US: record number of C-section births causing debate

While I am totally in favour of medically necessary procedures, from what I've read, seen and heard over the last few years, a LARGE majority of c-sections are not warranted, and it's scary. I cannot imagine a woman being scared of her own body being in labour, but wanted to undergo MAJOR surgery.

I find it disturbing, and sad. As well as the VBAC declines, which seem to have more to do with the reluctance of doctors than any TRUE concern for a woman's health.

It's hard enough to keep our rights-we then throw them away?

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After a long, long labor and hours of unsuccessful pushing, my son's heartrate fell drastically. He was taken by almost-emergency c-section (it all happened really, really fast, but I was cut horizontally and not vertically, for which I was grateful later), and my recovery was hard and painful. *Hard* and *painful*. My daughter was born easily and quickly, via VBAC. My (new) OB wanted me to go for a VBAC from day one, even though I was sort of against it. I was scared, I didn't want the same outcome as before, and did I mention that I was scared? She assured me that she wouldn't let things go as far as they had with my son (which is one of the reasons I switched OBs), and I had a textbook delivery.

I'm SO glad I did a VBAC. I've talked with many, many women who had medically necessary c-sections who simply wouldn't consider VBACs even though their OBs said that the first birth didn't necessarily warrant a second c-section. While I understand that fear of the unknown, I wish more women would trust their bodies. My recovery the second time around was amazingly fast--I was at Target the day after we came home! The first time around, I couldn't even stand upright for about a month!

Anyway, it always, always irks me when women *choose* to have c-sections. I don't know why. I think it trivializes the incredibly scary thing that those of us who have had medically necessary c-sections have gone through.

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I think it should be a woman's right to choose how she wants to give birth. I would hope most would listen to recommendations by their doctors, but the final decision should be the woman's.

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As a woman who has now had two C-sections, I have to say, if I had been given the choice I would have chosen a regular vaginal delivery for my first son. I was in labor for 14 hours and it was just obvious he wasnt coming out on his own. When I had my twins, I chose to have another c-section as my recovery from the first one was very easy and I liked the idea of being able to somewhat plan when I would give birth (as to make arrangements for my 4 year old). However all the planning in the world doesn't matter when you have twins (they came 4 weeks ahead of schedule). I think it should be upto the woman and whatever makes her most comfortable.

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I had to have a csection, but the recovery is pretty miserable. I was in labor for a little over 24 hours. Being in labor wasn't really that bad, since you know it's going to be over relatively soon. And yeah, I know there's some soreness when you recover, but it seems like unless you have an episiotomy or tear badly, it's not as bad as a csection recovery.

My incision healed poorly and now that I have a "previous history of big babies", it means that I'm now in a much higher risk for uterine rupture if I get pregnant again. Worst case, baby and I die. Best case, we deliver early and spend a few months in the NICU. You never know when you're going to be in that small percent of women who have to deal with the bad stuff.

My original OB tried to push a convenience induction on me at 36 weeks, even though I'd stated I wanted to give unmedicated labor a go. I know that preemies that are 32+ weeks have a much better prognosis these days, but why risk it? Long NICU stays interfere with sucessfully nursing, and my milk did not come in until a week and a half post partum between the csection and not being allowed to nurse. I think in most cases, it's better to let labor start on it's own, and use csections as a tool for when there's no other way to get the baby out, not because the OB doesn't want to be at the hospital right now.

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I have been present at this NIH forum. I have found it to be helpful in presenting what little data that exists regarding Cesarean birth. The meeting was marred, however, by a group of providers and public groups who would have NO cesarean births. The right of a patient to be able to get accurate data is paramount when they might be considering an operative delivery whether it be out of fear, personal scheduling issues or as a member of the press from the UK put it "prefering a cut on her abdomen over a cut on her vagina". The presenters worked very hard to look at the available information to put into perspective of the cesarean delivery at maternal request (CDMR) only to be called frauds by a member of the audience who strongly opposes cesarean delivery.

Face it, people are going to want to do what they want to do. It is my job as an OB/GYN and that of the other medical professionals that take care of women to be able to get the best medical information available and give it to the patients for them to utilize.

On a personal note, I have experienced both types of birthing experiences. I did not feel any less of a mother following my cesarean delivery than I did my VBAC's (deliveries post c/s). Nor did I feel my infant bonded less.

