No, the new PLOS study does NOT show that C-sections cause obesity

overweight woman biting cake

What would you say if I told you that a study was just published that showed that visiting Weight Watchers causes obesity?

The authors looked at more than 150,000 people across multiple states and found that those who visited Weight Watchers were 25% more likely to be obese. This relationship was true for all subgroups: male, female, white, African-American, and across all ages.

I can imagine you rolling your eyes, but wait! How about if I added the the authors had provided all manner of charts, including funnel plots, and corrected for publication bias?

I bet I know what you would say (after you picked yourself up from rolling on the floor laughing). You’d point out that Weight Watchers doesn’t cause obesity. You’d probably point out that the people who visit Weight Watchers differ substantially from the people who never visit Weight Watchers. At a minimum, the people who visit Weight Watchers are more likely to be obese to begin with.

You’d be right. In other words, the study is meaningless if the authors did not correct for confounding variables. The investigators might have identified a correlation between visiting Weight Watchers and obesity, but that doesn’t mean that visiting Weight Watchers causes obesity. In fact the opposite is true, being obese makes it more likely that you will visit Weight Watchers.

There is no study that shows that visiting Weight Watchers causes obesity, but if you understand that example, you will understand why the new study published in PLOS ONE, Mode of Delivery and Offspring Body Mass Index, Overweight and Obesity in Adult Life: A Systematic Review and Meta-Analysis, by Darmasseelane, Hyde, Santhakumaran, Gale, and Modi is equally meaningless.

What did the authors do?

15 studies with a combined population of 163,753 were suitable for inclusion in the meta-analysis. Comparing all CS to VD in pooled-gender unadjusted analyses, mean BMI difference was 0·44 kg·m-2 (0·17, 0·72; p = 0·002), OR for incidence of overweight was 1·26 (1·16, 1·38; p<0·00001) and OR for incidence of obesity was 1·22 (1·05, 1·42; p = 0·01). Heterogeneity was low in all primary analyses. Similar results were found in gender-specific subgroup analyses. Subgroup analyses comparing type of CS to VD showed no significant impact on any outcome.

In other words, they found that for people born by C-section, the risk of obesity in later life was increased by 22%. The association was robust, meaning that it was found in most subgroups, but it is actually rather small.

But it is well known that women who undergo C-section differ substantially from those who do not. They are more likely to be obese themselves, more likely to be carrying large babies and more likely to have gestational diabetes, which impacts metabolism. The authors are aware of this, and even mention it, but they do not correct for these confounders, making their conclusions rather suspect.

In media interviews, the authors have indulged themselves in flights of fancy:

Study co-author Dr. Matthew Hyde suggested possible ways that C-sections might influence later body weight.

“The types of healthy bacteria in the gut differ in babies born by cesarean and vaginal delivery, which can have broad effects on health,” Hyde said in the news release. “Also, the compression of the baby during vaginal birth appears to influence which genes are switched on, and this could have a long-term effect on metabolism.”

No, Dr. Hyde, we have as yet no evidence that the differences in gut flora in the first few days of life have any impact on health, let alone broad effects. Furthermore, I am unaware of any studies that show that “compression” of the baby influences which genes are switched on, let alone whether that affects metabolism.

Speaking to The New York Times, Dr. Hyde said:

… [A] woman cannot make a reasoned choice [about a C-section] unless she’s fully informed not only about the short-term outcomes, but also the long-term outcomes. We want to give you the data you need to make an informed decision.”

But you haven’t given us that data, Dr. Hyde. You haven’t given us any evidence of any causal relationship.

In the paper, the authors are a bit more circumspect:

… [S]everal factors associated with increased risk of CS are also associated with increased BMI in offspring, including high maternal BMI [70], gestational diabetes [71], and lower socioeconomic status . Of these, maternal obesity is probably the most significant confounding factor in the relationship between CS and offspring BMI. This needs elucidation in datasets which can be properly controlled for maternal BMI. (my emphasis)

No fooling!

Simply put:

Although the authors analyzed data from more than 150,000 individuals, although the relationship between C-section and obesity was found in most (but not all) subgroups, although the authors provide all sorts of elaborate tables and charts, they never corrected for confounding variables, meaning that they are not entitled to conclude anything about a causal relationship between C-sections and obesity.

  • Epidural Guy

    Debunking this kind of nonsense is very time consuming and… mostly useless. Even though this is pretty much the material of the first year biostatistics: association does not mean causation. Alas, this is going to fall on deaf ears. But I don’t want to be negative and will dispense the advise of the same vein. Most people who present to the hospital have gray hair. Therefore, in order to reduce your chances of this happening dye your hair. Further: most dead people have gray hair; if you take care of the color you might live forever.

  • Marf

    … [A] woman cannot make a reasoned choice [about a C-section] unless she’s fully informed not only about the short-term outcomes, but also the long-term outcomes. We want to give you the data you need to make an informed decision.”

    Is he kidding? It’s a c-section , not cosmetic surgery. Women typically get them because there are serious and immediate risks to the health and/or life of herself and baby. Even if there was a causal connection (which there clearly isn’t) who would take that info and tell the doc recommending a c-section, “No, I’m gonna pass, my kid might end up fat.” ? Ridiculous.

  • guest

    Hahaha. I just have to laugh at the idea that my daughter will be obese because we had a c-section. I was not fat, did not have diabetes. It just happens we are a tall people with big heads.

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    caaaaaaaaaaaake

    • Jocelyn

      Hahaha. :) I’ve had to cut dairy out of my diet lately for my daughter’s allergies, and to compensate I’ve been eating a ton of cake. So I’ve recently learned if I can’t have milk or cheese = I eat cake.

  • Joe68

    I just read a book “We Are Our Brains” by prof. D. F. Swaab. He mentioned research results that some abnormalities in the brain of human fetus cause a delayed birth. An obstetrician decides a c-section in such a case. The same brain abnormalities can cause later some problems in life of the person delivered by c-section. Therefore – the c-section and later obesity are correlated because they have a common cause. Dr. Tuteur is right! The authors of study published in PLOS ONE made wrong conclusions mixing correlation with causation.

    • anion

      Really? That’s fascinating; as the mother of a daughter who is just barely touching the high end of the autistic spectrum, and whose problems in that area were (at least to me) evident from her infancy, I’d be very interested to read that. (I was induced at 40 weeks, she still hadn’t dropped, so ended up being a c-section.)

      Thanks for mentioning it! I’m totally going to get a copy of that.

  • carr528

    Hmm, my kids are all c-sections, and not a single one is obese. The only one that’s close is my oldest, and I think it comes more from the video games than the method of his birth. And, even he isn’t obese by BMI. He’s just the only one I know could end up heavier if we didn’t keep an eye on it. My youngest is 2 1/2, and she hasn’t even crossed 30 pounds yet.

    Of course, I’ll risk the fact that they MIGHT be obese when I consider my oldest would have killed me 150 years ago because his head literally could not fit through my pelvis. And, if he hadn’t, my third would have, since he had craniosynostosis, and he would have never made it out vaginally. So, natural birth lovers can bite me. My kids and I are alive today because of c-sections.

  • Jessica S.

    OT alert! :) I’m 20 wks pregnant with our second and, like the first go-round, I’ve been iron-deficient from the start. Each appt I’ve had so far (Dec, Jan and now Feb) my iron levels continue to be low, which again is not dissimilar from the last pregnancy. My doc has me taking a slow release iron supplement (45mg elemental iron per pill) three times a day now, either with a glass of orange juice or 500 mg vitamin C to help with absorption. I’m hoping this will do the trick, I’m tired of feeling tired, regardless of how much sleep I get!

    I kind of just wanted to hear from other gals who dealt with this while pregnant, if anything just to have company for my misery. I just have to wait for the dose increase to work. I know this is very common for pregnant women. I thought someone might have a tip or two, but heck – I’m happy to get a “yes, that sucks!”, too. :) I realized that the SOB blog is about the only place I could ask this and not get ridiculous woo-filled answers, or people second-guessing my doc for whatever quack reason. I know I’ll get a load of those if I ask anything from my Facebook peeps. :/ Or any other forum I belong to, for that matter. :)

    • Mer

      Here’s a hearty “that sucks!” Because it truly does suck, pregnancy is fatiguing enough without anemia thrown in. I haven’t dealt with it in pregnancy, but last year I miscarriage and hemorrhage that required 2 units of blood and it still took 3 months to recover from and I just felt like a limp noodle most of the first month. Hope the iron kicks in soon!

      I wish we had a forum here for woo free pregnancies!

      • thepragmatist

        Nobody told me how sick I was in the hospital, so I had no idea why I was crashing into walls and falling over. I could barely walk up the stairs and I couldn’t figure it out. Only on discharge did some jerk of an OB come in and say, “Oh yeah, your red blood count was low enough for a transfusion but we didn’t do one because you’re young and healthy enough.” My ex and I were appalled and looked at each other like, WTF? My actual OB/GYN was off sick by then, and I didn’t even think to ask for blood draw before leaving that wretched hospital. And then they wonder why women don’t want to come to the hospital. That doctor was so rude to us. Oh yeah, you could’ve died, see you later. Maybe it was because I was noted as an MRCS. I don’t know. I did recover but I remember being so faint I couldn’t walk up and down the stairs at home for about a week afterwards. Luckily I had good iron stores. (Which is what he should’ve said, because he terrified us).

