Another day, another effort by ImprovingBirth.org to demonize C-sections

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Extra! Extra! Get the latest from ImprovingBirth.org! Are C-sections Damaging Our Children?

I can save you the trouble of reading the piece by giving you the answer:

No, they’re not, but that doesn’t stop the folks at ImprovingBirth.org from trying to convince you that they are.

The release of the largest study of its kind [Cesarean Section and Chronic Immune Disorders] confirms yet again that the Cesarean epidemic in the U.S. deserves more attention, and women deserve better information and options. Evidence continues to emerge that birth by surgery, while sometimes necessary and wanted, is not benign.

Increasingly, researchers are finding relationships between Cesarean birth and babies’ future health. The latest findings come from a mammoth study including two-million full-term births over 35 years in Denmark—showing that children born by Cesarean had “significantly increased risk” of developing certain chronic disorders.

Does ImprovingBirth.org despise C-sections?

Is the Pope Catholic?

And just like anyone committed to free thought needs to take the Pope’s pronouncements on God’s wishes with a grain of salt, anyone committed to scientific evidence needs to take ImprovingBirth.org and Cristen Pascucci’s efforts to demonize C-sections with a whole salt shaker.

Why?

1. Bias

Getting your information about C-section from natural childbirth advocates is like getting your information about solar power from Big Oil. If you think they are going to tell you the truth, and the whole truth, then you are very naive.

2. Motivated reasoning

No doubt the folks at ImprovingBirth.org believe that C-sections are “bad.” And because that is non-negotiable, their reasoning is motivated to support their belief. They promoted papers that support their pre-existing convictions, and ignore everything else that doesn’t.

3. Training

Cristen Pascucci is a public relations executive and board member at ImprovingBirth.org whose claim to understanding the obstetric literature appears to be the fact that a baby transited her vagina.

4. A fundamental misunderstanding of the scientific literature

Just because a scientific paper is published doesn’t make it true. Reading a scientific paper is similar to reading a newspaper article. A Democratic leaning newspaper may have an article with the headline that Obama was born in Hawaii. A radical Republican newspaper may have an article with the headline that Obama was born in Africa. One article is true, the other is not. In science, publication of a paper means that it is worthy of discussion, NOT that the reviewers agreed with its conclusions.

5. A profound belief in the naturalistic fallacy

Pascucci and her natural childbirth cohorts are absolutely sure that if it’s natural, it must be good. That’s why tobacco, heroin and tsunamis are good. Oh … wait. But it is why getting the message to your followers by shouting it is better than using the Internet. Oh … wait I’ve got it! That’s why vaginal births are better than C-sections.

6. A serious misunderstanding of evolution

In a perverse way, natural childbirth advocates are eugenicists. They appear to be convinced that some peoples genes are “better” than other people’s genes. Hence the fatalism when babies die at homebirth that “some babies are meant to die.” Hence the unstated assumption that modern obstetrics must be weakening us in important ways.

7. A serious misunderstanding of chronic diseases of wealth.

Alternative health advocates in general and natural childbirth advocates in particular are desperate to pretend that chronic diseases of wealthy countries are “caused” by failing to follow the ancient wisdom of our ancestors. That’s absurd. Our ancestors died in droves from easily prevented and easily treated diseases. When you prevent those deaths, as modern medicine does, what’s left is chronic diseases of wealth. That doesn’t mean that medical care causes those diseases; it means that you can’t get those diseases unless modern medicine allows you to live long enough to get them.

Moreover, we have no idea of the prevalence in indigenous populations of diseases like Crohn’s or juvenile rheumatoid arthritis or defects of the immune system. We have no way to compare contemporary prevalence of these diseases with their prevalence in societies that lack modern medicine. Therefore, we are reduced to drawing conclusions from studies that trace prevalence over time or between groups within wealthy societies, limiting our ability to determine what modern medicine does or does not cause.

Let’s get back to the original study and see what it actually showed.

Pascucci acknowledges the difference between correlation and causation:

That is, they show a strong association between the presence of these immune diseases and the occurrence of Cesarean birth, but more research is needed to determine whether Cesarean birth is the cause of these problems, or merely an associated event.

Denmark saw an increase in the rate of C-sections from 5% in the 1970s to 20% in 2010. The U.S. saw a similar but even more dramatic rise to over 32% in 2012, according to Centers for Disease Control figures here. This is the same time frame during which we have seen an increase in immune-related disorders in westernized countries. The Danish study suggested this correlation was important, and their data supports that assertion.

Unfortunately, however, she never deconstructs the actual study and, therefore, fails to note it’s most serious flaw. Immune diseases like Crohn’s and juvenile rheumatoid arthritis have a large heritable component. Though the authors of the study took the mother’s history of immune disease into account, they failed to take the FATHER’S history of immune disease into account. Without that, they can’t draw any valid conclusions since it is entirely possible that the difference in the two groups of children is the results of differences in the fathers’ medical history, and NOT the difference in mode of birth.

Pascucci is careful to resist firm conclusions and instead settle for good old fashioned insinuation:

Emerging research points to the microbiome of babies as being a determinant in long-term health and even epigenetic changes [Actually, such research is in its infancy and offers no firm conclusions about anything] …

But this part is my absolute favorite:

At the same time, withholding information from women because we don’t want to cause hurt or guilt is a misplaced effort. It’s a perpetuation of what is truly hurting women and babies today: known but undisclosed risks of procedures like Cesarean section, biased information from care providers …

Excuse me while I pick myself up off the floor where I fell because I was laughing so hard.

Why was I laughing?

In the world of natural childbirth advocacy, informing women of the risks of death in childbirth is known as “fear mongering” and “playing the dead baby card” despite the fact that the statistics quoted are firm, reproducible and based on decades of data.

Obstetricians are bitterly chastised for “playing the dead baby card,” but now ImprovingBirth.org and Pascucci are advising us to play the “immune injured baby card” in the interests of full disclosure.

But they can’t have it both ways. And when we compare the known risks that a particular baby will die in childbirth without a C-section to the highly theoretical, unreproduced and unproven claims of future immunological diseases, C-sections win every time.

The folks at ImprovingBirth.org need to understand that what’s good for the goose is good for the gander. If you are going to condemn “fear mongering” over dead babies, you have no business fear mongering over theoretical risks of C-sections.

