby's heartbeat to go away; lying on her back while all comfy with the epidural causing the baby to be posterior; the baby's persistent posterior position causing the tearing. She is convinced that every subsequent birth will be like this, so she wants to avoid all the fear (with the fetal heartbeat problems; and the baby didn't start breathing for some time, and everyone was worried) and all the complications, so sees a C-section as an easy way out -- it just takes an hour and you're done, no breaking the water, no disappearing of heartbeat, the abdominal incision can't be that much worse than tearing around the clitoris, etc. And talking to her does no good. So I keep my mouth shut.
I must be in the minority because I know far too many women who sign up for c-sections for what I consider to be totally invalid reasons. One co-worker requested a c-section because she was having twins (after she already had a vaginal birth years earlier) - then when she got pregnant again she never even considered VBAC. She actually went into labor on her own both times, no medicine necessary, and still chose to check straight into the OR instead of a labor room.
Many of the primary c-sec moms I've come into contact with go straight for the repeat C - never even stopping to consider VBAC. Does that mean it's "Maternally Elected" or does that mean their doctor never told them they had a better choice?
When I've spoken in front of groups about my VBAC advocacy, I get a lot of young women telling me that they always assumed they'd just ask for a c-section and "get it over with." Some change their minds after hearing what I have to say - some don't.
I think many women think that having a c-section makes their birth "more important" than an uncomplicated vaginal birth. You know... they like having the story to tell - it's always the same - "baby and I nearly died, we were in so much danger, his heart rate was dropping, they had to do an EMERGENCY c-section." It's all very dramatic, and important. I saw a woman on one of the message boards say "My Not-So-Typical Birth Story" - then proceed to explain the exact same scenario we all saw in the BoBB cartoon. Pitocin, epidural, pitocin, epidural, low fetal heart tones, OMG "emergency" c-section. She thought she had some incredible story to tell. The only thing incredible about it was the it happens to thousands of women a day in this country.
Mine was classified as an "emergency" c-section too. I think they all are, actually - at least all the ones that aren't planned months in advance. But the doctor announced my c/s at 5 pm and didn't start cutting into me until 7 pm. Couldn't have been that much of an "emergency."
Kathy, Birth centers are like Cinderella home births, then! They're great if you ___, and if you ___ and make sure you don't have ___, and so forth.
You know what I say to friends that don't choose VBAC? Nothing. I figure that they are happy with their decision and have faith in their doctor. Faith in something is a positive and it's really common to have loads of faith in Medicine, Science, Technology and Doctors. My friends all know that I'm a no-epidural kinda gal (for myself) and I figure they know where to find me if they want more info. I know you know how I feel-- "necessary" is subjective. If everyone feels something was necessary regardless of whether there was any medical evidence to support the decision, then it's time to move on. We'll just keep picking away at the overall cultural and medical attitude toward birth and encouraging people to question commonly held beliefs. It's hard to see friends struggling with surgical recovery, but now that my kids are getting older, I can do more postpartum "doula-ing" and watching their older kids while they recover.
With so many c-sections, I think we all need to step up our efforts (personally and at an institutional level) in making sure our post-surgical loved ones get extra support. It blows my mind that women have babies cut out of their abdomens and are home in three days trying to juggle breastfeeding, healing, new motherhood and older kids jumping all over them. Talk about Supermoms!
TFB, I was looking more for the true non-medical indication c-sections. Elective repeat c-section has perceived medical benefits in this climate. I'm more curious about how many women people know that just were not going to end their pregnancy with vaginal birth from the get-go. No judgment from me... just curious.
I think I offer my two cents to those who don't ask because I wish someone had done the same for me. I believed, and I mean BELIEVED in the OB and the hospital and the nurses, and walked away from that car crash with such severe emotional trauma that I'm still fighting with it. I wish someone, anyone, had told me there was an alternative - that there was information out there that didn't jive with what the doc was saying. If only.........
But I learned the hard way. I'd like to help other women avoid "the hard way" if at all possible. And you know what Gloria Steinem said: "The truth will set you free, but first it will piss you off."
I only know of one woman who plans on having a totally elective medical cesarean whenever she gets pregnant (getting married in a few months--kids to come later). I know her mind may change--but it may not. Her mentality is and has always been "childbirth is scary, painful and unpredictable"(...and a cesarean is NOT any of those??)
Her mom also told her "horror stories" about her labors and labors of her friends. Her mom thinks a scheduled c/s is a good idea too. It amazes me when women want THEIR OWN DAUGHTERS signing up for an unnecessary surgery that has a mortality rate 3-4 times higher than that of a vaginal birth. Um..twilight zone...