        • Mer

          Oh my goodness! You are so lucky you did have good iron stores! I regularly eat wild game, a lot of it is much higher in iron than beef, so I had good stores too, but my hemoglobin was a 9 after 2 units of whole blood and it took a good 2 months before I got it up to the minimum of 12. I did lose a LOT of blood though and had been pregnant but who knows. I still can’t believe that he told you that and didn’t explain it more, that would be terrifying.
          A similar thing happened to me with my first, but they just never told me I was anemic. I was a very healthy 19 yo old though and 6 weeks later bounced back and had to d/c my iron supplement because my iron level had jumped up too high. So I can see why they chose not to give you a transfusion, but good grief he could’ve explained it to you for sure!

          • thepragmatist

            I WAS totally terrified. I had follow-up midwife care, and asked my midwife, WHAT THE HELL? How could you not have told me?! I think the problem was that my OB/GYN was only on for a couple of days and then her and her whole family got viciously sick with influenza. So she disappeared and there was a breakdown of communication. My ex probably also had a lot to do with that, because nobody wanted to tell me how bad it was, worried that I was going to freak out.

            From what I gather now, everyone thought everyone else had told me. It wasn’t like I was abandoned– my midwife came every single day to see me once I got home and we made sure those levels were rising. But the behaviour of the on-call OB who discharged me was rather reprehensible and I was so glad he didn’t deliver me! That said, I was surprised, in hindsight, that they let me go ANYWHERE alone. Then again, you’ve not met me. I’m extraordinarily stubborn and would not listen to orders to stay in bed anyway. That stubborn streak is a plus and a minus. Haha.

        • Jessica S.

          Are you in the UK? I have a friend who had a horrible experience when her husband was stationed in Britain. She had an emergency and wound up at a local hospital instead of one on base (she must not have been living on the base). I’m not going to make the jump that ALL hospitals there are therefore horrible, I’m sure that’s not the case. But she said there was a distinct difference in experiences.

        • Jessica S.

          That’s horrible, btw. I would’ve been do scared and angry! Never mind that the low iron makes me feel all confused and foggy-minded to begin with!

        • guest

          Ah how awful! I had an emergency c and was told they were going to see how I was doing before giving me transfusion, as I was in a similar state. However, anytime I wanted to do anything, there was a nurse or a nurses aide.My husband was ordered by them not to let me get up or move the baby on my own until they gave him the OK. I have photos from then and I looked like death. I am glad you recovered, you could have been seriously injured.

      • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

        I was fortunate to avoid anemia, but I did have hyperemesis. For nine freaking months. Then I had my baby via c-section and was like “finally no more puking” but I threw up during the surgery and the whole next day. Oi.Pregnancy is brave no matter how you end up delivering. I wish all women who have been pregnant got enough credit for how hard it can be.

        • Mer

          Blech! Hyperemesis is awful, I didn’t have it but was sick enough at the beginning that I scared my medwife into giving me zofran. Even with it I never did gain back the weight because I was still nauseous, just not puking. I think hyperemesis moms deserve a medal for surviving that particular hell!

        • Jessica S.

          Ugh. I’d much rather have anemia. I hate hate hate throwing up! :(

    • thepragmatist

      I became anemic in the middle of pregnancy and rather than do iron supplements (I had no choice, I was throwing them up), my midwife had me eat a steak a day, fairly raw. I hated that f-ing steak by the end. My ex used to cut it into little pill sized pieces for me because I hated it. But I had an extensive bleed during my c-section, and my iron levels rebounded so quickly everyone was shocked. I had huge iron stores from that steak. LOL! Sorry, that’s a bit on the woo side, but I got to say, I do give credit to the steak. I never could (and still can’t) tolerate iron supplements. They just make me viciously sick. I was only anemic for a short time after my c-section, despite having my blood cell count drop to 7.4! A week later it was in the 10s and then I was fine.

      • thepragmatist

        To add to this: I will never willingly eat steak again. Ha.

      • Jessica S.

        No, I don’t think that’s woo-y! And steak (meat in general) has heme iron, the kind that the body absorbs better. Or however that goes. I definitely have to split the doses up, otherwise it makes me very sick! But interestingly enough, I read yesterday that it’s actually better to split up the doses, to ensure maximum efficiency in absorption. Something about the higher the dose, the less efficient the body is at absorbing it, like a point of diminishing returns. I’m butchering it, I’m sure! :)

      • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

        You know I was vegetarian through my pregnancy and never had my crit fall under 45. I wonder if its largely genetic, or what, because I never had to try to keep my levels up.

        • Jessica S.

          I wonder! My mom has always struggled with low iron/spells of anemia.

          • KarenJJ

            In my family and myself it was due to an auto-inflammatory syndrome. In our case there was an inherited reason for it.

      • Bomb

        It isn’t really woo. Iron from meat is the easiest to absorb and is more bio available than iron in plants or supplements.

      • http://Www.awaitingjuno.blogspot.com/ Mrs. W

        With my pregnancy with my daughter – I had a food aversion to steak…just could not stomach it. I became somewhat anemic and wound up on iron supplements. No problems with my son. I wish I knew about the Total cereal thing.

    • KarenJJ

      Anemia and iron deficiency really does suck. I was barely functional during the first half of my second pregnancy (I ended up on high dose iron tablets but was getting close to needing an iron infusion). My anemia turned out to be an undiagnosed underlying rare syndrome.

      Once that was diagnosed and treated properly my anemia and iron levels went to normal for probably the first time in my life and it was SUCH a dramatic change to my energy levels. I hope this passes soon and your are able to get some rest. I also hope if there is an underlying issue unrelated to pregnancy that your doctors are better at getting to the bottom of it then mine were (they got there in the end with the help of a haematologist a family member saw).

      • Jessica S.

        That’s really interesting, I should have her continue to check my levels after I’m pregnant, after everything settles back down.

    • OB Doc

      Total Cereal. This is what I prescribe to my patients instead of iron supplements, since in my experience most people stop taking the iron b/c of constipation and stomach upset in general. It works great–one bowl a day or at least 5 times a week. Cream of Wheat is another option, or Grape Nuts.

      • Young CC Prof

        You know, I ate Total Cereal with whole milk every day while I was trying to get pregnant. Iron and folic acid, only a small amount of vitamin A, plus a little extra animal fat to prove to my skinny body that food was plentiful and baby-making conditions favorable.

      • fiftyfifty1

        That’s what I ate. Had hyperemesis but managed to not get anemic despite my overall poor nutrition and inability to tolerate vitamin pills because I could reliably get down , and keep down, at least one bowl of Total at dinner time each day. Haven’t touched it since, but am grateful to it.

      • Jessica S.

        Thanks! I’ll get a box next time I’m at the store.

    • The Computer Ate My Nym

      Venofer is class b for pregnancy. If you’re intolerant of oral iron and still badly iron deficient, that might be an option. Also, pregnancy makes you tired. Or, at least, it made me extremely tired, even with normal iron levels. It gets better. Even with the baby up all night, it gets better after delivery.

  • Guestll

    My husband’s twin was born first, vaginally. He is slender. My husband was born via emergency c-section (footling + cord prolapse) and he is not.

    IF ONLY THEY HAD KNOWN!!11!!!! HE COULD BE DEAD INSTEAD OF FAT. :(

  • Karyn Croushore Hodgins

    What I find really funny about this study is that my kids seem to prove the exact opposite lol. My two oldest were natural vag deliveries and they both are overweight/obese. My youngest was a section because he was breech and his BMI is 15! lol… Explain THAT with their silly study

    • Young CC Prof

      Clearly we need a discordant sibling study just like the breastfeeding discordant sibling study. Or, we could just not bother.

      • The Computer Ate My Nym

        Given that the claim is out there, it might be worth looking at a discordant sibling study. Sillier things have had to be refuted by formal study (MMR causing autism, laetrile curing cancer, etc.)

        • Young CC Prof

          Well, that would be the simplest way to check the claim. The only thing you’d need to watch out for would be changes in maternal health. For example, Mom had GD which was undiagnosed and untreated with the first baby, who wound up being almost 10 pounds, born by c-section because he was way too big. Second time around, Mom found a better doctor, her GD was very well controlled, and the younger sibling was only 7.5 pounds, successful VBAC.

        • theNormalDistribution

          (homeopathy, accupuncture…)

  • thepragmatist

    Two words (just in case they’ve not been said): Occam’s Razor

    That’s all. I think Dr. A is bang on. Big babies of obese mothers are going to have a higher risk of GD and c-section and go onto have a higher risk of obesity. This seems like a pretty clear causal relationship to me.

  • The Computer Ate My Nym

    One other point about this study: Let’s ignore the issue of causality versus correlation for the moment and take the results at face value. Ok, so babies born by c-section have an odds ratio of obesity of 1.22 compared with those born by vaginal birth. That’s not much of an increased risk. Compare that to the odds ratio of getting lung cancer for smokers versus non-smokers, which is about 40 or the odds ratio of a baby dying in a home birth versus hospital which is greater than 4. Even in the worst case scenario of c-section being completely causal, the relative risk is low. Much lower than the risk of brain damage from hypoxia when a c-section is not done. And, personally, I’d be fine with a world full of fat, smart people.