  • no longer drinking the koolaid

    The thing that really annoys me about Improving Birth posting these articles is their sham “concern”. The couch these articles in terms of “we agonized about posting this because we don’t want it taken the wrong way, but feel it’s important to post it”. They then proceed to do exactly what they said they wouldn’t which is to fear monger.

  • Joyce

    I am a L&D nurse currently working in a hospital where I have never seen a C/S that was not necessary; a C/S can be a life saving intervention for both mother and baby, and the doctors with whom I currently work perform Caesareans completely appropriately. Having said that, I will acknowledge that there are unnecessary operative deliveries; I used to work in a hospital where the majority of Caesareans were likely uncalled for. So often, the physicians would tell me they had a golf date or a dinner date so, if the patient was not delivered by a set time, they were going to perform a C/S. One physician, tired of waiting for a primigravida who was progressing well, called a STAT C/S for fetal intolerance of labor even though the fetal heart tracing was category I the entire time! He had been told that, unless he called for a STAT, he would not be allowed to bump the scheduled sections and he wanted to go home. One time, a patient was denied a trial of labor because an ultrasound had shown an estimated fetal weight of 9 lbs; the patient was 6 feet tall and the baby was just 8 lbs 3 oz. That patient most likely could have had a vaginal delivery.
    I circulate in Caesarean deliveries often and I am happy to explain to my patients why the Caesarean is called for in their case; it is unfortunate that labor units like the one I used to work in do give the impression that Caesareans are unnecessary, making it more difficult to make the case for a necessary Caesarean.

    • yugaya

      Golf? Really?

      • Joyce

        Really.

    • Neya

      I am so tired of the “doctor had to rush out to play golf” line. In the middle of the winter in New England? Sure! After the end of her shift at 7p? No doubt. With all his doctor buddies who have all come out of work simultaneously? You bet ya! So many people have a cartoonish picture of doctors that must come from a 50’s sitcom…

      • Joyce

        I worked in that hospital for 10 years; it was located right at the edge of an extremely wealthy area, full of golf courses and country clubs and equestrian clubs. If it wasn’t golf it was tennis or squash or a dinner date. Not every OB was like that but there were several who routinely set a time limit for labor so they could make a dinner or sporting date. You don’t have to believe me, but it happened all the time. There were OBs who did sections if a woman’s labor pattern did not follow the Friedman Curve perfectly as well. We had one OB whose C/S rate was close to 100%; the only time his patients didn’t get sectioned was when they delivered before he could get to the hospital. When I moved to a different state and started working where I’ve been for the past 14 years, I was amazed at how few sections we did and how long women were given to labor.

        • Neya

          The golf comment seems to show up in every NCB blog. Maybe your hospital was the exception, but your comment fit into a rather trite narrative.

          • Joyce

            I have heard jokes about physicians having to rush off because of a tee time and I never thought those jokes were based on reality until I worked at that hospital. It was a large teaching hospital in New York City, by the way.

          • Bombshellrisa

            When was this? All the OBs I know hike or are more likely to be found in a kayak then on a golf course

          • Joyce

            Maybe the OBs you know don’t live in the wealthier communities of Long Island, NY.

          • Bombshellrisa

            My docs are from and practice in the most affluent area of the state.I asked when this was because most larger hospitals now have hpspitalists so nobody has to insist that it’s a gold date or a dinner date that makes doctors do c-sections. Also, So many OBs are women now. Sure, women play golf but certainly not as many as men.

          • Roadstergal

            I do play mini golf, but I’ve never rushed an experiment to do it.

          • Guesteleh

            You’d be surprised how retrograde some of the NYC hospitals are. Also, affluent in NYC means mega Wall Street money and the culture around all that is very different than in the PNW.

          • Bombshellrisa

            I am interested in how the culture differs. Around here, the more money you have, the less likely you will be seeking out the services of an OB and delivering in a hospital. Are most of the OBs still male?

          • Joyce

            Indeed. One of our female OBs used to show up for deliveries wearing huge diamonds, including a tennis bracelet in which each diamond was over a carat. She used to explain (after demanding that one of the nurses guard her fur coat) that she wore the diamonds to deliveries because they were a message to her patients that her financial success was an indication of her excellent skills as an OB.

          • Joyce

            And yes, NYC is quite retrograde in many areas. When I left that large teaching hospital in NYC to work at a fairly small community hospital in MN, I was totally blown away to find out that that small community hospital was more state of the art, more up to date in practices, than the teaching hospital in NYC, where episiotomies were still routine, where ALL laboring patients were on strict bedrest, NPO, continuous monitoring, no matter what stage of labor they were in. Patients on Mag Sulfate were ALL on strict bedrest, NPO for days at a time, with vital signs every 15 minutes round the clock, no matter the reason for the Mag.

      • Hannah

        Exactly! So many people have said my birth was scheduled for my doctor’s convenience. Uh, at 6:30am on a Sunday? Sure it was.

        No. Actually, my OB scheduled it then because she couldn’t get an early surgery booking during the week (she waited until I had made my choice about my delivery options so we only booked three weeks out) and she wanted to ensure that I didn’t go too long after my last dose of insulin with GD. So she gave up her Sunday morning in advance to make sure my daughter was delivered safely for her and I.

        She also billed my insurance $4k for an entire year worth of care once you factor in prenatal, surgery, postnatal care and help with some breastfeeding issues I had. My friend was charged $7k for her home birth and her midwife would not have 1/8th of the overhead my OB does. So the profit, profit, profit line don’t fly with me, either.

        My OB took a hit to her stats by giving me the cesarean I wanted. It was medically-indicated but not emergency so any scheduled cesarean impacts her stats. The fact that this is the case is appalling.

        Frankly, I call bullshit on your story, Joyce.

    • lawyer jane

      Yikes, that is awful. I imagine just a relatively small number of these unethical OBs could be responsible for a big percentage of the bump in c-section rates nationwide, not to mention fueling the NCB trend. Why do they feel they have such impunity?

  • Cobalt

    Question:

    There are some situations where c-sections are indicated (elderly obese diabetic preeclamptic primip with stalled labor, twins, macrosamia) to reduce risk and some situations where c-section is the only chance for survival (transverse lie, placenta previa).