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Well I for one am having another one in June! I had one with my first son and it was an emergency c section and the whole gotta go , gotta go right now thing was scarey. My dh was totally freaked out LOL You see my first son had a cord around his neck and I was pushing for 2 hours and he was going no where and then come to find out that my pelvis is just to small to accomodate a vaginal birth, so I have a planned c section, scheduled and actaully am looking forward to the no labor aspect of it. I was in labor for 14 hours with my first son and it was horrible. Yes I was in pain for a bit with my c section, but hey I had some amazing drugs to help with that! LOL

After going thru one, I FIRMLY believe that its a womans choice, its her body, and her fears, noone elses!
So if she wants one and her doctor says ok, then so be it! So what if she doesnt want to sit and go thru the labor of it all? it doesnt make her any less of a mother does it? no! Noone should look down upon that. The outcome is the same, either way you have an amazing bundle of joy in your arms at the end of it all!

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I don't think it should be a choice and I agree with Thordora. It is a natural process that has been turned into a medical procedure--which in most cases just is not necessary.

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This STILL infuriates me! How are they determining the women who have "chosen" to have a c-section? Based on the "elective" versus "emergency" declaration (meaning the first they have some time to plan it, and the second they wheel you out immediately, like in placenta previa or abruption, etc.)? If so, that's just a bunch of hogwash! ASK the woman if she CHOSE the c-section or if her physician convinced/coerced her, or if she was even given the choice in the beginning (i.e. VBAC). I think NIH would be pretty darned surprised by the results. These type of surveys are misleading at best, and make widespread policy changes at worst.

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"Barbara Stratton of Baltimore, disagrees: "I don't believe that any women should go through this major surgery unnecessarily." Stratton had undergone a C-section that apparently left her in pain for months."

"Apparently" left her in pain? Apparently? Wonder what someone has to do to prove that she was actually in pain...

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This is yet another topic that becomes a big "blame the mother" discussion. I agree that a scheduled c-section on first childbirth with no complications is not a very good choice (hello Britney!). But beyond that, you really don't know what goes into a decision. It bothers me that insurance companies are the major force in fewer VBACs (and it is the insurance companies, not the doctors). But these articles seem designed to just make mothers feel guilty for their decisions, and to feel that they were "poorly informed."

My daughter is an example of why inducing early might have been a good idea; she aspirated meconium and spent three days in the NICU and has had eating problems ever since. She was born at 41 5/7 weeks, and post-40 weeks is a risk factor for aspirating meconium. That was a factor in MY decisions on my next birth, but I'm not going to tell anyone it should factor in their decisions. All options should be available, and vaginal birth should be encouraged, and beyond that this second-guessing has got to go.

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I had a planned c-section with my firstborn due to the fact I had a large fibroid blocking my cervix. I had no choice in the matter. The baby was also in a breech position so they ended up doing a "classical" incision (fancy!) which is vertical. The healing was brutal, painful, and my incision became infected to boot. Once again I have to have a c-section in may due to the fact that VBAC's are dangerous after a classical section. I WISH I could deliver vaginally as having a major surgery and a new baby is a lot to deal with. My take is that if it is medically necessary or adviseable for saftey then go ahead. I do not not believe one should be able to have an elective c-section if it is not warrented.

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You do not believe that one should be able to have an elective c section? Why? Who are we to tell another mother what she can and cannot do? I mean seriously. Would you want to be told what to do with your body? No!!! so the next thing is being told that you have to raise your children a certain way? I just dont think its right for any of us to say that they shouldnt have the option.

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CJ, I have a LOT of trouble using the "my body, my decision" when it comes to something like a csection. This has nothing to do with personal choice, and everything to do with the medicalization of birth, which I do NOT agree with.

Why should birth, a natural process, be fit into someones scheduale? A CSection is a terribly unnatural form of birth which is thankfully available should the medical necessity arise. Why force your body into all sorts of problems because it's "your" body?

And I don't think this is a "blame the mother" problem. I firmly believe that many women are made to believe that a C-section is a viable option for a normal lowrisk birth because their doctors find it easier. THAT is my main concern, and by hiding behind "it's my body" we are rapidly losing control over that very thing by turning the birthing process over to hospitals and doctors, instead of ourselves.

