What if your baby can’t get enough oxygen during childbirth?

suffocate

One of the great ironies of natural childbirth is that the same folks who get hysterical about the possibility that a baby’s umbilical cord is cut early, potentially depriving him or her of oxygen, blithely ignore of what happens to a baby who isn’t getting enough oxygen during labor.

What will happen to your baby if he or she is chronically deprived of oxygen during the hours of labor — because the placenta isn’t transmitting it fast enough (placental insufficiency, postdates pregnancies) or your baby is deprived of oxygen acutely (a tight nuchal cord, severe shoulder dystocia, breech with a trapped head, placental abruption, ruptured uterus during attempted VBAC).

The new paper Pathophysiology of foetal oxygenation and cell damage during labour is highly technical, but in its own way quite chilling.

The authors set the stage:

Your baby must have a steady supply of oxygen for cells to work properly.

All human cells require oxygen and glucose to maintain aerobic metabolism and for energy production. The foetal oxygen requirement is determined by foetal size, activity and essential metabolic processes. During foetal life, the oxygen supply is dependent entirely on maternal respiration and circulation, placental perfusion, gas exchange across the placenta and the umbilical and foetal circulations. If the supply and requirement are in balance, the foetus has adequate oxygen to metabolise glucose aerobically to produce the energy required for organ function…

During the human birth process, the foetus is squeezed through the birth canal over a period of up to several hours, during which the head sustains considerable pressure and the foetus is intermittently deprived of oxygen. A reduced oxygen supply is often categorised into three types: (1) hypoxaemia, involving a reduced oxygen in the arterial blood, but where cell and organ function are not usually affected; (2) hypoxia, with reduced oxygen and subsequent anaerobic metabolism, mainly in the peripheral tissues; and (3) asphyxia, where the hypoxia extends to the central organs e the heart, brain and adrenal glands e and potentially leads to metabolic acidosis.

… Asphyxia is one of the main causes of neonatal and childhood mortality and morbidity, and it has been associated with neonatal death, hypoxic-ischaemic encephalopathy (HIE), seizures, intraventricular haemorrhage, cerebral palsy (CP) and delayed development.

In other words, your baby must have a steady supply of oxygen for cells to work properly. A baby can tolerate the reduced oxygen supply during contractions, but only if the placenta is transferring enough between contractions. What happens when that steady supply is compromised by a poorly functioning placenta?

First:

…[F]oetal metabolism switches to anaerobic. This leads to a decrease in pH, accumulation of lactate and an increase in the base deficit (BD)…

According to the international consensus, metabolic acidosis in the umbilical cord arterial blood at birth is defined as umbilical cord pH

When there isn’t enough oxygen available, fetal cells switch to an alternate method of metabolism that produces lactate, which accumulates and makes the blood acidic. This is similar to the process that might happen to you during vigorous exercise. In adults it causes cramps, nausea and weakness. It’s unlikely to be pleasant for your baby.

If the process continues, your baby will begin to asphyxiate (suffocate).

The authors note:

Foetal asphyxia almost always occurs as a result of a gradual insufficiency in the umbilical blood flow or insufficient uterine blood flow, and in most cases, it is attributable to a reduction in gas exchange for variable time periods. However, a sudden complete cessation of oxygen delivery to the foetus as a cause of asphyxia is clinically rare, but often catastrophic.

Your baby will attempt to protect him/herself.

This includes changes in FHR, reduction of oxygen consumption secondary to the cessation of non-essential functions such as body and eye movements, reduction of body temperature
and centralisation (redistribution of cardiac output to preferentially perfuse vital organs such as the heart, brain and adrenal glands (Fig. 3); and a switch to anaerobic cellular metabolism first in the peripheral organs and subsequently in the central organs). The degree to which these mechanisms are effective in preventing asphyxia depends upon the overall health of the foetus and the placenta, as well as the duration, frequency and intensity of the hypoxaemic event(s).

To conserve oxygen, your baby will stop moving in, lower his or her body temperature, and shunt blood away from most organs to send oxygenated blood preferentially to the heart and brain in a desperate attempt to stay alive.

But:

As asphyxia progresses, the foetus loses the ability to protect its vital organs, and there are subsequent further decreases in the blood flow to the heart and the brain. Decomposition with severe metabolic acidosis is associated with a reduction of the arterial pressure due to a decrease in the cardiac output, and ultimately a decrease in the cerebral blood
flow. Thus, the combination of asphyxia and ischaemia due to hypotension and hypoperfusion results in decreased cerebral oxygen consumption and, if sustained, hypoxic brain damage, organ system failure and, ultimately, foetal death.

The brain and the heart and ultimately your baby him/herself begins to die.

The damage does not end if your baby is born alive. Many natural childbirth and homebirth “success” stories imply that if a baby is successfully resuscitated at birth, the problem has been solved. Nothing could be further from the truth.

When the tissue is reoxygenated and reperfused, energy-rich phosphates are rapidly replenished. However, reoxygenation entails the initiation of complex chains of events that result in secondary energy failure and neurotoxicity. The neurotoxicity in the second phase starts by the generation of oxygen derived free radicals and an excess of excitatory amino acids This takes place at 2-6 h after the primary insult, as the restoration of the cerebral blood flowincreases the pO2 in the tissues …

Another significant component affecting the progression of foetal brain injury is the cerebral inflammatory response following hypoxiceischaemic insults. This inflammation is generated by both the activation of local inflammatory cells in the affected brain tissue and the recruitment of circulating immune cells.

The damage to your baby’s brain continues to get worse even though he or she is now getting enough oxygen and looks fine. There is evidence that the bulk of the permanent damage to your baby’s brain will happen in the hours after birth, not during the actual oxygen deprivation. That’s why high tech resuscitation often involves brain cooling. The idea is to decrease the metabolic rate during those critical hours when your baby’s injured brain is producing toxic substances that harm brain cells, and thereby minimize the inevitable additional damage.

The damage may have a long term impact on your baby:

… [H]ypoxic damage typically afflicts the grey matter … The resulting clinical syndrome may take several forms, but two major syndromes can be schematically described. First, when the lack of oxygen develops gradually, the resulting clinical picture in surviving neonates after severe hypoxia-ischaemia is an acute and transient failure of kidney and liver functions together with chronic brain injuries… The neonate shows the typical signs of severe brain injury, and the head does not grow during the following months (microcephaly), and a typical CP syndrome develops with severe spastic paralysis of all four extremities. In the second major syndrome after acute severe hypoxia, the typical brain injury is severe damage to the basal ganglia with sparing of the cerebral cortex… The clinical picture in typical cases is of a child with a normal head circumference and often well-preserved developmental functions, but with gross impairment of motor coordination and balance, and consequently of their total motor performance…

So if your baby experienced ongoing oxygen deprivation during labor the result may be severe brain injury affecting all aspects of function. Your baby will be severely handicapped both physically and intellectually. If your baby was temporarily deprived of oxygen because of an acute event like severe shoulder dystocia, he or she may have normal intellectual function but impaired motor function, typically known as cerebral palsy.

The authors provide a pie chart of outcomes:

Outcomes metabolic acidosis

How can you protect your baby? The best way is fetal monitoring during labor, either electronic fetal monitoring or intermittent listening (auscultation) following a rigorous protocol. Fetal monitoring, particularly electronic monitoring, has a high false positive rate. That means that it may indicate distress when your baby is not actually oxygen deprived. It does, however, have a low false negative rate, meaning that if your baby’s heart rate monitoring is normal, your baby is very likely to be safe.

A high false positive rate means that a lot of babies are rescued (by emergency C-section, forceps or vacuum) who were never in any trouble. On the other hands, it means that if there is even the slightest indication that your baby’s brain is at risk, everything will be done to prevent injury.

Of course, you could always opt not to monitor at all and “trust” that your baby will survive birth unscathed. Ironically, natural childbirth advocates, the folks who are most concerned with maximizing a child’s intellectual potential and health by breastfeeding, making their own organic baby food, and avoiding any toxins, are most likely to put their babies at risk of the biggest toxin of them all: oxygen deprivation during labor.

  • anotheramy

    Very, very off-topic, but a question for the health care professionals on the board: Do you recommend any vitamins to prevent colds/ illness? Our house has *constantly* had someone sick with colds or pink eye or a stomach bug since mid-Sept. I’ve really cracked down on hand-washing, but is there anything else I can do to prevent this junk? (My oldest is a first grader & middle is a preschooler.)

    • fiftyfifty1

      Nope. Nothing works. That’s just the age they are. They get everything.

      • anotheramy

        Thanks everyone. That way I won’t waste my money.

    • Azuran

      Unless they have an actual real specific vitamin deficiency that could potentially weaken their immune system (which is highly unlikely), no, it’s not gonna help.

    • Dr Kitty

      Soap, water, lots of Kleenex, disinfectant wipes on door handles and hot washing towels and face cloths as frequently as you can be bothered to.

      Beyond that… Nope.

    • Gene

      Children are germ factories. Cute germ factories, but germy nonetheless.

    • EmbraceYourInnerCrone

      Use disinfectant wipes on the house phone after each use , if you have a house phone. If your kids have tablets or they use your cell phone or tablet use disinfectant wipes on those as well. Wipe off things multiple people use that everyone forgets about, the fridge door handle for instance, the TV remote, light switches.

      • sdsures

        Doorknobs, too.

  • Sue

    This confirms what we already knew – radical-NCB is not about pathophysiology or driven by safety – it is about IDEOLOGY.

  • sdsures

    My cerebral palsy and hydrocephalus happened because I was a micropreemie. Fortunately for me, my parents hadn’t done anything to make that happen, as happens with HB and NCB parents when they’ve drunk the kool-aid.

    From a medical standpoint, I’m very high functioning, but I do have complications that will always be with me. I have friend who also have hydrocephalus, and some of them have more complications with it than others, like seizures or spina bifida.

    My complications are:

    1) we were told I couldn’t walk, but I figured out how to at age 6.
    2) hydrocephalus that required multiple shunt revisions (some patients need more than others). The good news is that it arrested in 2006, so I don’t need more revisions, fingers crossed, but that has caused…
    3) recalcitrant migraines that haven’t responded well to most prophylactics, but the GOOD NEWS is that they are responding very well to Botox. 🙂 Fingers crossed that it keeps on working.
    4) Tendon surgery when I was a kid, to fix toe-walking (a common thing with spastic cerebral palsy). It makes shoe-shopping difficult, but we finally have been able to get me orthotic shoes on the NHS. Thse days, did you know that they also use Botox to fix toe-walking, instead of major orthopedic surgery? It’s much easier on the patients. 😀 The surgery was all they could do in those days, and at that time, it was the right call. I don’t know if it’s ever performed these days.

    As far as my meagre amount of reading tells me, I don’t think they had cooling therapy for preemies in my day (1981). I was very lucky.

    This is why NCBers irk me, SO MUCH. They take it for granted that whatever crazy schemes they want, or “want” for mothers and babies, that on the best case scenario, moms and babies will come out just fine at the other end, or in the worst case scenario, dead baby and/or dead mom, and that “some babies are just meant to die”.

    • demodocus

      hugs from one preemie to another. Fortunately, I was later term and my issues were more minor, some heart problems as a little that eventually resolved.
      Its seriously heartless to tell grieving parents “some babies are just meant to die.” If the parents tell themselves that to help cope, that’s one thing, but if its your care provider? Ugh.

      • sdsures

        Yep. Boggles the mind, doesn’t it?

    • SporkParade

      This is why I positively despise Ina May Gaskin. If my husband survived birth, then there’s absolutely no reason to think her son wouldn’t have lived if he had received some form of medical care.

      • sdsures

        What age was her son again?