    Are there any situations where c-section is contraindicated? For actual immediate medical reasons (not future pregnancies/planning or personal preference or hospital admin stats or QUANTUM arguments)?

    • Amy M

      Maybe if the patient has issues with anesthesia and can’t be anesthetized safely?

      • Haelmoon

        A c-section can be more risky once labour is advanced. Although not an absolute contraindication, it is more difficult and risk to perform once the baby is near delivery. There are still reasons why it may be done. I warn my breech moms, ERCS moms and MRCS moms that if they present in active, advanced labour (think fully and pushing) that it may actually be safer to proceed with vaginal delivery over c-section, inspte of plans for a prelabour c-section. In some ways, the criteria for the c-section need to be stricter because the risk is greater – I am happy to consent them for an elective c-section, but not always for the emergency one if it associated with increased risk (it depends on the situation). I think that lack of patient consent is the only real absolute contrindication.

    • Cobalt

      I know there was one case discussed here where there was pre-viable preterm labor that couldn’t be stopped (don’t remember if they couldn’t stop it or if continued pregnancy itself was expected to be fatal), but c-section was a poor option because of the risks to the sick mother of operating on the uterus in the second trimester.

    • When you are far away from safe, sterile operating facilities. By which I don’t mean “ten miles from the hospital in your living room,” but you’ve time traveled back to 1741 or something.

      • Cobalt

        True, but that’s more of an access problem. I’m looking for a purely medical issue.

      • yugaya

        That scenario indeed happens in places where your OB gives you a list of things to bring to the hospital when you come in to give birth that includes:

        industrial strength disinfectant liquid
        sterile gloves ( 2 pairs)
        surgical thread
        surgical needles
        IV needles and IV solution
        Rhogam shot if you need it
        induction drugs and local anesthetic ( if you can procure them, if not, hope for leftovers from someone who could but ended up not needing them)

        A certain OB once upon a time ought to have added bedsheets to this list, because two days on a bare mattress full of your own and other people’s bodily fluids can give you such a nasty case of skin infection that it will last you a year.

        The reason why that particular OB who wrote that list was hell bent on vaginal birth even against written recommendation for a c-section from a colleague? At the time, the maternity ward had c-sections infection rate of over 30% (probably mostly because vaginal birth meant two days of exposure to friendly mattress microbiome, and a c-section would sentenced you to spend a week rolling in it).

        Country-wide c-section rate that year was 8%.

    • no longer drinking the koolaid

      In preeclampsia it is preferable to induce labor rather than doing a C/S as long as mom and baby are not getting worse. The issue has to do with dropping platelets which makes surgery more risky for excess blood loss due to loss of clotting.
      However, there’s a pretty narrow window and if baby can’t handle the labor, the C/S is needed despite clotting issues.

  • Bugsy

    “3. Training. Cristen Pascucci is a public relations executive and board member at ImprovingBirth.org whose claim to understanding the obstetric literature appears to be the fact that a baby transited her vagina.”

    Bingo. I find the same to be true with lactivists and much of the entire NCB movement generally. Because they’ve had kids and breastfed, they’re the experts in it…and they use specific research claims (i.e.: The Womanly Art of Breastfeeding & Dr. Sears) to back their “expertise.” Research that does not support their claims is simply shunned.

  • Courtney84

    I’ve been waiting for a VBAC post to ask my OT personal question, but since this is about C-sections and the Pope got a mention today seemed like the day.

    I’m 9 weeks pregnant with my second. I conceived at 11 months PP. My first was born via c-section at 40w0d. I was induced at 39+6 for hypertension. 22hrs of induction later I had a C-section for FTP. I’d been at 7cm, -2 station for at least 8hrs. He had a nuchal chord x2. During the course of my induction my BP worsened and I had traces of protein in my urine. I was on magneisum for the majority of my labor (and the 24hrs following delivery). My discharge papers read that I had severe pre-eclampsia.

    I am also heavy with a BMI around 30. I will be 30 years old when the baby is born. I expect I will still by just shy of 5′ 3″.

    We are religious Catholics. We would like to have 3 or 4 children total, and aren’t firmly opposed to more than that.

    Per a recent conversation with my OB nothing about my surgery puts me at increased risk for rupture. She quoted the standard 1%. She also said that she prefers to recommend VBACs to patients who have had a previous vaginal birth or who had their first baby by c-section for breech presentation. Her assessment, based on FTP, no previous vaginal delivery, and my BMI was that I had about a 50% shot of delivering vaginally. She felt that I should definitely consider the VBAC if we wanted 4 children, and maybe consider it if we intended to only have 3. She also advised started the GD diet (I did not have previous GD) to manage my weight gain and the size of the baby, which I have done. Her final note was she had a patient who’d had 8 c-sections that had all gone well, but that it’s not without risk.

    What would you wise commenters advise? I see pros and cons for each option, but not clear answer.

    • Sarah1035

      I’m also a Catholic who thought I’d have 4 maybe more and I’m lucky to be pregnant with my second and likely final child because of some infertility issues and miscarriage. Sometimes our bodies have other plans and missed the big family memo. If you stay a good canidate for VBAC per your doctor and want to give it a shot go for it, but it’d be wrong to endanger this baby or your health for future maybe babies.

      • Courtney84

        I’m sorry to hear that your family plans aren’t working out the way you hoped. I had repeat loss and difficult conceiving prior to my first. I was definitely surprised to turn up pregnant with no effort after the difficulties we’d previously faced.

    • OBPI Mama

      (I am not a medical professional)…If the doc said I was a good candidate then I’d go for it, knowing it might not work out and preparing for a c/s just in case.
      I wanted a large family and am having my 4th C-section (5th baby). I had a severe shoulder dystocia with my first and C-sections are safest for my babies. My doc has handled all the emergencies of multiple C-sections and so I feel like I’m in good hands, but I know my risks increased with this baby. For that reason, this is our last baby, which I am semi-sad about.
      I am also obese and gain very little while pregnant (6-12 lbs with my 2nd through 4th babies) and yet my baby boys are still very large (with no g.d.).

    • Bugsy

      I’ll leave the medical advice to the medical professionals on this board, but just wanted to say that I love your comment: “I expect I will still by just shy of 5′ 3″.” 🙂

    • Cobalt

      I’ve heard here that emergency c-sections, the kind where seconds count, are more difficult and dangerous on larger moms, both from an anesthesia and a mechanics of surgery standpoint. A uterine rupture is that kind of emergency. I don’t have answers, but that’s the kind of questions I would ask if it were me.

