The Real "C" Word: Cesarean Section

One large detail is that while the rate of cesareans have increased dramatically in the last 30 years in the US it has not changed the morbidity or mortality rates. Recent research has pointed to more negative outcomes with surgical birth.

Cesareans have their place, but the reality is few are truly "emergency" though that is often how it is described. An emergency cesarean means that the need is stated and the baby is born in less than 10 minutes.

in peace
Dharma
semi-retired doula/child birth educator
www.dharmarants.blogspot.com ( http://www.dharmarants.blogspot.com )

I'm the friend that Suzanne mentioned and the acquaintance was a childhood friend of mine. Like Suzanne said, the reason she even made that comment was because she really had no idea what a c-section was like. For instance when I told her that the NICU team has to be present at every c-section at the hospital I delivered at, she was really shocked. (Even more so when I counted up all the people who probably saw my snatch since I had a giant sheet over me and could not see or feel anything.)

I really wish that I had been able to have vaginal deliveries, but my pelvis is abnormally shaped and I gave birth to two big babies. I had an infection after the first c-section. The recovery for the second was much better although despite having a scheduled c-section I went into labor a day early. However, this time I had a toddler waiting at home for me that I need to care for in addition to my new baby.

I really do think that the risks of c-sections are down played. That's what concerns me when I hear women like my friend saying that she wants a c-section. If she had said it knowing all the facts, I would have thought it was weird, BUT she's capable of making her own decisions and certainly doesn't need me to make them for her! However, once I told her about my recovery etc., she quickly changed her mind.

So after saying all that, I think it's just such a personal decision. You have to take into account all your factors and come up with the decision that best for you and not for your neighbor etc. I agree with Parker101 that there does seem to be a lot of judgement out there about how women have their babies. The whole epidural thing drives me crazy. Why is there such judgement? Why do you care how I gave birth? I can honestly say that I've never felt like I haven't given birth (water breaking naturally and then 39 hours of back labor with 2 hours pushing with the first and 8 hours of back labor with the second), but I do know women who have felt that way. The worst part about the judgements is that it tends to come from other women!!! With both my pregnancies I asked myself "will (blank) make me a better mother." I filled it in with an epidural (which I was denied for 35 hours with the first and did not get for quite a long time with the second), finding out the sex of the baby, etc.

Here are the type of birth stories I find the most amazing: when a women is able to give birth the way she envisions herself doing it. Whether it's a natural childbirth, or being able to say "I want an epidural" or being okay with having a c-section. The best birth story I've ever heard was not my friend who had a natural childbirth (although I was very happy for her) but it was my friend who got through many hours of successful hypnobirthing only to be told she needed a c-section (her baby ended up being 10 pounds). She immediately asked when the surgery would be and after being told that it wouldn't be for a few hours, she had her mom go out and get her a giant stack of pancakes. She said she was completely relaxed during the surgery and felt very happy and alive when her son was born.
A. Elliot ( http://www.blogher.com/www.flexibleparenting.com )

I agree with you 100% that a birth by c-section does NOT make a woman any less than one who has a vaginal delivery. But, I do think that this procedure is, as a whole, taken too lightly by people. I'm sure that many - if not most - women do research it. But if it is not medically necessary, I also don't think that people should have the right to opt for one any more than they should have the right to demand that they have pre-emptive bipass surgery because they don't want to change their diets at all.

Surgery is not, and should never be, just something that one does just because they prefer it over something else with no substantial reason. And while obviously not all women (and worse, doctors) view c-sections this way, there is enough evidence that this is exactly what is happening. Given the number of my friends who had high risk pregnancies and may have been badly hurt, died ,or lost their baby without a c-section(and wonderful people who wrote so eloquently here), this is not an issue I take lightly at all.

Suzanne ( http://www.blogher.com/member/suzanne ), BlogHer Contributing Editor - Feminsim & Gender ( http://www.blogher.com/topic/feminism-gender )
Campaign for Unshaved Snatch (CUSS)& Other Rants ( http://cussandotherrants.com/ )

I am currently pregnant and was told early on that I might need to have a c-section. As of my 34 week scan, I probably won't need one. Part of me was relieved, but the other part is now thinking, bother, now I have to figure out what kind of pain medication I want. I am neither pro or con c-sections, and have had conversations with many women who have had both vaginal births and c-sections, and have heard pros and cons about both.