    • The Bofa on the Sofa

      I think it’s mentioned below, but I will just reiterate it:

      I’d GLADLY trade a 22% higher chance of obesity for a 2% chance of my baby dying, which is what my first faced by being breech.

      Similarly, even though the risk for the second was not as high, I’d still trade obesity for the risk that was there.

      • The Computer Ate My Nym

        Not to mention the NHANES study which showed a lower mortality among people who were mildly overweight (BMI 25-26). Maybe we should ask whether something that leads to a higher BMI might not be a good thing…

    • AllieFoyle

      The really stupid thing is that obesity is very obviously related to a number of modifiable variables, so even if CS did magically confer an increased risk (doubtful), there are a number of known ways to address the issue after the fact. It’s not like your personal odds of obesity are set in stone the day you are born–they’re modified over time by what you eat and do day in and day out over the course of a lifetime.

      • thepragmatist

        Unlike hypoxic brain injury, where the brain can only recover so much. They LOVE to gloss over brain injury but every day I watch a woman walk down my road with her brain injured son and sometimes we talk about her life at the play ground. I’d agree that I would rather give my son a slightly increased risk of obesity than role the dice on brain injury. That’s something the NCB movement DOES NOT want women to know about. It’s something most women aren’t even aware of as a risk of vaginal delivery.

        • http://Www.awaitingjuno.blogspot.com/ Mrs. W

          And those who know, and choose cesarean in part because of this risk, are treated unfairly.

          • thepragmatist

            It was one of the first things on the plate when I went to my OB/GYN. I was terrified about hypoxic brain injury because of my field of work. I knew exactly what could happen. I knew my baby was going to have a large head and I was probably headed for a difficult first time delivery. The idea of an obstructed labour… no, thanks. There were many reasons I wanted that c-section but for him, it was to protect his brain.

    • Comrade X

      As a fat, smart person, I’m very glad to hear that. :)

  • disappointed

    What’s up with the fatphobic picture? I expected better from you, Dr. Amy. Even the usual, generic headless fat people pictures are better than that.

    • ngozi

      I guess she provided a ridiculous picture to go with a ridiculous study?

    • Amy Tuteur, MD

      That’s the point of the picture. I picked it specifically because it is fat phobic.

      • thepragmatist

        You nailed it there, too. It’s really stretching it to suggest it would be better that some babies DIED than to be fat, you know? The authors aren’t going to come out and say it, but the focus on obesity as a fate worse than preventable death rings true to me.

        Gut flora my ass. I’m so sick of hearing about the gut flora. If they cared about gut or vaginal flora, there’d be a pretty easy (if not revolting way) to expose baby to both.

  • LibrarianSarah

    What jumps out to me is that is largely class-based. A lot of the activities that one needs to do in order to be “in shape” require quite a bit of income. The healthy item in the grocery stores are also the most expensive. Loading my cart with fresh veggies, lean meats, low fat dairy, etc. costs me over $50 in groceries and I live alone…and clip coupons. I hear a lot of people say “pay for it now or pay for it later” but those people CAN pay for it now. I can barely pay for it now and still cringe every time I go to the store.

    I think it is easy for people of privilege to make excuses and claim it is easy for the lower classes to lose weight and there are a lot of free or low cost alternatives but they don’t really think it through. My personal favorite is when someone said “Just go outside and run. That’s free and people of any class can do it!” Last week in my neighborhood someone shot at a school bus that was carrying about a dozen children. The week before that my entire block was shut down because someone shot at a detective and took off through the neighborhood. Tell me, would you go running after work if you lived here?

    • Danielle

      Couldn’t agree more. There’s nothing so obnoxious as listening to relatively well-off people make snide remarks about what “some people eat” after they “go shopping at Walmart,” while they expound upon how Enlightened they are because they Buy Real Food courtesy of Whole Foods grocery stores.

      It’s wonderful. All power to them. I’m glad they enjoy being marketed to so well by a major US company and can buy their way to culinary virtue. And that chain does sell some good products. Affluent Americans are eating better.

      But the gloating should stop: you’re affluent and you jumped on a relatively positive bandwagen. Unless you were one of the original health good crunchies back in the ’70s or earlier and helped found a food co-op, you don’t get to say you pioneered everything. And you certainly shouldn’t mock people who can’t afford to double their grocery bill.

      • LibrarianSarah

        Exactly, it’s just a socially acceptable way for the upper classes to look down on the lower classes. Or for men to look down on women that they don’t find attractive. You’re not a snob/misogynist, you are concerned about people’s heath.

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          My personal pet peeve is when my endocrinologist tells me to take up swimming because my bad back and arthritic knees and right hip make walking very painful. I asked her if she had the $1000 to give me to pay for a pool membership. She thinks I don’t exercise because I don’t want to, not that I CAN’T.

          I KNOW I’d lose weight and feel better with exercise, darn it!

          • sleuther

            Antigonos – I’ve had it UP TO HERE with my endo, lately. Without going into all the details, I feel as though he is not listening to me with respect to my TSH levels and the reason I have NO energy. My previous endo (who retired) understood that I need to have my TSH on the very low end of the ‘normal’ range to even have the merest CHANCE of achieving weight-loss.

            At the moment I’m on a split-dose of synthroid (150 mcg one day, 137 mcg alternate days) to try to get into even the ‘high’ end of ‘normal’ for my TSH. Still no energy. Found myself on a fairly woo-ish website not too long ago reading about people’s great experiences with Armour Thyroid — and how synthetic levothyroxine was “evil.” Maybe I’ll enter the World of Woo….

          • The Computer Ate My Nym

            Time for a new endocrinologist?

          • sleuther

            (sorry, Disqus ate my comment)
            Yeah, maybe…. I’ve just felt very hopeless about it lately. Like maybe I was just meant to be fat.

          • Danielle

            I have a thyroid condition too, and I also wonder if it is time for a new endo if the current doctor isn’t listening to the fact you cannot lose weight and don’t feel right. I always got the impression that within the “normal range” there is a lot of room for fine-tuning and that different people simply feel better at different places.

            I think in the recent past researchers from Johns Hopkins and somewhere else (Dartmouth maybe?) narrowed the acceptable range considerably. Perhaps its worth checking into whether your doctor is following these new recommendations?

          • KarenJJ

            NEW DOCTORS!! Seriously, been there done that and awesome doctors are the awesomest. Crap doctors are money, energy and time sucks and not much more. My health never got better until I got one that listened and checked things out thoroughly. (and what may be a great doctor for you may not be a great doctor for someone else).

            ETA it can be incredibly frustrating to get there though

          • sleuther

            Thanks..I think I’m going to have to bite the bullet and find a new endo (see my reply to Danielle above) because this one is driving me crazy, and probably vice-versa….

          • Young CC Prof

            Definitely definitely. On a vaguely related note, a conversation here a couple weeks ago inspired me to quit putting up with pain that was mostly tolerable most of the time, except when it wasn’t. New doctor prescribed something that actually helps, and made it clear she’s willing to keep prescribing it. (Although I still find myself hoarding and rationing them, which says something pretty weird about my mind.)

          • sleuther

            Yes, just getting him to let me try the split dose was a trial…. My TSH was well above 3 on 137mcg and too low (below bottom of range) on 150mcg, so he just wanted to leave it at 137 because there’s no dosage of Synthroid sold between those two, and above 3 TSH was “close enough” to normal range for him. I agitated and prodded him into letting me try the split dose, and in a couple weeks I’ll get the thyroid panel done to see how it’s going. But I feel like the trust is gone. And I’m intrigued by Armour, yet he doesn’t prescribe it.

          • The Computer Ate My Nym

            I do think some people are “meant” to be fat (that is, are healthier and happier living with a BMI higher than “ideal” rather than trying to lose weight), but you’re describing a specific issue that has responded to interventions (i.e. increasing your synthroid) in the past. I’d say that it’s time for a new endocrinologist before deciding to do nothing. Also, you kind of sound depressed. Can I suggest that you consider getting that evaluated too? (As always, please take any advice I give that isn’t helpful to you and flush it.)

          • sleuther

            Hey! Just saw this…. Thank you, truly, for taking the time to reply. I am fairly depressed, I think, although it’s a chicken and egg thing with the weight and the lack of energy.
            I think I do need a new endo, though….

          • fiftyfifty1

            Thyroid levels. A HUGE source of patient-doctor conflict.

            Here’s the conflict from the doctor’s perspective (and I’m not saying it applies to your personal case, but it may be helpful to know how much baggage is out there already):
            It is extremely common for thyroid patients (almost always female thyroid patients) to want to run their TSH levels at the very bottom of the normal range, if not below the normal range altogether (for those who don’t know, as the thyroid dose goes UP the TSH goes down, so a low TSH reflects a high state of thyroid in the body). Women love the extra energy and weight loss that high thyroid levels give them. It’s almost like taking a little dose of speed. Endocrinologists who have “given up the fight” and allow women to run near the edge become VERY popular in the community. Docs who insist on running their patients in the middle of the range, where health outcomes are best, are seen as the bad guy and accused of “not listening to me when I tell you that the lower TSH is where I feel best and is where my natural level must be”. But running the TSH on the low end of the range has health risks that include long term heart problems and osteoporosis.

