Melissa Cheyney admits home VBAC has a horrific mortality rate

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Surprise!

Attempted vaginal birth after Cesarean (VBAC) at home has a horrific mortality rate.

That’s what Melissa Cheyney, CPM and promoter of home VBAC was forced to acknowledge in a new paper in the Lamaze “journal” Birth: Issues in Perinatal Care. The paper is Planned Home VBAC in the United States, 2004–2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making.

Cheyney and colleagues analyzed the MANA Statistics, a self-reported survey of homebirth midwives in which only 25% of eligible midwives participated.

The perinatal mortality rate is more than 300% higher than hospital VBAC.

Cheyney reports two confirmed cases of uterine rupture and 2 additional cases of suspected uterine rupture for a uterine rupture rate of 3.8/1000.

Cheyney acknowledges:

Given the high proportion of women in our study with a prior vaginal birth and/or a prior VBAC, we expected the rate of uterine rupture to be low. The recent Agency for Healthcare Research and Quality VBAC systematic review described pooled relative risks of uterine rupture of 0.26–0.62 for women with prior vaginal delivery and 0.52 for women with a prior VBAC.

So the rupture rate at home was 630% (7.3X) higher than in the hospital.

Of those 4 ruptures, 50% of the babies died.

Overall, the attempted VBAC group had a perinatal mortality mortality rate of 4.74/1000 compared to a mortality rate of 1.24/1000 in women who had not had a previous C-section (and compared to a perinatal mortality rate of 0.4/1000 at low risk hospital birth).

Cheyney notes:

Compared with the overall rate of combined intrapartum stillbirth at term and neonatal death (1.1/1,000) in Landon et al multicenter study of women who attempted an in-hospital TOLAC, there is some evidence that TOLAC in out-of-hospital settings demonstrates increased fetal/neonatal risk.

Indeed, the death rate at home VBAC was 330% higher than for hospital VBAC.

Why did these babies die?

This is expected in a setting where decision-to-cesarean delivery time in the event of a uterine rupture is presumably greater than the 18- to 30-minute interval at which evidence suggests neonatal risk increases.

In other words, they died because their mothers chose to give birth at home, far from lifesaving medical technology and personnel.

Who could have seen that coming?

Certainly not homebirth midwives and homebirth advocates who have promoted home VBAC (HBAC) as an ideal way to avoid a repeat C-section in the hospital. They rail against obstetricians who “play the dead baby card” and routinely discount the increased risk of perinatal mortality.

For example, Jen Kamel of VBACFacts participated in an Interested Parties Meeting held by the Medical Board of California that discussed, among other things, whether CPMs should attend VBACs to support her contention that home VBACs are safe.

Kamel insists that only 6% of uterine ruptures are catastrophic and quotes a perinatal death rate of 1.3/1000 at hospital VBAC.

According to Kamel:

What determines if a baby dies or has brain damage? Some research on infant cord blood gases has suggested that if the baby isn’t delivered (almost always by CS) within 16 – 17 minutes of a uterine rupture, there can be serious brain damage or death to baby…

Kamel, like most homebirth advocates, likes to take hospital safety statistics and pretend that they apply at home. As Cheyney’s data (which almost certainly undercounts the real risk of home VBAC) demonstrates, hospital statistics don’t apply at home for a very simple reason. The lifesaving technology and personnel that MUST be available to achieve those statistics are not available at home.

The bottom line is that home VBAC is dangerous.

The rate of uterine rupture is more than 600% higher than hospital VBAC.

The rate of catastrophic outcome is 8X higher than hospital VBAC.

The perinatal mortality rate is more than 300% higher than hospital VBAC.

When will we see homebirth advocates acknowledge these figures? When will MANA (Midwives Alliance of North America) begin counseling women about the dramatically increased risk of home VBAC? When will Jen Kamel and others like her change her woefully erroneous statistics?

I’m not holding my breath.

Home VBAC is dangerous, but I predict that the industry that profits from home VBAC won’t reveal that information to American women any time soon.

  • Faith

    There are variables involved. VBAC after 1 section risk is very low and VBAC after 2 C sections is only slightly increased. There are some women that are having VBACS after three and four C-sections and that is a lot higher of a risk of rupture than after one or two. This article doesn’t say whether they are lumping all VBACS together or not, regardless of how many sections each patient in the study has had. That’s an important variable. I would like to see a study of home VBAC after one or two sections done separate from VBACs after 3 or 4 sections. Not all VBACs have the same risk. I’m not biased against hospitals by any means. I had my first VBAC after 1 previous C section 6 months ago in the hospital. I’m prefer the hospital than home because the OR and the NICU are right there and waiting if any problems arise. However, I’m not totally against VBACS at home depending on the history of the patient. I feel like these statistics are a bit skewed if they are lumping low and high VBAC risk patients all together and then saying how dangerous it is. Someone who has had 4 sections is going to have a lot higher risk for potential bad outcomes than someone who has had only c section.

    • Daleth

      You’re totally right than someone with 3 or 4 prior CS is at higher risk, but is it really reasonable to call a risk that’s between 1/200 and 1/150 a “low” risk? One in two hundred? That’s the risk for good VBAC candidates with one prior CS. Diabetes is about as common as that in the US, and it’s considered so common it’s a public health emergency.

      Remember that almost 4 million babies are born in the US every year. If even 1/10 of them are born to moms with prior c-sections (and the number is probably higher given the c-section rate in the US), that’s 400,000 babies a year. If all those women have VBACs, that means at least 2000 women will have uterine ruptures (actually it would be far more because 1/200 is the rate for good VBAC candidates; it’s much higher for women who aren’t good candidates).

      Even in the hospital, 1 in every 12 babies will die–so that’s 167 dead babies who would be alive if mom had had a repeat c-section. Not to mention a few dead moms and almost 2000 more moms whose future fertility is likely destroyed–ruptures often require emergency hysterectomies, and even when they don’t pregnancy on a previously ruptured uterus is very risky.

      And don’t forget that about 2% of births take place at home or in birth centers, and a uterine rupture outside the hospital is a death sentence for the baby (because the only way to save the baby’s life during a uterine rupture is to do a c-section immediately). So, 2% of 400,000 is 8000. Of those 8000 out-of-hospital births, 1/200 (in other words, 40 women) will have uterine ruptures and their babies will die.

      So now we’re talking over 200 dead babies who would have lived if their moms had chosen repeat cesareans instead of VBAC.

      Try picturing 200+ tiny coffins–a funeral almost every day, and none of these funerals had to happen; these were perfectly healthy babies until the rupture happened–and then get back to me about how the risk is very low.

      • Wren

        A risk of less than 1%? As long as the risk is explained, it’s entirely up to the woman in question.
        Not every woman who has had a section will have the same risk, and that is why some are advised against a VBAC, even if they have only had one C-section. I don’t know every country and every hospital’s rules, but where I had mine there was no question of being at home (well, I guess they couldn’t have forced me into the hospital, but the NHS would have risked me out of home birth) or in the midwife-led unit on the hospital site. The only option was the OB-led unit, where a C-section would be available.
        C-section does increase the risk to the mother. It’s a small increase, but one that any woman has the right to know about before making the decision.

        • Daleth

          I agree, as long as the risk is explained it’s up to the mom. The problem of course is that the risk of HBAC is pretty much never explained by HBAC providers.

          • Wren

            Oh, no way wold I support HBAC. VBAC in a hospital though, that’s potentially an acceptable risk.

          • yugaya

            It’s not the risks, it’s the deadly consequences of those risks if you are at home.According to this paper , the two ruptures that resulted in death were with babies being delivered 30 and 35 minutes after signs of distress. That is too late and confirms that if you HBAC and rupture at home your baby will die. The two ruptures that resulted in babies surviving were to women who transferred to hospital but not because their awesome MANA midwives used their special powers and detected UR – one was transferred for failure to progress, one for pain relief, luckily in time.

          • Daleth

            Yes. There is a big difference between “a 0.5% or 1/200 risk of uterine rupture” (hospital VBAC) and “a 0.5% or 1/200 risk that your baby will die” (HBAC).

          • yugaya

            Yes – four ruptures in this study, two babies survived, those are the two babies that were born in the hospital via CS after HBAC transfer that was unrelated to rupture. Their signs of rupture were detected in the hospital.

            Two moms that ruptured during HBAC and where the rupture was first noticed at home were the ones who lost their babies. Uterine rupture during HBAC is a death sentence for the baby.

    • yugaya

      If there was such a significantly bigger number of women with three or more previous CS that made the rupture rates in this study as bad as they are then MANA needed to address that, state that ” Not all VBACs have the same risk” and say out loud that HBAC after three or more CS is extremely dangerous.

      But MANA refuses to acknowledge that because that would lead to clear and defined risking out criteria and limited ethical scope of practice regulation.

      I think you are right that HBAMC will have worse outcomes, but they luckily make up the tiniest portion of MANA’s market and if their outcomes “skewed” these statistics in any way it is because MANA allowed and encouraged such unacceptably dangerous births to be attended by its midwives.

  • moto_librarian

    A friend should be celebrating her son’s fourth birthday today. He died as the result of a HBAC attempt. It didn’t matter that the CNM transferred at the first sign of a problem. It was already too late. Melissa Cheyney, Jen Kamel, and the rest of their ilk made it seem that HBAC was a relatively safe decision for my friend, and she paid the ultimate price. Not that you will be able to read about what happened to her son on ICAN, VBACFacts, or any other NCB echo chamber. The stark reality of what happens when things go wrong can’t be acknowledged lest it make some other mama rethink her decision to give birth at home.

    Melissa and Jen have blood on their hands. Don’t ever stop reminding them of it, Dr. Amy.

    • Daleth

      I’m so, so sorry for your friend. And so so sorry for her son.

    • Cobalt

      And that’s why the SOB matters.

      I’m so sorry.

    • JellyCat

      I’m sorry for your friend’s loss.

  • Dr Kitty

    Thanks for all the good wishes guys!
    We’re doing great.
    Just 25g under birth weight (up 75g in 48hrs) feeding well, sleeping well and big sister is totally smitten with him.
    Kiddo #1 goes back to school tomorrow, so today has been an interesting challenge of multi-tasking while breast feeding: turns out you can feed a baby and make a packed lunch or label school uniform simultaneously!

    Things are definitely easier second time around.

    • seekingbalance

      Congratulations!!! Thanks for adding your positive cesarean experiences–not enough of those being shared on most (other) forums, as we all who follow and admire this blog know! But my experience–especially the second c/s delivery and recovery–was much like yours. Quite healing and peaceful, in fact. Everything is *so* much easier the second time around….

    • I often tell patients, when they ask for advice about parenting tips, that the only advice needed is to have child # 3 first.

      • sdsures

        LOL

    • Allie P

      Second child first is TOTALLY the way to go. Mine is almost two months, and she’s feeding better, sleeping better, crying less — I have no idea how i lucked out.

    • Medwife

      Congrats, Dr Kitty 🙂 it seems like things SHOULD be easier the second time around, when a newborn isn’t a scary alien being (cute, but totally mysterious!).

    • demodocus

      I should send my bard your comment. He’s anxious that a potential second child will be so much harder than having 1.
      Glad things are going well!