        • SporkParade

          He was two months premature and died 12 hours after birth. Estimated birth weight of 3 lbs.

          • sdsures

            🙁 Bigger than I was at birth. He could have been saved were they in hospital. Or at least, he’d have been given a f***ing fighting chance.

          • An Actual Attorney

            I had lunch last week with a colleague who is built like a linebacker and a very successful partner at an international law firm. Came up that he was a preemie and just over 3 lbs at birth, and then dropped to 2 lbs something. And he’s probably close to 60 at the youngest.

            She’s a murderer.

          • SporkParade

            Bigger than my husband was, too.

  • mythsayer

    This is rather off topic, but I need to vent. I read a statement analysis blog. Statement analysis is looking at the words someone uses to try to decide whether they are being truthful or deceptive. It is really fascinating. Anyway, last night someone commented that she thinks the reason all these children are going missing or are dying from neglect/accidents is because of an increase in inductions and CS’ and a decrease in natural childbirth and breastfeeding. Because of course those moms are not bonding properly and therefore care less about their children.

    I was beyond horrified. I commented back. She said she knows lots of moms who’ve had c-sections who are bonded but generally she wonders if the decrease in natural birth has caused less bonding. I asked her how she can claim she knows CS moms who have bonded fine and also claim that vaginal birth is better for bonding. Doesn’t that imply personality has a big part in bnding? Or some other thing besides birth type playing a role?

    She went on to discuss how inductions cause cs’ and how most women could have vaginal births if they tried, etc, etc. I hate it when people claim cs’ are usually unnecessary. But it’s totally okay to put your baby at risk during homebirth? But I can’t CHOOS a CS? Makes me so.freaking.angry.

    And this was on a blog about the words people use during certain situations (like the words DeOrr kunz’ parents have used after he went missing in July -he’s still missing and the question is whether the parents’ words indicate they know more than they claim to know). How is a blog about statement analysis an appropriate place to go on and on about type of birth.

    Gah! The crunchies are everywhere!!!! Just had to vent.

    • Blue Chocobo

      I’d moms who seek out knowledgeable care and accept rather than refuse recommended intervention are already more bonded to their babies, as they are willing to take on the risks to themselves (interventions are more risky for the mother, her body has to absorb whatever risks are present first) instead of risk their babies.

      • mythsayer

        Agreed.

    • Monkey Professor for a Head

      Is there actually even an increase in child neglect and missing children, or fo we just hear about it more because of the media and Internet?

      • mythsayer

        Oh I agree with you! I don’t think there are more. I think it’s just more exposure.

        But how offensive, right? As if, because I chose a c-section, God forbid my daughter goes missing, I’m just going to take my time calling 911, and I’m going to be all blasé about it, and not express concern for her well being. Right. That’s totally going to happen because my c-section prevented a strong bond between my daughter and I. That’s why she sleeps with me, and practically on me every night (and it’s not fear of sleeping alone…she just likes sleeping with me). And why she kisses me of her own accord about ten times per day. but no. No bond at all.

        No, the lack of concern some parents show couldn’t be because they’re, you know, just really bad parents. Nope. Must be those evil inductions, c-sections, and formula filled bottles.

        Ugh. It just makes me so mad.

        • demodocus

          totally explains why my sister drove 5 or 6 hours after putting in a full day of work to pick up her kid when he got pneumonia at camp.

          • demodocus

            (They called at the end of the work day.)

        • Monkey Professor for a Head

          Absolutely offensive! Although I’d love it if you replied with stats showing kids are safer now, followed by the conclusion that it’s all down to c sections and formula!

      • Bugsy

        I’ve read some studies on this recently that state that it’s actually much safer for kids now than ever before (fewer kidnappings, etc)…but it does get hyped up a lot more.

    • demodocus

      what a fool.

    • Madtowngirl

      It also drives me insane when people claim sections are usually unnecessary. I delivered at a hospital that will not do one without a medical reason. Their section rate is still about 30%. Maybe a few happen for the reasons listed in this article, but I can’t imagine the majority are “unnecessary.”

      • Azuran

        Only an omnipotent god or someone with the power to see the future can know which c-sections were ‘really’ necessary and which one weren’t. Those who complains of unnecesarean just don’t get it.
        Doctor, caring about the baby and the mother’s life, will recommend c-section in a particular situation if it is less risky than vaginal birth. Of course, most of the time, baby would have turned out fine. But some of them would have died, and you will never know which ones.

        • sdsures

          “Only an omnipotent god or someone with the power to see the future can know which c-sections were ‘really’ necessary and which one weren’t. Those who complains of unnecesarean just don’t get it.”

          They don’t get it, and they are stubbornly NEVER going to get it.

      • Hilary

        What do these people consider a good reason for a c-section? I’m curious.

        • Amazed

          A blue floppy baby who spends at least 3 days at NICU.

          Think I’m kidding? I wish.

          • Sue

            …and then, only accepted retrospectively.

            Heaven forbid that you might try to predict and prevent…that would be unnecessarean.

      • RMY

        If the doctor told me without one there would be a 10% chance my child would be injured and disabled for life unless I had a c-section, I’d tell the doctor to get me prepped for the surgery right away. I’d wager most women would feel that way (wanting to take as small of a risk as possible). So the anti-CS crowd are counting that for that particular case, 90% of c-sections done for that specific reason were “unnecessary”, as only one case of injury/disability was prevented. The thing is, nobody can predict which of the women would’ve been in that 10% and which would’ve been just fine in the 90% category.

        The problem is that they’re not pushing for better diagnostic criteria to better identify which women absolutely need c-sections, they’re only asking people to take risks they’re not comfortable with.

        • fiftyfifty1

          “The problem is that they’re not pushing for better diagnostic criteria to better identify which women absolutely need c-sections, they’re only asking people to take risks they’re not comfortable with.”

          Exactly!
          They seem to have absolutely no interest in working to develop tools to improve diagnostic specificity. I think they don’t even want better tools because they’ve already decided that CS are never needed, cased closed.

      • Allie P

        To the NCB crowd, a C Section is unnecessary if they get the baby out and it’s fine. Only if they get the baby out at the moment of near-death was it “necessary.”

        • mythsayer

          Even then it’s not necessary because the baby wouldn’t have been in that situation had the doctor not given all these interventions. They literally will barely ever acknowledge that any c-section was necessary.

    • Guest

      Could you please link to this? Statement analysis sounds fascinating.

    • Amy

      That’s bizarre, considering that the numbers of missing children and children who are the victims of violent crime have been decreasing by quite a lot since the 70s and 80s when we were all kids. It’s never been a safer time to be a kid than now. (No, I don’t have numbers on hand, but I’ll see if I can find some.)

      • The Bofa on the Sofa

        That’s bizarre, considering that the numbers of missing children and
        children who are the victims of violent crime have been decreasing by
        quite a lot since the 70s and 80s when we were all kids. It’s never
        been a safer time to be a kid than now.

        It’s not bizarre at all, Amy, if you just remember that this is not actually a serious hypothesis put forth to explain any observation. Instead, it’s just another attempt to demonize c-sections. Who cares whether it has any bearing with reality.

  • SarahSD

    Stop trying to scare us with science.

  • demodocus

    So, the brain damage is caused by a chemical build up that continues after birth, like a roast’s temperature continues to rise after you take it out of the oven?

    • Roadstergal

      I did some work a while back on just one of what I’m sure are many, many mechanisms. :p It was on the ischemic penumbra in stroke, but the idea is the same – neurons die from oxygen starvation, then you get a penumbra of increased damage even after reperfusion occurs. I focused on the role of microglia, the brain-resident macrophages (a certain type of immune cell), which become activated and initiate inflammatory processes that cause more damage. They’re lovely little cells that do a lot of work to protect neurons, but when things go off, they’re a double-edged sword. They’re very sensitive to the ROSs and excitatory peptides mentioned in the bits of paper Dr Amy quoted, and are key players in the cerebral inflammatory response mentioned.

      So maybe not so much an oven heat sink, as an internet gossip chain, where someone hears something and gets angry, and starts telling other people what they think is going on even though they don’t fully understand the situation, and THEY get angry, and a big misunderstanding perpetuates more damage?

  • My heart is pounding after reading this post. I have shared a little here about my second c section but nothing about my first. I was scheduled for a c section at 37 weeks because of a prior myomectomy but didn’t quite make it to the scheduled date (having contractions). During the c section things got very ugly when they had trouble getting the baby out. Apparently when they broke the bag of waters he moved and they couldn’t get him out through the incision they had made. He was deprived of oxygen while they tried to move him back, then did an inverted T incision and ultimately pulled him out by his shoulders. I have never really understood why he was deprived of oxygen – I think it was because the placenta was cut when they initially opened my uterus (it was anterior). I don’t know how long he was deprived of oxygen either. It seemed like forever before they finally got him out but it can’t have been that long, really.

    His first Apgar was 2. He didn’t cry. He was purple. His whole body was bruised from having been pulled out. I’m tearing up just writing about it now, 2 and a half years later. There are no words for how it felt to be lying on that table knowing my baby was in trouble.

    He did great after that – 5 minute Apgar was 7, was out of NICU after only a day, and now he’s 2 and a half and seems to be on track developmentally – but I am still terrified that effects are going to show up later because of that initial oxygen deprivation.

    The second time around, with placenta accreta, was a cakewalk compared to that.

    • Daleth

      Oh, Gingerandlime, how scary. I’m so glad they got him out as fast as they did! His 5-minute Apgar sounds great and like a very good sign that they got him out before damage was done.

      • fiftyfifty1

        Not to be a nitpicker, but actually Apgar scores can’t be used to predict future learning problems or measure if there has been permanent damage. They are just a quick and dirty tool to decide whether a baby needs more resuscitation measures and/or close monitoring in the short term. NCB types will claim that if a baby perks up nicely for the 5 minute score it can’t have sustained damage, but that’s not how Apgars work.

    • Megan

      That does sound scary! I agree that his second APGAR improving so much is reassuring.

    • Kathleen

      My daughter had the cord wrapped around her neck when she came out. Her Apgar was 6 first and went up after 5 minutes. The doctor mentioned nothing about oxygen loss and said sometimes that happens (we also noted it on the fetal monitoring we did every week (including ultrasounds because of my high blood pressure). We don’t know for sure but are suspicious that perhaps there WAS some oxygen loss (even just minor, if that’s possible) and that is the reason for her speech delay (she is 3 going on 4 and speaks at a 2 year old level though improving thanks to intervention). Now, we could just be grasping at straws, but it’s terrifying to think about.

      • Wren

        My daughter had a nuchal cord as well, so I know the scary side of that. My son, who did not have one, was the one with the speech delay. At almost 10, he never shuts up and though there are a few sounds he still struggles with after years of speech, you would never guess there had been any delay. Hopefully in a few years you will never be able to guess your daughter had a delay at all either.

  • Amazed

    Today I got to learn why a baby of a woman I know was born 1 week pre-term. Turned out that she was sitting there checking tones and fully expecting that a week later, she’d have a baby. Right up to the moment the heart rate plummeted down right there, in the doctor’s office. An emergency c-section revealed a nuchal cord. You know, one of the things that don’t kill babies. Except when they do.

    Hurrah for the lucky chance and all them evil intervens!

    • Angharad

      Wow! What good fortune that they were in the right place at the right time to catch it and save the baby!

      • Amazed

        Indeed. She was so stunned that she kept thinking, “I cannot have this baby now. I am not ready. I don’t even have a nightgown. I was planning to wash my hair after my appointment!”

        Incredibly good fortune. She wasn’t quite clear what caused the falling rate. Perhaps the baby moved and the cord started tugging. I don’t think that even she knows.