            Anyway, it’s very reasonable to aim for a TSH of 1-2. But personally I wouldn’t recommend aiming lower. The artificially-induced weight loss that occurs from a too-high Synthroid dose is not a healthy weight loss. And treating fatigue or depression by going overboard on Synthroid is not the way to do it. It’s way better to dig and try to find out what’s causing those symptoms rather than cover them up.

            Anyway, if none of this is helpful to your case, do ignore it. At a minimum you deserve an endocrinologist who can explain his or her rationale behind what doses they suggest, which doesn’t sound like has happened with yours.

          • sleuther

            Thanks fifty, this was helpful and informative. For what it’s worth, I don’t feel great when my TSH is below range either, and weight loss is very difficult across the board–it’s theoretically possible at a TSH in the 1 – 2 range, I suppose. I just want a fighting chance.

            Do you know anything about Armour vs synthetic thyroid hormone? I’m on the latter and I feel like crap. Most of my Google-fu re: Armour ends up at woo-fests like Mercola.com, but I’m wondering if it’s worth trying.

          • fiftyfifty1

            Yeah, Armour thyroid is super woo. Research does not support the idea that Armour thyroid (or any other thyroid prep or combo of preps) is better than levothyroxine (Synthroid). This is going to seem really mean, but very truthfully I do not have a single patient who takes Armour Thyroid who isn’t a total woo-filled nut and besides that a personal pain in the butt.

            The problem with feeling crappy is that SO many things can cause a person to feel that way from anemia, to personal stress, to auto-immune, to cancer, to depression, to sleep apnea, to med side effects, to menopause, to societal shaming, to undetected heart disease, to Hep C, to a million other things. Lots of times the cause can be found, but sometimes not. Anybody who tells you that they have the one true answer (You have systemic candida! You’re too fat! You need Armour Thyroid!) is a quack.

          • sleuther

            Thanks, fiftyfifty – I really appreciate hearing your thoughts on this. I guess it’s back to the drawing board…. I was diagnosed with severe Vitamin-D deficiency a couple months ago by my GP and have been supplementing for that, so maybe I need to get it re-checked and up the dosage.

            I do see why people get sucked into the woo. It’s tempting to think that there’s a magical answer out there when the scientific answers don’t seem to work. I hate having no energy and hearing people say “Well if you’d only exercise more…” I Don’t. Have. Energy. It’s like trying to press the accelerator in a car with an empty gas tank. You can press harder and harder and it still won’t go (at all, much less faster). That’s how I feel. I get that I’m lazy and lethargic – I’m not saying my lifestyle is ideal for losing weight – but sometimes it seems very hopeless to me.

            Again, thanks for weighing in (ugh, no pun intended) – at the very least, you’ve saved me from pursuing an expensive and time-consuming dead end.

          • fiftyfifty1

            The only further advice I might add is about the weight issue. Society at large, and sadly also way too many doctors, will send the message to people with obesity that they can’t expect to feel good, and maybe even don’t deserve to feel good, until they lose weight. But that’s not true. I have a number of patients who are 100+ pounds above the “normal” range who are happy and energetic. All of them tell me that sure, they would like to be thinner. And some of them have health conditions like diabetes or arthritis that would be simpler to control if they were successful with losing some of their weight. But here’s the thing-they prioritize being as healthy and happy as they can be *at any weight they happen to be at the time* and don’t put off feeling better until that mystical day arrives when they find the magic formula for weight loss.

          • sleuther

            Thanks fiftyfifty, I wish you were my doctor! I did my 30 minutes on the elliptical this afternoon; maybe there’s hope for me yet. I’m certainly not averse to experiencing life as a fat person if that’s the only way it’s offered, and indeed i do work, parent, and even travel when i can, although many naps will be needed. Fortunately my husband is a very understanding guy.

          • The Bofa on the Sofa

            Most of my Google-fu re: Armour ends up at woo-fests likeMercola.com, but I’m wondering if it’s worth trying.

            Yeah, I think you pretty much answered your own question, in addition to 50/501′s response below.

            Hint: if it ends up on mercola, you can pretty much count on it being whackaloon.

          • sleuther

            Thanks, Bofa – (see my full reply to fiftyfifty below) – what was I thinking, posing this question on SOB? I must have wanted y’all to talk me out of it! LOL ;-)

          • KarenJJ

            Sorry to make an example of you fiftyfifty, but this is one of my signs of a good doctor. Not necessarily one that fobs me off and/or lets me go on my own merry self-destructive way but one that listens, understands what I am saying about my symptoms and explains things such that I understand what I’m doing and why.

          • fiftyfifty1

            It’s a lot easier to seem like a good doctor when you have all the time you need over the internet. Also here I am free to give more of the inside scoop. That can go over really badly in real life sometimes.

          • thepragmatist

            Arg. My family physician is like that sometimes. He does NOT understand how poor I am. He just seems to not be able to wrap his head around living way below poverty line, that we live on the charity of our family, and that this means the things he suggests are just CRAZY (to me) but perfectly reasonable to him. Like, hey, Patient Pragmatist, I’ve got three specialist appointments set up for you two weeks apart in two different cities, alternatively, 3 and 6 hours away. Now take your toddler and GO! What? You can’t afford gas and your tire is a spare? Oh.

          • ngozi

            …like my former OB who suggested I hire help when I mentioned that I wouldn’t have much help with my newborn. I don’t think he liked the way I laughed in his face.

          • thepragmatist

            Yes, it must be nice up there… that’s all I could think, staring at him as I tried to explain I’m living on 600 dollars a month. I’ve also heard the “hire help” thing too, considering I am disabled. Ok, I’m disabled, and now have no income. I am a single mom. I will hire help how?

          • Anka

            *I* like the way you laughed in his face! I hope it made him think.

    • theadequatemother

      agree agree agree agree. Fat shaming often = poor shaming.

      • Amy Tuteur, MD

        And shaming about breastfeeding is often poor shaming, too.

  • Dr Kitty

    It is almost as if obesity has nothing whatsoever to do with the type and amount of food eaten vs the calories expended through exercise…
    Nope. Gut bacteria and epigenetics.

    I’m a small, thin person, from a family of small thin people.
    We all like to eat one big meal of whatever we feel like in the evening and eat very little during the day (maybe coffee and a roll for breakfast, a cup of soup for lunch…
    My husband is a big man from a family of big people, who eat like Hobbits.

    He and I would eat exactly the same thing for dinner, but he’d probably have had a bowl of cereal, peanut butter and toast, some soup, a sandwich, fruit, a cookie and three cups of coffee as well, and I’d have had a cup of coffee and a mug of miso.

    He was getting bigger and less healthy…so now he runs 30-40miles a week and does weights for a 45 minutes twice a week…has lost 40lbs, looks amazing, and still eats the same.

    My sisters and I-all CS babies.
    My husband’s family…all VB, all the way.

    • anion

      How you eat is almost exactly how I eat. :-) 5’2, about 108 lbs.

      Have you ever watched the show “Secret Eaters?” It’s about how many calories people think they take in vs. the amount they actually take in. It’s quite eye-opening. To my recollection they’ve never looked at c-section vs. vaginal birth as a factor, though, so obviously they’re just fooling themselves and the viewers.

      • Dr Kitty

        Never watched it, but I can believe it.

        I’m not going to pretend I have a rule about snacks, or not eating before 5pm or anything, I eat when I’m hungry…but mostly that means I just eat one meal a day.

        Our kid is a weird combination of both of us.
        She’d ideally like to eat 12 tiny snacks a day. Physically she takes after me though.This is a child who thinks a filling dinner is six raisins, half an apple and a mini pitta, and who has to be coaxed to eat a meal, because she’d much rather be doing something else instead of eating.

        • thepragmatist

          That’s me all the way Dr. Kitty. I just do not want to stop and eat. I take my meals leaning against the kitchen counter while preferably cleaning up the mess from the day. The only reason I ever really eat a meal is because my son implores me, as only a sweet three year old can, to “Sit down and God, Mama?”… he wants me to say grace and then once I’m there, I quickly realize I am too damn tired to get up… lol… then I will eat. Sometimes, if I’ve not eaten all day, my kid will shove food at me and say, “EAT MAMA!” It’s so easy to forget to eat in the hustle of my life.

      • KarenJJ

        I was always confused about my weight. I was quite thin but knew that I ate chocolate each day and knew that my diet wasn’t all that much different from other friends who were larger then I was. It makes a lot more sense now that I know that I had an underlying issue. I would’ve been burning up a lot more energy then they were, plus I had regular periods of very low appetite and plus I suspect I had some absorption issues due to the chronic inflammation.

        Now it’s hard because I’m a lot healthier due to the underlying condition being well-managed but I now have a lifetime of poor eating habits to change.

    • The Computer Ate My Nym

      But most likely your husband would feel hungry if he ate what you did whereas, I presume, you don’t. What causes that difference? (Probably not whether you were born by c-section or vaginally.)

      • Dr Kitty

        I know- which why he chose exercise over changing his diet.
        I genuinely think it is largely genetics and habit (your opinion of what is a sensible portion size depends very much on what you grew up eating).

        Breast feeding was weird for me because I was so hungry all the time. Eating lunch became mandatory.