    • Ceridwen

      Congratulations! I’m so glad everything went well!

      Hoping things go as smoothly for us. #2 is hopefully making his appearance via scheduled induction in 3 weeks. His big sister is getting quite excited, though I don’t think she understands what she’s in for.

    • sdsures

      That’s great! Mazels!

    • sdsures

      “turns out you can feed a baby and make a packed lunch or label school uniform simultaneously!”

      Oooh, care to share the secret?

    • Tiffany Aching

      Congrats ! Hope everything went well for kiddo #1’s first day back to school.

  • Medwife

    Well… No 🙂 the hga1c is a measure of blood glucose levels on average over the last 6-8 weeks. Gestational diabetes usually develops late in the second trimester. Hga1c is not a good diagnostic test for GDM.

    I also had/have severe nausea and vomiting in both of my pregnancies and had to take my tests twice each time because I puked up the glucola. Ultimately passed. I heard myself telling so many patients that you can have GDM and have zero or very few risk factors and still have the disease, and decided to take my own advice.

    • JellyCat

      According to the new clinical guidelines used in Canada HbA1c is an acceptable test for gestational diabetes. It is done at 25 weeks and it covers the last three month.

  • ca3799

    This woman describes her attempted VBAC with uterine rupture in a hospital setting. In the comments, there are several commentators who describe their rupture and loss as well.
    https://www.youtube.com/watch?v=DbM3vR2IX2Q

    • yentavegan

      Am I wrong to assume things would have progressed differently if this mother had been in the United States? I have never heard of sending a mother with uterine bleeding home if her last delivery was a c/section.

      • Medwife

        Well, that was horrific. She had classic signs of abruption and/or rupture for a long time before everything crashed. I didnt realize the UK had a tendency to be quite so stingy about ultrasounds. There’s a lot of things that I hope would have been handled very, very, very differently anywhere else.

        • sdsures

          Part of the problem, not just in L&D, is a lack of assertiveness on the part of patients. Happens all over the world, unfortunately.

          What are the risks of an ultrasound? None.

    • Daleth

      Maybe I’m just unusually risk averse, but I cannot FATHOM why anyone would want to attempt a VBAC when even for the best candidates (just one prior CS, low transverse incision) there is a 1/200 chance of this happening. And if it does happen, you then have–in the lowest-risk environment, namely a hospital L&D ward–about a 1/12 chance of your baby dying as a result. Wtf wtf wtf?!?! Not to mention the risk of emergency hysterectomy, hemorrhage, destruction of your future fertility…

      What is so magical about vaginal birth, or so horrific about a 30-minute operation done while you’re wide awake (namely a c-section), that it makes risking this seem worthwhile? I do realize that a lot of women want VBACs… but with the exception of women who know they want tons of kids and are thus looking long-term at the risks of 6-8+ c-sections, I just genuinely don’t understand why.

      • sdsures

        Beats me. I’m in the UK.

        Maybe I’m unusually private person, but I can’t fathom making a “labour and delivery” video at all. Video the crap out of the baby once it’s born, to remember and share the joy…but the rest? What for?

      • disqus_e9doORxc9t

        More recent data sets suggest the risk is 0.2%
        (I have attached the publicly available reference)
        https://www.npeu.ox.ac.uk/ukoss/news/31-uterine-rupture-is-rarer-than-previously-thought?highlight=YToxOntpOjA7czo5OiJjYWVzYXJlYW4iO30=

        • Daleth

          I’d like to see the study that article is talking about, because it sounds small (“researchers compared outcomes for the uterine rupture cases with those
          for a control group of 448 women giving birth after previously having had a caesarean section”) and the article is written in a really slanted way:

          – It gives ridiculous statistics like “uterine rupture occurs in just 2 in 10,000 pregnancies in the UK – confirming that this is a rare complication.” Um, who cares? That statistic is utterly meaningless to women trying to decide how to birth. Stating this statistic makes it sound like it’s a freakish lightning-bolt event, not something to worry about.

          – Also about that statistic, it says, “There were 159 cases of uterine rupture in the 13 months between 1 April 2009 and 30 April 2010. In that time there are estimated to have been around 800,000 births in the UK, giving an estimated incidence of uterine rupture of 2 per 10,000 pregnancies.”

          Wait, what? They didn’t even ACTUALLY COUNT how many births there were in that time period? Why not? What the hell numbers were they looking at? They probably estimated the number of cesareans too!

          – Oh by the way, they mention offhand way down at the bottom of the article that of those 159 ruptures, “Two women with uterine rupture died and there were 18 deaths among the babies that were associated with the uterine rupture event.” Associated with? No, caused by. And that’s actually a lot, considering that in the UK most likely all the ruptures occurred in a hospital, since women attempting VBACs are risked out of home birth. That’s, what, a 12% death rate for the babies (about 50% higher than the hospital VBAC death rate in the US)? HORRIBLE! And a 1.25% death rate for the MOMS?!?!? GOOD GOD!!!

          • Roadstergal

            “since women attempting VBACs are risked out of home birth”

            Except that they’re not. The VBAC sub-study in the Birthplace study had enough HBACs to show a shocking death rate, about 1/100.

          • AA

            Actually, you can do a TOLAC attended by a MW in the UK. If a patient absolutely refuses to go to a hospital, the NHS is obligated to provide midwifery care, even if all HCPs strenuously emphasize that it’s a bad idea. And you can also hire a private MW. private one to one midwives ( a company) reported supporting a HBA3c (quite willingly)

          • Daleth

            Thanks for that clarification. How many women are going to “absolutely refuse” to go to a hospital, though? Particularly when the midwife explains why home birth is a bad idea with VBAC? That’s likely a tiny, tiny minority, so I wouldn’t expect it to have an appreciable impact on the statistics.

          • AA

            Yep, it is rare. However, given the focus on “normal birth” in the UK midwives’ organizations, it’s hard to believe that the average TOLAC at home has been vehemently counseled against it by their healthcare providers.

            https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-assess-maternal-fitness-for-home-birth

            VBAC is not in the “not suitable” category.

          • Daleth

            That’s a fair point.
            I’m glad to see VBAC is in the not suitable category.

          • AA

            No, vbac is NOT in the “not suitable category.” It’s in the “identifiable risk” category

          • Roadstergal

            Yeah, the VBAC spinoff paper from the Birthplace study showed HBAC death rates at home to be 1/100, and then said in the Discussion basically that was generally a low risk and women shouldn’t be bothered by it. It was a vomit-worthy bit of writing.

          • Daleth

            Omg how horrifying. BTW do you have a link for that? I’d love to share it with a particular friend of mine.

          • AA
          • Roadstergal

            That’s the one. You have to dig into the paper itself to find the death rate – they buried it by making some composite endpoints to make home look better. Much as they did in the Birthplace study overall.

            I don’t know how it’s ethically admissible to a: not have a prespecified primary endpoint of perinatal mortality and b: not report that regardless.

          • Roadstergal

            “Particularly when the midwife explains why home birth is a bad idea with VBAC?”

            Yeah, except they don’t. My UK friend had friends who had HBACs, which were supported by their midwives, and she had midwife support.

            I don’t know what convinced her to do it in the hospital after all – it certainly wasn’t the midwives – but I’m glad she did, because she had some damage and the boy spent a week in the NICU. I don’t think he would have survived at home.

          • Daleth

            Omg. So glad your friend and her son dodged the bullet. How awful that midwives support HBAC!

      • Faith

        The ACOG ( American College of Obstetrics ) recommends a trial of labor after 1 or 2 c sections. This article seems overly slanted. I had a VBAC just 6 months ago and know many others who have had VBACs. According to the ACOG the risk is low. After one previous c section , the risk isn’t much higher in a woman who hasn’t had a section. And yes, you can rupture even if you haven’t had a section before. In order to be more accurate articles need to include things like Pitocin or no Pitocin, Induction or no Induction, Epidural or no Epidural, and 1 or 2 sections versus a VBAC after 3 or 4 sections. These all effect outcomes. C sections have risks also. You have to look at the risks and benefits of VBAC versus C-section, and then see if the benefits of a VBAC outweigh the risks or vice versa.

        • Faith

          My Ob was well known for attending VBACS, and one the things he likes to stay away from was Pitocin. Even when he uses it on VBAC patient he tries to keep it at a low dose.

        • Daleth

          Not sure where you got the idea that uterine rupture risk is only slightly higher after 1 c-section than it is in women with no prior c-sections. It’s like 90 times higher–between 1 in 200 and 1/150 with one prior c-section vs. 1/15,000 with no prior uterine surgeries. (Oh, and the risk is closer to 1/8 for women whose one prior section used a classical incision instead of a low transverse one.)

          I would not be surprised if some natural childbirth pro-VBAC website is touting falsely optimistic statistics by glomming together women who got uterine scars from something other than a c-section (for example, fibroid surgery) and women with no prior uterine surgeries. If you group those women together, there is going to be a much higher rupture rate than the 1/15,000 rate that women with no uterine scars have. If you then compare that group to women with one prior c-section, that will make it look like VBAC isn’t dramatically more dangerous than regular vaginal birth.

          But you should never group those women together–not if you’re interested in accurate statistics or honest risk assessment–because women with fibroid and other uterine surgeries have crazy-high rupture rates and are generally not VBAC candidates at all. Two friends of mine who had fibroid surgery were told they could never deliver vaginally but would have to schedule pre-labor c-sections for any future childbirths.

          • Faith

            I got my data from the American College of Obstetrics Recommendations/Guidelines for women with one or two prior sections. According to the ACOG, VBAC should be offered to women with 1 or 2 previous C-sections with a low transverse scar. There is slight increase in risk of rupture but to say it’s a dramatic increase is an exaggeration. If it was such a dramatic increase , I doubt the ACOG would have revised its guidelines in 2010. I’m not a natural birth hippy by the way. I’m pro hospital. I’m a nurse and I am more comfortable with a hospital setting. My view is pro hospital but low intervention unless a medical need arises. I’m not overly biased to one side or the other. I had my VBAC in the hospital ,I asked for a heparin lock just in case;and was fine with continuous fetal monitoring; and Pitocin IV post birth to decrease bleeding. I had an epidural and Pitocin free labor. I walked and stayed in the tub . However I did consent to stadol to help me rest between contractions.

          • Faith

            It really comes down to what’s best for each individual patient and their previous medical history. Benefits vs risks are going to be different for each patient.

          • The Bofa on the Sofa

            It really comes down to what’s best for each individual patient and
            their previous medical history. Benefits vs risks are going to be
            different for each patient.

            If it “really comes down to what’s best for each individual patient,” why are telling us about ACOG recommendations, which are complete generalizations

          • Wren

            To be fair, we do tend to rely on professional bodies’ recommendations and apply those individually to patient decisions, don’t we?

          • Daleth

            ACOG recommendations are not the same thing as actual data about the statistics on uterine rupture. I’m not quarreling with what ACOG recommends at all. I’m saying that recommendations and statistics are two different things and you haven’t yet even said what you think the statistics are, much less why you think that (i.e. where you got that information).