      • Courtney84

        This is good stuff. I hadn’t considered this at all. I will ask my OB at my next appointment what her impression is of my weight and body shape/the regarding an emergency surgery.

    • Mother

      I am not a medical professional. My first child was born by c section six years ago because she was breech. As it turns out, she profoundly disabled as a result of a genetic abnormality. Her profound disability has been a nightmare for us, her parents, and for her. It has ripped our lives apart. When I was pregnant with our second child, we choose a repeat c section even though I was an ideal candidate for a vbac. To us, ANY increased risk of damage to our unborn child, in light of our experiences with our first child, was too much. I am currently pregnant with our third child and this child will also be born by repeat c section. First c sections are a hard recovery…two weeks of feeling terrible and barely being able to move. The second c section was a breeze. My sister and cousin have each had three and they both say the third is even easier. I would advise you, as the mother of a profoundly disabled child, to have the repeat c-section. It is just not worth the risk.

      • Courtney84

        I’m so sorry to hear of your daughter’s disability. thank you for sharing your perspective. I do appreciate it.

    • carr528

      Another “not doctor”, but I’ve had four c-sections with no complications. My first two were only 15 months apart, which is why I chose the repeat, but my last two pregnancies had 3 years and 4 years between them, which I think helped in my case. So glad my doctor didn’t scare me away from a 4th pregnancy, since I wouldn’t have my girl! 🙂

    • Mishimoo

      My mother had 3 caesareans – 1 emergency, 2 repeats – without any longterm issues. She did have the scars revised with the 3rd, as there was some room between the emergency scar and the planned scar, and the Ob/Gyn was concerned about how it would hold up in the long run, especially with a 14 month gap between the 2nd and 3rd. I’m also not a medical professional, but I personally would ask for a repeat caesarean if I were in your situation.

    • Judging by what you’ve written AND, IF your pregnancy progresses normally, I think you are a candidate for a VBAC attempt. However, although pre-eclampsia is seen more often in primips, it can recur in subsequent pregnancies. If the estimated weight of the baby is large, and/or you don’t dilate enough within a specific length of time, then C/S is definitely the best option, since you describe yourself as small. Hanging on “forever” in the hope of a vaginal birth isn’t sensible.
      After two C/Ss, I don’t think any responsible OB would recommend trying for a VBAC in a third birth.

      This is the kind of situation where one needs to expect to be flexible, depending on the situation of the moment. If your OB agrees to a trial of labor, go for it — but prepare yourself mentally for the possibility or probability of a repeat C/S.

      I know many women who had 5 C/Ss without incident. The technology is constantly getting better as regards operative technique.

      • Courtney84

        Thanks Antiginos. My OB and I discussed if I developed pre -e again we’d go strait to a section, and I am completely on board with that. I also realize with an estimated 50% chance of success during a TOLAC, I should be prepared to have another surgical delivery.

        I’m glad to hear someone who’s opinion I value doesn’t think I’m nuts for wanting a TOLAC.

        As far as surgical technique improving, I’ve wondered how that effects the evolving statistics for complications of multiple c-sections. I’ve also wondered if newer techniques are decreasing risk of rupture.

        I’ve heard plenty of anecdotes of woman having many (4+) sections without complication, I can’t help but wonder if this is something to put much weight in. My understanding is that you can’t know in advance if the surgery what kind of difficulties might be encountered. Plenty of people have an uneventful homebirth,but they can’t know that will be the case until after the baby is born, (I do not think that having 4+ sections is as risky or foolish as a home birth)

        • Dr Kitty

          My mother had 4 CS between 1982 and 1988 without any issues.

          Her OB told her after her second CS he would tell her, based on thinness of her uterine scar and amount of adhesions, when he felt it would be a good idea to call it a day. He told her to start to be prepared for him to do that after the third, but that some women got more, and the most he’d happily done on one patient was eight.

          My SIL was told she shouldn’t have more babies after her second CS, because her uterus was paper thin. She didn’t listen and had an uneventful 3rd pregnancy and CS six years later…

          A lot depends on you- how you heal, how you scar, how comfortable your OB is with RCS.

          TOLAC sounds like something you want to try, and you’re realistic about your chances of success and planning to do it safely in a hospital, so why not keep an open mind and see how it plays out?

      • Haelmoon

        Regarding VBAC and two c-sections. I would caution against blanket statements (but agree with you if you had two c-sections for failure to descend in the second stage) – each situation is unique. I have recommended VBA2C, but in carefully selected women, mostly those planning large families (I trained in an area with large Amish and Mennonite populations). Each case should be a risk and benefit situation, and if they are similar, then decide by maternal preference. If one is clearly safer, take that choice.
        However, for this particular patient, I agree that if she has spontaneous labour she would be a candidate for TOLAC. I would hesitate to induce of augment because of the 20 month interval. Flexibility is the key – normal sized baby, no hypertension – wait for labour if you want. Marcosomia, post-dates or hypertension, assess the cervix, go for the c-section if it unfavourable and then only with a really favourable cervix try for VBAC, but low threshold to convert and have a c-section.
        I wish you good luck and a safe delivery for this baby!!

    • yugaya

      Listen to your qualified care provider, consult equaly or more qualified care providers for a second opinion, and be prepared to change and adjust your birth plan and decisions as the pregnancy unveils. I’m a practical person so I personally would not be making decisions based on my want of having more children or potential future risks associated with potential future pregnancies, I would limit my concerns to the pregnancy happening right now, but that is me. I wish you all the best with your kid number two!