        • The Computer Ate My Nym

          Dieting makes you hungry: your body perceives it as starvation (which it is: if you eat fewer calories than you need to maintain your body weight you’re starving, no matter how intentional it is). Exercise seems to ameliorate the effect and maybe even make you less hungry at baseline. Lower insulin or higher insulin sensitivity, perhaps?

        • Amazed

          “(your opinion of what is a sensible portion size depends very much on what you grew up eating).”

          This. Plus, your taste for this or that is largely cultivated by what you grew up eating.

          Last week, I counted by blessings because I had to take some drops dissolved in hot tea. Had it been hot milk, there’s no way I would have been able to swallow it, even for my health’s benefit. My grandma doesn’t drink milk. My mom doesn’t drink milk. We don’t drink milk. Period. But oh, we’re always ready to eat all pigs’ around shares of corn…

          I attract much notice in the restaurants and shops when I order my meals unseasoned. The reason? My brother was very ill when we were children, so seasoning went out of the window. Forever, it seems. Sometimes, I cook fried meals. That’s it. People think I am making a commendable effort to live healthily. Not at all. It’s just how they got me used to eat in my formative years. Sadly, no success with chocolate or vanilla ice-cream.

      • KarenJJ

        I wonder about hunger too. Being pregnant/breastfeeding made me so hungry all the time that it is hard to wind back after having kids because the memory of feeling hungry all the time is so miserable. I hate feeling hungry and light-headed.

  • ngozi

    I am so sick of people inventing these far-out reasons for being fat. I am overweight myself (I would like to lose about 35 pounds). I’m fat because I got depressed about a miscarriage and started eating like the woman in the picture Dr. Amy used for this story (just substitute a chocolate cake). I haven’t had time to exercise. I can’t blame anyone but myself; not McDonalds, not the neighborhood I live in, nobody.
    Sorry, I don’t mean to offend.

    • RebeccainCanada

      I’m so sorry ((((( hug ))))) I understand. I had a m/c last Oct. it was beyond hard. FWIW, I don’t think anything you said was offensive.

      • ngozi

        I’ve gotten better but still fat because I have always liked to eat. But I have six great children, last one born by c-section because he was dying in my uterus. I don’t mean to dump on people, but “studies” like this just make me furious.

        • RebeccainCanada

          I have a large family too. I felt very thankful for my children, I was very thankful for amazing, compassionate hospital staff. It still was very hard, very painful. Sounds like you’ve been through a lot. I didn’t think you were dumping. You just sounded sensible! :)

  • The Computer Ate My Nym

    I agree. Without data including rate of maternal diabetes (gestational and baseline), maternal BMI, and SES at the least, it’s hard to say whether these data mean anything at all. They might, it’s just not possible to tell.

    Incidentally, call me cynical, but I suspect that the reviewers made them put in the caveats about correlation not proving causation, etc.

    • The Computer Ate My Nym

      Oh, duh, and birth weight.

      • lizzo

        The study didn’t look at birth weight?

        • The Computer Ate My Nym

          If so, it’s not obvious to me, though I admit to skimming the paper only.

          • lizzo

            I was going to ask about neonatal head circumference, but if they didn’t even look at birth weight …

            This is not a good study. And the epigenetics and gut bacteria explanations seem … disingenuous, you know? Like purposefully obtuse.

          • The Computer Ate My Nym

            It’s a meta-analysis and therefore the available data are limited to what the authors of the initial study collected. I am reluctant to draw any conclusions at all with respect to causality based on what they have. (And several reviewers have “yelled” at me for calling causality too, um, casually, so I don’t think I’m excessively cautious.)

  • auntbea

    I’m not entirely sure this is fair. The authors mention several times, including in their conclusion, that they are only capturing correlation and not causation. I mean, I think it’s a little silly to even entertain the possibility that would it would causal, when there is such an obvious non-causal explanation. But academics gotta publish with what they got.

  • AllieFoyle

    Ok, I have to confess that it’s cracking me up a little to look at the cake picture on top and then the sidebar with an ad featuring a product that promises to get rid of cellulite. Can I have the cake and the toned abs? And maybe a c-section too? That’s not too much to ask, is it?

  • AllieFoyle

    I saw an article on this in the NYT Health section: Birth by C-Section May Raise Obesity Risk.

    More garbage-y correlational anti-CS propaganda. I was hoping to see Dr. Amy’s take on it. I don’t think you can even comment on the Times’ piece to point out that the relationship is completely correlational and the attempts at ascribing causality are nothing more than science-fiction/wishful thinking on the authors’ parts.

    The study is meaningless for all the reasons already discussed here, but again, I’m left wondering where the obsession with demonizing c-sections comes from in the first place. You don’t see this kind of focus on other medical procedures. If someone comes up with an alternative treatment for arthritis or heart disease researchers don’t come out of the woodwork with fanciful negative interpretations of correlational studies to keep people from choosing it. There’s a pathological undercurrent in society that doesn’t want women to be able to make choices in their own best interests, that still wants them to be obligatorily subject to the vicissitudes of nature, no matter the cost.

    • fiftyfifty1

      those nasty, nasty artificial women and their nasty artificial births (and that nasty artificial chemical food that they give their babies)

      • anion

        Yep. Those dirty women should pay for letting a man do Those Things to them.

      • rh1985

        My poor baby was conceived artificially, born artificially, and is being fed artificially. I am pretty sure she will grow up to be smarter than whoever did this study.

        • Young CC Prof

          With such a clear-thinking mother, how could she not?

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      It is a bizarre world – and I am at a lost thinking how we really haven’t come that far. Feminism forgot maternity and biological essentialism filled the void :(

      • thepragmatist

        It’s worse than that, in itself. Feminism did not forget biological essentialism– that’s the real crux of it. Mothering became a radical statement for cultural feminists reclaiming their femininity after being told by Second Wave liberal feminists that mothering was a worthless enterprise. Third Wave feminists embraced NCB as a way out of this and I think, there is a degree of rebellion against our mothers, as well, those of us who have feminist mothers who broke glass ceilings. I didn’t even know my mother: she was too busy practicing law and she had to work twice as hard as her male counterparts when I was a girl and faced quite a lot of discrimination. I remember her weeping over me being sick: not because I was sick but because there was no allowance for her to take time off with me. But this denial of mothering began with necessity and I give a lot of credit to the women in my mother’s generation who fought through so much discrimination to enter male-dominated fields. As a daughter, though, I was lost. My mother was lost to me. The most I saw of her was the back of her, shadowed by the lamp in front of her, while she wrote legal briefs and worked her cases long into the night, and if I didn’t sleep, she was angry and enraged. And I vowed to EMBRACE mothering one day. I just wonder how many young feminist women watched this very thing and decided to embrace mothering in a way our liberal feminist mothers COULD NOT. I do not blame my mom at all for this.

        My women’s studies department head (I guess, the equivalent of a “dean”) wrote her doctoral thesis on mothering. There are but a few scholars of feminist thought that address mothering. There is, of course, Adrienne Rich, and Thurer and so on, but it is a burgeoning field. There is a small journal in its nascency devoted to feminist scholarship devoted to mothering. But I find that cultural feminism has taken on mother in large part through the internet and cultural feminism lends itself naturally to biological essentialism: accidentally at times, in the celebration of our bodies and our differences, in a war-cry for our experiences of mothering to be seen as worthwhile, important, even as a form of employment that deserves to be compensated.

        When I was in my BA program almost 15 (!!!) years ago, the natural birthing paradigm seemed like an escape from the horror stories the older women in our class told us. And they were horror stories. One woman sent by plane to deliver elsewhere with her legs tied together; another drugged with twilight sleep; and the younger women having had variously negative experiences, especially with episiotomies that left many of them sexually dysfunctional. But it is like we have stalled in our thought process. For, to me, knowing now that half of our OB/GYNs are women, and knowing what I do about c-sections now, I feel like we’ve made a glorious error as feminists, following the biological essentialism of cultural feminists down the rabbit hole and right into the hands of religious purists and cultists. Because, when I said I was having maternal-request c-section, I should’ve been met with support, instead feminist women I know recoiled in disgust. Indeed, I have a friend who had a hysterectomy and her feminist friends– some teachers at the college, no less– stepped away from her for “allowing” the patriarchy to remove her femininity. There are a score of ridiculous feminist authors who tow this line and are firmly into the woo, and not enough feminists speaking about birth politics from a more pragmatic place. I’m a liberal feminist and that is what I do. I’m much more interested in the legal aspects and the ethics of birthing and mothering. Harm comes from ignoring the financial and social sacrifices and contributions of mothering, and mothers are a disenfranchised class especially in a society that places little value on producing offspring (in fact, we are rather dystopian, my generation), and mothers had very little voice… right up until now, on the Internet, in mommy blogs, in forums, on Facebooks. Suddenly mothers who otherwise had a very little sphere of influence can speak out and reach thousands, tens of thousands, of readers. One of the sites I run has ten thousand readers– that’s a small town newspaper. And I am one of the editor. What we’ve managed is to wrest the control away from the mass media and give voice to women, so now it’s our job to answer those in the feminist movement who confuse biological essentialism with empowerment with our own POVs. Skeptics are great at that.