            Where did you get STATISTICS showing that UR is only somewhat more common in moms with prior c-sections than it is in moms with unscarred uteruses? Do you have any such statistics? Please post the statistics and the links.

      • Wren

        I had a VBAC with my second. My C-section was a non-repeating reason (he turned to footling breech at term, discovered when I went into labour and my water had broken). I went into labour on my own at 39 weeks with my second and it was confirmed she was head down. It was pretty much an ideal VBAC situation.
        I didn’t have the easiest recovery from my C-section, despite not having done a whole lot on the labour side (no pushing and the section happened before I was fully dilated). I didn’t really want that again with a newborn and a toddler to care for.

      • Amanda Harper

        I attempted VBAC the result was rupture, EmerCS and a stillborn son. I specifically asked my OB about the risk of UR, he said, and I quote “There’s a 1% chance of UR but that won’t happen to you.”

        I wish I had had access to the internet back then and been able to research for myself rather than trusting in my doctor.

        • Sarah

          Sorry for your loss Amanda. And thank you for telling us about your beautiful boy, he deserves to be remembered.

        • Daleth

          Oh, I’m so, so sorry.

  • Gatita

    OT: Saw this blog post on my FB feed and it made me crazy. The basic message: give up your entire life so you can breastfeed. No effort is too much. Low supply is a myth and if you can’t fix it, it’s your fault for not staying in bed all day doing nothing but nursing.

    http://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/low-milk-supply-101

    • Young CC Prof

      I don’t like the way she downplays feeding behavior. Unhappiness when nursing is not necessarily a sign of low supply, but it’s not something to ignore, either. Maybe feeding physically hurts your baby, maybe the baby has severe reflux, and these problems also need to be looked into.

    • KeeperOfTheBooks

      Ugh. That one’s been shared on a number of blogs I read, and it drives me mad. The assumption that you’re a Bad Mom if you can’t just lie there and nurse for weeks…what the hell?
      When I recently pointed out that most parents in the US have atrocious parental leave, and that most dads aren’t able to just take weeks off every time mom has a baby (and even if they do have the vacation time, do you really think you’ll have better-quality family time if you never go anywhere or do anything if mom has a baby that year?), I got told that if a dad can’t take the time off to do the Right Thing by taking care of the house and kids while his wife is lying in bed and nursing for weeks, then he has his priorities wrong.
      Perhaps I’m completely crazy here, but I thought that my DH’s priorities of “keep my family fed, housed, and insured” were pretty darn good ones…
      Don’t get me wrong: I think that parental leave should be mandatorily offered, and I think that we treat postpartum women horribly in this country. I think that we could make a LOT of changes in the way things happen postpartum for both parents. However, my thinking so won’t make it so, and thus in the meantime DH and I do the best we can. If that includes my needing to take care of a toddler and not nurse a newborn if doing so requires a month of lying in bed, so be it. That’s not a possibility for us. Speaking strictly from a biological/evolutionary perspective, I can’t imagine it was necessary for a majority of nursing women through history, either.

      • Young CC Prof

        “Speaking strictly from a biological/evolutionary perspective, I can’t imagine it was necessary for a majority of nursing women through history, either.”

        Well, an awful lot of human cultures do have the tradition of secluding new mothers for 30-40 days. Partly that was because 100% natural childbirth results in a lot of bleeding and/or tearing sometimes, but partly for the baby too.

        Of course, after the lying-in, the baby would be passed off to a grandmother or sibling most of the time, and often supplemented with porridge or something, because the work of a healthy young woman was too valuable to be lost for long.

        But yeah, the family’s financial stability is more important than breastfeeding. Breastfeeding studies even prove it, the effect of SES on the child’s outcomes is far larger than that of breastfeeding.

        • The Bofa on the Sofa

          I’ve pointed this out before. The fact that you have to control for so damn many big confounders in breastfeeding studies in order to isolate the benefits of breastfeeding is a pretty good indication that breastfeeding in itself is a pretty minor issue compared to everything else.

      • Kelly

        I have been a stay at home mom for my second child and I had the help to lay around and breastfeed and it still did not fix my problems. While my problems were not low supply, I could not fix my other problems and I was still going crazy. My Mom cooked, took care of the older child, and cleaned for two weeks. The help did not help with breastfeeding. I am not saying that it would not help other people who have different problems than I do, but even having all of that support could not get me to a satisfying breastfeeding relationship. Maybe, just maybe they need to just realize that it does not always work and the needs of the FAMILY need to be first, not the way that one child is fed.

      • Cobalt

        “The assumption that you’re a Bad Mom if you can’t just lie there and nurse for weeks…what the hell?”

        It’s an awful assumption, and its so pervasive on breastfeeding help sites. It ruins the actual good, helpful advice by wrapping it in unexamined judgement.

        There’s plenty of tips on ways to increase supply or dealing with various struggles, but never any mention of how to come to the decision if dealing with those struggles is worthwhile for the benefit.

        Yes, you might make breastfeeding work if you spend 16 hours a day just working on breastfeeding, but should you? Is it really going to be best for your family? No one asks or even vaguely approaches that question. That omission is oppressive.

        • KeeperOfTheBooks

          And the assumption is always and without exception that breastfeeding must be the best for your family, so you’d better do whatever it takes to accomplish it.

    • KeeperOfTheBooks

      Also, “Most people who genuinely have low milk supply got themselves into a pickle with using artificial nipples or not breastfeeding enough or breastfeeding ineffectively.” Wow, blaming, much?

      • Sarah

        I dunno, I’ve got exceedingly low supply because I didn’t breastfeed at all, ignored my milk when it came in, then it went away. Hey presto, zero supply. Wouldn’t define it as a ‘pickle’ personally, though.

    • Angharad

      These people are always so sure that bottlefed babies can’t stop sucking on whatever’s in their mouth, and I always wonder if they’ve ever met a bottlefed baby. Mine had zero problem unlatching from the bottle, stopping sucking, or spitting out the nipple.

      • KeeperOfTheBooks

        I got told off by a LLL leader once for saying that my DD did that all the time. I was informed that she was a LLL leader, so As A Leader, she was telling me that babies can’t stop sucking on a bottle once they started. Oh, okay, then. Guess I just imagined DD doing exactly that…*snort*

        • Kelly

          Both of mine did too. When they felt full, they stopped. It was not that hard for them to figure out. I don’t know how a breastfed baby would automatically be better at knowing when they are full than a bottle fed baby.

          • fiftyfifty1

            “I don’t know how a breastfed baby would automatically be better at knowing when they are full than a bottle fed baby.”

            Oh this is another way that lactivists like to have it both ways. They claim the reason a breastfed baby stops sucking is because breasts have natural portion control built into them. When the milk is gone, voila, the baby stops sucking….But then there are the cases where mom tells the lactation consultant that she is not making enough milk, that the baby empties the breasts, but is still hungry. Then the LC looks at her pityingly and says “Don’t you know that breasts are not like bottles? They can never ‘run out’. There is always more milk there because they are continuously producing.”

          • JellyCat

            Or, it might be that baby is choking at the breast due to oversupply or overproduction issue.

          • araikwao

            Ohmygosh yes! I had trouble BF my first, and remember crying my eyes out as she would cough and gag, getting totally drowned by the gush! It was horrible, but fortunately she got a bit bigger and learned to cope. With my son, the only way I could get him to take a bottle was by using a fast-flow teat (supposedly for older babies) to mimic the onslaught he was used to. (and that was after spending a stupid amount of money on a Medela bottle that was supposed to be good for breastfed babies. It was not for mine!)

          • Kelly

            That is so ridiculous. I pumped and I had a great supply but when I was out I was out. You would have to wait a certain amount of time to get milk to come out. They are starving these children. I felt bad my second did not get enough food for two days. After I made her eat longer, she woke up and was a vicious shark baby that has never stopped being hungry.

          • Faith

            That’s true when it comes to pumping but a baby can actually get more out than a pump can.

          • Kelly

            I know that some people don’t respond to a pump and so there is a difference in the amount they pump and the amount that a baby can get out but when you are talking about getting 20 oz at a time, I really don’t think that a baby would be getting much more after that. When I was done, I would still have to wait a few hours to get milk out.

          • AirPlant

            But… even if that were true, that doesn’t mean that the breast contains the correct serving for the baby! If the mother has over supply and an active letdown wouldn’t that be the firehose effect but from a breast? Just like they say is an inevitablity from the bottle? It seriously defies all logic. It almost feels as if they, as a group, have decided to just make things up supporting their argument that breastfeeding is superior in every way and has no downsides but that couldn’t be the case, right?

          • KeeperOfTheBooks

            The claim is that a baby a) is somehow incapable of turning their head away rather than continuing to swallow if a nipple is dripping milk into their mouths and b) gets milk too fast from a bottle, rather than the slower pace of the breast. Which again, seems to me like it must vary from woman to woman, depending on the type of letdown they have: some women have overactive letdowns, with milk spraying like a fire hose, which would suggest that others have underactive letdowns, where the milk just doesn’t come out at any reasonable speed.

          • Cobalt

            I 1) have faster flowing breasts than any bottle I’ve ever come across and 2) have seen any extra flow leak right out of the baby’s mouth whether the milk is from breast or bottle.

            Babies may be born ignorant, but they’re not stupid.

          • AirPlant

            But I thought it was a logistical impossibility for breastmilk to pool in the mouth…

          • Cobalt

            My babies were all highly illogical.

          • sdsures

            *picturing Leonard Nimoy as Mr Spock*

          • Ceridwen

            Indeed. My daughter refused bottles initially because the flow was too *slow* relative to my breasts and she was getting pissed off at it taking too much work to get the milk. Bumped her to the next faster nipple (the horror!) and she was perfectly content (and it never remotely made her refuse my breast).

          • Kelly

            Both of my children needed different nipples. My oldest needed a fast flow. She had the same problems on my breast as she did with the slow flow nipples. My second needed a slow flow and had a hard time with a sippy because she has a strong suck. Both of them could turn their head away even when it was drowning them. They must think that if you are bottle feeding, your child is completely stupid and can’t figure things out.

        • Cobalt

          My nearly exclusively bottle fed baby could not only stop sucking on the bottle when full, but could pull it out and chuck it at you as though insulted he was not given the perfectly correct amount.

          Sigh.

          I blame the vaccines.

          • KeeperOfTheBooks

            Probably. That, or you didn’t wear him enough. Or something. 😀

          • Cobalt

            If you wear your baby WHILE they are getting vaccinated, does it modify your babywearing achievements badge?

            Asking for a friend… 😉

          • KeeperOfTheBooks

            Depends. If it’s a Baby Bjorn, you’re probably a horrible person anyway, so does it matter? If it’s a $750 custom-made Tula (or whatever the current fad brand is), then the babywearing may almost make up for vaxxing. Almost.

        • Daleth

          Had she ever MET a baby?

          My twins were slightly premature and even in the NICU when they had near-zero muscle strength and were only eating like 23ml at a time, they would STOP EATING when they were done. As I’m sure you know, bottles don’t come in 23ml sizes–they come in 60ml and my babies would drink 19 or 23 or whatever ml, and then just stop…. regardless of the fact that there was a nearly upside down bottle in their mouth with another 35-40ml pressing down on the nipple.