  • Sarah1035

    Personal question semi on topic. I am 35 yrs old pregnant for the second time, not over weight or any other health concerns. First pregnancy at 32 went well, low risk, SROM at 38 weeks after 4 weeks of daily painfulll BH that never got organized. After my water broke at 5:30 contractions picked up and when I was checked in triage at 6:30 I was already 7cm and delivered at 9:00. I ended up with 3c tears that took FOREVER to heal. I’m left with mild FI. I’ve had full blown urge incontenance the one bout of food poisoning I had, but it’s mainly mild leakage if my stool is at all soft or mucus is present. I’ve always had a bit of IBS, I know what foods to avoid, but sometimes I just want spicy Chinese take out anyways.
    My OB is being wishy washy on if I need a csection or not. She said it would be written up as medically indicated for insurance, but that I can try vaginal again if I want and there is no guarantee one way or the other that I’d rip again like that or not. I’d defiantly take the csection over the recovery from last time and definitely if it will make the FI worse.
    Any thoughts? I’m 23 weeks now so just starting the weigh my options now that I’m showing and things are more definitely happening (long bout of infertility and a miscarriage since first pregnancy)

    • Cobalt

      A vaginal delivery certainly won’t help pelvic floor troubles, unless additional damage will get you insurance justification for repair surgery.

      • Sarah1035

        I’m going to be evaluated after this pregnancy anyways. I was just waiting to be done with childbearing. I’ve made sure to complain in my med record about the FI since it started and was told not to seek repair till I was done with babies.

        • Cobalt

          Hopefully you can get a solid recommendation from a specialist one way or the other and the baby doesn’t require the plan to change.

          Absolute best of luck to you with the pregnancy and getting your repair done quickly and easily.

    • Ash

      Is your OB a pelvic medicine specialist? You could try to get a visit with a pelvic medicine doc if that’s not your OB’s specialty.

      • Sarah1035

        I’m at Health Partners in the twin cities, the OB I saw for the first two appointments is nice enough but she’s like 12 and just finshed her residency last year. I’m encouraged to see other doctors in the office since they do rotations and there is no guarantee who will deliver me, even if it is a scheduled csection.

        • Ash

          U of Minnesota and I’m sure other clinics have MDs that have completed residencies in pelvic floor medicine. If these types of physicians are out of network, you could try asking the clinic’s billing service for their Level 4 New Patient Office Visit (CPT 9204). Make sure you ask for a total quote that includes the professional fee (doctor fee), clinic charges, and facility fee for hospital outpatient departments if applicable. You may not be billed for a level 4, but it’s a reasonable base for determining your fee for 1 office visit without any additional procedures. You could get an office visit for the sole purpose of deciding on prelabor CS vs possibly vaginal delivery.

          If you self-pay, U Minnesota offers 20% off for self pay at the time of service for estimated charges.

          Do you have HealthPartners/CIGNA? It seems they may be in your network

          http://www.umphysicians.org/for-patients/Insurance-and-Financial-Information/index.htm

          • Ash

            FYI I looked up the charge at another academic medical center in another state. A urology new patient office visit at a hospital outpatient department is about $359 on average. This is not the insurance negotiated price–it’s the “cash” price.

          • Sarah1035

            Thanks for the info. I do have Health Partners. I recently moved here from Rochester where I grew up. I’d be more comfortable going back to Mother Mayo (where half my family works in one capacity or another and I used to work too) but unless I change benefits year they’ll be out of network for my plan. Plus the 90 minute drive would be a pain. Mayo had told me unless I started getting ulcerations from the leakage to hold off on treatment till I was for sure done with care. At the time I was also an employee so they didn’t reccomendation imaging studies if I wasn’t going to be treated in part do to cost I’m sure since they self insure.

          • L&DLaura

            I don’t have anything to add, but I had to snicker. I worked for “Mother Mayo” for a short while.

        • MegaMechaMeg

          They sound a bit crunchy on their webpage, but I have a ton of friends who gave birth at the Mother Baby center and they have nothing but glowing things to say about it. I don’t know about pelvic floor specialists, but I have heard that the doctors are fantastic. They might be worth a visit.

    • fiftyfifty1

      I was in a similar situation myself. I consulted both a general pelvic floor specialist as well as a specific anal repair/FI specialist. The fecal specialist was clear that his recommendation was CS, and because I also only wanted 2 kids total that made my choice easy. I remember the fecal doc saying something like “I am a worldwide expert in anal repair, and yet what I can accomplish with the tissue is really limited at best”.

      I went for the CS and all went very well and the recovery was a breeze compared to my vag birth. But if you are planning a larger family, the risk/benefit ratio changes.

      • Sarah1035

        I’ve recently moved to the area so need to look into specialists to see after I deliver. This will be my last one. I already feel like hell and I’m only three years older than last time.

        • fiftyfifty1

          If it’s any comfort, I too hard a hard time adjusting to the physical realities (multiple) after having my first and also felt fairly hellish and just generally very aged. I worried that if I felt that bad after the first, how much worse might it be after 2. And yes, pregnancy #2 was hard. But I was surprised to bounce back much better than I expected after birth and feel fine and energetic now, and yes I crap my pants sometimes, but what of it? It doesn’t slow me down much.My life is happy.

        • rh1985

          If you are done having kids after this one – personally, I’d have the CS in your situation.

    • Hannah

      I am not in the same position but I had a pelvic floor injury and chose a cesarean for my first baby for that reason. I was scared of any more damage beyond what pregnancy and my accident did. If I were in your position, I would be really uncomfortable with a vaginal birth. However, we don’t plan to have any more than 3 children (and the jury is still out on whether I want more than two with how pregnancy treats me).

  • Amy M

    I was looking at the study, and saw this:

    “The prevalence of several diseases among the mothers was significantly

    higher if they had ever delivered by
    cesarean delivery when compared
    with vaginal delivery. Especially
    mothers with type 1 diabetes (27%)
    had an increased risk of cesarean
    delivery compared with motherswithout diabetes type 1 (14%)”

    Wouldn’t that imply that a mother with a pre-existing condition be more likely to deliver by Csection (and that her offspring would be predisposed to the same condition?) Further along, they said they controlled for that, but if so, what does the above excerpt mean?

    Unrelated–the authors of the paper quoted the WHO “recommendation” of 10-15% Csection rate. Evidently they didn’t do their research very well.

    • Young CC Prof

      I read the study, and I’m still not sure. The authors noted a relationship between the presence of some diseases in the mother and the probability of cesarean delivery. (Keep in mind that autoimmune diseases, inflammation, clotting, and high blood sugar can all damage the placenta.) They said they controlled for it, but I didn’t see an explanation as to how.

      They also did not consider genetic contributions from places other than the mother.

  • mostlyclueless

    “In science, publication of a paper means that it is worthy of discussion, NOT that the reviewers agreed with its conclusions.”