        The radical cultural feminists (not to be confused with radical feminists who would rather NOT breed and go as far as to see all sex as rape kwim) have the market cornered at the moment. When I’m working on other sites (which is why I keep this persona for here and other fun debate sites), we have to be very careful to tow that culturally accepted line. Because liberal feminism amongst third wave feminists such as myself is seen as a sort of shaming of women who have chosen to stay in the home, and liberal feminist critiques of mothering are harsh, often, toward mothering. Attention is focused primarily on the rights we have yet to obtain or are trying to hold and it is not nearly as attractive as declaring your feminist power in a purely biological way: either by being the mother of the century (something that Second Wave feminists would choke on– my mother sure did when I told her I was staying home with my son) or by embracing your “sexuality” and displaying it as a weapon, almost. There is very little place for a liberal feminist geek like myself there. And in terms of birth politics, there is very little place for reasoned discourse when you run up against such a hard division in the feminist world. You will not bring a feminist like TFB, a radical cultural biological essentialist into the fold, no matter which way you slice it. You must counter her claims. You must do it again and again all over the internet until a more liberal feminism is attained, focused on the nitty gritty of things like informed consent. It doesn’t feel nearly as good as telling the man to shove it, but I will tell you one thing, as a feminist who has done this in a small town, it is even more offensive to the status quo who consider this a post-feminist world, when really we have so far to go to even begin to imagine it so!

        • DaisyGrrl

          I really enjoyed your comment. As a feminist, this part really stood out to me: “…I feel like we’ve made a
          glorious error as feminists, following the biological essentialism of cultural
          feminists down the rabbit hole and right into the hands of religious purists
          and cultists. Because, when I said I was having maternal-request c-section, I
          should’ve been met with support, instead feminist women I know recoiled in
          disgust.”

          So very true. I remember in my courses discussing how it was important to encourage agency among women, even if their choices were different than ours (or especially if they were different). Yet this goes out the window the second anyone talks about childbirth. Natural childbirth and home birth are seen as transgressive, yet the maternal request c-section is truly the transgressive choice among many feminists. It took several months of reading here for me to realize that and see it within my own thoughts on the matter.

  • anh

    am I being crazy if this makes me worry that people are going to start finding ways for their C-section babies to be “compressed” to make up for the lack of a trip through the ole birth canal? I can see chiropractors offering to squeeze babies to simulate the experience

    • SuperGDZ

      already happening

    • Danielle

      I didn’t run across that, but I know at least one blogger suggested that maybe mommies should cotton swab their nether regions and then introduce the microbes to the baby’s gut.

      • Young CC Prof

        Assuming you don’t have GBS or active infection, that’s a FAR better idea than letting a chiro play with your newborn!

      • thepragmatist

        LOL I’ve suggested this. Why can’t this be a treatment for c-section babies? Exactly what would happen? And beyond all that, I don’t know about you, but not to be absolutely revolting, the few days after baby’s birth, the last thing I was thinking about was hand-washing and sterility. I was covered in milk, my own fluids, I could barely stand up and I was nursing around the clock. There is no doubt (to me) that my baby got plenty of my flora. I was careful about allowing family who could’ve been carrying pathogens around my child, but while we nursed through those first days and especially the first two weeks, cleanliness was really just a far off dream. Like, when was I going to shower, again? I think this whole thing is really overblown. I’m pretty sure most moms who have just had a baby aren’t taking obsessive care to be clean. In fact, I would say the opposite is true. I don’t think I had a shower for the first WEEK because I had stitches and I was in hospital. I’m sure babes got lots of me.

  • R T

    Are there really people out there who think their baby is better off dead than alive with a slightly higher risk of being a fat adult? I mean there’s no evidence being born by csection makes you fat, but even if it did, how is being dead better than being fat? This is fat shaming and anti-fat discrimination to the extreme! Good grief!

    • theNormalDistribution

      Considering that there are people who think that their baby being dead is better than being born in the “wrong” way, I wouldn’t be surprised.

    • NoLongerCrunching

      I think they don’t think the babies would be dead; after all, the c-sec was just done for the doctor’s convenience, not because the baby was in trouble.

    • thepragmatist

      Add to NLC: people would rather STARVE THEIR BABIES than give them the dread formula, so yes, I would say so.

  • http://www.antigonos.blogspot.com/ Antigonos CNM

    I was fat before my C/Ss. In fact, looking back now, I probably had GDM. [in 1980, the diagnosis of GDM was made on fasting blood sugar levels, not on a 50 gm GTT at 24-28 wks. My FBS was always normal] Fat women who have babies weighing over 4 kilo [all three of mine] have a 50% chance of developing type 2 diabetes later in life. I’m a statistic — I’ve been diabetic for the past decade.

    Might as well claim my C/Ss caused my diabetes, right? Because, if I hadn’t had my first C/S, I would have died [CPD, failure to progress] and not gone on to develop diabetes. It’s so obvious [sarcasm].

    • Amy M

      I think they are trying to “prove” that C/S causes the BABY to be fat, not the mom.

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        Either way, in my case the “anecdata” proves the study wrong. fat mom, thin kids.

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    Of course the NCB’ers have it ass backwards – if they want to discourage those women who would choose cesareans from having them, they need to appeal to their selfish interests. Don’t tell those moms that their kids will be fat (they obviously don’t care about their kids or they wouldn’t be choosing cesarean in the first place) – you have to tell them that THEY will get fat if they choose cesarean. After all cesarean by choice moms are vain and selfish…

    • theNormalDistribution

      Won’t work. Being fat is miles less awful than peeing yourself when you laugh.

    • Guest

      Mrs.W
      I’m in Alberta and this is somewhat OT, but I’m pg w/twins. My Doc (GP) wants to achieve v@g birth, so he won’t transfer my care completely to an OB. We thought twins meant automatic section in Canada, but he said the only reason he could see a section is if they are both breech. I wasn’t given any say, or asked. I’m seeing the OB soon, what should I be asking? I’m not sure I want to try for v@g birth, I’m too concerned about them. I would rather have fat babies than brain damaged ones.

      • Dr Kitty

        Say exactly what you have said here to your OB.

        VB for twins may be reasonable if baby 1 is cephalic.
        VB for twins is not reasonable if baby 1 is breech.
        VB is not appropriate if you are not comfortable with the risks of breech extraction or podalic version of the second twin (because second twins can change position after delivery of the first twin).
        VB is not appropriate if the babies are positioned in such a way that good continuous monitoring of both babies can be ensured.
        VB is not appropriate if there is a big size discrepancy between the babies, especially if twin 1 is much smaller.

        This might help if you want data.
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252881/

        You might want to change your GP. It doesn’t sound like you are comfort

        • Dr Kitty

          …comfortable with how he is managing your pregnancy.

          • Guest

            Thank you for taking the time to answer. I think you are right.

          • mtbakergirl

            In BC you can see an OB without a referral. I would try just calling local OB practices (ask friends for names?) and switching your care yourself. On the one hand, it would be challenging to switch horses midstream and potentially emotionally difficult if you have a relationship with your GP, but if he/ she is not listening to you now, they are not going to be any better on delivery day.

            In my experience, I really wanted an epidural (pain management is a human right!) and kept getting brushed off by the GPs staffing the maternity clinic I was attending, but liked everything else about the clinic so stayed. Unsurprisingly, there was no epidural forthcoming at my delivery and the nurses were somewhat dishonest about my chances of getting one i.e., wouldn’t say no but kept saying “we will see”. Delivery is tough enough without feeling like your care providers are listening to you.

            In hindsight the writing was on the wall- I will delivering elsewhere if I am lucky enough to have anther :).

            Tl;dr- if your docs aren’t listening now, leave the practice- it won’t improve. I suspect you can self refer to an OB.

          • http://Www.awaitingjuno.blogspot.com/ Mrs. W

            MtBakerGirl – not true – even in BC you need a referral to an OB and cannot just go see one. In Victoria – it’s a real battle and they generally won’t refer to an OB unless your are high risk.

          • mtbakergirl

            Whoops, you are right! I’m not sure how I missed that (possibly my wooish OB nurse friend constantly ranting about how all these low risk women are seeing OBs and should be with midwives- I assumed they were just walking in to the OB office like a MacDonalds :).

            I’m glad I know now, thanks!

            OP-I would still say if you are not comfortable, keep trying to change docs. It won’t get any easier as you go along.

          • thepragmatist

            Ditto. We only have three left here. They are transferring care like crazy to the freaking midwives. And the midwives tell women MRCS is NOT available.

          • Mac Sherbert

            That’s awful!! I’m horrified they are Forcing women to VBAC. Wow. I know we aren’t perfect here in U.S., but I’m so glad I had my pick of OBs willing to do MRCS.

          • Mac Sherbert

            Wait never mind…I read that wrong. Oops.

          • Mac

            I thought twins was high risk?

        • anion

          Dittoing this. I don’t know how it works in Canada, but IMO it might be worth telling the OB that your GP is refusing to discuss c-section with you or allow you the option, and v-birth is a risk you don’t want to take, so what does s/he suggest?

          It’s your body. I’m just a layman, but I personally don’t think you should be forced to deliver vaginally (and possibly end up with a crash section or physical harm anyway) just because your GP has a love-on for vaginal birth.

          (I almost used a cruder phrase in that last line, but I am a lady, after all.)

      • Karen in SC

        You should visit the blogs listed on the right: Awaiting Juno and Cesarian Debate.