      • fiftyfifty1

        Yes, they are idiots. They should spend even an hour in the hospital nursery feeding the babies. I have fed many, many babies and have never met one that couldn’t stop sucking and spit out the nipple.

        But of course lactivists are not interested in listening to the facts. Because the facts might conflict with the horror stories that they like to use to manipulate women: A baby feeding at a bottle literally cannot stop eating! It’s like what they do in France to the geese to make Foie Gras!! Your baby with be obese, OBESE I say!!!

        • Kelly

          But it is ok to constantly nurse to not only feed a baby but for comfort. If I ever did that with a bottle, they would be at my throat. They love a double standard.

          • AirPlant

            I read a blogger once who claimed that it was literally impossible to over feed a breastfed baby. I am still trying to work that one out it my head.

          • KeeperOfTheBooks

            They must’ve never met my goddaughter. The kid would literally nurse so much she’d vomit it back up, and then go back to eat again. She just adored eating above, well, almost anything else. Unsurprisingly, her mother got a bit fed up with this and started exclusively pumping, giving her a reasonable amount in a bottle, and then distracting her post-meal with a fun toy or something.

          • Sarah

            Conversely, mine have never had any problems refusing the bottle when they’ve had enough. Perhaps they are unusually stroppy children.

          • Generally speaking, babies do stop eating when full. But, especially if the breast is used as a pacifier, they can be taught to overeat.

          • Young CC Prof

            My baby was constantly ravenous as a newborn and would eat until he puked it all back up.

            We measured his bottles very carefully for a while, trying to get in enough that he would actually sleep for a couple hours without overfilling his belly.

          • Was your baby by any chance small-for-dates or IUGR? They are sometimes so eager to make up for the lost period of inadequate nutrition in utero that that happens. In any case, I never say never. Another of my [ahem!] pearls of wisdom is that just when you’ve figured out your baby’s needs and schedule, he’ll change completely.

            The important thing, I think, is the ability of the mother or parent to be flexible. ANY sort of “one size fits all” in parenting is bound to be problematic, and I think this is a major problem with the fanatic NCB/lactivist crowd.

          • Young CC Prof

            My baby was in fact IUGR: not quite 5 pounds at 37 weeks. He was a bit sleepy until his due date, then woke up all the way and turned into the hungry caterpillar baby. In a single month, he moved two standard deviations on the growth chart, turned from an alarmingly skinny baby into a properly padded one, and basically caught up in size.

            He’s still intense about meals even as a toddler, but that raptor-style hunger did calm down once he gained a normal fat reserve.

          • sdsures

            I’m trying to lose a bit of weight by eating more sensible amounts (plus exercise), and I find it takes about 20 mins after you’re done eating to actually feel full. Is it similar with babies?

          • KeeperOfTheBooks

            If so, so’s mine. 😉

          • sdsures

            I’ll try to remember that!

          • sdsures

            Their poor tummies!

          • I immediately know when the mother of a breastfed baby is opposed to the use of a pacifier. The baby, all too often, is obese, from the endless dribble of milk he gets from using Mom as a dummy (in more senses than one). Not infrequently, he is also anemic-looking, since such mothers often delay solids, and do not supplement the breast milk with either iron or vitamin D drops.

          • Allie P

            Neither of my kids would take a paci. I tried! They’re no fools. No milk, no suck. I definitely used (and use) my breast to comfort them because the occasional drop of milk was enough to keep them working at it and quiet. And they are both in 90% percentile height, 50% weight. I’s just their body type.

            Though I’m with you on the weird delayed solids thing going hand in hand with lactivism crazy. People take the saying “food before one just for fun” as if it’s the gospel truth. I’ve even seen some offer NO food before one. I started my daughter at six months and she took to it like a fish to water.

            It’s all part of this weird idea like, if breastmilk is good, then MORE breastmilk must be even better. At a certain point, there are diminishing returns.

          • Kelly

            I was wondering about that in breastfeeding children. No one seems to have a problem with it when breastfeeding but they do with bottle feeding. I was waiting to get burned by my comment since I know that a lot of people do it.

          • sdsures

            Guess fathers are never allowed to feed their kid, eh?

      • Allie P

        My baby will spit out any nipple: real, bottle, or paci, if she isn’t interested and she’s only 7 weeks. Also, if she’s hungry, she’ll suck on anything that will provide milk, no matter the size or shape. No nipple confusion at all.

      • demodocus

        Mine would keep sucking, on my boob. sigh.

    • Faith

      You don’t have to give up your life to breastfeed. I work 40 hour 7:30 to 4pm work week and only pump twice a day.

      • Fallow

        Congrats; you’re lucky in a thousand ways that tons of women are not. But keep on citing your sample size of one.

        Wait, you’re the person who called Dr Amy a “raging liberal” like it was an insult. If it wasn’t supposed to be an insult, you could have fooled me.

        • Faith

          My comment just now was about being able to breastfeed and still have a balanced life. Your last comment is irrelevant to this discussion. Thankyou

      • Megan

        When I dropped to pumpin twice a day my supply dropped in half. There’s my sample size of one.

        • Faith

          My supply always drops too as my babies have gotten older and I go back to work.Pumping twice gives her something , which is better than nothing though. I don’t have the time to pump a ton. She gets about half breast milk and half Similac everyday.

          • Daleth

            Uh, ok, but it sounds like you would still have to give up your life to breastfeed if you wanted to breastfeed exclusively, instead of doing half boob/half formula.

          • Faith

            Well yeah , I mean to only breastfeed and no bottles you would have to be a stay at home mom, which is what my mom pretty much did. We never had a drop of formula and she only left us every now and then for a few hours and would leave a bottle or two of breast milk. I actually would love to be a stay at home mom , I just can’t do it.

          • Wren

            So….you don’t have to give up your life to breastfeed, but you pretty much do to exclusively breastfeed?
            Actually, sample size of one again, my sister managed to never use formula and breastfed my nephew until he was 2 despite going back to work before he was 3 months old. Her trick? Working somewhere with good access to pumping, both in terms of time and space.

  • areawomanpdx

    Agree. I’ve had two cesareans, one emergency and one planned. The recovery from the planned one was easy peasy, but even the recovery from the first one wasn’t bad at all.

  • Dr Kitty

    OT:
    Got home with my baby 48hrs post CS. We’re now day 4.
    So far recovery has been very, very easy: I was doing laundry and we went to the supermarket yesterday!
    I have had pretty heinous afterpains when feeding, but those seem to be settling, thankfully only last for 30 minutes at a time, and I got some fast acting opioid analgesia to take if I needed, so it has all been perfectly manageable.

    Baby is the most chilled out little guy, he’s lost 100g since birth, but as my milk has come in and he’s feeding for 25min every 2-4 hours, I’m not concerned. We’re currently sitting out on the deck behind the house, getting a little sunshine. My husband and daughter took the baby downstairs for a couple of hours this morning (he slept while they played video games) so I’ve even caught up on a little sleep.

    I know that a CS was what I wanted, and it isn’t for everyone, but really the idea that it’s going to be a dreadful experience with a terrible recovery seems to be the only narrative that is out there, and obviously it isn’t necessarily true.

    • KeeperOfTheBooks

      I wasn’t quite to the level you describe at 4 days PP (here, you have the option of staying at the hospital for 4 days after a CS, and believe me I took them up on it 😉 ) but I will say it was nowhere near as bad as I’d heard, and I’ve made a point of telling other moms that my experience was tiring, yes, and I had a fair bit of pain about 48 hours later (ie, when the IV drugs wore off but I hadn’t taken any oral meds yet), but nothing a Vicodin didn’t take care of, and I didn’t even need to fill the Vicodin prescription when going home, though of course many women do need it and should have it.
      One of my PP nurses said that in her experience, a really skilled surgeon (ie, like mine) has patients who recover better and faster afterwards. I’m not sure if that’s true, but she had far more experience than I in the matter, so I’ll take her word for it. Perhaps, for lack of a better term (not a medical person here) an excellent/more practiced surgeon doesn’t have to mess around quite as much in there? Who knows. *shrug* Either way, mine was overall a thoroughly pleasant experience, and one I wouldn’t mind repeating.

      • Erin

        Very small sample size but I wondered if the longer you take to get up etc, the harder recovery is because all the women on my ward plus friends who have sections stayed in bed for as long as possible in hospital and complained of insane pain, gas problems and constipation. Whereas I was on my feet within around 4 hours and only went back to bed because they told me if I ripped my stitches open I wouldn’t get any pain relief whilst they sewed it back up and I thought that might not be a pleasant experience.
        However 24 hours afterwards I was wandering around the hospital (baby in neonatal unit at opposite side of hospital) in pain but definitely not in agony (compared to my son smashing his head into my spine it was absolutely fine), didn’t take pain relief much at all and on my release from hospital on day 4, would have been sooner from a physical perspective but apparently they don’t like letting suicidal people leave, we went to Costco and apart from the part where I thought pushing a trolley was a good idea, it was fine.

        My sister-in-law who is prone to what my Father-in-law refers to “elephant” babies had far more recovery issues with her “normal” births than I did from a physical perspective. So I would have no issues having another child by repeat section if I could only guarantee my mind cooperating.

        • Dr Kitty

          I had the full 24hours of catheterised bed rest after the section, but as soon as I was allowed up, I was walking around my room.

          This time I had a private room with an ensure bathroom, much nicer than the open ward and communal bathroom last time, but I didn’t leave the room the entire time I was in hospital.

          My advice is to take all the painkillers, laxatives and anti-spasmodic drugs you are offered, but get up and do whatever you can for yourself as soon as you can.

          • Theoneandonly

            I agree with this – my second c-section was at 7:30 pm, and I was catheterised until 12pm the next day. After that was out I was walking to the NICU every 3 hours to feed, but made sure to check with my nurses if I was due for pain relief/anything else every time I came back to the ward to sleep – regardless of whether I had pain or not – and I believe that helped my recovery immensely. When my OB’s midwife came out to do the well child checks after discharge, she would have sworn I had had an uncomplicated vaginal birth if she didn’t know otherwise.

        • KeeperOfTheBooks

          I was in bed for about a day afterwards due to the catheter. Getting up was…interesting…the first day or so; I had a hard time walking without bending over, and the constipation was…well, it was horrible all pregnancy, so I was less than shocked that that was the case just afterwards, too. Bleh.
          I’d still do it again, though. I’m willing to give VBAC a shot next time if things look favorable because we’d like a bigger family, but I won’t be heartbroken if I get a RCS.
          Lastly, “wouldn’t get any pain relief while they sewed you up?!” WTF?! What the hell is wrong with those people?! My OB’s a very gentle, mild-mannered guy, but I can see him going absolutely apoplectic if someone so much as said that, much less tried that, with one of his patients.

          • Erin

            I like to think it was more a threat to keep me in bed than a promise they would have carried out but who knows. I’m still being surprised by the hospital’s general attitude six months down the line. Filled in a feedback form, more as a form of personal therapy than anything, lots of feedback both positive and negative plus praise for the staff who really tried to make a bad experience as bearable as possible and I’ve just received a letter saying “Thank you for your complaint, we take complaints really seriously blah blah blah. Phoned them up say “what complaint” and got told you complained.. nope I didn’t, yes you did… pointed out that the form didn’t have the “complaint” box ticked and neither was there any mention of the word throughout.. however she said well it’s been actioned as a complaint so it’s complaint.. so now I’m in the middle of drafting an actual complaint about the hospital’s feedback service.