    Gotta disagree with you there. I think it DOES mean that the reviewers believe the conclusions, as written in the paper, are justified by the data presented in the paper.

    That doesn’t mean the reviewers aren’t morons though. Lots of reviewers are morons. Sometimes, I’m a reviewer, and sometimes, I’m a moron. Sometimes both of those are at the same time.

    • RKD314

      I agree, as a reviewer I’d never agree that a paper that made unsupported conclusions should be published. I think that Dr. Tuteur is right that just because it’s published doesn’t mean it’s true, but that’s because “supported by the data published in the paper” =/= “true”, necessarily.

  • staceyjw

    I don’t even get the justification for why a VB would be any different from a CS health wise, excluding the actual effects of the birth itself (like brain damage, etc). If something so minor as baby coming out of an incision in the uterus vs out of the uterus via the vagina, makes huge differences, we have MUCH bigger problems to worry about, as m,ugh bigger changes are going on these days.

    I am sure this person is also into food woo, why isn’t she blaming the rise of disease on HFCS or something? I guess that will go onto a different quack website/

  • Roadstergal

    I fully admit, I don’t get it. I have a good friend who is massively into NCB, I have other friends who are less massively into it but still into it, I came to this site partly to understand all of this better and have read all of the NCB commentators to come in here, and my opinion of C-sections is the same as it was when I first heard about it when I was a girl. Damn, that just sounds like such a civilized way to have a baby! The time is scheduled, you do it at a time that’s convenient for you and yours; you go in, and with low-pain or no-pain, your baby pops out without getting stuck or any other weirdness, and you get to hold it right away. No trauma to the vagina or the bits around it, which are bits I really like and enjoy!

    From just yer average non-OB gal, I just still don’t get it, not at all. I mean, I do get that other women have other perspectives and if they say they prefer to have the whole vagina experience, that’s fine, but I simply don’t _get_ why they think a C-section is this horrible tragedy for womankind to be avoided unless _certain death_ is the only other option (and maybe not even then).

    • theNormalDistribution

      I completely agree. My greatest fear in getting pregnant is going into labor too early and not getting my scheduled c-section.

      • Dr Kitty

        Yup.
        I do not want a TOLAC. I do not want a VBAC.
        This one better stay put until it is scheduled to come out!

      • Hannah

        This just happened to a friend. I was horrified and so relieved that I got my scheduled section just in the nick of time (I was contracting 3m apart and had been contracting erratically for weeks but it was not hideously painful yet). My OB thinks another 8-10 hours and I would have been in full blown labour at 38w.

  • Ellen Mary

    OKay, I was looking forward to your analysis, although my first thought was very simply: when the alternative to C is death or damage, even a slight increase in the risk of leukemia is not a big deal compared to the issue at hand. However, why bring the Pope and Atheism (free thought?) into it . . . The Pope has one of the highest educational attainments in Theology available on this planet, so while he might not know the whole truth of God’s will, like a MFM might not know for sure the best course for a pregnant woman, he has a better shot than average at taking a crack at it . . .

    • A

      Did she ready bring atheism into it? I didn’t read it that way, and IIRC Dr. Amy herself is Jewish, so I saw “free thought” as not taking someone else’s word at face value on matters can’t be proved. Then again, my interpretation could be wrong.

      • Ellen Mary

        ‘Free Thought’ and ‘Free Thinker’ is often short hand for Atheism, but maybe not in this case? I more objected to the diss of the Pope.

        • moto_librarian

          Right, but it’s in theology, which relies of “belief” rather than evidence, which makes it pretty similar to NCB dogma.

          • Ellen Mary

            Theology =/= dogma. No one would get a degree in Dogma.

          • Trixie

            But it’s a belief system rather than an evidence-based system.

        • Kq

          Free thought and atheism aren’t synonymous.

          – an atheist

          • Roadstergal

            Exhibit A, Bill Maher.

          • Kq

            I can’t stand Bill Maher anymore. I used to be a huge fan, but between the misogyny and the vaccine rejection (last I saw he was against the flu vaccine because stupid conspiracy reasons) I lost too much respect for him.

          • Roadstergal

            That’s exactly where I am. I used to watch his shows and enjoyed the movie – but the sneaking feeling of ‘This guy’s a bit misogynist’ was growing, and then I came across his vaccine denialism and his alt-med-conspiracy crazy and couldn’t run away fast enough.

            My husband still likes him because he’s a public atheist and anti-Republican. 🙁

          • Hannah

            I must have missed that. How disappointing.

    • Trixie

      Yeah except Theology isn’t science.

      • Mishimoo

        Thank you!!

        I’ve been having a bit of parental drama and that was one of the points of contention. Apparently, I don’t get to have an opinion on my own religion because I am not studying theology and I do not have citations from peer-reviewed and published papers at hand to defend my personal beliefs.

        • Trixie

          Welp, that’s a tough one. Once you leave the realm of facts, it’s all subjective anyway. Of course religions are welcome to set themselves up with whatever heirarchies of authority they want. Depending on your religion, your opinion as a layperson may or may not matter much.

          • Mishimoo

            I’m currently a non-denominational Christian who loves science and doesn’t attend church, with a fundamentalist Pentecostal upbringing. The issue seems to be more that I look at my own beliefs and the basis thereof in a critical manner instead of buying into the biased interpretations that others set forth to further their own agenda. Plus, I refuse to stand idly by when people say “The feminisation of the Church…” as though being female is somehow lesser.

            Edited to add: It’s extra frustrating because when I was growing up, my parents insisted that no theologian could be trusted as they were “all Satanists out to mislead the faithful” and now they’ve done a 180, where only university level achievements are worthy to discuss a subject, and everyone else must be lead by their wisdom. Not coincidentally, they’re both separately studying theology with a view to going into ministry. (They’re divorcing)

    • Mel

      Because the inverse is also true. Neil DeGrasse Tyson is an extremely intelligent and well-spoken atheist. As such, most Catholics will take his views on theism with a grain of salt. He’s also an amazing astrophysicist. When speaking on astrophysical subjects, people would be looking for a different type of bias – one based on a tendency to promote a certain model of astrophysics versus another model.

      To reverse it again, my mom trained in theology under a highly accomplished (and with more published theological works) Catholic theologian. I would trust either of their view points on, say, the nature of the Trinity. I don’t think, however, that either of them would be the best resources on atheism.