  • Bugsy

    39 weeks here, and I will admit to skipping most of this post so that my pre-labor anxieties don’t increase further. Fetal heart rate monitoring? Heck, yeah. I want it started as soon as possible. Not wiling to take any chances w/ my son’s life.

    • Blue Chocobo

      I don’t think there’s a cure for pre-labor anxiety, other than a safe delivery, but I just want to say I hear you, I feel for you, and I hope everything goes well and soon!

    • Inmara

      Wishing you a safe delivery and healthy baby!

    • Megan

      I admit I skipped a lot of it too. Even at 18 weeks this was hard to read. So exciting for you that you’re so close!

    • demodocus

      I skimmed and I’m months from worrying about it. 🙂 Good luck!

    • Bugsy

      Thanks for all of the support. 🙂 Had final u/s today – #1 was born at 39 weeks – and little guy is looking as good as can be expected. Around 1.5 lbs bigger than his brother, head down and pretty much ready to go. Now just to convince him to not wait out the next week!

  • Neya

    Makes you want to make all births c-sections.

    • Daleth

      I certainly want all mine to be. So far so good. My preemie twins had Apgar scores of 9 and 10 after their c-section birth, and they’re big vigorous happy healthy toddlers now.

      • Amy M

        When my Twin A started having late decels, they hauled him out with a vacuum…and he was fine. I am so glad we were constantly monitored, so he could be born before any damage was done. Twin B never showed any signs of oxygen deprivation, and had the same Apgar scores as his brother. (8s and 9s) They are 1st graders now, doing fine, no signs of issues from being pre-term or experiencing O2 deprivation.

    • Blue Chocobo

      There is a point at which the scale tips and cesareans cause more problems than they solve (somewhere between 20 and 90% of births, depending on a LOT of variables), but the option should be available wherever possible. Women deserve to know the benefits and risks of having or avoiding interventions and be able to choose.

      • Daleth

        The question isn’t whether they cause more problems, it’s whether they cause more serious problems. I had a wound vac on for three weeks or so after my c-section due to healing problems with the incision, but good lord, who wouldn’t prefer that to having a brain-injured baby who would have been perfectly healthy if only they’d gotten him out in time?

        And for that matter, who wouldn’t prefer it to having a wound vac on their devastated genitals?!

        • Blue Chocobo

          Yes, a tipping point for serious problems. There’s even a tipping point for deaths.

          Cesareans have risks. Serious issues are relatively rare, especially in planned instead of emergent. Deaths are very rare but do occur. If we decide to just make every birth surgical, people will die that wouldn’t have if a more individualized approach was taken.

          It would be safer to have all births (in a population, not necessarily for an individual) be via cesarean than all by vaginal delivery, but it is safest to evaluate on a case by case. It is most ethical to let the patient decide which risk they’d rather take. W

          omen shouldn’t have to beg for a planned cesarean, or worry about non-consensual intervention (not that forced cesareans are at all common, but are a violation none the less for their rarity).

          • Roadstergal

            “It is most ethical to let the patient decide which risk they’d rather take”

            I agree, but it has to be done in the context of informed consent. Before a C/S, you have to be informed of the risks to yourself and the baby. Is this _ever_ done for a VB? It seems rare to vanishingly rare.

            I wonder if private insurers and public national health agencies have ever run long-term numbers on childhood disability and pelvic floor issues in women vs the immediate cost of a C-section. To go by upfront costs alone is simply the wrong way to go about it.

          • Blue Chocobo

            Of course. Highlighting “informed” for emphasis isn’t bad at all, as consent cannot truly exist without it. If you are mislead, you cannot really freely choose.

            As I said above:
            Women deserve to know the benefits and risks of having or avoiding interventions and be able to choose.

          • sdsures

            I would love to see a study done. I’m in the UK, but I was born in Canada, and rarely do I have complaints about socialized medicine. It’s not perfect, but it’s better than the alternative. When the BBC ran a series of stories about being “too posh to push”, it was irksome.

          • Daleth

            I agree that it’s most ethical to let the patient decide which risks she wants to take–but that does require the doctor honestly telling her what the risks of VB are.

            Sadly, doctors don’t seem to do that unless you’re already in either a mid-labor emergency or a situation that’s a clear medical indication for c-section (e.g., ultrasound shows the baby is breech). When I raised specific concerns about VB to my doctors–risk to the babies, pelvic floor damage–all but one of the MFMs on my team pooh-poohed my concerns. I had to fight for my c-section EVEN THOUGH I had a medical indication for it (mono-di twins, one of whom was breech or transverse at every third-trimester ultrasound).

            As for this, not sure I agree: “If we decide to just make every birth surgical, people will die that wouldn’t have if a more individualized approach was taken.”

            Have you seen the UK study of all births over a 3-year period (>2 million births), which found that the maternal death rate was actually lower in the planned cesarean group than in the planned vaginal group?

            http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html

          • Blue Chocobo

            Under those criteria, a planned cesarean means you are either already a good candidate for surgery, or you have high enough risk factors for vaginal delivery that a cesarean is safer even if you’re an iffy candidate for surgery.

            A real test would be to just assign everyone either a cesarean or a vaginal birth at random, but ethically that cannot be done as people would die easily preventable deaths. More in the vaginal group than in the cesarean group, but senseless all the same.

          • Daleth

            Under those criteria, a planned cesarean means you are either already a good candidate for surgery, or you have high enough risk factors for vaginal delivery that a cesarean is safer even if you’re an iffy candidate for surgery.

            I don’t know about that. This study covered a time period when maternal request c-sections were not generally available in the UK, certainly not on the NHS. So the vast majority of planned prelabor c-sections in the study were presumably done for medical reasons. And aren’t most medically indicated prelabor cesareans done for fetal indications rather than maternal ones?

            In other words, breech, transverse, multiples, micropreemies (the UK study looked at all births after 24 weeks), etc.? While it’s true that some c-sections are done for macrosomia or cephalopelvic disproportion, aren’t those usually done during labor once labor turns out not to be progressing well?

            In other words those “high enough risk factors” you mention are mostly risks to the baby, not to the mom. So they shouldn’t skew the maternal death stats, as you seem to be suggesting they did.

          • Blue Chocobo

            Preeclampsia, placenta previa, accretia, and macrosamia all can indicate a need for a cesarean for the mother’s health and safety, and can be detected before labor onset. I’m sure there are other conditions. It’s not just to benefit the baby and the mom would have been fine without intervention (aside from the trauma of injury to her baby). Most? Maybe, I don’t think it’s been studied in that kind of detail.

            And they still weigh the risk of non intervention against the risks of surgery, and the ratio changes from case to case. Probably around half of women, it could really go either way and no “deciding risk factor” jumps out and waves it’s flag. For about a third (assuming access to modern medical care), a cesarean is definitely safer. For the small number remaining, a vaginal delivery is safer for them unless new risk factors present.

            A mother who cannot have a good epidural because they have spinal issues will require general anesthesia, which makes a higher risk surgery. If she has a very high likelihood of a vaginal delivery going well for both of them, she should not be expected to take on the risk and cost of general anesthesia unless they are worth it to her.

            The study is still not randomised, and cannot and should not be.

        • Azuran

          That’s what annoys me the most about the NCB people. They are always complaining about ‘complications’ moaning about ‘unnecesarean’ Post-op pain, post-op infection, longer hospitalization time etc. They act as if c-section exist only for OB’s fun and are 100% negative and all possible negative outcomes have the same weight.
          What’s a dead or permanently brain damaged baby when compared to not having instant skin to skin contact.
          And of course they often don’t even count vaginal birth complications as complications. You practically get congratulations and an award if you get a 3rd/4th degree tear during vaginal birth.

          • Blue Chocobo

            They are also shockingly blase about the predictable, avoidable NICU stay. How many posts has Dr. A done about homebirth mothers bragging about HBACs that ended with babies fighting for their lives?

          • Dr Kitty

            Both my children were lifted directly out of my abdomen, over the surgical screen and into my arms, for a few minutes of skin to skin. Their one minute APGARS (9, obviously) were done while I held them.
            CS doesn’t necessarily mean forgoing skin to skin IF your baby is doing well… Which is unlikely to be the case of you wait until CS becomes a life saving necessity.

          • Megan

            This is unfortunately not standard practice in our hospital and I’m trying to help change that, at least in our family-centered OB clinic. I think moms having elective CS should have the opportunity to have those nice cuddly first moments with their babies too (as long as baby and mom are doing well, of course!). I’m hoping my delivery can be a trial run for them. The issue is going to be getting cooperation from the staff and from anesthesia. It’s always hard to change how things are done in hospitals.

          • Dr Kitty

            I hope it works out for you.
            My babies were both in my arms immediately, then to the warmer for a nappy, 5minute APGAR and a quick wipe, before back to my husband and I.

            Given that my first CS was 20 minutes start to finish, and my second was 28 minutes, the longest either baby was away from me was maybe 10 minutes total, and if they were, hubby was with them.

            My tip, if possible, get your IV in your forearm, not your hand or antecubital fossa. It makes holding the baby much easier, and the line won’t kink so much.

          • sdsures

            Well, I learned something new today. 😀 I’ve had IVs placed in the antecubital fossa (had to look that up), and one particular time, whole thing just fell out because I was trying to read (flexing my elbow :P). https://www.youtube.com/watch?v=IxhXahrXLbQ

          • Dr Kitty

            Despite my surgeries and letting medical students practice starting lines on me, I still have great veins, thankfully, so it isn’t a problem to put a line wherever I want.
            Obviously, it isn’t always possible for everyone. This CS I had a very senior anaesthetist who put it there, with local, without me even asking, and largely without me noticing , while we chatted. .
            I am not a fan of the hand either, and wrist isn’t much better.

            I’ve been on both sides of this.
            My approach was always to try first where the patient wanted, and if that didn’t work we’d try where I wanted next.
            Because sometimes their favourite vein really has just given up, and it is time to move elsewhere, but not everyone will take your word for it unless you try and fail first.

          • sdsures

            Yeah, a vein on the inside of my right wrist gave up a long time ago because it has a bunch of scarring on it from previous IVs. It must have been a nice vein, because everyone wanted to use it, LOL! I usually ask if we can try the right arm or hand first because I’m left-handed.

            No trouble with blood draws on either arm.

          • demodocus

            they insisted on putting it in my hand. I *hate* hand IVs.

          • Blue Chocobo

            One hundred upvotes. Hand IVs are awful. Staff that insist on them in the absence of a truly compelling reason are evil.

          • Charybdis

            Foot IV’s are worse. Had one in my foot when I had bilateral carpel tunnel release surgery. It infiltrated, so I had a soggy, floppy foot for a bit.

          • Kelly

            Me too. This last time they put an IV in my arm near the bone and I barely felt it. I have only been in the hospital to deliver my kids and the first time I got an IV, they had to stick me three times and it ended up on my hand. I did not realize how much IVs sucked because I always thought it was like a blood draw.

          • mythsayer

            I really don’t understand the skin to skin contact thing. I was totally cool with them cleaning the baby, wrapping her up, and then stitching me up. They cleaned her and wrapped her and then gave her to my husband while they stitched me and that’s the first time I saw her. It was only a minute or so after they’d taken her out of me…but even so HE held her, not me. And that was fine by me. I keep thinking there must be something wrong with me. If everyone else thinks the immediate holding is important, I must be the weird one. But I really didn’t want to hold a goopy baby. No thanks. Clean her up, then hand her over. And even then, I didn’t see her again for over an hour, and then not again for hours AGAIN. It was a Japanese hospital so they do things differently. They let me rest the entire first night. And that was blissful. But other women would have been freaking out. So I guess I’m just weird.