          • Sarah

            You know, I didn’t mind getting up afterwards so much. I’d heard it was awful, but didn’t find it too bad. We’re all so different.

          • KeeperOfTheBooks

            I didn’t feel wobbly or anything; it’s more that my abs were just…gone…because of not having that huge, firm baby belly in front of me. It wasn’t painful or anything, just disconcerting, and I had recovered a lot by 48 hours after that.
            As you say, we’re all very different.

        • Dr Kitty

          BTW, that is awful that anyone would say that to you!

          The OB who did my CS this time is an absolute lady- she not only excised my old hypertrophic scar and closed with the neatest subcuticular sutures I’ve ever seen, she used some long acting local anaesthetic in the wound, so I had minimal wound pain. I lost very little blood for a CS (less than 400mls).

          The anaesthetist was also great. Local for the big IV cannula and this time I had no issues with nausea or low BP, because he made sure problems were treated before they started. He even changed up the standard mixture for the spinal for me, based on my old operating notes, and I got almost 12hrs of pain relief from the spinal.

          A good surgeon and anaesthetist definitely affect the recovery!

        • fiftyfifty1

          “I wondered if the longer you take to get up etc, the harder recovery is

          Not sure. In my own example, I refused to get up. They told me that their protocol was to ambulate every woman at x hours after delivery and so they would be coming for me at midnight. I said “No way, I will be sleeping and you are not to wake me.” They made me sign a waiver that said that I realized I might die from a PE if I didn’t ambulate at x hours. I was glad to sign it to get a little extra sleep. My recovery was easy-peasy anyway.

          • Young CC Prof

            They put the little inflatable cuffs on my legs after, and let me wait until the next day to actually get up. My recovery wasn’t bad.

          • Ash

            Do women wear compression stockings after c-section? Or sequential compression devices?

          • JellyCat

            Were you not on anticoagulants? Everyone post c-section is on dalteparine shots as a part of standard clinical protocol where I worked. This would certainly reduce the risks of PE anyway.

          • fiftyfifty1

            No, women here don’t get anticoagulants s/p CS unless they are high risk (h/o clot before, factor V L etc)

          • Dr Kitty

            I had delightful TED stockings and Clexane, as per hospital policy.
            All CS patients get Clexane (Enoxaparin) post op during the inpatient stay, those with extra risk factors also get it pre-op and for 7days post op.

            I get a baby dose because of my low BMI, and the midwives helpfully agreed to put it in my thighs this time. Last time one midwife insisted in injecting it in my upper arm, where I don’t have much subcut fat, which not only hurt like a mother, but also meant I was bruised from my shoulder to my elbow and had difficulty holding the baby.

            So, again, little changes this time that made for a better experience.

        • Dr Kitty

          Erin, your experience was obviously very difficult.
          I would suggest that if you are considering ERCS you arrange a meeting with your anaesthetist beforehand.
          They don’t need to know a lot of specifics of why, other than that it triggers severe anxiety, but knowing in advance not to touch your hair, and to make sure you have oxygen and lots of warning before anyone presses on your chest would probably make things a lot better for you. You could also agree under what circumstances you’d want to be put under altogether.

          I have drug allergies and weird responses to some common drugs. An ERCS meant that the anaesthetist and I had a chance to talk about that in advance and so there were lots of warning stickers all over my notes, and he could make some tweaks to the SOP based on our conversation.

          Nobody wants to think that they have traumatised someone, and certainly the anaesthetist took it as a point of professional pride to ensure things were as good as possible for me.

          The other bonus for ERCS would be that you can schedule therapy sessions or get medications with a definite date and game plan. You know the plan, you just have to prepare yourself for it.

      • Roadstergal

        “One of my PP nurses said that in her experience, a really skilled surgeon (ie, like mine) has patients who recover better and faster afterwards.”

        I wouldn’t be surprised – I haven’t had a C-section, but I’ve had a few collarbone operations, as has my husband. Mine were done by one ortho all of my friends rave about, and my recoveries were _way_ easier than my similarly-fit husband’s with his very similar breaks with different orthos (and left just beautiful, non-tight scars). It makes sense to me…

        The one thing that’s helped full recovery from _every_ surgery I’ve ever had is good, science-based physical therapy. Everyone should have that! The woman who did my most recent PT told me that she does a lot of C-section recovery work.

        • KeeperOfTheBooks

          Do you know, I never even heard of PT for CS moms, but it sounds like a great idea! Even just an in-hospital visit with a “these exercises can be helpful” sheet could be really awesome.

          • Roadstergal

            It sounded awesome, from how she talked about it – a combination of scar work (which is what she did for my non-CS scar, and was wonderful) and gradually building back core strength and flexibility…

          • KeeperOfTheBooks

            That is great! Again, I wonder if it’s partly the surgeon, but my CS scar is incredibly faint 18 months later. It’s the faintest white line about as long as my middle finger. Even I have to look closely to see it. The core strength/flexibility thing is why I’m going to ask my OB about PT. At the very least, can’t hurt, and it would be nice to feel a bit less wobbly, ab-wise, those first couple of months…

          • Outi

            Actually, here in Finland I’ve got that kind of sheet after each of my c-sections. I’ve lost them somewhere, otherwice I would have shared what was in them.

          • KeeperOfTheBooks

            If I have another CS, I think I may suggest this to the staff/management at the hospital.

    • areawomanpdx

      Agree. I’ve had two cesareans, one emergency and one planned. Both recoveries were quite easy, especially the planned one. Not to say that some women don’t have difficult recoveries, but it’s certainly not a given. Just like an easy recovery isn’t a given with vaginal birth. I’ve seen some doozies.

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    • Megan

      So glad you and the LO are doing so well. I hope my RCS goes that well!

    • yugaya

      Congrats Dr Kitty on your new baby!!!

    • fiftyfifty1

      My recovery was the same, although I got to skip the afterpains entirely thanks to what they tell me was the Duramorph added to the spinal. Lovely. I remember the afterpains from my first birth (vaginal) and they were a bear. I was glad to skip them the second time around. I agree, more good stories need to get out there.

      I am thrilled you are doing so well.

    • Montserrat Blanco

      I am so happy you are doing so well!

      Yes, I also recovered very well from my CS, running three weeks after giving birth. I am really glad you are having such an easy recovery. Your little guy seems lovely!

    • Box of Salt

      Please allow me to add my congratulations and best wishes to the whole family!

    • yentavegan

      Congratulations!

    • Anna

      Oh, I absolutely loathe the way they portray C-section as some horror movie event with all your adherent organs being bruised and damaged, your intestines spread all over the OR etc. all that crazy nonsense, not being able to walk straight for months, ugly scar which will never allow you to wear bikini and repulse your husband, where do they take this bullshit from?

      Most people don’t even know that nowadays doctors try not to cut through the muscles but to stretch them, try to use glue for the closure, try to make you get up as soon as possible. But they do feel free to make statements like: Oh, you know you will never get rid of that belly cause they’ve cut your muscles OR You will be unable to take care of the baby for MONTHS, make sure someone helps you around OR The doctor just wanted to get to his golf game and now your health is RUINED.

      Don’t know what’s wrong with me, but I was up walking in 8 hours, driving in a week, fully taking care of my baby and all in all I was doing A LOT better then my close relative who refused the c-section she needed and ended up with 4-th degree tear.

      • KeeperOfTheBooks

        Yes! I was freaked out about the stitches/wound more than anything else, and was delighted when I finally got up the courage to look and found it was closed with glue. I was still quite careful about it, of course, but it was a big relief to me to not have to see a big cut, even a healing one, in that area. Seeing one on other people doesn’t bother me, but on me…urgh.

      • Sarah

        Yeah, it’s the section that gave me this belly. Totally. I’d have a washboard stomach otherwise…

        • Cobalt

          I just wish a combo cesarean/tummy tuck was actually a possible thing. Or even just taking a bit of the extra skin out. I might have planned my last delivery differently!

          • Megan

            Actually a hospital I workd at had an OB with plastics training as well who did offer this. Women loved him! He moved away though, or I might be knocking on his door to have him fix my horrible diastasis recti and tighten things up a bit during my CS!!

      • Who?

        It’s the same catastrophising riff as used for hospital deliveries, non-water births, formula feeding, non-attachment parenting and whatever else they dream up: the sky will fall if you do this! If that is done to you you will never be the same again!!

        So predictable, but so scary if that happens to be the source of information people have.

        • Anna

          Yeah, it just freaks me out! What if some pregnant woman absolutely needing c-section or new mother not producing enough milk reads any of this crap? And they make it look scientific! Don’t believe it’s all flowers and sunshine in their world of non-medicated deliveries and breastfeeding for years, or they wouldn’t be such agressive morons.

    • wookie130

      I’m late in offering my congratulations here, so…CONGRATULATIONS, Dr. Kitty! Like you, I really wanted a c-section for both of my births, and due to issues during my pregnancy, I luckily needed to deliver via c-section anyway. My first recovery experience was rather awful, and took me a good 3 weeks before I could move correctly. My second c-section birth was MARVELOUS, and I was quite mobile and active the same day, getting up and out of bed, and caring for the baby completely on my own. That was a major surprise, because my c-sections were only 17 months apart! C-sections can be a wonderful birth experience. I know mine were. I also become annoyed that they are most often portrayed as horrible and nightmarish. It just isn’t the reality for a lot of us.

    • Outi

      I’ve had three c-sections. With the first two, the recovery was easy. The scar looked good and I wasn’t using any pain meds after getting home. The third was a complete opposite, the scar ruptured on the surface and ended up bleeding slightly for the next two months. Now, a year after the last operation, it finally looks good and I can move like I used to. Looking only my first two, I would have recommended c-section as easy to recover, but the third changed my mind. The recovery is distinctive to everyone and can change even for operation to operation.

  • Angharad

    OT, but I was at a museum recently that had an exhibit about gestation and birth in various animals. At the end there was a wall with the invitation “Tell us your birth story!” The children’s stories probably did not match too closely with what the mothers would tell if asked the same question. Samples: “I’m an only child” “I was born in New Zealand” “I came from my mom’s tummy.” None of them even mentioned whether they were vaginal or c-section, or anything about music, lights, or breastfeeding.

  • Bugsy

    Completely OT: just had my 30-week scan, and generally things are looking great. Measurements are suggesting the little guy is in the 68th percentile size-wise. The u/s tech did note a nuchal cord, though. Not a complete surprise – he had one at the 20-week ultrasound as well. This is something that didn’t occur with our first son. Is it a concern? How will it be handled from here on out?

    • Nothing to do about it at this stage but keep an eye on it.

      • Bugsy

        Ok, thanks!