With my last pregnancy, my doctor was VERY hot and bothered to induce, considering my "late". I was late according to the ultrasound, and early according to my LMP.

He was going on vacation in a week, and wanted his lose ends tied up though.I gave birth the week after, while he was on vacation, all by myself. There is no need to interfere with the birthing process when it is not medically indicated! I will never understand why someone would want to do that. Of course, I don't understand wanting lipo either, but that's me.

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again--totally agree with thordora. A good book to read is the birth book by Dr. William and Martha Sears.

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Thordora, I agree that this *shouldn't* be a blame-the-mother problem, but I still think this is a blame-the-mother article. The subhead says "1 in 3 moms opts for surgical route, increasingly for convenience" implying it is for the convenience of the mother. Several paragraphs in the article discuss the convenience of the mother as well. Even though this article is theoretically about a conference to discuss why there is an increase in c-sections, there are quotes like: "We all have noticed that women are asking for Caesareans more often." I don't think an "elective" c-section means a woman walked in the doctor's office and asked for it.

I'd love to see the article/study that focuses on what mothers are told about risks, whether they think VBAC is an option, and whether they were pressured to induce (because induction is probably contributing to the increased c-section rate too). But I think I'll be waiting a while for that; it seems so much easier for journalists to say "mom requested it."

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If you are interested in new information about these 'maternal request' cesareans, see what Childbirth Connecction just published - online at http://www.childbirthconnection.org/article.asp?ck=10372

Here's just one snippet:

"These first national results from women themselves clarify that demand from mothers for planned primary cesareans with no medical reason is virtually non-existent. Maternal request for such cesareans is not a factor in escalating cesarean rates. It is time to dispel these myths."

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Um, for one thing having a VBAC only doubles the slight risk of uterine rupture (from 0.5% to 1%), and usually the OBs know who is a good risk and who is not. For that reason I am trying for a VBAC with my second this June.
I never in my life thought that I would have a ceasarean in the first place, but after leaking amniotic fluid, being beta-strep negative, initially responding to pitocin (administered because of the light leaking of amniotic fluid), and then my vein collapsing and the pitocin no longer being administered - never mind the forced rupture of my water which started the clock ticking - I had to have a c-section after about 24 hours of labor.

But, and this is a big but, what I believe really contributes to my and other women's c-sections is that we are obese. No, not pleasantly plump (although my husband thinks so), but obese. There is a trend for obese women to not only have a higher risk for c-section, but for some reason being obese makes labor take longer so that our OBs start to get nervous when the clock in their head thinks its taking too long, so they head for c-section. I don't blame them, they are interested in a garuanteed outcome with good results.

For myself, after being in pitocin inspired labor (good God that was horrible), no pain relief (oh, we spent many hours on two different tries for an epideral but being obese I guess it was too hard for the anthesiologist to find the right spot), and being stuck at 5 cm for hours and no break between contractions, I was more then ready to have an out. I am grateful it was not exactly an emergency c-section and that I healed well and had no pain (who knows why) from the incision, but for my health and my future health I wish it had gone differently.

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The times that I am against elective C-sections are when you hear of a celebrity that does it just so she doesn't have to go through the pain of labor and pushing. UGH. For instance, Angie Harmon who said that she did not want to be laboring up on a table with her legs spread-and have her husband see it. She really said that! So she had two C-sections so everything would look nice "down there". What a shallow person. Of course, she is also one who never got up in the night for feedings with her babies and had a baby nurse do all duties. Weird. Honestly, if your reasoning for having a C-section are that shallow and self-serving, then I do think you are kind of a poor mother in my eyes. Sorry. I do understand about necessary C-sections however.

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My daughter was born via c-section after 15 hours of HARD labor with little progress. I did NOT want it, I wanted to keep going... I was determined to get her out vaginally, but she had her own ideas about it all. Thankfully my recovery was an easy one, but this is MAJOR surgery, and although I would never judge a woman for electing to have it, it is certainly not the way I intended to give birth. That being said, I am electing to deliver my next child via c-section because I cannot imagine willingly putting myself through the agony of labor for so long and then having to be whisked away for surgery again. I mean, it was a long and hard day for me. And honestly, I am terrified of a VBAC after what I've read (and my OB, whom I adore, is not a fan, either).

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