          • KarenJJ

            I especially requested it with my first and it felt like a big deal at the time but I felt a bit silly, it was difficult to hold her lying flat on my back and I couldn’t really see her, and the operating theatre was very cold (she has a rare immune system thing that causes a rash especially if exposed to cold temperatures and she broke out in the rash shortly afterwards).

            I didn’t even bother requesting it with my second. He was wrapped up snug and warm (important to us because he had a 50/50 chance of having the same genetic condition his sister has) – my husband got to hold him securely and I got to see his little face properly.

            We did some lovely snuggles during the rest of our stay in the hospital instead. It’s made no difference.

          • Charybdis

            I’m with you on the “eeewwww…..clean that shit OFF the baby before givingu him to me” camp. I also don’t *get* the big deal about immediate skin to skin contact and would have been less than pleased if it had been tried to be forced on me. I have the rest of my life to bond with and enjoy my son. I really doubt getting him.cleaned up first and letting me recover a bit from a CS is going to make that much difference.

          • fiftyfifty1

            “And that was fine by me. I keep thinking there must be something wrong with me.”

            Not at all. This extreme NEED for immediate skin to skin is a cultural need manufactured very recently in human history.

          • Megan

            You aren’t weird. Everyone has different wants and needs. I did want to hold my baby but that doesn’t mean everyone should want that. I just wanted the option and our hospital doesn’t do that. I’m just hoping moms can have that choice.

          • Anna

            I think it is extremely important to highlight that BOTH CS and vaginal birth can be extremely traumatic events. While CS is obviously surgery and traumatic by default, vaginal birth is something like a Russian roulette with outcomes ranging from complete recovery within days to fatal comlications to mother and/or baby. First CS is of little risk, multiple CS are pretty dangerous. VBAC is dangerous too. I am just happy I’ve never wanted more than one child. Birth IS dangerous, vaginal doesn’t mean safe, how don’t they get it!

          • Roadstergal

            “While CS is obviously surgery and traumatic by default”

            And even that is variable. A relaxed, scheduled surgery is a very different animal from an emergency surgery. That’s what makes VB even more of a Russian roulette – if it doesn’t work out, you’re looking at a C/S that’s going to be more rushed and messy, more dangerous for mom and baby, and harder to recover from than if you had decided on C/S from the get-go.

          • Azuran

            I’d say that even vaginal birth is traumatic by default as well. Even if you have a very easy birth, you are still pushing a baby out of your vagina, it will hurt. Even if you don’t tear, I expect pretty much everyone to be pretty sore down there for a while afterward.

          • mythsayer

            Not necessarily traumatic by default. I CHOSE to have a CS BECAUSE it is surgery.

            I lived in Japan and can guarantee that an American hospital would’ve forced me to try a vaginal birth. But I didn’t want to. Nope, not at all. The very idea of a vagunal birth terrified me.

            I had a very traumatic gallbladder episode when I was 19. A stone got stuck in my bile duct and blocked my liver so I had severe pain on and off for six months..,always being told it was the stomach flu. Six months after the pain started, I was throwing up everything and in horrendous pain. I could barely walk. Essentially I was nearly in liver failure.

            So the took my gallbladder out and my liver took a couple years to fly heal.

            And then I am told by several women that gallbladder pain is nearly as bad as, or worse than, labor pain. And my gallbladder/liver pain was horrendous. Like I thought I was dying horrendous.

            So the thought of any pain even remotely close to that pain terrified me.

            But surgery? No problem. Surgery made me better after my gallbladder issues. Surgery helped me lose weight (gastric bypass). In my world, surgeries are great things. They fix me.

            So to me labor = horrid pain and possible tearing, but surgery = a way to get better.

            Surgery was the obvious choice for me.

            So not all c-sections are traumatizing. Some people really do prefer them.

            This is why choice should be the default for everyone. It’s just that choice should be as safe as possible…and homebirth isn’t. But if it were, I’d be the first to say “traumatized or scared of hospitals? That’s cool…I support your choice for a SAFE homebirth.” We need to emphasize the safety part in the us. I think homebirth is a bad choice, even in other countries. But if I want the choice of surgery, then I would be a hypocrite to not support other choices. I just think those choices should as safe as possible and made with a true understanding of the risk.

            A bit of a tangent, but still…underlying point is that surgeries aren’t always traumatic.

          • Anna

            I don’t think we should start glorifying c-sections the way many did in response to this article. I don’t think Dr. Amy would’ve agreed. I think we should just leave the right to decide on the mode of delivery to medical professionals and not any woman’s choice. This is not plastic surgery where you come in and book whatever you want. However, even with plastic surgery there are certain limits that you can’t go past. Why were you so afraid of vaginal birth anyway? What about the epidural?

          • fiftyfifty1

            “I think we should just leave the right to decide on the mode of delivery to medical professionals and not any woman’s choice.”

            In medicine, when 2 different ways of treating a problem have generally acceptable risks and outcomes, patients get to decide. Why do you think it should be different for birth?

            “Why were you so afraid of vaginal birth anyway? What about the epidural?”

            Epidurals treat the pain of labor. But only when they work. There is a small but real chance they won’t. And of course they don’t prevent pelvic floor injuries or shoulder dystocias or fetal asphyxia or the need for a crash CS with its risks. All of these are of importance to women.

          • KeeperOfTheBooks

            And from what I’m told (never experienced vaginal birth myself) they also don’t take care of the pain of crowning, any tearing associated with that, or the repairs afterward. *cringes*

          • fiftyfifty1

            It very much depends. It did for me, and it does for most women luckily, but certainly not all.

          • KeeperOfTheBooks

            Interesting! If that’s the case, I stand corrected. I would have sworn I’d been told in comments here that the opposite was the case (ie, that a good epidural will take care of contraction pain but usually doesn’t do anything for crowning/tearing/repair), but on this I’ll bow to those who have actually experienced vaginal birth. 😉

          • demodocus

            It hurt, but not to the level of agony I’m told unmedicated birth has

          • Wren

            Even unmedicated childbirth is going to vary in pain level from woman to woman. My VBAC wasn’t super pleasant or anything, but honestly I have had worse menstrual cramps than the labour and coughing after the c-section (admittedly undermedicated thanks to a bitchy midwife I did complain about) was far more painful than crowning. The worst, for me, was the 3 stitches to repair a small tear as the local didn’t take.

            Really no one but the woman involved can tell you how painful the birth is, and that may well vary from child to child too.

          • demodocus

            lol, I suppose that’s true. I’ll find out the latter part soon enough.

          • Wren

            If it helps any, most of my friends and family who have had more than one vaginally claim it’s easier in subsequent births. I hope that’s what you find.

          • demodocus

            I’m just hoping to avoid pre-e. That magnesium stuff made me very loopy. General labor was about 18 hours, but I vaguely remembering the staff being mildly surprised how fast the pushing part went for a 1st timer. I shudder to think of others pushing for hours.

          • fiftyfifty1

            It’s true that you shouldn’t tell/promise a woman that the epidural is going to cover crowning/tearing/repair, because there is a significant chance it might not, but in most women it does really help. I trained at a hospital without epidurals but also did a rotation at one with epidurals where most women got them. The difference doing repairs was night and day. The first was coaxing screaming women to keep their legs open long enough for me to inject lidocaine, the second was “Um, hey, maybe I felt something kind of poking down there?” “Oh sure, let me give a little squirt of lidocaine down there to top you off while I finish these stitches”.

          • Mer

            Epidural made a huge difference for me when I needed suturing of just 2nd degree tears. It didn’t cover a small portion of my left side but it covered enough that it was only about a 4 plus no ring of fire during crowning and felt absolutely nothing during the laceration repair. I’m also resistant to local anesthetic, it works eventually after large doses but still damned uncomfortable especially after all the other abuse that poor tissue just went through. only 1 out of 3 repairs with epidural, 2 with just local, so theres my anecdote.

          • Medwife

            Crowning pain- I’d say it’s not a majority of women who have that with an epidural. And those that do, well, the vast majority of the time it seemed to me that while they had pain, the epidural was helping even though the mother may not have realized it. There’s no way for me to know, but judging from external signs. Unmedicated crowning is usually pretty dramatic. I very rarely have had to give lidocaine when repairing women with epidurals. I just keep the drip going until I’m done.

          • KeeperOfTheBooks

            I guess you learn something new every day. 🙂 I’m quite glad to hear that I’m wrong, as I’m hoping for a VBAC next time around, and have somewhere between little and no interest in being in any more pain that I have to be in.

          • Monkey Professor for a Head

            Anecdotal, but my epidural didn’t cover the right hand side of my stomach fully (but after 15+ hours of back labour it was so much better that I didn’t care) but covered my perineum beautifully. Pushing actually felt good as it relieved the contraction pain without any pain from crowning. Didn’t feel the episiotomy, didn’t feel whatever examination the OB did afterwards with the PPH (they said something about checking my cervix for clots or something, but I had a baby on my chest and I was pretty disassociated from everything else).

          • Toni35

            I had an epidural with my first, and yeah…. Absolutely no relief for crowning, tearing, or repair (even the lidocaine given when the OB realized I was able to feel the stitching didn’t help much). I went on to have my other three children with no mess at all. I figured if it’s not going to help with the truly awful part, why bother? But then, my labors weren’t that bad, second stage is the worst for me, and the part that the epidural, unfortunately, doesn’t seem to help me with.

          • Toni35

            “Mess” should be “meds” stupid autocorrect…

          • KeeperOfTheBooks

            Ugh. 🙁 I’m sorry; that really sucks.

          • Megan

            I am one of those people that had an epidural not work – twice. It was horrible because I’d already waited to get one until I literally couldn’t take the pain anymore and then I was left with no pain control options. There was no way I was going to make it without since I was on pit and progressing slowly, (which we later found out was because DD was OP and asynclitic) and so that’s why I ended up with a CS. I was so relieved when I felt my spinal actually work. In my case, had I still tried to pursue vaginal birth I guarantee the pain would’ve been much more traumatizing than my CS.

          • Monkey Professor for a Head

            Trauma isn’t just physical either. Being denied pain relief for hours was traumatic. Fearing for my sons life when his heart rate started dropping during pushing was traumatic. My PPH was very traumatic for my husband (I wasn’t aware of the severity at the time). I had an episiotomy, which was painful for a few weeks but I didn’t find it traumatic compared to everything else.

            If I find out in a future pregnancy that my baby has a nuchal cord (which caused my sons decels) or anything else that might make vaginal birth risky, I’d probably have a c section and take physical trauma over emotional.

          • Monkey Professor for a Head

            Although I must say that what I went through is nothing compared to what some other women have suffered. In the grand scheme of things, I’m very very lucky.

          • Who?

            What you went through was terrible, and that doesn’t change because now everyone is well.

            You’re in a position to reflect and to make different choices next time, and having the courage to do that, rather than trying to have a different (‘better’) version of that experience, is smart.

          • Monkey Professor for a Head

            There were plenty of things about my sons birth that sucked, but in the end I have a healthy little boy and no long lasting physical effects. It certainly helps keep things in perspective. It doesn’t affect me on a daily basis, I don’t think about it most of the time, but I suspect I’ll find any future pregnancies somewhat anxiety inducing. But I think that’ll be a few years down the road.

            On the plus side, when I did get an epidural, it was awesome! Think I’m a little in love with that anaesthetist!

          • Daleth

            when I did get an epidural, it was awesome! Think I’m a little in love with that anaesthetist!

            A friend of mine joked (I think she was joking, haha) that “by the time the anesthesiologist came in, I would have given him a blow job for that epidural.”

          • KarenJJ

            She just described why she was so afraid of the pain. Do you not believe her?