What drives me mad, however, is the notion that women who get c-sections are "too posh to push" and snarky comments that a woman who has a c-section is less of a women than a woman who has a vaginal birth. (Kate Winslet reportedly lied about having had a c-section for this reason). This of course leads into the further discussion that women who go through "natural" (medication free) labour are better than women who have epidurals and other drugs. Oh yeah, and that women who breast feed are better than those that don't. And on and on and on with a million stereotypes and generalisations that don’t look into the experience of each woman.

Blah, blah, blah. How about we assume from the beginning that the majority of women make these decisions as they would any other major decision, and get the research, and speak to friends and experts and doctors, and then respect their decisions.

Does my nose turn up a bit when I hear about women (or doctors) scheduling c-sections around golf games and holiday plans? Well, yes. But neither would I like someone else telling me what kind of birth I should have.

I have had a traumatic predicted c-section due to placenta previa and two natural med free vbacs. My experience was that the recovery from the c section was longer and more difficult and was also emotionally hard on me and it left a large disfiguring scar. Here is my list of c section complaints: Pre-op was chaotic and disorganised I was in need of immediate surgery and was bleeding tremendously and had already lost a lot of time/blood getting to the hospital- despite being warned that we were coming- the hospital was not fully prepared to handle our arrival and my husband had to argue for simple things like a stretcher over a wheelchair. Our doctor, whom I had selected for the express purpose of managing my high risk pregnancy, was not available because he had hidden from me the fact that he was leaving the country on vacation. In the time waiting for another doctor to arrive, a stricken resident braced herself for the possibility that she might have to go in. Her terror was apparent. During surgery I had an awake in anesthesia experience (it was supposed to be general) my experience of this was denied by all when I came around. I had a difficult time coming out of the general, was separated from my baby for an excessively long time and had an allergic reaction to the tape they put across my incision. So not only did I have the wound, I had hives across the wound. The post op antibiotics caused me to develop a whopper of a yeast infection in my breasts so that early breastfeeding was engorgement coupled with deep glass like pain of thrush. The remaining scar is a large thick cable and not only can I no longer enjoy the look of my belly, I don't like to even touch my belly- which used to be a very comforting zone to "self hug" it's now repulsive to me.

The upside of the c section is that without a doubt, I can rest assured that it was a necessary c section that was not caused by mismanagement or local trends. Without it, I know that both my son and I would most certainly be dead. This knowledge gives me quite a bit of comfort.

The terror and trauma of that first very high risk pregnancy and birth created a very bad situation for me as a woman who formerly hoped to have a family with several children.

I looked into VBACs, but due to the large vertical scar on my belly I realised that I was not a candidate for even trying this- and the fear of having to submit myself to another disemboweling at the hands of doctors who despite their surgical skill had done nothing for my emotional trust- I was put off childbearing and my entire feminine sexual side of being. This was very painful and sad time for me. Eventually thank goodness, I became pregnant and was forced back into the game.

At a prenatal interview the nurse asked me if I had considered a VBAC and I told her, "No because of the vertical incision." and she said she could check my chart... and I told her I could check my body... because I think I know which way it's going... and then she reassured me that although the incision in my skin was going vertically- the incision on my uterus had been done sideways and I was still a candidate for a VBAC if I was interested. Was my emotion joy or FURY? I had suffered for YEARS not even knowing this basic information about the way they had done the surgery to my body. Really suffered and almost gave up on ever having children ever again because of my fear which could have simply been brushed aside by opening my chart and interpreting the scribbled code for me.

The VBAC was a beautiful and empowering experience and I am glad that I did not use any pain meds because the full force of childbearing, although I certainly would not describe it as pleasure, was another dimension of my sexual and physical being as a woman which I am glad I was able to finally experience and embrace. Whatever physical pains and swelling the natural birth caused to my body- it did tenfold in healing my wounds from that first birth trauma- and I finally felt normal, feminine and in control of my body again. The birth of my third child was accompanied by similar exhilarating and joyful emotions- the only contrast was that it was on the heels of a positive birth experience.