      • http://Www.awaitingjuno.blogspot.com/ Mrs. W

        Guest – I’m sorry you are in this position, it is a really terrible spot to be put in. You can email me at qualitycareforbcmothers(at)gmail.com. I would like to echo what the other posters here have said – it does not sound like you are comfortable with how your doctor is handling this pregnancy. I would be asking for a referral to another doctor – and ideally an OB. The approach to maternal request cesarean in Canada is patchwork at best, and unfortunately a little deplorable in some areas – and you most definitely should have a say in your medical care regardless of your pregnancy status. You have a right to informed consent, and also a right to make reasonable decisions regarding your medical care, and many doctors view planned cesarean as a reasonable option. I’d also join the facebook group Cesarean by Choice Awareness Network https://www.facebook.com/#!/groups/403330643071622/ . Another great resource is a book “Choosing Cesarean: A Natural Birthplan” by Pauline McDonaugh-Hull (runs cesarean debate) and Dr. Magnus Murphy.

      • theadequatemother

        I would give this a read: http://www.nejm.org/doi/full/10.1056/NEJMoa1214939 and have a strongly worded discussion with your GP and OB. Maybe bring your partner or someone supportive with you if you have a hard time talking to people who are real and/or perceived authority figures.

        This is the twin birth study. Randomized women at 32-38 weeks carrying twins where twin A was cephalic (head down) to either a trial of labour or a c/s.

        Things to note:

        1) a trial of labour resulted in an unplanned CS 44% of the time. Over 60% of these CS were performed during labour.
        2) whether TOL or CS, there was no difference in neonatal morbidity or mortality or maternal morbidity.
        3) of the women assigned to TOL, 4.2% of them had a combined vaginal/ CS delivery…ie vaginal for the first twin, then a CS for the second. This most likely would have been a very EMERGENT kind of CS due to prolapsed cord, failed breech extraction, abruption etc.

        I would say that if you elect for a TOL (and it SHOULD BE YOUR CHOICE) then you have a high risk of having an urgent or emergent CS during labour and a pretty reasonable risk of having to have both a vaginal delivery AND a CS. 1/25 isn’t that LOW!

      • thepragmatist

        Tell them you want a c-section and that you are concerned about the risks of hypoxia and emergency c-section (which is by far the most dangerous route for you). And if you have a problem presenting your case, do bring someone with you. If that’s an issue with the OB/GYN, then demand they transfer your care. If the OB/GYN says they will do an MRCS make sure s/he books you in. Get a date. Get it charted. If you can’t get a date out of the OB/GYN I’d be very distrustful of a Mrs. W situation arising. A doc who wants to give you an MRCS is going to treat you like a surgical candidate and book your surgery as soon s/he can to assure she’s got time in the OR for you. Mine booked me months in advance, first thing in the AM so we wouldn’t get bumped out of OR for an emergency. She meant business. I’m seeing more of these OB/GYNs leading women to believe they will give them a MRCS (especially now after Dr. Murphy’s book put it out there) and then yanking it at the last minute. This is reprehensible.

        You could try to contact Dr. Murphy personally and get a name of someone to trust. If that is the case, to sidestep your own GP, you can go into a walk-in clinic with that name, claim you have no doc, and ask the walk-in physician to refer you to the OB/GYN.

        The other option is to get yourself a mental health DX but I don’t suggest it, because that’s great way to get social services breathing all over you once baby is here. :(

        The fact I just wrote this post makes me angry.

    • thepragmatist

      LOL!

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    Really this is all about discouraging those who would choose cesareans…after all if it is “needed” then the risk of obesity is okay, but if it is just “wanted” then the mom should suck it up… after all the only thing worse than an unnecessary c-section is an unnecessary fat kid.

  • fiftyfifty1

    Do the stock photo people really think that overweight people eat cake by just opening their mouths wide and gobbling it down without using a fork?

    • Trixie

      That’s definitely how I ate cake when I was pregnant.

      • KarenJJ

        I just made chocolate pavlova so will be doing this later today :) With whipped cream and berries on top. Not even pregnant. Although maybe I will use a spoon. We do have guests coming..

        • anion

          Tell them the meal’s theme is “medieval,” so you’re going to eat the way people did then, and then just shove it in with your fingers.

      • The Computer Ate My Nym

        When I was pregnant I looked at cake and wondered why someone was trying to poison me. Then went and threw up. It wasn’t a fun pregnancy.

        • ngozi

          I sometimes looked at cake and felt angry and cried. And that was even before I developed gestational diabetes.

          • The Computer Ate My Nym

            **Hugs.** Isn’t pregnancy a joy? Especially with everyone and their second cousin telling you that you’re eating too much, eating too little, eating the wrong thing, gaining too much weight, not gaining enough weight, etc?

            I was fat when I started pregnancy. This turned out to be ok because my pregnancy was an object lesson in why starvation leads to infertility: I simply couldn’t eat due to nausea and if I’d been thin to start with it could have been bad.

          • ngozi

            UGH! All of that advice, often unwanted. This is the very reason why with every pregnancy I waited until I showed before I told most people I was pregnant (fortunately I tend to show late). Those kinds of people certainly made me feel like I was just a box carrying a baby.

          • AlisonCummins

            I think of pregnant women as a public service. Advice-giving is one of the most fun activities there is, and pregnant women are the perfect advice-receivers because they can’t run fast.

    • Josephine

      They have it all wrong. Personally as a fat person I just dip my head into a trough of hydrogenated oil and HFCS.

    • auntbea

      I am a healthy weight. This is how I eat cake.

    • ngozi

      I use a fork in each hand. Have to consider manners, you know.

  • Sue

    Idea for complementary study – what percentage of the offspring of obese mothers, who are born vaginally, go on to be obese? There – BIRTH causes obesity!

    • KarenJJ

      Obviously the way to avoid having obese babies would be to not give birth.

    • ngozi

      Excellent point!!!!!!!!!!!!!!!!

    • thepragmatist

      WHAAAAAT? You mean, have some sort of alternative COHORT for COMPARISON? In a STUDY? What is this, science or something? Sue, for shame.

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    obesity is worse than death, y’all! yet another reason to turn down a life saving c-section (totally kidding, if you can’t tell)

  • http://kumquatwriter.wordpress.com/ Kumquatwriter

    I am so sick of demonizing c sections!

    • Jessica S.

      Preach it!!

    • rh1985

      Yeah, I really don’t get the hate. I have nothing to compare it to since it was my only birth, but my c-section wasn’t traumatic or awful. I am still sore but it is less than two weeks later. I don’t feel I missed out on anything. I have an adorable and healthy daughter and that is all that mattered to me.

      • http://www.antigonos.blogspot.com/ Antigonos CNM

        The problem with C/S is almost entirely psychological. Here’s the logic, more or less:

        1]Most women, prior to giving birth, have not been hospitalized, and hospitals are, by definition, places of sickness and death. Therefore, going to a hospital to give birth means that birth must be somehow pathological, which is patently false.

        2] Having an operation to do something which, in nature, does not require surgery, also “pathologizes” a condition [birth] which isn’t illness.

        3] Being in a place of pathology and surgery means that the risk of pathology and surgery are increased automatically by the very nature of being in that place. It’s SO easy to have surgery in a place where surgery is performed! [0% of the patients I've delivered at home had C/S! Q.E.D.]

        4]Since birth isn’t pathologic or an illness the way to prevent the terrible negative effects of hospitalization is to stay the heck out of hospitals. Concomitant to this is the idea that complications won’t happen unless you are in a place which routinely deals with complications. After all, you don’t try to buy vegetables at a butcher, do you? That is the correct place to buy meat. Hospitals are the correct place for complications, which shouldn’t happen since birth isn’t an illness.

        Now, this logic is extremely flawed, not to mention circular, but it is the way some people think. Not everyone is a genius.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      It goes beyond any reason…and is really, really misogynistic.

    • ngozi

      I used to sit and CRY at the very thought of a c-section when I was pregnant. Cry to the point of vomitting! Then I absolutely needed one with my last birth. It was not fun, but it was NOT the nightmare that some groups and people make it out to be. I realize that some women do have c-sections that are an absolute nightmare, but that doesn’t mean every c-section will be a nightmare.

      • Mac Sherbert

        And from some of the posts here it appears that some women have vaginal births that are absolute nightmares. That’s the problem with NCB it can only be one way! Their truth is only truth!

  • Trixie

    Oh I bet the Microbirth people are freakin loving this!

    • Sue

      Yep – a few hours of mechanical force changes those GENES, doncha know? And ”epi-genetic” sounds SO sciencey!

      • Young CC Prof

        epigenetic is kind of like quantum, in that people who have no idea what it means think it can be a magic explanation for all sorts of impossibilities.

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      Anything to demonstrate that birth the way nature intended is better – and that those who choose cesarean are lesser people…

      • KarenJJ

        IF there are potential issues, then that’s great and adds to the whole risk/benefits we go through when making decisions. As long as the potential issues are actually potential issues. This is such a non-issue.

  • Durango

    Even if the data were 100% clear that c-sections always cause obesity, so what? If the baby is in trouble, the baby needs to come out fast. You have to first survive birth before you worry about obesity. This study feels like just another attempt to shame women for failing to have a vaginal birth.

    • Violet EMT

      Better to be alive and destined for a future as an overweight adult than to wind up another intrapartum death statistic.