          • Anna

            I don’t want to be judgmental. I know some people have low tolerance of pain, I know that having had a traumatic painful experience before makes you even more afraid of birth. But is major surgery the answer? Yes, you skip the pain. Hopefully you skip the post-op pain as well with good meds. But… Your stomach will never look the same. You have a whole list of don’t do this and don’t do that and a newborn. You have weird memories of people digging into your insides while you were awake. I had a medically necessary CS and I’m happy they did it because things would have been worse without. But if I had a magical ability to change one thing about my life that would be it.

          • fiftyfifty1

            “I don’t want to be judgmental.”
            Then do your best to really listen.

            ” I know some people have low tolerance of pain”
            Mythsayer doesn’t describe that she has a low pain tolerance. She describes that in her life she has already had to tolerate multiple episodes of labor-level pain and that compared to her experiences with surgery, she chooses surgery.

            “But is major surgery the answer?”
            Mythsayer has had plenty of experience with major surgery already. They were positive experiences for her and so she chooses it.

            ” But… Your stomach will never look the same.”
            Mythsayer already has experience with abdominal surgery, and presumably has already experienced some of the changes in appearance it can cause, and finds that acceptable to her.

            “You have a whole list of don’t do this and don’t do that and a newborn.”
            There is no long list of rules. The only rules are don’t lift anything heavier than your baby for 2 weeks, and don’t drive if you are on a narcotic (typically the first 5-7 days).

            “You have weird memories of people digging into your insides while you were awake.”
            I certainly don’t. Most women don’t.

            ” I had a medically necessary CS and I’m happy they did it because things would have been worse without.”
            Yes exactly, it’s the “things would have been worse without it” that people who request a CS are looking to avoid!

            “But if I had a magical ability to change one thing about my life that would be it”
            To each their own. I wish I would have had a CS for my first rather than a vaginal birth. I wouldn’t pee and poop my pants and wouldn’t be facing a hysterectomy and sling.

          • Anna

            I am really sorry for what you and Mythsayer had to go through. I didn’t mean to be harsh or anything. Sorry if sounded that way.

          • Azuran

            Well, I’m pretty sure your ‘lower part’ will never look the same after pushing out a baby as well. You also have a long list of ‘don’t’ with vaginal birth. Many of my colleagues had c-sections and all of them have a pretty normal looking stomach. The pregnancy itself did more damage to their stomach then the c-section.

            Can surgery be the answer? Absolutely.
            You can have a very easy and comfortable c-section with an easy and painless recovery. Just as you can have complications. Same goes with vaginal birth. Some women will literally have the baby slip out of them like a greasy pig. Others will labour in extreme pain for long hours before tearing all the way up to their bellybutton and not be able to sit properly for weeks.

            Vaginal birth is not better than c-section and c-section is not better than vaginal birth. They are 2 different ways to have a baby and depending on the unique circumstances (both physically and mentally) of each mother and baby, either one of them, can be the best option.

          • Anna

            “You can have a very easy and comfortable c-section with an easy and painless recovery”. I had it that way and still hated it. I definitely wouldn’t opt for it if had choice.

          • Azuran

            But other people feel differently. That’s the point­. Some people love their c-section, others hated it, regardless of how it went and why they had it. Some people love their vaginal birth, other people hate it, regardless of how it went.
            Nobody is saying that you ‘have’ to love your c-section. It’s alright for you not to. But other people had them and loved them and they have to right to say it. The same way people loved or hated their vaginal birth. (or even feel neutral about it)
            Both vaginal and c-section birth have positive and negative possible outcomes, neither is perfect. Whenever those two are safe options, a woman should be free to chose which of those potential risks she wants to face.

          • Anna

            Like I said in my original comment I’m against glossing over any of the two modes of delivery, obviuosly they both can be traumatic but with the c-section trauma is unavoidable. What is cutting a person open if not trauma? It’s obviously not a spa-procedure. Sometimes you have to choose the lesser of the two evils like I did, because vaginal delivery in my case would’ve been a disaster. I don’t know why you guys got all worked up when I pointed out the obvious fact that surgery IS traumatic.

          • Amazed

            It’s also a way of bringing your child into the world. Today, the sports friend I wrote about two weeks ago came to train with us. The three men in her life – her husband, her dog, and her two weeks old purely elective c-section baby were taking care of each other. She was definitely glowing, jumping and stretching with us (admittedly, today we trained on a much relieved schedule.)

            C-section wasn’t traumatic to her. It was her choice. It was what she wanted.

          • Anna

            It sounds great, really. It did not traumatize her emotionally, but physically it did. She has the scar, doesn’t she? Now, let me explain, when I say trauma I don’t mean smth absolutely horrible and life-altering. I mean the body has been cut and sewn back. This doesn’t mean life ends at that or anything. But let’s call things what they really are. C-section is not just “another way of bringing your child into the world”. If it were so the c-section patients would leave the hosp in a couple hours and not stay there for 3-5 days.

          • KeeperOfTheBooks

            Some of us would find having our genitalia cut/torn and sewn back together rather more traumatizing than an abdominal incision that has no possible affect on our sex or personal lives. My scar is hair-thin and about as long as one of my fingers. Frankly, I don’t notice it most of the time. If I tore through my clitoris, as some women do, I think I’d notice that a lot more.

          • Anna

            “If I tore through my clitoris, as some women do” – sounds awful… Does it happen frequently? I thought it was the perineum that tears. God, THAT must be horrible…

          • PrimaryCareDoc

            I would consider my fourth-degree tear, which went up to my anus and took almost 2 hours to stitch back together to be trauma.

            The c-section- no trauma. Trust me. It was not traumatic.

          • fiftyfifty1

            I’m with you. My levator ani avulsion-traumatic. My planned CS – not traumatic.

          • fiftyfifty1

            “I thought it was the perineum that tears. ”

            It is if you’re lucky. It’s true that posterior tears are more common than anterior ones, but one of the commentors here on SOB (I’m not sure if she still comments frequently or not) had an anterior tear. Yep, she tore right through her clitoris!

          • Blue Chocobo

            Including a tear to the clitoral artery. So, not just horrific, but horrific in a very urgently dangerous way.

          • Amazed

            You can really stop with the patronizing tone, you know. Do you know who is really traumatized by her births – I mean, physically? My mom. If you think the scar you’re so intent to focus on is worse than having to find a toilet immediately when you feel the urge to go, you’re way off the mark. I’d rather take 3 – 5 days in the hospital that this “other way of bringing your child into the world” leads to than spend the next 30 years the way my mom has. Because, you know, she has certainly spent faaar more than 3 – 5 days wondering if she’d make it or if she’d poop her pants. The second has happened. More than once.

            But yeah, c-section scar, 3 – 5 days in the hospital and those weaklings who just fear vaginal birth. If I can return to sports with my traumatized body 2 weeks after the c-section instead of being unable to hold the weight of my vaginally-birthed babies for months as my mom has – the more power to me.

          • Anna

            I’m sorry but where was I being patronizing? I’m only trying to be objective. And I absolutely agree that vaginal birth can have fatal outcomes and that was why I didn’t go for it. I am just sharing my experience here. Not meaning to offend anyone. I just like to call things what they really are. It wasn’t until I realized that I needn’t think of my c-section as a positive thing that I was able to come to some peace with it. I just treat it like: shit happens. I don’t try to convince myself that vaginal birth is worse really but it’s some big secret kept up by doctors. Your Mom should have had a section obviously, because for her it would have been the lesser evil of the two.

          • Amazed

            You like to think that things are always the way you feel them and you apply this rule to everyone. You “know” that the woman I was talking about was “traumatised” physically, although she was jumping and stretching two weeks later. You offend everyone who defines their level of trauma by any other parameters than yours. Fiftyfifty1 has shared her personal experiences with physical trauma of childbirth. You read that and THEN you chose to enlighten me that my friend was traumatised because she has a scar? You do come across as offending, although it’s clear that it isn’t your intention.

            Live and let others live, I say. But it looks like you think healthcare providers should always present c-section as a great physical trauma for the patient’s consent to be an informed one. That’s what I find offending.

          • Anna

            Of course she was traumatized physically, she’s got a cut and sewn up uterus, for God’s sake! I don’t understand why you want to deny obvious facts. I am not telling her or anyone how they should feel about it, it’s up to them. Besides, has it not crossed your mind that your friend simply didn’t feel like telling you all the particulars as to how she felt because it was too personal? I never told any of my friends how scared and helpless I felt on that table. And if you met me two weeks postpartum, you wouldn’t think I had just been through surgery either. I was wearing high heels, make up, my hair done and strolling across the mall shopping. So what? Things aren’t always how they look. Just watch a video of c-section, the one for medical students and say it’s not physically traumatic if you have the nerve to.

          • Box of Salt

            Anna “traumatized”
            With apologies to Rob Reiner: You keep using that word. I don’t think it means what you think it means.

            I had a c-section. Two of them in fact.
            I am not traumatized, neither emotionally nor physically.

            To me, controlled, carefully surgery is clearly NOT trauma.

            Anna, you are projecting.

            I believe you when you tell us that you are having a hard time coping with having needed a c-section.

            Why can’t *you* believe those of us who tell you we do not consider our experiences with birth via c-section as “trauma”?

          • KarenJJ

            If I’d had ‘trauma’ I guess I’d expect to be upset about it in some way.

          • Amazed

            Ah, so it’s about physical trauma. We can agree on that, although I suspect that my definition and yours would differ somewhat. Anyway, it wasn’t what you initially talked about. You were talking about stomachs looking different and memories of strangers reaching inside one’s body. You were talking about perceptions.

            You keep dancing around the issue of vaginal birth being traumatic by default – because sometimes, it’s uncomplicated. For many women, it’s the first time they meet with great pain,. For others, the loss of control is traumatizing. As to my friend, I’m far from the thought that she told me everything. I am aware of the opinions she was bombarded with before giving birth though – mainly, that she’d ruin her life and health, that she’d never bond with her baby and that it was a major surgery. As if she didn’t know! As if she just decided, “Well, hell, I’ll just go and have myself cut open because it’s so fun! No way is it going to have any downsides!”

          • PrimaryCareDoc

            I don’t know. I don’t really consider being carefully cut with a scalpel and then meticulously sewn back together under sterile, calm conditions with state-of-the-art medical care and anesthesia to be physical trauma. At all.

          • Amazed

            I am not sure. But then, I’ve never had anything I consider a physical trauma. Including this extremely traumatising time when I was lying in a pool of my own vomit, unable to reach the foot I had just broken and the migraine that had made me try and walk through the wall, not seeing that there was one, still raging. There was pain in my foot, pain in my head, vomit on my face – and I was terrified dumb by the total loss of control, the realization that I had to wait for Nature to kindly release me of the migraine so I could crawl into the bathroom and hoist myself up on the edge of the bathtub.

            This far, the unexpectedness and loss of control have been what traumatized me, not the physical pain or damage.

          • FEDUP MD

            I have assisted in several csections in medical school, attended dozens and dozens as a pediatric resident, and actually watched my own in the surgical lights. I don’t find them traumatizing at all. In fact, I have had 5 surgeries in total including 2 csections and they were the least painful and best ones I have had (a baby in the end, yay!)

          • Who?

            My friend has had 4 cs, not traumatised by any of them, including the first one which was done in a pretty big rush for failure to progress, and despite her vomiting as soon as baby is out every time. After the second one she had a nurse with an emesis basin teed up before the action started.

            She’s had some pretty big dramas in her life and honestly the cs is so far down the list of things she cares about I don’t think it would occur to her to mention any of them in the top 100.

            She wanted 4 kids, for everyone to be alive sections were the option, she ticked the box and got on with it.