      Doc A’s comment is about BIAS, not intellectual accomplishments.

      On a note about the Pope, his understanding of the truth of God’s Will is also limited by situation. He’s charged with guiding the entirety of the Catholic Church and IMHO has been doing a pretty good job of it. I suspect, though, that if I asked him what God’s Will for my personal life is he’d direct me to listen to God myself.

      • Ellen Mary

        Thx for the thoughtful response . . . My comment just meant sorta that invoking the Pope & all that entails sorta detracts from what Improving Birth is up to . . . Certainly they aren’t nearly the job shepherding their flock.

        As a minor point though, NGT doesn’t actually align himself squarely with the atheist camp . . . He has expressed a bit of perplexity that they claim him so often . . .

  • lawyer jane
    • lawyer jane

      and omg in tears! so glad that baby is ok, and feel so sad for the mom. but what honesty on her part. I hope she forgives herself.

      • A

        It’s great that everything turned out alright at the end, but I feel sorry for how that mother is traumatised about her birth (who wouldn’t be, after almost ending up with a dead baby?). She’s a really brave lady. After homebirths with the same outcome, we’ve seen many other mothers patting themselves in the back because no one died. Few are as honest as this woman and as willing to look back and evaluate her own mistakes. I appreciate that a lot.
        I wish she eventually stops feeling guilty about it – it’s not her fault, she was misinformed about the risks and tricked into it by the homebirth industry.

        • OBPI Mama

          I’m impressed it only took a year for her to process and be honest with herself! It took me 3-1/2 years-ish… it’s hard to wade through denial and start being honest.

          • MLE

            But as far as I can tell, this was a year without all the medical stuff that you and your son went through (I think?). I am impressed with her clarity, but it might have been easier for her to focus.

    • The Bofa on the Sofa

      So there were a lot of things I was about to quote here for posterity, but then I hit this line and it’s game over:

      The first thing that was said, “There is no heartbeat, I don’t hear a heartbeat.” Then the next thing was, “Listen HARDER!”

      There are no words to respond to that.

      • MLE

        Right? You can think yourself out of interventions if you think hard enough, and you can hear life into someone if you hear hard enough.

      • NatashaO

        even better than listen harder is to tightly strap an oxygen mask to a baby who has no heartbeat and is not breathing, cause that works. see, homebirth midwives are experts in resuscitation and carry life saving oxygen. who needs NRP or intrusive medical equiment?

        • D/

          On the mother’s actual blog (in the “But I didn’t” pic #4) it looks like the MW is delivering chest compressions without the face mask in place. I’d be willing to bet if ventilations were being delivered that mouth-to-mouth was used.

          Evidently it is in no way uncommon for home birth MWs to use m2m rather than a bag and mask device as their ventilation method of choice even after completing a popular home birth-specific NRP course (which includes m2m instruction) … primarily because it is “easier, more efficient, and safer”. This is according to a prominent CPM involved in midwifery education (international conference speaker and textbook author).

          It completely boggles my mind to think of PAID “professionals” in attendance at births, in developed countries choosing mouth-to-MOUTH in their primary resuscitation plan of a neonate … completely.

          • RNMomma

            Well, since they aren’t actually medical professionals it is much safer. A lot less chance of blowing a pneumo with m2m.

            But a real trained medical professional would absolutely prefer an ambu bag and mask. And knowing how to use those things properly, they would be much more safe and efficient and handled with ease. Then again, maybe that’s because real trained medical professionals hold drills on a regular basis in order to fine tune their skills.

          • Samantha06

            I love the Neopuff, but of course, those aren’t available at home births.. not that the “birth attendants” would have a clue how to use one…

        • Mer

          I saw that O2 mask on baby and it took me a minute to figure what bothered me about that, and then I realized. They should be using a BAG! You use a bag to assist a compromised newborn so they don’t have to work as hard and that I know that and midwives don’t just infuriates me. I’m not involved with labor and delivery and I only get to do basic normal pregnancy prenatal visits, I should NOT know more this stuff than so called professionals of “normal birth”.

      • Dr Kitty

        Don’t forget that nobody called an ambulance during the 8 minutes the baby was stuck, but waited until he was a minute old and clearly not breathing.
        The time to call an ambulance in SD is as soon as you realise it is happening.
        If all is well, the paramedics see a cute baby and go about their business, if all is not well you have at least two extra pairs of hands, more oxygen and more people trained in resuscitation to help, or scoop and run.

    • Trixie

      This mom is amazing. I’m so proud of her for speaking out.

      • rational adult

        I agree. She is brave. I’ve read her story twice now. It is so clear and so heart wrenching. The pictures of her baby just after delivery and in the NICU look so much like my son did. Except of course I don’t have pictures of my son right after delivery because the pediatrician whisked him upstairs asap with my husband trailing behind. But I will never forget the glimpse I got of a still and quiet baby.

    • Mel

      The original posting by the photographer is shocking in the level of her hubris.

      Declaring that the photos she showed the mom were “just what she needed” for the placenta to come out is bat-shit crazy.

    • Trixie

      They’re reporting her pictures for nudity, now. Funny how that didn’t happen when it was the photographer’s narrative.

      • The Bofa on the Sofa

        Who is “they”? And reporting to whom? Popsugar isn’t a social media page with private content or a blog on a public server, is it? It appears like it is it’s own company that is in full control of what it publishes.

        • Young CC Prof

          I think “they” are reporting on Facebook, which is where it’s being shared.

          • The Bofa on the Sofa

            OK, anything I guess to shut her up. You can always tell when you’ve hit too close to the target.

          • Samantha06

            Yep.

        • Trixie

          Facebook users are reporting the article for nudity in an attempt to get it taken down.

      • MLE

        That’s outrageous. Once again, take note potential home birthing mothers. This is what will happen to you if something goes wrong and you don’t toe the line…

    • Ash

      Who is the woman with the turtle scrub top, LONG NAILS, and COSTUME JEWELRY! Was that a midwife or a midwife’s assistant? My goodness, you could NEVER put gloves over those nails and that jewelry, but she’s assisting in clamping and handing off equipment. Gloves to the wrist only in the pool, no gloves when handing baby to mom nor during resuscitation. If you look at the Mom to Five blog, you see pairs of bare hands stained with blood. Women deserve true professionals to attend their labor, not these clowns! :0

      • D/

        Be-jeweled, bangled and ungloved … just a “professional” variation of normal.