I don't expect that other women will feel the same way as I do. I don't think that these women who want planned sections would ever have the positive feelings I did if they were told to birth with no meds. I know my feelings don't apply to them- but what I find so terrifying is that complicating factor of my first pregnancy- placenta previa... the #1 group of people who have it happen are women who have had previous c sections. I was a fluke- I didn't have any of the risk factors (c sections, smoking, abortions, many children) so the idea of a woman purposely scarring a pristine uterus at the very start of their childbearing journey- astounds me. The most common "good" outcome of a placenta previa pregnancy is a very premature live baby. Common tragic outcome is a premature baby who can't survive or a mother who requires a hysterectomy during surgery thus ending their future childbearing because of Placenta accreta. Super bad outcome- mom dies too. I think we were really lucky- my son was only 5 weeks early and we both did pretty well if you don't count all the other stuff. But do these women who think that c sections are a walk in the park think that watching a preemie struggle for life in an isolette is a walk in the park as well? How would they feel if their second pregnancy resulted in a beautiful little child, a preemie from placenta previa- if their first birth was a c section chosen just to have it entered in their day planner?

I just know how much reassurance I find knowing that my situation was an unavoidable fluke... and I can't imagine how I would feel if my situation had been something I felt I had brought upon myself/my baby.

The Front Porch Swing ( http://thefrontporchswing.blogspot.com )

Henci Goer's "The Thinking Woman's Guide to a Better Birth" is really good to read on this topic. It's good to ask your ob/gyn what their c-section rate is. 25% is bad and anything over that is amazingly bad. There is no medical reason why 1/4 of women giving birth need c-sections! Being stuck in a hospital bed hooked up to monitors and told not to move, the administration of pitocin, drugs & epidurals all make it much more likely you'll end up getting one.

If you need one great, it might save your life and your kid's. But to opt for major abdominal surgery because you're embarrassed for someone to see your snatch is a symptom of the total insanity of our society... I have also heard many women say they want a cesarean because of shame or modesty, or because vaginal birth "seems so messy". Or for the convenience of their own schedules. Do I respect their choice to have a c-section for those reasons? Absolutely not.

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Liz Henry
lizzard@bookmaniac.net
Badgermama ( http://badgermama.blogspot.com ) - personal & mommyblog
http://liz-henry.blogspot.com

I delivered my first child naturally and my second child with an epidural. The second birth was so easy it's shameful. The first? I'd have to write in all caps to convey the pain. BUT - I have two friends who've had c-sections and I would not choose their recovery for anything in this world. I also agree; why choose a c-section if it's not needed? That's what your vagina is there for.

Dana
Mamalogues.com ( http://www.mamalogues.com )
In the St. Louis Post-Dispatch ( http://www.stltoday.com/mamalogues )
Pop Mama ( http://www.stltoday.com/popmama )
Since Eve ( http://sinceeve.clubmom.com/ )

P.S...Suzanne..the whole circumcision thing is just starting to die down and now you bring this up? ;-)

Wheat Among Tares ( http://wheatamongtares.blogspot.com )

My first pregnancy I miscarried at about 9 weeks.

My second pregnancy I developed pre-eclempsia that went undiagnosed. I had even thought that I might be developing it, but was reassured that I wasn't....yeah right! I believed them because I had never been pregnant for the whole process before and didn't know what was "normal" and what wasn't. BTW....if you are pregnant; it is important to know what your blood pressure is normally before pregnancy. Mine was usually about 60-65/ 110-115...pretty low. As a result when my blood pressure was 95 over 135 that was very high for me, but not what they considered abnormal blood pressure for a pregnant woman in the thrid trimester. As a result my pre-eclempsia actually became full-blown eclempsia. I had a seizure and passed out...luckily this happened as my husband was escorting me to the Emergency Room. We were already in the hospital. It wasn't luck...God was watching over us.