          • fiftyfifty1

            ” I just like to call things what they really are. ”

            Huh? Then why do you call surgery “trauma” instead of just calling it surgery?

          • EmbraceYourInnerCrone

            I found my vaginal birth traumatizing, My daughter was in fetal distress and did not breathe at first when she was born. I had 2 tears and an episiotomy because they had to use the vacuum to get her out before she suffocated. I had weeks of pain when sitting, standing , walking or rolling over in bed. Personally I think a scheduled C-section for macrosomic baby(8lbs 15 oz and I am 5 foot tall) and some nice pain killers would have been awesome.

          • Blue Chocobo

            The offense is saying women shouldn’t have a choice. The choice of intervention or non intervention should be made with the informed consent of the patient in every possible instance.

          • Hilary

            Not sure where to put this – it’s not really directed at you Amazed but I’m putting it here because of the 3-5 days comment. Just wondering if I’m the only person who still has pain from their c-section? 16 months postpartum and it hurts pretty much daily, mostly on one side of the incision. It’s not excruciating or disabling, but … it is ongoing pain.

          • Amazed

            Not a doctor but… have you gone to one? You aren’t the only one who still has pain, I’m sure. But as far as I know, it isn’t the norm, so doctors should really address it. There’s no reason for you to keep living in pain – there wouldn’t have been even if every second woman lived this way.

            Don’t suffer in silence. Don’t accept that it’s just the way it is and it might just go away. It might. But it might not.

          • Hilary

            Thanks. I guess I can mention it at my next pap smear. The incision looks well-healed. It feels like the nerves are being pinched or something.

          • Amazed

            So everything looks good on the outside? That’s another reason to mention that there are problems inside!

          • I felt like this after my first c section. I never mentioned it to a doctor until I was pregnant again, and when I finally did he told me that it’s possible a nerve got pinched or constrained when they were stitching me up, and that they could try to fix it the second time around. I am 9 weeks out from the second section and feeling the same pain in the same spot, so I guess that was a bust … But like you said above, it’s not like it’s debilitating or anything.

          • Hilary

            Wow, that must be what it is. I know it’s probably too early for you to tell long-term, but do you think your second section made it worse or is it about the same?

          • So far I think it’s about the same but like you said, it’s early.

          • Hilary

            Did it hurt more while you were pregnant, from the area being stretched?

          • Yes, that’s why I eventually mentioned it to the doctor.

          • fiftyfifty1

            Yep. I describe it like this: The Could go, Should go, Must go and Did go process gets compressed into a 60 second span (or less).

          • Box of Salt

            Anna “when I say trauma I don’t mean smth absolutely horrible and life-altering. I mean the body has been cut and sewn back.”

            That’s not a good definition of trauma. It’s too general, and it absolutely includes way too many things that most people would not consider truly traumatic.

            For example: I would not consider a small cut that happens to require stitches “trauma,” but your definition does.

          • The Bofa on the Sofa

            Anna “when I say trauma I don’t mean smth absolutely horrible and life-altering. I mean the body has been cut and sewn back.”

            That’s
            not a good definition of trauma. It’s too general, and it absolutely
            includes way too many things that most people would not consider truly
            traumatic.

            And more to the point: if that’s what you are talking about as “trauma”, then so the hell what?

            The reason trauma is considered bad is because it is absolutely horrible and life-altering, or at least has negative connotation. However, if you talk about trauma as something else, something that doesn’t mean negative connotations, then who cares if it is traumatic or not?

            So this insistence on calling it traumatic is really disingenuous. It’s basically a passive-aggressive attempt to poison the well.

            .

          • Hilary

            And if all c-sections, or all births, are traumatic then we need a new term for births where (for instance) there’s an emergency CS and the spinal doesn’t work, or massive PPH necessitating multiple blood transfusions and a hysterectomy, or the baby gets stuck and ends up with massive brain damage, or they both almost die from catastrophic uterine rupture.

          • Anna

            Then I’m being agressive towards myself as well, huh? Any medical professional will agree that uncomplicated vaginal delivery is “better”. It’s a fact. Now English is not my native language. Perhaps the word trauma was a bit far-fetched here. How would you call it?

          • Azuran

            You really have a fixation on the abdominal incision. You are really just playing with the word ‘trauma’ at that point. With your thinking, everything is traumatic.

          • Dr Kitty

            For what it is worth, I stayed 48hrs with my second, and the anarsthetiat told me that there have been studies with good outcomes on day 1 (24hrs post op) discharge after CS.

          • Fallow

            In some ways I follow what you mean here, because invasive surgery produces a controlled “trauma” to the person’s body. I’ve had various surgeries in my adulthood. I am familiar with how a person’s body can react to a surgical procedure in less than ideal ways. I’m also familiar with the body horror of surgery, and I get how a c-section could cause that horror.

            However. When I gave birth, my child’s shoulder dystocia caused permanent damage to my pelvis. There are no visible scars, and no artificial intervention caused this damage. But unlike a carefully made surgical incision, I had rather diffuse, chaotic damage that cannot be fixed.

            Vaginal birth has plenty of potential to cause physical trauma that rips you apart, instead of slicing and repairing you in a targeted fashion. In this sense, the fact that I was discharged earlier than a c-section patient is irrelevant. Because a c-section patient stands a fair chance of feeling normal again, and I don’t. That is some very long-lasting physical trauma, and it came about the good old fashioned way.

            You should at least consider that it’s not okay to tell someone that their c-section was traumatic, if they disagree. Physically or emotionally, you can’t make that call for them. Not everyone feels like the controlled damage of surgery constitutes physical trauma. You’re projecting onto other women.

          • Anna

            Thanks for understanding. Controlled trauma – that’s it! I never meant to undermine people’s traumatic experiences with vaginal birth or convince women who were happy with the c-sections that they needn’t be so.

          • fiftyfifty1

            ” But let’s call things what they really are.”

            Yes, let’s! Let’s call vaginal birth, vaginal birth. Let’s call C-section, C-section. Let’s let women themselves decide whether or not they consider either to be “traumatic”.

          • Box of Salt

            Since I cannot upvote – “Let’s let women themselves decide”

            Thank you, fiftyfifty1!

          • demodocus

            The only stitches I’ve had in my life were from my kid’s big head ripping my poor perineum. Took 6 months before sex didn’t hurt thanks to that scar. I don’t feel traumatized from it. My sister was way more traumatized by her cancer diagnoses that came about because of her son’s birth than the unplanned C-section itself. (That crap was all over, even the umbilical cord)

          • An Actual Attorney

            That sounds horrible. Is she OK now?

          • demodocus

            It’s been 8 years. She went into remission for several years than a few years ago it came back. She’s still in the fight, but has been upgraded from Stage IV to Stage III and her meds were recently halved. So, relatively good.

          • An Actual Attorney

            Hopefully the news continues to improve.

          • Charybdis

            C-section is CERTAINLY another way of bringing your child into the world. I think the only other alternative other than vaginal and CS is to use a fetotome/embryotome. That’s where the baby is cut up and removed in pieces after death. I would think THAT scenario would be the most traumatic.

            CS patients remain in the hospital for several days due to their surgery. Vaginal deliveries stay for 24-48 hours after birth. Back in the late 80’s and early 90’s, if you had a vaginal delivery in the hospital, you were discharged within 12-24 hours. This was a money-saving HMO policy and they were called “drive-through deliveries”. Babies and mothers started having complications that showed up after they had gone home. Here’s a link to a 1997 law review on the subject. http://scholarship.law.marquette.edu/cgi/viewcontent.cgi?article=1495&context=mulr A few excerpts:

            Having a baby is one of the most joyous events in life. For nine long
            months, the anticipation builds. Finally, the day arrives and labor begins.
            After the excitement and exhaustion of delivery, mothers desperately
            need time to rest. First-time mothers particularly must learn to care for
            their infants, while others simply need time to recuperate physically and
            emotionally.
            In 1970, the average hospital stay for a vaginal delivery was four
            days.’ Within the last three years, stays have declined from 48 hours to
            24 hours.’ Some were even required to leave the hospital in as little as
            8 hours after delivery.3 Women in labor were told to “wait in the
            hospital parking lot, as long as they can bear it, so that the clock doesn’t
            start ticking . … “‘
            All of this changed on September 26, 1996, when President Clinton
            signed a bill entitled “New Borns’ and Mothers’ Health Protection Act
            of 1996.”1 The new law, which becomes effective January 1, 1998,
            requires insurance companies to cover forty-eight hours of care following
            a vaginal birth and ninety-six hours following a cesarean birth.’

            By the 1950s, hospital delivery was the norm.’ By the 1960s,
            essentially all births took place in a hospital. This led to a drastic
            reduction in the mortality rate of infants because of cleanliness, training,
            and observation.26
            In the 1970s, the average hospital stay after a vaginal birth was four
            or five days.2 After cesarean births, it was about one to two weeks.28
            At the same time, however, more women were choosing to give birth at
            home. Recognizing this trend, Kaiser Permanente Medical Center in San
            Francisco introduced an early discharge policy where mothers in the
            Family Centered Perinatal Care Program could leave after twelve
            hours.2 9 For this early HMO, the initiative was economically sound and
            socially acceptable.
            By the 1990s, these shorter stays had become the norm.3° Between
            1970 and 1992, the median length of stay decreased by almost 50%.
            The safety of such practices became the topic of many studies. 32 In one
            study, 24 to 36 hours seemed to be sufficient, although the readmission
            rate for infants discharged before 36 hours was 2.5 times higher than the rate for infants staying longer than 48 hours.3 In another study, those
            mothers required to leave in less than 48 hours showed a 50% increased
            risk of readmission to the hospital and a 70% increased risk of readmission
            to the emergency room.3 4
            The obvious problem with early discharge is that some illnesses for
            mothers and infants do not develop until days later.3 By leaving early,
            symptoms do not appear until the infant is at home.36 Coincidentally,
            medical complications which had become non-existent began to rise. For
            example, jaundice in the newborn, after becoming virtually eliminated
            decades ago, made a comeback.37 Jaundice, which is usually diagnosed
            and treated with special hospital lights on the second or third day, was
            beginning to go undetected.3”
            Also on the rise was kernicterus, a rare and preventable complication
            of jaundice.39 Physicians say that until recently, they had not seen kernicterus in twenty-five years.’

            In 1992, California
            adopted an early discharge policy.42 Since that time, Dr. Sola saw “six
            otherwise healthy, full-term newborns rushed to his neonatal intensive
            care unit with permanent brain damage due to severe jaundice (bilirubin
            encephalopathy).”‘ In addition, Dr. Sola found that in 1992 alone, “nine full-term newborns discharged early as healthy suffered irreversible
            brain damage because of severe jaundice.”‘
            Dartmouth Medical School
            conducted a study to determine the risk of hospital readmission and
            emergency room visits within the first two weeks of life.54 The findings
            were startling. For infants discharged in less than 48 hours, “there was
            a 50% increased risk of readmission and a 70% increased risk for emergency room admissions.

            Now this study was on the legal side to force insurance companies to cover longer hospital stays for mothers and babies for their health and safety, but it does touch on the fact that there are health issues that take a little time to show up, for both the baby and the mother. And the hospital is the better way to monitor these things.

            Vaginal delivery can be traumatic as well. Trying to shove something the size of a football out of an orifice that can stretch some, yes, but often winds up tearing to differing degrees of severity, is traumatic. It is up to each individual person to weigh the risks and benefits of each type of delivery and make their own decision. BUT, they need to have the facts and the risks of each type of delivery spelled out to them so they can make an informed decision.