      • Certified Hamster Midwife

        There are a lot of people who would disagree, and say that people are better off dead than fat.

        • anion

          True. Those people are called “assholes.” :-)

    • Young CC Prof

      Yup. I’ll take a 22% increase in risk of my child being obese in adulthood over an immediate risk of perinatal death.

      If I believed the study, which, you know, I don’t.

      • fiftyfifty1

        Hey, don’t worry about your baby. He may have a 22% greater risk of obesity due to his C-section but remember that the Belarus PROBIT study found that obesity was 17% MORE common in the BREASTFED group. So you can reduce his excess risk down to 5% (22-17=5) by formula feeding him!

        (Wow, after that marvelous piece of science analysis, I think I’m going to declare myself the SOB’s resident stats junkie/guru!)

        • Young CC Prof

          That is an excellent use of percents, better than so many I’ve seen lately. (No, not sarcasm.)

          • KarenJJ

            Oh pfft! What would you know about it? Are you a self-proclaimed stats junkie on a website?

            (and yes, completely sarcastic).

    • http://Www.awaitingjuno.blogspot.com/ Mrs. W

      There are those who choose cesarean – and this demonizes them for doing so with inadequate cause to do so.

  • Renee

    SO DUMB.
    I am sure the NCBers are jumping on this so they can brush off the latest debacle.
    Besides, EVEN IF it was true, so what? Most CS are done for very good reasons. Would you rather a small chance of a chubby adult kid, or no kid at all????
    Once again, their priorities are out of whack.

    • lizzo

      The argument is always that some mysterious/unknown subset of Cs are unnecessary, and if we could just stop doing those (again, no way to know which were necessary and which are not) we could avoid this unnecessary obesity.

      People love (love!) to tell you that you had an unnecessary C. Ask me how I know.

      • Young CC Prof

        One of my friends just “liked” an ICAN post on Facebook about reducing the mythical excess c-sections. This would be the friend who had a c-section for complete previa last year. I admit, I failed to fully contain my rage. (and bafflement.)

        • lizzo

          The only moral C-section is my C-section. Sigh.

    • Are you nuts

      There are some people out there who are so hateful towards overweight people that they would say they’d rather be dead than fat.

      • R T

        ““I’ve always thought Marilyn Monroe looked fabulous, but I’d kill myself if I was that fat…I went to see her clothes in the exhibition, and I wanted to take a tape measure and measure what her hips were. She was very big.” – Elizabeth Hurley

        • anion

          You know, this is OT, but I saw a dress Marilyn Monroe wore once, and she was actually quite small. Her waist was 22-23 inches.

          Her weight fluctuated, so I think that’s where part of he question/myth/whatever comes from, but she was not a big woman even at her heaviest, which was apparently around 140; slightly heavy for a woman her height (she was like 5’4) but still not the hefty load some people claim.

          (Please forgive my use of “hefty load.” It’s for emphasis/illustrative purposes, not because I actually think any woman should be referred to that way.)

        • Trixie
          • thepragmatist

            I really loved that article. I’m a fan.

    • Trixie

      No, they wouldn’t, because NCBers, well the hard-core ones anyway, are eugenicists at heart.

      • thepragmatist

        Arg, they really really are.

    • Josephine

      Considering that my husband comes from large-boned, hearty stock and I’m fat as well as generally sturdily-built, my kids are already doomed, so slice me up.

      Whoops, I forgot to feel guilty, self-loathing, and ashamed.

  • theNormalDistribution

    Oh gawd, that cake looks so good.

    • Meredith

      You filthy c-section baby!

      • theadequatemother

        I was an unassisted precipitous birth, an I think that cake looks really good. Some might argue that the cake to icing ratio isn’t optimal but I would disagree with them. I couldn’t pull off that hairstyle though.

        • theNormalDistribution

          Their argument would be invalid. Clearly it is the best kind of cake, with some kind of chiffon or cream frosting rather than buttercream. The cake is only there to hold it all together.

      • theNormalDistribution

        I’ll have you know that my mother birthed me naturally, thank you very much!

        But I was exclusively breastfed so that’s probably why I’m a fatty cake monster.

        • ngozi

          I was an induced hospital birth (my mother had two previous labors that were both over 50 hours). Maybe this is why the cake in the picture doesn’t look good to me. But I have been known to eat a whole dozen of Krispy Kreme donuts by myself. Maybe the induction did it.

  • Violet EMT

    Neither does being a Weight Watchers member cause one’s children to be obese.

    • Amy Tuteur, MD

      But I bet if you did a study, you’d find that being a member of Weight Watchers increase the risk that your children will be obese.

      • Violet EMT

        Not sure what I’d find if I did a study, but I’m sure that’s what NCBers would find, with their feeble grasp on research methods.

        • Elizabeth A

          Yup. And they’d blame it on gut flora.

          • Sue

            There’s also good evidence that a baby’s gut flora is a moving feast (so to speak) until solids are fully introduced – so those minutes to hours in the birth canal don’t have a lasting effect anyway.

      • Young CC Prof

        I wonder if staying in Weight Watchers for several years reduces the probability that your children will be obese, compared to people who joined Weight Watchers and dropped out within a few weeks. (Assuming that your children were young and living under your roof at the time.)

  • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

    Had a weird thought- how do they do c-sections on people who are very fat and have their stomach hang substantially lower than where the incision usually goes?

    • Awesomemom

      They pull it up and cut away. You just have to be more careful about how it heals and make sure to keep it nice and clean.

      • MJ

        Which is really not all that different from caring for stitches from a vaginal delivery – keep it clean and as dry as possible. I know I made some novel use of my little fan heater!

    • mollyb

      They taped my belly up and made the incision under the skin fold. I had to keep a clean towel over my incision and had to dry it with a hair dryer after showering. There was an increased risk of infection due to the damp environment of the skin fold but I had no problems and healed completely and in record time, according to the surgeon. In fact the only complication I had to my very easy c-section recovery was the allergic reaction I had to the adhesive in the tape they used to pull up my belly.

      • http://safermidwiferyutah.wordpress.com/ Safer Midwifery Utah

        THANK YOU! that is super interesting! I wondered if they would maneuver around the pannus or if they would make a classical incision.

        • Sue

          The supra-pubic incision is quite low (below top of pubic hair), so the abdominal ”fatty apron” mostly hangs over it from above, rather than being attached.

        • R T

          On the VBAC boards the obese women are much more likely to have been given a classical incision. I don’t know why it’s just an observation.

          • mollyb

            My understanding, and I’m not an OB, just someone who did internet research prior to my c-section, is that classical incisions were commonly done on obese women but have fallen out of favor. The exception being if the woman is extremely morbidly obese. I was a size 24 when I had mine and classical incision wasn’t even floated as an option. Happy to be corrected by an actual doctor but that was the gist I got.

          • R T

            That makes sense as many of them had their primary csection many years ago, but it does seem to have been common at some point.

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          Nowadays the classical incision is avoided if at all possible. Less problems. And don’t forget, the way the skin is cut is different from the way the muscles and uterus is cut.

        • AlexisRT

          Studies have shown that a classical incision is more likely to cause problems in the obese than the low transverse incision. (I did some research on incisions before CS #2 because I had had issues.)

          My 2nd CS, the OB did an incision a little higher up to avoid some problems I had had with my first. Not very high, just a couple of cm above the original, which was so low it basically got buried.

      • Josephine

        With me they taped and sort of used some kind of surgical plastic wrap to yoink everything up and contain it, tethering the plastic high up near the surgical drape, IIRC. The little residents were all excited about the lead surgeon’s new plastic wrap technique (not sure what the plastic is actually called, it just was very reminiscent of cling wrap, haha). It worked wonderfully and kept everything out of the way no problem. Like you I had very quick healing time and impressively “nice” incision that healed in no time. You can barely tell I even had surgery two years on.

        I made sure to keep everything nice and dry after showering…I’ve never had issues with that area being damp or sweaty in general anyway, though I’m sure it happens with some people. They didn’t make me feel disgusting or embarrassed at all, which I was very grateful for.

        • Amy M

          Seprafilm?

          • Josephine

            Seems most likely, but I can’t say for sure as I wasn’t entirely privy to what was going on at that point from behind the drape. I just remember that it worked like a charm and I was duly impressed!

    • Gene

      It can be quite technically difficult. Most OBs I know use vast quantities of surgical tape on the pannus (part of abdomen that hangs down) and then lift it back towards the anesthesiologist’s pole/drapes.

    • Ob in OZ

      Carefully. And take NSAIDs as you will be sore after.

    • http://www.antigonos.blogspot.com/ Antigonos CNM

      Tilt the operating table backwards a bit, so the patient’s head is lower than the body, or get an intern to hold the pannus [overhang] out of the way. Surgeons generally aren’t enamored of fat people in any case, but it’s workable.

      • mollyb

        Oooh, I just googled “pannus” as I’ve never heard that term. Apparently, the fatty apron is often mistakenly called a “pannus” but the correct anatomical term is “panniculus”. Thank you, Google MD! I shall open my medical practice shortly.

        • http://www.antigonos.blogspot.com/ Antigonos CNM

          Admittedly my high school Latin is 50 years behind me, but I’d expect “panniculus” to be translated as “little pannus”. :-)). My “whatever” isn’t so small.