  • areawomanpdx

    The most interesting thing about this to me is that HBAC advocates are always claiming that hospitals cause all the uterine ruptures by inducing labor. This data refutes that idea. I would like to put forth the theory that not only are hospitals decreasing the potential rupture rate by performing cesareans when indicated, but homebirth midwives are actually causing ruptures by allowing these women to labor outside of the normal labor curve and have hours upon hours of active labor with little to no progress (or 8 hour-long second stages), all the while cheerleading them to believe their bodies were made to do this.

    • rh1985

      That was my first thought when reading this post. An OB will at some point do a CS for failure to progress because it’s not safe to be in labor forever and better to prevent a problem before it occurs. I’ve heard of homebirth midwives encouraging women to labor for days at home, push for many more hours than what is recommended.

    • yugaya

      I’m interested in what the explanation is behind the two “suspected” ruptures – were these mothers lost to follow up after transfer like breech babies in MANA homebirth paper? Also – what the transfer time was, what the diagnosis to baby out time was, and what is the outcome in terms of permanent injury for the babies that survived.

      If Cheyney admits to this, imagine how much worse the real, fully disclosed data that wasn’t cooked for year look like.

    • SporkParade

      I was under the impression that VBACs and inductions don’t mix, no? At least, my friend who is deliberating between VBAC and RCS was told that VBAC is off the table if she needs to be induced.

      • Young CC Prof

        Certain induction techniques, especially Cervadil, can increase the risk of rupture. Many doctors have a blanket policy of no induction for VBAC, others will under certain circumstances.

      • areawomanpdx

        Lots of providers (most I’ve worked with) will induce a VBAC with pitocin or a foley bulb for cervical ripening + AROM. They won’t push the pit beyond 20 mu/min (can go up to 40 without a prior cesarean) and they won’t use pharmacological cervical ripeners.

      • areawomanpdx

        It may be a regional difference. It seems like the west coast is quite a bit less conservative in obstetrics than the south or east coast.

      • Outi

        When I tried VBAC with my second, I was given pitocin. Can’t remember how much, since it was 10 years ago, but that was the only induction method they were willing to try. The labour stopped and I ended up getting another c-section.

  • Gatita

    Completely OT but Kim Kardashian recently gave an interview where she says she has placenta acreta and will likely need a hysterectomy after having her second child. She also had infertility issues and needed ART. It’s so rare lately for a celeb to admit having any problems with babymaking I thought it was interesting.

    • DelphiniumFalcon

      That is interesting. I don’t like the Kardashians all that much but it’s nice to hear a celebrity talk about needing ART instead of these 40+ women pretending they did it all naturally. Leads to a lot of women in their late thirties getting discouraged that they can’t have a baby but so and so was able to. But so and so also has $150,000 lying around and they weren’t using it anyways.

      Also, placentas are weird. Like, really freaking weird. This thing that nourishes a baby trying to dig in as deep as possible and then the mother’s body trying to make it go away without accidentally aborting. They’re just weird.

      • Froggggggg

        Haha, yes – they are weird. I asked to see the placenta after my second child was born (by c/s). That was even weirder – well, the looks I got from the theatre staff and OB were! Apparently it’s not a very frequent request and they thought I was nuts, but showed it to me anyway. 😉

        • Allie

          Ha! I had a different experience. I gave birth in a slightly wooish but mostly respectable, evidence-based teaching hospital specializing in obstetrics & gynecology, and they seemed disappointed when I showed no interest in my placenta or in having a mirror so I could see my baby crowning.

          • Dr Kitty

            I had no interest in my placenta, but it was nice that this time during my CS I was asked if I would like them to lower the drape so we could see the delivery, and I didn’t have to ask.

            Which meant that I could see that we had a boy before anyone else and promptly burst into happy tears, so my husband thought there was something wrong!

          • Megan

            That is definitely something I want in the likely event I have a RCS. I hated not being the first to see my daughter when she was born. This time I will ask.

        • Angharad

          Haha. They asked me if I wanted to see my placenta and I told them to please not let it into my sight. Apparently my husband had wanted to see what it looked like and was disappointed they whisked it away so quickly.

          • KeeperOfTheBooks

            Haha! I’m not entirely certain why–maybe in case I started bleeding heavily and they’d want to reexamine it, or something?–but mine was put into what I can only describe as a sort of deli container, like what you’d get a pound of potato salad in, and put on the gurney with me while I was wheeled to recovery. I found this weird; I wasn’t grossed out by it, but…weird. Very.

        • areawomanpdx

          I always offer to show people the placenta! I think it’s cool. I would say about 60% are like, “Sure!” and the rest are like “Why would I want to look at that?” hahahaha

          • KeeperOfTheBooks

            Reminds me of my DH when asked if he’d like to cut the cord. “Isn’t that what we’re paying the doctor for?” quoth he, looking genuinely confused.

        • SporkParade

          My mom and husband both photographed the placenta on their smartphones.

      • Allie

        Yes, also highlights that younger women can have problems too, as she’s “only” 34, which isn’t all that young when it comes to baby-making.

    • Fallow

      I don’t really like the punitive way that some people talk about Kim Kardashian’s pregnancy issues. The line of thinking that goes, “She is fake, and I find her unlikeable, therefore she must have brought her problems on herself.” She’s a person, too, and she’s probably terrified. And yes, it’s refreshing that she actually talks about these issues without being apologetic or ashamed about it. At least, she’s spoken about it in a straightforward manner in the interviews I’ve noticed.

    • RMY

      It’s nice that she’s frank about that. It helps hearing that even celebrities about my age also have infertility and require IVF to conceive. It makes me feel like less of a failure.

  • Cartman36

    I honestly don’t understand how anyone can think home birth is safer than hospital birth. Common sense tells you it isn’t. I don’t need a study to tell me that having a NICU, trained medical personnel, an operating room and a crash cart available is safer than giving birth in my living room.

    • Squillo

      I think they depend on a particular definition of “safer.” It’s clear that, in a homebirth, you are less likely to have an unnecessary intervention. You are also less likely to have a necessary one. The former happens frequently, the latter, seldom. What people fail to realize is the the sequelae of the latter tend to be worse.

      • Young CC Prof

        Also, they tend to overestimate their probability of an unnecessary intervention in hospital birth, like they literally think one out of three women gets a c-section in the hospital. For women who are actually low-risk, the probability of needing a c-section in the hospital is a whole lot lower than that. For women who are not low risk, the probability of home birth going badly is, hmmm, not low.

      • Sarah

        Yeah. Obstetrics being what it is, as a lot of interventions turn out not to be ‘necessary’, you can dispense with some of them and, if you have a sufficiently low risk population, still have pretty good stats. Hence homebirth in the UK for healthy, low risk multips. But when things go wrong, they go very very wrong. It’s a greater risk of smaller problems as against a lesser risk of huge problems. And this only works when homebirthing women are a very select group.

        • The Bofa on the Sofa

          s a lot of interventions turn out not to be ‘necessary’, you can
          dispense with some of them and, if you have a sufficiently low risk
          population, still have pretty good stats.

          And “Obstetrics being what it is” already DOES dispense with a lot of those interventions for the “sufficiently low-risk population.” What is the hospital c-section rate for those candidates who are best suited for homebirths (previous successful vaginal dellivery, in particular, and no other indications)? Maybe 5% or so?

          • Sarah

            I recall researching it during pregnancy with no 2, when offered an ELCS because of fuck ups with no 1. Would’ve fallen into the homebirth suitable category myself as a low risk multip singleton under 35 etc, and indeed was asked if I wanted to try for one. IIRC the section rate for women in that group is in single figures in the UK.

      • Medwife

        “Safey-ness”?

  • DelphiniumFalcon

    Please tell me I’m not the only one that cringes and wants to scream in terror every time they read or hear “uterine rupture.”

    It’s just such a horrifying thing to picture.

    • JellyCat

      We must be unique because when VBAC question was brought up on FB moms group, doulas were not impressed by uterine rupture and said that incidence of shoulder dystopia and cord prolapse is higher, so not to worry …

      • KeeperOfTheBooks

        Yes, and my risk of developing certain cancers is slightly more likely than of my having a catastrophic rupture, but that doesn’t mean I’ll fret about cancer and decide to HBAC instead next time.

      • Roadstergal

        I think the ’80s, with the shoulder pad trend, was the heyday of shoulder dystopia. 🙂
        The incidence of shoulder dystocia and cord prolapse for VBAC are higher than rupture? Really? That’s scary. Like, reason # *fill in the blank* to be in a hospital.

        • JellyCat

          They use this kind of approach to concince others that VBAC is safe. But to me it sounds like a c-section would be the safest choice, since elective c-section will certainly eliminate the risk of shoulder dystocia or cord prolapse.

          • Roadstergal

            Or rupture. And you could skip the VEs?

          • KeeperOfTheBooks

            Not sure what “VEs” are in this context, so maybe we’re saying the same thing, but my two cents is–and any baby for whom shoulder dystocia is an issue is rather unlikely to come out without a good bit of tearing. *cringe* *whimper*

          • Mattie

            I think Roadstergal means vaginal examinations, which would be unnecessary when having a c-section. Not actually sure whether shoulder dystocia = more tearing, any studies that anyone knows of?

          • Poogles

            “But to me it sounds like a c-section would be the safest choice, since elective c-section will certainly eliminate the risk of shoulder dystocia or cord prolapse.”

            Yep, among other risks to the baby that are avoided; that’s why I hope to have a MRCS 🙂

      • DelphiniumFalcon

        Of course they’re not impressed by it. They can’t bullshit their way into saying they can fix that. There is no fixing that! There’s just surviving it!

      • Well…they are right, in a way. The incidence of uterine rupture is not all that high FOR MOST WOMEN. But when it happens, it can be catastrophic, not just leading to the death of the baby, but the permanent loss of fertility for the mother and all the complications of massive hemorrhage such as DIC. Most mild shoulder dystocia is not a major emergency; cord prolapse, in hospital, results in an emergency C/S [and there are techniques to maintain oxygen supply to the baby until born which usually work if the condition is addressed immediately]

    • KeeperOfTheBooks

      Speaking as a mom who had a C-section, believe me when I say that “uterine rupture” is one of those phrases that freaks me the heck out.

    • areawomanpdx

      As someone who has witnessed a uterine rupture (as a doula), it is one of the most horrifying things imaginable.

      • Tara Coombs Lohman

        What she said

  • Anj Fabian

    Anyone surprised? Anyone…?
    .
    .
    Bueller?

    Horrified, shocked, but I’m not surprised.

  • MrG

    While the raw data are very telling, the study itself lack of any academic credentials.

    Most importantly, they did not even dare to calculate statistics properly and failed to mention RR or relative risks and confidence intervals.

    Had they done it, the data would have been crystal clear:

    NICU admits
    44 vs 1008 and 243 vs 11849
    RR 2.08; 95% CI 1.5-2.8 p<0.05

    IP Death
    4 vs 1049 vs 8 12084
    RR 2.16; 95% CI 1.15 – 16.22
    p<0.05

    All significantly worse outcomes at homebirths.

    They say: "However, the intrapartum/neonatal
    mortality rate of 4.75/1,000 when higher
    risk births were included suggests that home VBACs
    are associated with an increased risk to the fetus/newborn,
    particularly in women without a history of a prior
    vaginal birth."

    But then do not mention the next steps:

    VBAC patients should NEVER have a planned homebirth. Nor should others.