            In a CS, yes, tissue is cut and sewn back together. But it tends to be in a controlled fashion, whereas perineal tearing from a vaginal delivery can be quite extensive and require just as many, if not more suturing than a CS incision. You can also tear your cervix, which will require repair as well. Plus, it makes sitting more painful/uncomfortable than a CS.

            Sometimes, you will not like either option, and/or find the associated risks of each unacceptable. But the baby has to get out somehow. And I don’t think anyone is demonizing either type of delivery. There are good and bad experiences for each type and they fall along a continuum, from relatively mild and easy to horrific and traumatic. You evaluate the information and risks and make the best choice for you at the time. Doesn’t guarantee that you will *love* one choice and *hate* the other; you might dislike both choices and have to choose the lesser of the two evils. But that’s life. You often have to adjust your plans on the fly and choose between two options that you don’t like. It’s not fair, but life is like that.

          • KeeperOfTheBooks

            I had a CS. I didn’t find it at all traumatizing to be cut open. (Unless by “traumatic” you mean involving your body being cut open, but I don’t see how this is more traumatizing than, say, getting your genitals shredded over the course of a vaginal birth.) I understand that some people do find surgery to be traumatizing, and that’s certainly fine, but surgery doesn’t particularly scare me. Not being able to control various bodily functions or enjoy sex with my husband? That scares me. (In my case, my CS was required because of my daughter’s position, but I enjoyed it so much that if I didn’t want several more kids, I wouldn’t even try for a VBAC.)

          • Wren

            Do we actually need to demonize vaginal deliveries here? It is sounding as bad as when NCBers talk about C-sections. Vaginal births do not necessarily involve genitals being “shredded”, being unable to control bodily functions or not being able to enjoy sex afterward any more than c-sections necessarily involve wound healing problems, huge scars or failed anaesthetic.

          • Anna

            Exactly! We need to be objective. I have a baby girl. When she grows up I’d rather she had an uneventful vaginal delivery than surgery. God, it’s so obvious. I didn’t mean to put down any of those that needed it (being one of them myself obviously). But we shouldn’t be doing sour grapes I believe, because if we do how are we any better than the NCB?

          • KarenJJ

            I’d rather my daughter receive the best medical care properly, the best information available and using her life experiences and intellect, to make up her own mind.

            No one’s saying vaginal births mean that your genitals are shredded, but that it would be traumatising to have that happen and that their c-sections didn’t cause that level of trauma for them.

            My mum was very very hung up over her c-sections. I was terrified of the idea. I had to get over myself a little when faced with the necessity of a c-section and to my surprise the entire thing was fine. I’m still fine. It was not nearly as traumatic as other events in my life. It’s by far the least traumatising surgery I’ve had (I react to the gas used in laparoscopic surgery) and the most rewarding. They have to come out some way or other and neither is a walk in the park.

          • fiftyfifty1

            “When she grows up I’d rather she had an uneventful vaginal delivery than surgery. ”

            The point that everyone is trying to make is that you can’t just walk up to the counter and order up “an uneventful vaginal delivery please”. The only thing a woman can choose is a Planned CS vs. a Trial of Labor. The planned CS has its risks. So does a TOL.

            Many well informed sensible women will choose TOL, hoping for the happy luck of an uneventful vaginal birth. Other equally well informed sensible women will choose the MRCS, deciding that the risks of a TOL gone bad (damaged baby, damaged genitals, crash CS etc) are risks that they want to be sure to avoid.

            When MY daughter grows up, I hope her choices on the matter are respected. God, it’s so obvious.

          • Wren

            I completely agree that maternal choice should be the choice. My only argument here is that neither choice should be vilified and described as though it is inevitably going to be terrible. The risks and benefits of each should be properly explained in realistic terms.

          • Roadstergal

            What if that’s not what your daughter wants?

            Personally, I’d be creeped out by my parents expressing their preferences for my use of my genitals.

          • fiftyfifty1

            “Do we actually need to demonize vaginal deliveries here? ”

            Who is demonizing them? Did you read what KeeperOfTheBooks had to say? She plans on trying for a VBAC for future births because she knows the downsides of multiple CS.

            But if not for that, she would choose CS. CS went very well for her. She enjoyed her CS. At the same time she has concerns about the risks of vaginal birth. The possibility that her vag births might be complicated and end in incontinence and sexual dysfunction scares her. She’s not saying it happens to everyone, or even most, but she’s saying it could happen, and it scares her. Should she have to pretend it doesn’t happen? Should she pretend she doesn’t care? If so, why? Why “should” she have to care about the risks of CS but not about the risks of vaginal birth?

          • Wren

            There were quite a few posts I was responding to, not just that one. Yes, some vaginal births have various complications, but so do some c-sections. Focusing only on the negative vaginal births and the positive c-sections is exactly what the NCBers do in, just swapping the method of delivery. In reality, most births of either type go well without lasting negative effects.

          • KeeperOfTheBooks

            True, but it’s not an inconsiderable number who have to deal with that. Look at tearing alone: about 4% of women will get 3rd- or 4th-degree tears during vaginal childbirth. Those tears *will* involve not being able to control feces/gas–it’s just a question of to what degree, and how well they can get stitched up afterwards. Even a really good OB often can’t fully compensate for a rectum that has been torn through because there just isn’t very much you can do once that ring of muscle has been cut. Not being able to control that stuff on a regular basis, much less during sex? Well, I know that DH would be a gentleman about it, and probably joke a little to lighten the mood, and would still find me attractive, but I can tell you that my self-esteem would take a massive hit anyway.

          • Wren

            That would be one of those cases where the dreaded (by NCBers) intervention of an episiotomy might have been very useful.

            I know women with ongoing problems from vaginal birth and would never deny that is a risk. I also know women with ongoing problems from c-sections and c-section does carry an increased risk to the mother. My point is just that: both methods carry risks and it should be up to the woman concerned, hopefully with the advice of an actual health care professional, to make that choice. It’s no better to talk about “shredded genitals” than “major traumatic surgery”.

          • fiftyfifty1

            My genitals were shredded. It’s the truth. I don’t have to pretend it didn’t happen just because NCB advocates demonize C-sections.
            What you are missing is this: NCB advocates demonize ALL C-sections. They call ALL of them traumatic. They tell ALL women that it will be ALWAYS be horrible. What we are advocating is something different: that women be aware that a certain small percentage of women will have major genital damage with vaginal birth, a certain moderate percentage will have mild to moderate damage, and many will have no clinically significant damage at all. It is not “demonizing” to tell the truth. It is not “demonizing” if a woman says that the risk of catastrophic genital damage, although a small percentage, is a risk she is not willing to take personally.

          • Wren

            I am sorry you had that experience.

            Most of what I have read here in this thread has not explicitly said “all”, but neither has it said “in a relatively small percentage of cases”. A statement like “vaginal deliveries lead to shredded genitals” does not imply “in a small percentage of cases”. NCB posters frequently do not explicitly say ALL c-sections cause X, just “C-sections cause X”. If a poster comes here and says “C-sections lead to infections, thrombosis, excessive bleeding, damage to the bladder and babies being cut” the “all” is assumed and the immediate response is to say those occur in only a small percentage.

          • Azuran

            And I’m pointing out that vaginal birth is obviously traumatic as well. Or is having a baby overstretch your vagina not a trauma? ‘trauma’ is unavoidable either way.
            Neither type of birth is a spa-procedure. Birth, either vaginal of by c-section IS ‘traumatic’ by default.
            Whether or not you feel traumatized by it and which one is more traumatic to you is entirely dependent on each person in their own set of circumstances. Trauma isn’t limited to ‘physical’. it also includes pain without actual physical trauma or psychological pain/trauma.
            If you have a painless c-section, how do you compare this physical but painless trauma to someone who has a painful 12 hours labor but without physical injury? Some would be more traumatized by the c-section, others by the pain of the labour.
            For you, the physical trauma of being cut open for your c-section might weight more than for another person, some people might not actually care at all.
            Each one is free to decide which kind of trauma she would rather face based on their own set of experience and desire.

          • Anna

            Vaginal birth isn’t traumatic by default. Would you argue with that? Really? Will you go so far as to state that there is no such thing as uncomplicated vaginal delivery? Whereas c-section can’t be uncomplicated, it’s a complication in itself. For medical professionals c-section ranges as delivery with complications. Regardless of what you or I or your friend think. There is such a thing as objective truth.

          • Box of Salt

            Anna, ” it’s a complication in itself”

            No. It’s not a complication.

            It’s a treatment, to prevent further complications.

          • Anna

            It’s not a healthy and natural condition. It means smth has gone wrong. There are restrictions afterwards.

          • Azuran

            And here you lose at claiming that because it isn’t ‘natural’ is is something bad.
            The incision of the c-section is not a complication by itself. It just is.
            and no, it is not an ‘objective truth’ that c-section is worse by default. There is no absolute truth when dealing with medicine.
            Sure, 100% of people with c-section will have the abdominal incision, it comes with it. But there are many potential benifits of c-section and negative possible outcomes of vaginal birth, that will overthrow this.
            There is NO absolute truth about which one is better. Each situation is unique, and yes, the opinion of the mother, while it is not everything, DOES matter in the bigger picture.

          • fiftyfifty1

            You are basing your definition on there being restrictions afterwards? How about this then: After my vaginal birth I was given the standard post-vaginal birth restriction of pelvic rest (i.e. no sex) for 6 weeks. After my CS I was told not to drive until I was off of narcotics (5 days) and not to lift anything heavier than my baby for 2 weeks, but that I could resume sex as soon as any postpartum bleeding stopped. So I was actually done will all restrictions much FASTER after my CS than after my vaginal birth. So I guess by your definition, that makes vaginal birth more traumatic, no?

            In my own case, my damage from vaginal birth was such that my inability to have sex lasted for more than 6 weeks. Due to the vaginal tearing and levator ani avulsion, I wasn’t able to successfully complete intercourse for 1 year. After my second (a maternal request CS) the bleeding was gone at 2 weeks….and so we had sex 😉

          • fiftyfifty1

            “Vaginal birth isn’t traumatic by default.”

            Of course it is if we use your definition of trauma. It is nothing that anyone would ever agree to do if it didn’t produce a baby, that’s for sure! It always produces lasting changes to the woman’s body. As a doctor, I have done thousands of pelvic exams. I have never once mistaken a cervix/vagina/perineum that has given birth vaginally for one that is a nullip. Birth overstretches the tissues at best. The majority of women tear.

            “For medical professionals c-section ranges as delivery with complications.”

            I’m a doctor, so I can tell you that you are objectively wrong about this. A TOL that doesn’t go well that ends in an emergency CS, yes is tracked as a negative outcome. But a Maternal Request CS that ends in an uncomplicated MRCS is not.

          • Wren

            Honestly, I’ve done both and the vaginal delivery was easier with a quicker recovery for me. Both babies were healthy. If I were to have a third, I’d hope for a vaginal delivery. However, I do not regret my c-section and I would not deny another woman her choice to have one.

          • crazy grad mama

            “but with the c-section trauma is unavoidable”—um, I had a C-section and did not find it to be the least bit traumatic. Your absolute is disproven.

          • the wingless one

            For me the traumatic part was knowing my son might have been stillborn without the c-section and then having a baby in the NICU for three weeks. Also traumatizing was the time when he was two weeks old and the pediatric GI told me he might have to be transferred to another hospital in case he needed a liver transplant. The c-section itself was not the least bit traumatic.

          • the wingless one

            For me the traumatic part was knowing that my son could have been stillborn without the c-section. The three week NICU stay was also pretty traumatic. Or that time the pediatric GI told us he might need to be transferred to another hospital in case he needed a liver transplant – when he was two weeks old. The c-section was NOT traumatic, sorry.