They put me under general anesthetic and did an emergency c-section. I woke up the next day with no memory of anything after walking into the ER. I didn't even get to see my son for 3 days. He had been moved to a more advanced NICU almost an hour away. I wasn't released from the hospital for several days.

My third pregnancy developed normally, other than wicked morning sickness. When it came time to discuss the birth, none of the doctors would offer any advice about whether to do a C or try a vaginal birth. They would evade any possibility of pointing one way or the other. They were trying to cover their behinds in case something went wrong.

One of the concerns with a VBAC is that the uterus has an elevated risk of rupturing at the former incision point. It isn't an enormous risk, but it's there. I chose to have a second c-section in an effort to avoid that risk, but I always wished that I would have been able to experience at least one "normal" birth. At least I was conscious during my second C and got to see my son right away.

I never suffered much from my c-sections. The first week was very painful, but after that I mainly felt like a boot camp instructor had made me do about 1,000 sit-ups when I was very out of shape....it was a dull, achy, muscle soreness that last for another week or so.

My best friend was not as lucky as me. She had to have a C after an arduous labor with no progress. She felt pain for way longer than I ever did and said that she could actually feel them tugging at her insides while she had her C's (She had a second one because she is so petite. The first one was a result of her birth canal being too narrow for the baby.)

Getting a C for vanity is just plain dumb! However, if you have already had one, the decision-making process is a little more complicated.

Terri

Wheat Among Tares ( http://wheatamongtares.blogspot.com )

Another hot button! You do love to push them Suzanne, don'tcha? *L*

I am pretty well versed on c-sections and the actual pain involved. What I can't give is any idea what a 'natural' birth feels like, though I wanted one with every bit of my being. Especially after watching my sister give birth in 1.5 hours start to finish. b*tch. Harumph. (...yes, she knows I call her that - it's a long standing joke. Relax.)

So, from one who knows - here's how I know:
- 1st baby, 28.5 hours of hard back labor, only got to 5cm dialated, emergency c-section. 6lb 6.5oz baby boy, healthy in all ways. 5 day hospital stay, MUCH PAIN, minor alergic reaction to morphine (I looked like rudolf! Did ya know Morphine makes you ITCH? Guess what, it DOES! all around your nose and lips...), weeks of recovery time.
- 2nd baby, try for VBAC (Vaginal Birth After C-section), 8.5 hours of hard labor, never got past 3cm (where i STARTED labor), emergency c-section. 9lb 10oz baby girl, healthy in all ways, 4 day hospital stay, MUCH PAIN, More mild alergy to pain meds, weeks of recovery time while chasing a 2yr old around the house.
- Emergency Surgery: Etopic pregnancy, presented as a typical miscarriage, a week later the Fallopian tube burst, I was rushed to the hospital when I passed out and my 3 year old daughter found me on the floor in the bathroom, was told another 30min of blood lost and I'd be dead. Lost over half the volume of my blood supply into my abdomen - used same incision sight. 5 day hospital stay, 2 transfusions, way more pain meds then I thought humanly possible to need, and severe depression.
- 3rd (and last - whew, figured out what causes that stuff and STOPPED IT. heh.) baby, planned c-section due to my history of not dealing well with labor. 6lb 6oz baby girl, healthy in all ways. 2 day hospital stay (this was old hat by now - no need for the extra time) Much pain, though less then having gone through hours of labor before the surgery, weeks of recovery time.

So there's my history - I clearly have experience in dealing with abdomen type surgeries. Nothing irritates me more then folks who want c-sections for cosmetic reasons. All of mine were medically necessary, and I would still much rathered had a 'natural' birth and fought for them each time. I knew the risks of going into surgery, as well as the risks of VBAC - with a uterus as abused as mine, had we attempted a 3rd natural birth, there was a very real chance that my uterus would have burst at the sight of the scarring and resulted in either infant death, my death or both.

My scars are hideous. I would take a picture and show you - but well, ew. No one wants to see that. Not only that, but even NOW - with my youngest being 7 years old, I still have residual pain from the surgery scars. I can stretch, and be doubled over in pain suddenly - another time I can stretch the same way, and be fine. Any fall brings pain in stretched scar tissue, as well as whatever area I actually fell on. This is 7 full years after my last surgery!