  • The Bofa on the Sofa

    Implications for Shared Decision Making.

    IOW, damn, this is so bad that we can’t even blame the parents for the deaths!

    Barf

  • Ash

    From the fulltext: Given that the rate of abnormal placen-
    tation is rising, particularly for women with multiple
    cesareans , an obstetrical ultrasound should be consid-
    ered the standard of care for any woman with a priorcesarean.”

    Dear HB midwives–how about EVERY woman?

    • KeeperOfTheBooks

      That’ll be the day.
      A friend of mine is now planning on becoming a HB midwife. She’s had no ultrasounds with any of her pregnancies because they might cause the babies brain damage. Also, I dunno, I guess placenta previa only happens if you don’t trust birth, and she does, so no worries there. Or something. Grrrrrrrrrr.

      • Roadstergal

        Funny how sound waves cause brain damage when it’s an ultrasound, but ‘enhance’ the fetal brain when it’s Mozart or whatever the trend is to put on headphones over your belly.

        • demodocus

          They wouldn’t be the same frequency. That might, theoretically, make a difference if you had dozens or hundreds of ultra sounds. me not know

          • Shawna Mathieu

            While pregnant with my son, I had an ultrasound and two NST sessions every day for a month and a half. He’s 3 1/2 now. I’m reasonably certain the ultrasounds didn’t harm his brainmeats, as he was just recently telling me quote “fire trucks have telescopic booms” unquote.

        • KeeperOfTheBooks

          Quite.

      • DelphiniumFalcon

        Please. My mom and dad went to Neil Diamond concert when she was like seven or eight months along with me and she could feel the sound waves going through the fluid and me going nuts in there.

        I can hear a pin drop across the room and still hear high pitched noises I should have lost the ability to hear over a decade ago.

        Ah but I am autistic and have depression and anxiety. But that couldn’t be from screwy genetics or anything. Must have been the ultrasounds. Damn.

        • KeeperOfTheBooks

          Yep! Don’t you know that ultrasounds, and I quote, “modify fetal brain waves” and “cause babies pain”? And of course, as a side note, I do so love the implication that having a child with autism is the most horrible thing that could happen to a parent. *snort*

          • Young CC Prof

            Yup, they might modify brain waves. Just like listening to voices, or feeling mom walk or change position.

          • KeeperOfTheBooks

            But those are naaaaaaatural, and ultrasounds are done with a big, scary, unnatural machine!

          • DelphiniumFalcon

            Well I must be well and proper fucked because my dentist uses one of those ultrasonic teeth cleaners. That’s right next to my brain!

          • KeeperOfTheBooks

            Oh, but that’d be the case anyway, because after all, your dentist probably uses FLOURIDE. And even if it’s not used specifically on your teeth, it’s no doubt outgassed into the office for years! It’s a chemical weapon!

        • Angharad

          When I was seven months pregnant I went to a fireworks show. The baby reacted with violent kicking and turning. She had no such reaction to ultrasounds. Of course, since I had the ultrasounds now I have a handy scapegoat for any and all of her future problems.

        • Liz Leyden

          It’s settled, Neil Diamond causes autism. 🙂

      • Allie P

        I know when my baby is in pain. She gets really stiff, screws up her face muscles and screams. While viewing US, however, I saw her: sleep, pee, suck her thumbs, have hiccups, and slowly turn over. That is not the actions of a baby in pain.

        • KeeperOfTheBooks

          *shakes head* Ah, but you see, you just don’t understand how to interpret those actions in light of an ultrasound! Sleep? She was physically shutting down from the horrors of the ultrasound probe! Pee? She was peeing in fear! She was trying to comfort herself by sucking her thumbs! The hiccups were from the pain and fear caused by the ultrasound! And in turning over, she was just trying to escape it, poor baby!
          /extreme sarcasm alert, in case you couldn’t tell…

    • Outi

      In Finland it is a standard and if there is a possibility for troubles, it’s done twice.

  • attitude devant

    Huh. I was not surprised that the home VBAC death rate is higher because, as you say, the lifesaving personnel and materiel are far away, but I was surprised at the rupture rate being higher….until I remembered all the home VBAC transports I have received where the mom has been allowed to labor in the face of a labor that has long ago arrested. We’re talking 6 hours at 8 cm, or pushing for six hours. Even worse are the midwives who don’t believe in cervical exams so that they have NO idea whethere labor is progressing. Of COURSE rupture is more likely in that setting.

    • Young CC Prof

      I wonder if some of their patients were actually bad candidates, maybe told not to attempt VBAC by the local hospital: special scars, multiple CS, multiple CS for failure to progress, or other issues leading to a low probability of success and higher probability of rupture.

      • Ash

        because TOLAC at home with twins is surely a good idea!

        http://homebirthersandhopefuls.com/can-i-still-have-a-homebirth/twins/

        • Kelly

          That pool had red water. Ew.

          • Mattie

            I’m not condoning homebirth of twins, but the red water is pretty normal after a birth, it’s not a sign of loads of blood just the usual amount of birth juice (lovely) diluted in water….

          • Kelly

            I recognize that but I do not want to sit in or have my child breath in this. It is so gross. Water births just are not anywhere near sanitary.

          • Mattie

            You’re well within your right to make that choice, I’ve always quite wanted a waterbirth, I like that women have options 🙂 although I wouldn’t have a home waterbirth of twins

          • Somewhereinthemiddle

            I had a waterbirth and it was quite nice to have the support of the water. Babe *was* brought directly up to the surface, I was monitored the whole time, and the water *was not* full of poop. It can be done safely with the proper protocols in place and with a qualified birth attendant in the hospital.

          • KeeperOfTheBooks

            Also providing that the pool is properly cleaned between patients. I remember reading a horror story about improperly-cleaned Jacuzzi-style tubs in laboring suites. *gags*

          • Somewhereinthemiddle

            This was the portable, inflatable, medical grade kind and each user gets a fresh liner so there isn’t cross contamination between patients. No jacuzzi plumbing to worry about cleaning or trapping biohazardous material either. It was a pretty clean process.

          • KeeperOfTheBooks

            Sounds like a good idea to me!

          • The Bofa on the Sofa

            Once again, by that definition (“I did it and it turned out fine”) then you could also say that drunk driving “CAN be done safely.”

          • Roadstergal

            My friend tried to convince me that waterbirth was safe by sending me a paper on a waterbirth cohort where no babies died. The things I pointed out to her were 1: it was a tiny cohort of low-risk women, it’s not surprising no babies died, and 2: they sampled the pools after the births, and they were all swimming (literally) with a diverse bunch of bacteria.

          • Cartman36

            “they were all swimming (literally) with a diverse bunch of bacteria.”

            That is so gross!

          • Somewhereinthemiddle

            Seriously? Back off wth the obnoxious bullshit today. We can each and every one of us understand the risks and benefits of any particular procedure and proceed as we see fit.

          • Fallow

            He is not wrong, though. Just because you didn’t see floating turds in the water, doesn’t mean it wasn’t colonized with your own fecal bacteria and/or viruses. Bathing a newborn in fecal flora, is not what I’d consider an acceptable risk. I can think of at least one child who died from from ingesting/inhaling their mother’s fecal microorganisms in a water birth.

            Also, you didn’t have a guarantee that your child wouldn’t take their first breath underwater. Great, it turned out fine, you liked it, it was a blast. But it was an added unnecessary risk, and it would be intellectually dishonest for you to deny that.

          • Somewhereinthemiddle

            No one is saying that it is possible to reduce risk to zero. I was comfortable with the information that was available and there *are* things to be done to reduce said risk. Those were followed in my case. I believe the case you are refering to is a mother that had some sort of active gastro-intestinal virus and the baby was born into heavily contaminated water. We are talking about using good, common sense.

          • fiftyfifty1

            But they were using “common sense” in that case. She was having frequent stools. They told her it was the normal “cleaning out” that so often accompanies early labor. I had it myself. Only when baby died of adenovirus did they realize that mom was the cause.

          • Fallow

            And yeah, I am aware that children are exposed to their mother’s flora on the way out during a vaginal birth. That’s a bit different than soaking them in a tub of inhalable shit germs.

          • fiftyfifty1

            But if it is so safe, why have they issued a policy statement stating that it should only be offered in research settings because the safety hasn’t been established and case studies are pointing towards poor outcomes?

            Bofa’s comment was not “obnoxious bullshit”. It was factually correct.

          • The Bofa on the Sofa

            And look, SomewhereInTheMiddle has thrown a temper tantrum and quit.

          • fiftyfifty1

            Waterbirth produces cognitive dissonance for loving mothers.

            “I put my baby at risk for benefit to me” is hard to admit. It’s hard enough to say in the case of choosing VBAC, and VBAC has real hard line benefits for mother, like reduced maternal mortality and hysterectomy (not to mention improved outcomes for theoretical future sibs).

            With waterbirth, in contrast, it’s about the mom’s comfort, pure and simple. Sure, you can make the risk somewhat smaller by following the guidelines. But even if you do everything “right” you are still trading an increased risk of your child’s life for your subjective experience.

          • Guest

            No. I am absolutely okay with the choices I’ve made. Like VBAC, you can reduce risk factors and I’m comfortable that I did those responsibly with waterbirth. You can see my response above to Bofa for a fuller explanation of why I’m chosing to leave and not come back.

            I thought I had found some sort of community here and I was absolutely wrong. I don’t mind disagreeing but this “attack” mode that some of you revert to as a complete default is intolerable and I’m done. And as I said above, you guys are chasing away middle ground folks that are here to learn with your nasty, self important, snotty responses. I’ve been here for 2 years and am leaving because I’ve had enough.

          • fiftyfifty1

            If you are absolutely okay with the choices you have made, why the need to claim that waterbirth can be made “safe” if you do everything right? Why not just claim “It still isn’t as safe as dry birth, but I’m okay with that because the absolute increased risk to my baby is small, and I personally liked the water so much in so many ways” ?

            As I’ve shared on the blog before, I have myself made choices that increased risk to my babies at benefit to me only. Both times I refused the Glucola test. I had ongoing nausea and vomiting, and even the thought alone made me gag. Not having to do the diabetes testing was a benefit only to my own comfort. It was a potential detriment to my kids, increasing their risk of outcomes like macrosomia, shoulder dystocia and postnatal hypoglycemia. I did mitigate the risk somewhat by doing a random glucose which was low, but still, a Glucola test would have been better. I could have sucked it up, dosed myself up on anti-vomit medicine, and made myself do it. But I chose not to. I decided I was okay with this tradeoff: my comfort for a low risk to my kids.

            But I don’t say I made it “safe”. And I don’t encourage other women to do it by telling them the choice is “safe” either. And I don’t think it’s okay that midwives (including some CNMs) tell their patients to skip it. And when OBs emphatically push their patients to complete the test, I don’t claim that they are unreasonable bullies who are driving women away etc etc.

          • Guest

            Not a temper tantrum or a flounce, I have three kids and am expecting a 4th. My time and energy is better spent on my friends and family rather than arguing with people on the internet with whom I don’t always agree 100%. I am refocusing my priorities.