TFB, you know what? You're right. In hindsight, I am so grateful for everyone (one older woman at work in particular) who planted seeds of normalcy regarding birth when I was pregnant. Even those questions that didn't sink in at the time, like "have you considered a birth center?" later resonated so clearly. Same with bedsharing, breastfeeding and other things that ultimately worked great for us.
I had a patient once, a while back (few years ago). first baby. having a c/section. i asked her why "because i don't want anything coming out of me down there" yes, her dr agreed to do it.
that was the one purely elective one i remember, but, so many ppl choose one for unecessary reasons-b/c the dr convinced them the baby was too big to come out (first baby, sometimes), or b/c they were tired of a very long induction and asked for csection. Many are supposedly medical, or from failed induction.
oh, and i know a ob/gyn resident who is not pregnant or married who said when she gets pregnant,s he's getting a "cut here" tattoo on her abdomen. she's very vain, and not too bright.
Rose,
Ugh. Bleh. That's just not funny and I laugh at almost anything.
I don't think I know anyone who would flat out choose a C-section, but I do know one person who is going to push for a medical indication if possible. She's a fellow law student, planned to get pregnant during law school then "take a few days off after the birth" and get back to school. She seems like she's pushing for a known delivery date (say, a Thursday evening? miss Friday and be back on Monday?). Ugh. Both to the idea and to what she's going to deal with. I tried to talk to her, but too many of the fellow (childless) law students are all freaked out by "something down there."
My mom also doesn't understand why I don't just get sections. I was one (2 weeks "late", breech, and over 9 lbs) and my brother was too (because I was), and she said they were "fine" and made much more sense than waiting for the baby to do something and "rolling around on the floor." And yet she's confused as to why I don't want her near me in labor... ;)
Fear of the unknown can be powerful.
Tara, I think I'm a wee bit older than you are, but I was three weeks late and my mom's doc did everything he could to try to avoid a c-section, including a pelvic x-ray (!) She didn't need a c/s but it was amazing to hear how long they "let her go" before giving her some Pitocin. I was 9#2 (and head-down). Times have changed.
It's so interesting to me how we moved from a viewpoint of "if it ain't broke don't fix it" (as Granddaddy Jake would say) to "well, it might possibly could break so we should fix it, just in case."
I also find it INCREDIBLY sad that we women are not supporting and sharing with each other. I think too many women go into pregnancy and birth with only A Baby Story and What To Expect When You're Expecting (aka, If You Never Want To Sleep Again: Read This). I know it drives some people slightly bonkers, but that's why Shafer and I LOVE sharing our birth stories. Both of them, because women need to hear the good and the bad, and know what birth is really like. We've become...almost antiseptic as a society, and we just don't talk about "that sort of thing" which is so very very sad, and dangerous, imo.
I've never actually known anyone who requested a c/s, out of the blue, for non-medically related reasons. I have, however, known plenty of women (most recently my SIL in spite of all my attempts to share information with her at the time) who have been said to have had a "maternally requested c/s", but as a result of a doctor's dubious recommendation (usually, the baby's too big or the baby's "overdue" in a questionable way).
I'd have a lot more respect for doctors who did these kinds of surgeries if they also were respectful of other medical choices that a birthing or laboring woman would make. Why is it that they stick up for this choice but not the rest? I, cynically so, suspect I know the answer which makes the whole thing even worse.
Alot of you seem to be posting comments that are quite judgemental. So what if someone elects to have a C section. What difference does it make to you? How does it affect you personally exactly? Sure, maybe it's not the decision you would make, but why all the negative judgements. Get over yourselves.
I had a 'natural birth', but I know several people who elected to have C sections. Personally, I don't really give a crap what they decided to do, it's their life.
to each their own,
I'm not sure I understand why it would matter so much, either. I've been trying to understand but I just can't. I get crabby about doctors pushing c-sections on women or selling them as a safer alternative to normal birth because I think it's ethically wrong to encourage a low risk patient to willingly become a high risk patient with unnecessary major surgery. However, if a woman is just not into childbirth, then she's not. What would I do? Stop being their friend? Refuse to drop dinner off at their house because I disagree with how they gave birth?
The only way it could affect me personally is the cumulative effect of many, many women requesting c-sections, thereby normalizing the practice to the point where docs are sectioning healthy women for no good reason. We're kind of already there, except for the part about the many, many women requesting them. Either way, it's a slippery slope argument.
I can appreciate that some people are more direct, blunt and tend to be advice givers. I've appreciated some of those people over the years even if I passed on their advice. I don't think all judgment is bad. I just tend to be way more open-minded and neutral in general. I am infinitely more concerned about a system that won't allow women to give birth vaginally in a hospital (or at home with a midwife for that matter) if they want to.
Come back. I'd love to hear your point of view more.