I'm not in the best of shape - but the last time I dropped weight (before that depression up there I glossed over where I gained all the weight back and more) and was in excellent shape and getting better by the day - I had NO ABDOMINAL MUSCLES. The more situps and ab-ercizing I did (and can I just say - OUCH?) the more the scar tissue stretched, but never, ever, did my belly flatten at all. The more I tried for strength there, the more I failed. My waistline shrunk - but there was nowhere near the tone I wished for. Those beauties who have surguries and look perfect days afterwards? Please. control-top hose/panties and tummy tucks asap - OR they have a natural body type that recovers well from such things. It happens, but my scenario is much more the norm.

Watching my sister go through labor and delivery easily was a blow to my ego, as well as jealousy inducing. Her recovery time was something I envied more then anything, however. She was up and walking without pain within a few hours. I was up and walking in 2 hours - bent over in horrible pain thinking my insides were going to fall out with every movement. She was cooking dinner for her family in 24 hours. I was still in the hospital eating crappy food and watching even crappier tv and being woken up every couple hours by nurses, and of course, trying to take care of the baby too - a baby I couldn't pick up by myself without careful planning and making sure that I wasn't tugging at the staples/stitches/tape/gauze holding my insides, well, inside.

What some of the articles don't add in about the re-hospitalization is the fact that many insurance companies treat c-sections the same as vaginal birth. That being - you get 24-48 hours tops in the hospital before they're discharging your or making you pay yourself. I was lucky, sort of, as my expenses were paid by the state (and by expenses, I mean the first hospital stay in 92 was $12k. The others all increased from there - not including doctors fees and pre-natal care.) but those with insurance face bigger challenges getting things paid for. Those extra days of recovery in the hospital are essential for first time c-sections especially as there are a myriad of things that can go wrong that you don't notices in the fog of pain.

A c-section is a major surgery. I could show you pictures of that too (ever seen your own uterus? I have! I have pictures of it laying on my belly - ON, not IN.) but I'll spare you. I could also show pictures of the bruising that turned my stomach BLACK, and lasted for weeks. I could also show you the incisions, the staples, the resulting scars, the picture snapped while I sobbed after having tried to get up and pulled wrong against the staples/stitches and near passed out from the pain - or - omg - tell you about how much a sneeze KILLS you and causes you to all but pass out again. Let's not even talk about that first few bathroom visits. Ow. just. OW.

But I'd rather show off pictures ( http://www.flickr.com/photos/eclat/245109122/ ) of my ( http://www.flickr.com/photos/eclat/268876067/in/ph... ) babies ( http://www.flickr.com/photos/eclat/268931269/ ), all three of whom I may have lost if I'd lived 100 years ago and had not the medical care that I did for a necessary procedure that ultimately protected the life of me, and my children.

Even if it did destroy my abdominal muscles!

To make a long post longer - C-sections for cosmetic reasons is beyond stupid. For medical reasons, they are necessary, but it is certainly not a bed of roses for anyone, as anyone who's actually had one can tell you. I have a friend who did both - c-section by emergency for the first, VBACs for the rest. Having done both, she concurs with the above - Vaginal birth is infinitely easier to recover from.

And? Dude. By the time you're in labor, a whole platoon could be in there looking at your vajayjay and you won't care, though you may decide to charge admission. But you will fall in love with your pain-med guy. I proposed to the one who gave me my epidural. Twice. Course, I also fired my doctor because his hands were too big. Go figure.

Thus ends my longest. comment. EVER.

Kaleidoscopic Eclat ( http://gonfalon.org/eclat )

There are too many factors to consider to just flippantly announce that you want one or flatly refuse to consider it.

I could not have said it better myself.

I truly wish I had prepared for the possibility of a c-section when I was pregnant with my older daughter. My L&D nurse mentioned it, and I brushed her off. Twenty-four hours later, guess where I was?

Having had two of them (both in New York City), I just have to shake my head at women who think a c-section is a breeze. Wait 'til they try breastfeeding...

mothergoosemouse