            As an observation, you guys are chasing away folks who prefer some sort of middle ground when it comes to these issues. I come here to learn but you guys caustic and nasty responses have led me to leave. Not the “tone” but the unnecessarily rude, disrespectful, self important, nastiness responses from you guys unless there is 100% agreement on every.single.point. 95% isn’t even good enough and having civil discussion sure isn’t.

            I’ve tried reasoning that you guys are just trying to make birth safer but the truth is many of you are nasty, rude people. Full stop. We don’t have to agree for things to be civil and I’ve been around here and agree with enough points with the majority of the people here to at least earn a *small* amount of civility. But the truth is, you aren’t civil and you never will be. I don’t spend time with obnoxious, inexcusably rude people like you in real life and I’m done doing it here.

          • The Bofa on the Sofa

            I’ve tried reasoning that you guys

            What reasoning? You never addressed the point of my comment, which is that by the measure of “can be done safely” as “I did it and everything turned out ok”, then you could also say that drunk driving can be done safely, too. All you did in response was to insult me.

            But the truth is, you aren’t civil and you never will be.

            Says the person who called my post “obnoxious bullshit.”

            I don’t know, I didn’t think any of the follow-ups to my comment were uncivil at all. How were they uncivil? Because they said I was right and you were wrong? Read what fiftyfifty1 wrote. Read what Fallow wrote. Explain how they were uncivil, other than they didn’t agree with you.

            And please, don’t give us this “my time is better spent doing other stuff.” How does deleting your Discus account give you more time to do other stuff? Having an account doesn’t require that you post, or even read this blog, so why delete?

          • JellyCat

            Red water while gross is not the worst case scenario. I read a story where fish tank net was used to fish out turd nuggets …

          • Daleth

            I can’t even… I can’t even… !

          • JellyCat

            That lady was constipated so the nuggets were hard. What if she had a soft BM or loose BM?

          • Roadstergal

            I’m thinking it’s a good day when the turds stay in nugget-can-be-fished-out form?

            Of course, you can’t fish out the bacteria colonizing the water from them.

          • JellyCat

            There is nothing more natural than bacteria colonizing your gut!

          • Roadstergal

            Nothing more natural than emerging from the birth canal to get your first gasp of air and getting a gasp of poopy, bloody, tepid water instead.

          • Angharad

            So… Question about water births (leaving aside sanitary considerations). I’ve heard that they’re desirable because the transition is easier for the baby (fluid to fluid instead of fluid to air). But wouldn’t it be delaying the fluid-to-air transition by just a tiny amount of time? The baby is coming into the air anyway. Is the pool-to-air transition supposed to be easier than the womb-to-air transition?

          • Kelly

            I guess. You would have to look at what all their reasons are. I have stopped reading any woo websites and don’t remember the specific reasons behind it. There have been some babies that have sucked in the water and have been very sick though. I know they say that they have a reflex to not breath in the water but it does happen. In hospitals, most of them let you labor in water but you have to give birth out of water because of a variety of things that can go wrong.

          • Roadstergal

            I thought one of the effects of a VB was to squeeze the fluid out of the lungs to help the baby take its first breaths? I’ve had a few friends tell me stories of their babies vocalizing – which the kid would first need to suck in a breath to do – as the kid was being delivered…

          • fiftyfifty1

            “just the usual amount of birth juice (lovely) diluted in water….”

            How can you (or anyone) assure that it is the “usual amount” of bleeding? Oh right, you can’t.

          • Mattie

            There are (I believe) ways to estimate blood loss in water, just as on ‘land’. Most blood loss is estimated rather than accurately measured isn’t it?

          • JellyCat

            Blood loss is usually estimated, but the estimates are pretty accurate. There is no way to even estimate blood loss in water, never mind you will not be able to see blood clots on the bottom of the pool. This is one of the reasons why water birth is not practiced in the hospitals.

          • Mattie

            Do you not have water births in hospitals where you are? We have water births on MLUs as well as delivery suite where I am., and lots of women in hospitals choose to labour or birth in water.

          • JellyCat

            We have jacuzzis and tubs but they are only permitted for use during contractions if waters are intact.

          • Medwife

            In the US there is a lot of variation in where water births are allowed. The hospital where I work does not allow them, although women labor in the tubs and showers often. If somebody refused to get out I’d slap on some gloves and catch anyway, but there is really no such thing as a “non infectious person”, as you referred to earlier. I would be very nervous about the almost certain exposure to infectious bodily fluids- at least with a dry land birth you can rely on some protection with gowning.

          • Mattie

            We don’t gown here (just disposable aprons,plastic kind that come on a roll) or use surgical masks, only anaesthetists do so for epidurals (and obvs in theatre for sections). When I say non-infectious I mean women who don’t have illnesses like HIV, Hepatitis etc…the women are tested for those things.

          • Outi

            We have tubs in the hospital, but they are only available when the water has not broken. I was bummed when delivering my first one I couldn’t go to the tub, because my water broke before going to the hospital.

          • fiftyfifty1

            Blood loss on land in measured directly when possible (e.g. weight of bloody towels minus weight of dry towels, how much blood in the suction etc.) and estimation. Measured blood is obviously more accurate than estimated blood. Estimation of blood diluted in water is far far trickier. And it’s difficult enough when the amount of water is a toilet bowl and the background color of the porcelain is white. Image trying in a blow-up tub of unknown size and grey plastic.

            In reality, the midwives have no idea how much a woman has lost (or is losing right there in front of them). They are just trusting and hoping that it’s “just the usual amount of birth juice (lovely) diluted in water”.

          • Mattie

            Ahh ok, yeh here it’s mostly just estimated. Understandably it’s more accurate on land, also there are usually policies on women leaving the pool after the birth, so third stage happens on land the majority of the time, obviously this doesn’t stop a bleed happening but it’s a way to minimise the risk of a serious bleed happening in the pool.

            There are also emergency procedures for getting women out of the pools in an emergency (if they can’t get themselves out). Not 100% sure what our local policies are for waterbirth at home, whether they are the same as in the hospital or not.

          • JellyCat

            We don’t have water birth in the hospitals. I cannot even imagine how it is possible to protect yourself from bodily fluids and blood if you’re a health care provider and attend water birth. This would not be possible from infection control and occupational safety points of view, so even for this reason alone it is completely off the table.
            There are cases when females refus to get out of tubs, but these are horror stories.

          • Mattie

            Um gloves and aprons? I don’t really know what precautions are used other than that when dealing with a non-infectious person. In UK non-sterile gloves are used for external procedures (injections etc) sterile for procedures requiring aseptic technique (VEs, deliveries, ARM etc). Aprons (disposable) are worn over uniform or scrubs. Does the U.S. have extra protections?

          • JellyCat

            You would need glows, waterproof gowns, facial masks and shields because contaminated water may splash.
            I bet labouring female would not be comfortable with people looking like they are handling biohazardous substance, which they are, at their lovely and relaxing birth pool 😛

          • Mattie

            Oh yeh, we don’t do that =/ just a plastic disposable apron and gloves, sometimes women want to guide the baby out themselves (when in water) so they can do that, sometimes a midwife will do it. No masks or shields or anything like that

          • Squillo

            I don’t know about other states, but the California Maternal Quality Care Collaborative has identified obstetric hemorrhage as one of their key improvement areas for the state. They’re encouraging all hospitals to adopt quantitative evaluation of blood loss using formal methods (weighing pads, or using drapes with graduated markers). As I understand it, current practices vary widely.

          • areawomanpdx

            Sometimes blood loss is estimated, but we have a calibrated drape and weigh the underpads if we think we’re approaching hemorrhage. Studies have shown (as has my personal anecdotal evidence) that estimation is not very accurate and almost always under the actual.

          • Mattie

            Interesting, it’s entirely possible that UK will go that way although atm women are encouraged to move around and can birth (baby and placenta) in whatever position or place within the room they want which could make measuring exactly more difficult

          • areawomanpdx

            Not really. I’ve delivered plenty of babies standing up or squatting. Most of the bleeding doesn’t happen until after the baby and placenta are out, at which point most women choose to lie down. And you can always put the pad underneath the standing women. We know how much the pad weighs clean, so you weigh it and subtract the difference.

          • Mattie

            That’s true, wondering why we don’t do that then *shrug*

        • JellyCat

          Ash, please tell me this is a piece of satire

          “The possibility of going into labour early need not deter you from planning a home birth: you can always go into hospital if you’re not happy labouring at home for any reason. One could argue that, as with pre-eclampsia … this is not something you need to weigh up when deciding where to give birth.”
          “Do remember that, as with any pregnancy, tests are not compulsory and can be declined if you wish.”

          “and research often doesn’t tell the full story”
          Because the studies look “at the highly medically managed vaginal birth that is normal for twin mums in hospital, not the physiological, active home birth you may be planning.”

          And the quote “In general those who know about privacy as a basic need in labour are not scared by this sort of birth. It is the art of doing nothing…..Giving birth without any privacy among scared people can be dangerous.’
          ~ Michel Odent ~ ”

          What? It cannot be for real, right?

          • Daleth

            Oh no, man. That is absolutely real.

          • The Bofa on the Sofa

            JellyCat, meet Michel Odent.

            Yes, he is real.

          • JellyCat

            I cannot comprehend how anyone can believe this nonsense. Art of doing noting? Really?

          • Susa

            Michel Odent gives me the shivers. I saw him speak once. The single most cult like moment of my natural birth world experiences. There really is some weird dynamic at play with the rogue male doctor in the natural childbirth world. A playground for the narcisissist.

          • Outi

            Scary stuff.

      • attitude devant

        Good call there too, YCCP

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    • Medwife

      That was my immediate thought- prolonged labors and VERY prolonged second stages. All that not putting a birth on the clock has some down sides I guess!

  • Roadstergal

    “Of those 4 ruptures, 50% of the babies died.”

    How did the other two survive? Honest Q, I thought rupture at home was sure death for the baby.

    • Amy M

      Maybe it was a small opening and they transferred? The rupture occurred at a place on the uterus where the placenta was not attached, so no abruption?I don’t know, I’m just throwing out ideas.

      • Sarah

        Maybe. Even so I was actually pleasantly surprised that ‘only’ 50% died. Obviously that’s a horrifying stat, but I thought it would be even worse.

    • Mattie

      I mean, they may have been resuscitated…not dead doesn’t mean perfectly healthy, the other 2 babies could have severe disabilities caused by their births.

    • Daleth

      Is it clear how they defined rupture? They could have included dehiscences in the ruptures group.

  • sdsures

    In the first link, here, http://onlinelibrary.wiley.com/doi/10.1111/birt.12188/abstract – there is an MD listed as the fourth author.

    What contributions did he make?

    • Ash

      It appears Dr Lawrence M Leeman is a family medicine doc with a fellowship in OB whose areas of research include TOLAC (this is per the Interwebz)

      • Roadstergal

        MDs are not immune to woo. Even AAP fellows (Jay Gordon, Bob Sears).

      • sdsures

        Thanks for looking for the info. I didn’t have the spoons at the time. Can people cherry-pick the co-authors of their “studies” like this one, so as to exclude the authors who might present evidence to the contrary…and then somehow get successfully passed through the Ethics Panel before publishing?