  • Mel

    There’s are FOUR huge flaws in NCBer’s understanding of evolution.

    FIRST: Maternal-fetal survival is controlled by many, many factors so you cannot pretend it will act like single-gene selection.

    In single-gene selection, people with two copies of a problem allele die before reproducing. This drives the frequency of that gene in the population to a very low frequency and so eventually most people will have no or one copy of the gene. (This alone shouldn’t be comforting. The problematic gene copy will stay in the population and unfortunate homozygotes will still appear….which could be you.)

    For maternal-fetal survival, there are probably at least thousands of genes with millions of alleles involved and environmental factors, too.

    Best support for my argument: Women and babies still die in childbirth. If birth success was a single gene trait, the number of deaths would be tied to the rate of mutation or around 1 death per million women.

    SECOND:Selection pressures are 99.99999% of the time a NEGATIVE force – not a positive one. Women aren’t designed/selected/evolved to give birth.

    Evolution selects AGAINST women and babies who cannot survive the birthing process. Those women and babies die. The remaining population is “good enough for now”.

    THIRD: One healthy birth does not promise the next birth will end well. In other words, “good enough for now” changes per pregnancy.

    Example: Each baby is a mixture of genes.

    Let’s look at “Mom”:

    Baby One (girl) had a mixture of genes from Mom and Pop that kept her fairly small and triggered labor at 38 weeks and so fit through Mom’s slightly narrowed pelvis. Everyone is fine.

    Baby Two (girl) has a mixture of genes that kept her fairly small, but triggered labor at 42 weeks. Baby Two is 1.1 pounds larger than Baby One and couldn’t get lined up correctly to fit through the pelvis for nearly 48 hours. Baby Two died intrapartum, but Mom survived.

    Baby Three (boy) mixture of genes caused him to be larger than both his sisters and trigger labor at 41 weeks. Baby Three died intrapartum and was unable to be expelled through the pelvis. Mother died from hemorrhaging due to the inability of the uterus to contract after the placenta detached since the Baby Three was in the way.

    FOUR: Genes act in concert and often have more than one role. In the previous case, the set of genes that kept Baby One small and allowed her to survive birth – those will also cause her to have her Mother’s slightly narrowed pelvis. Whether or not BABY ONE survives giving birth will depend on the interaction of her partner’s genes with hers.

    I research evolution for a living. I DON”T TRUST IT AT ALL.

    • Young CC Prof

      Lots and lots of people fall into the trap of thinking that natural selection produces perfection. Nope, it produces systems that work well enough often enough to perpetuate the species, unless conditions change. Guess what, I don’t want to be selected against.

      • just me

        Actually it is just random gene mutations, some of which work better in the current circumstances and thus get perpetuated and some of which don’t and therefore are not perpetuated since the offspring with such genes die off. It’s not tilted towards either perpetuation of a species or not. It just is. I hate when I read articles about for example how bacteria mutate to avoid antibiotic effectiveness as though it was on purpose. They just mutate which results in some bacteria that due to the mutation are not killed by that particular antibiotic.

        • Roadstergal

          Exactly – it’s stochastic, and dynamic. Things happen, those things that work (by a very limited and harsh/cruel/natural definition) with current conditions perpetuate, those things that don’t, don’t.

          I like to turn the eugenic argument on its head. By allowing greater genetic diversity in a population via medical interventions, we increase our ability to survive a catastrophic event that might tank a more genetically homogenous population. Yes, it’s BSy, but less BSy than NCB eugenecism.

          • Cobalt

            That’s some truly beautiful BS, though. I love it.

          • Young CC Prof

            I recently read a science-fiction short story about that. All the genetically enhanced people with optimum genes were incapacitated by a new disease, the non-enhanced guy with non-optimum genes was resistant.

  • A

    Duh, blaming c-sections for everything is so last year! Why don’t we start blaming other stuff… Let’s see… Okay, what about mobile phones? What, they already did that one here http://www.skepticalob.com/2013/09/sanctimommy-alert-dnt-txt-n-breastfeed.html? Argh, we’re just going to have to stick to c-sections for now.
    I guess, in NCB world:
    You didn’t do your homework ==> Student: “I’m sorry, teacher, but, you see, my mother didn’t love at all and had a c-section only to save my life and then fed me formula so she could go back to work, only to avoid losing our home! Therefore, I’m now so stupid that I can’t figure out how to do the work you sent”.
    “OH YOU POOR THING! No one should have to endure what you went through! Don’t worry, we are going to put you in the special, c-section kids class right away!”

  • Amy M

    Here’s another thing they can’t have both ways:

    “Stress hormone induction (cortisol) is lower in cesarean birthed babes, which may affect immune system maturation. 1”

    Many of these people believe that crying for 5 minutes causes brain damage due to high cortisol levels, so they should be jumping at the chance to have Csections, so their babies’ cortisol levels are lower. Or maybe they should let their babies CIO, so their immune systems are more mature? Which causes more long-term harm do you think- a Csection or CIO?

    (I don’t believe either of these causes long term harm, this is tongue-in-cheek)

    • Dinolindor

      Slightly OT: My otherwise mostly helpful LC told me that bottle fed babies have more cortisol in their system while being fed than breast fed babies – the easier bottle freaks them out or something something something. But if that’s part of the breastfeeding woo, this could help inform the “pumping doesn’t count” crap.

      (Side note: Even if that is true, she was helping me figure out how to exclusively pump because latching was not happening. Not exactly helping with the huge dose of guilt I already felt for breastfeeding not “coming naturally.” I eventually came to my senses and realized this was not working for us and switched to formula. It’s amazing how much more I enjoyed my baby after I made that switch, and I don’t think it’s just because he was 3 months old by then.)

  • Elizabeth A

    My daughter’s case of sniffles, and my case of breast cancer, were both equally caused by the c-section when she was born, although no one discussed these risks with me at the time.

    That’s because no doctor ever, so far as I know, has had a serious conversation that begins with “If you don’t do what we suggest, there is a x% chance that you or your baby will die in the short term. On the other hand, allowing us to save your life today will expose both of you to all the unknowable risks inherent in living the rest of your lives.”