          • Hilary

            I also found my son’s NICU stay and all the complications around his birth to be more traumatic than the actual c-section. The lead-up to the c-section was scary, with labor and being rushed to the OR, but once they got the spinal in and the baby out I just felt hugely relieved.

            But, I had an extremely difficult time afterward processing the fact that I would never be able to have a vaginal birth. I imagined all VBs were like my mom’s – both babies basically fell out of her as soon as she got to the hospital, no meds, no time for the doctor to arrive – and other than that everything I’d heard was from the NCB crowd about how empowering it is to give birth naturally. Even at the childbirth class at the hospital, the doula who was teaching it SKIPPED the entire part on c-sections because “It’s too gruesome.”

            There is an instilled fear and pathology around c-sections, I think. Reading about the complications of VB and also positive CS stories helps me to be more at peace with my CS and with future RCS. I don’t see it as glorifying c-sections, but trying to give some balance and perspective, to counteract the cultural negativity around them. I’ve encountered so much of the attitude that having a CS means you’re a failure and this horrible violent thing was done to you, probably unnecessarily. Or – if you chose it – somehow that makes you shallow and selfish. (Good luck reconciling those two attitudes towards CS, they seem contradictory to me!)

            Anna, I think I was kind of where you are for a while – hating my c-section and angry that anyone would actually CHOOSE to go through that. Reading about uncomplicated CS and smooth recoveries where the women were able to go jogging a week later – heck, even get out of bed and use the bathroom on their own – made me furiously jealous. I have gotten to a place now where I just hope that my next CS can go as smoothly as some of the women on here. But it took me at least a year to get to that place. Give yourself some time.

          • Anna

            Thanks for sharing and understanding. I was one of the ones with really fast recovery actually. I hated mine because:
            1. It was violent but at the same time it was so trivial. There was no sense of miracle and new life coming or anything. The people in the OR do them a couple a day and it was really like routine. It din’t feel like giving birth at all. Everyone was nice and comforting and joking but this moment of “hoorah! here’s the baby, finally” was missing.
            2. I was just a passive beholder. I didn’t even care very much because they had given me a strong sedative seeing how scared I was before the OP.
            3. I had thought surgery was there for elderly and/or sick people not smb in their twenties never had any health issues before.
            4. The aftercare. I felt really good but everyone just kept highlighting the fact I’d just had surgery. So don’t do this, don’t do that. I felt like a wreck having to ask for help.
            5. The shelf obviously.
            All in all it’s been a VERY humbling experience. I guess I emerged a reformed person from it, still in the process of reformation and my baby daughter has been the MOST healing thing for me so far. But I still refuse to see CS as an easy way out to escape shredded vagina. Not that I would deny smb the right to think so. All that I wrote here is my personal opinion based on conversations with medical professionals and numerous articles written by actual medical professionals. Dr. Amy here mentioned that CS IS NOT an easy ordeal a couple times too.

          • Amazed

            Again, NO ONE has declared that c-sections are the easy way out. You’re just creating a strawman and fighting it.

            What we say is that for some, c-section is a choice. And many of them have it easy, their mental recovery is as great as their physical one, they’re up to their pre-baby activities soon without much pain and they feel happy with their choice. You know, just like an uncomplicated vaginal delivery. Others aren’t so lucky. Just like women with complications during and after vaginal deliveries.

            Your insistence that a c-section is a complication by itself is wrong, that’s all.

          • Wren

            Anna, most of your reasons for hating your section seem to be your personal perspective on the c-section, not objective facts. All except the shelf are, and frankly most women have at least a bit of a shelf regardless of the manner of delivery.

          • AllieFoyle

            I respect your experience, and think that you have the right to feel however you do about it. However, your refusal to show respect for other women’s feelings and preferences is really hurtful and thoughtless.

            Reading your comments and list of complaints, it’s difficult not to feel that a) you were extremely lucky that your doctor gave you the choice of a CS to avoid damage (many women are not, and many times damage is not predictable), and b) you don’t understand just how badly things can go in a vaginal birth, or how unpleasant even an “uncomplicated” birth can be.

            Vaginal birth damaged much of my internal pelvic support structures– destroying my sex life, continence, and ability to got to the bathroom normally. I had to stop running and exercising, felt sexually damaged and revolting, and became isolated and depressed. I had surgery when my child was a toddler — 4+ hours under anesthesia, cut and stitched up front and back walls of vagina to fix bladder and put rectum back into place, then the perineum cut and re-stitched from vagina to anus. Six weeks of *painful* recovery, caring for my children with no help from anyone since it was too embarrassing to tell anyone about (I’d never heard of anyone having had it before it happened to me. I know differently now). I was definitely not exercising two weeks later. Years later and sex still hurts and probably always will. I’m never supposed to lift anything heavier than a milk jug. I decided not to have a hysterectomy or mesh repair, so it’s likely that I will need another operation in the future.

            As far as the birth itself, you seem to take for granted that it’s more wonderful and special with a vaginal birth, but that is far from a given. I look at your list and think:
            1) Violent and trivial — absolutely! It was so painful and traumatic for me, but my screams and horror didn’t even seem to register to the people attending me. It was just another birth to them. Being exposed and having people touch me in intimate places when I was in out of control pain and had no control over the situation was so upsetting to me, and absolutely mundane to them.
            2) Passive beholder — yeah, definitely. It was my body, the pain, and the midwives driving the train. I had no control over anything.
            3) Perfectly healthy before. Drastically altered afterward, but in a way that was personal and upsetting and humiliating, as well as invisible to everyone else.
            4) Aftercare? What aftercare? Since I’d had a good old natural birth everyone figured I was good to go. No help needed.
            5) I don’t have a shelf or stretch marks, but my tummy is permanently softer, despite being slim, athletic, etc. I’d happily trade my damaged nethers for a shelf, my labor and delivery plus repair surgery and recovery periods for a c-section, my memories of people doing things to my genitals while in unremitting pain for memories of rummaging during abdominal surgery, etc. etc. Which is not to say that you are wrong for feeling the way you do about your experience, but you are wrong in asserting that c-section is always traumatic and vaginal birth rarely is, or that women ought not to be allowed to choose one type of birth, just because it isn’t natural. It’s about risk vs. risk, and there is no clear answer. And that’s without even considering the risk to the baby, because MRCS is less risky for them. There are lots of reasons women should be able to make the choice. Have some respect.

          • Anna

            Thanks for sharing your experience. I am really astonished by how many women out there were left altered for a lifetime by what is supposed to be an easy and natural process. Clearly it’s not just a few unlucky ones. I am by no means an anti-c-section person. Actually I think they are a miracle of the 20th century, never have so many babies made it before. I am happy that medicine and technology keep developing so the section my Mom had with me and mine are not even to be compared.

          • Daleth

            You might also have hated vaginal birth (even if it resulted in safe delivery of your child), albeit for different reasons. Have you delivered both ways?

          • Dr Kitty

            Right, which is absolutely your prerogative.

            I had the option of trying VB or elective CS and chose CS, and then the option of trying VBAC or ERCS and chose CS again.

            Apart from the scar, my abdomen looks pretty much identical 9 weeks after the second CS as it did before the first one, because of a combination of genetics, daily core exercises (which I do for my back and have done since I was very young), having a low BMI and luck. Both recoveries were easy, and yes, I’ve had other surgeries to compare it with. I’m the sort of nutcase who goes back to work 10 days after ovarian cystectomy and getting my appendix out I know that my bar for “easy surgical recovery” is set high to start with.

            The idea of vaginal birth just doesn’t appeal to me more than the idea of a CS. That’s not “glorifying” anything, that’s just stating a preference.
            And mine is not to experience labour or vaginal birth.

          • Anna

            God, you’ve been through a lot of stuff! My c-section was my first encounter with medicine and hospitals and I am only 5,5 months postpartum so I don’t know how things will work out eventually. But so far I can state that my recovery was easy and my stomach is disfigured. I work out in the gym 3 times a week, but I don’t think it will help with the shelf. I just get upset every time I see a nice flat stomach in a bikini… Shallow, I know. I’m just not used to seeing my body like that. Maybe I will learn to take it easier.

          • Blue Chocobo

            I have a “c-section shelf”, there’s a line just above the pubic bone where the skin isn’t attached to the muscle anymore and droops. I ride horses for a living. I’ve never had a cesarean. I also have hellacious stretch marks even though I’ve never been overweight and my average pregnancy weight gain is less than 20 lbs.

            It’s pregnancy. It hits every body differently. Some get lucky, some don’t.

          • Amy M

            I didn’t have a Csection, but I have a fat pad/shelf now, where I used to have a flat belly. I had my children almost 7yrs ago. I don’t like the way it looks either, but short of losing an unhealthy amount of weight, I can’t get rid of it. I try to keep in mind that most mothers have bodies changed by child-bearing, and my friends and family (including husband) do not love me any less because of it.

          • Blue Chocobo

            How do you reconcile:

            “I had it that way and still hated it. I definitely wouldn’t opt for it if had choice.”

            and

            “I think we should just leave the right to decide on the mode of delivery to medical professionals and not any woman’s choice.”?

          • Anna

            My doctor clearly explained to me that vaginal birth would be a disaster and why. It was nature that left me with no choice.

          • Blue Chocobo

            You had a choice, you found the likely consequences of one of them to be unbearable and chose the other.

            Why take that choice away from others?

          • Amazed

            The medical professional who botched my aftercare when I had a fracture solehandedly gave himself the right to decide without informing me on my options. The result – 16 years of problems and counting!

            I wish I had made the decision myself, even if it was a bad one. At least I would have suffered my own mistakes and not someone else’s.

          • PrimaryCareDoc

            I’ve done it both ways. The damage to my body from vaginal birth was much worse than the c-section. I’ve had urinary incontinence and inability to control gas. I wasn’t able to have intercourse without pain for months and months.

            From my section- I have a tiny scar, probably less than 4 inches, and completely covered by my underwear. I’m not sure why you say your stomach will never look the same- the incision is at your lower pelvis, right above your pelvic bone.

          • Daleth

            Major surgery is the answer for some people. (And honestly, the only reason c-section is called “major” surgery is because the scalpel enters the abdominal cavity… it is NOT “major” by any stretch of the imagination when you compare it to, say, a hip replacement, an organ transplant, a mastectomy, etc.).

            As for my stomach never looking the same, apart from the scar itself, the reason my stomach looks a little different is pregnancy–not c-section. And I would far, far, FAR rather have my incision scar than have torn-up genitals.

          • Anna

            My c-section shelf is not from pregnancy. Acually people who’ve never been pregnant but had say myomectomy have smth similar. It’s the direct consequence of surgery. Maybe I was just unlucky and other people don’t have it.

          • Dr Kitty

            It’s not an inevitable consequence of a Pfannenstiel incision, by any means.
            Some people have a “shelf” some don’t.
            Sort of like stretch marks. A lot depends on genetics, luck and how and where you gain weight.

          • Anna

            Maybe if I had stretch marks all over the place and stretched belly I wouldn’t mind so much. Bu I have perfect skin, not overweight and toned, it’s just my upper stomach being a protruded shelf above my lower. I can’t help but look at it and think: if it were not for the c-section, I would be looking decent now.

          • Dr Kitty

            It’s not even six months. Give it time.
            My friends complain about having “mummy tummies” after babies, and most of them had vaginal births.

            If it makes you feel better, while I don’t have stretch marks or a CS shelf I have scars from spinal surgery and lots of gynae surgery for endometriosis. When I say that my CS weren’t traumatic and the recoveries were easy, I’m comparing it them to all the other surgeries and scars.

            If it was my one and only surgical experience I might feel differently and have made different choices.

          • Anna

            Thanks. I do hope it gets better, at least somewhat. I have noticed that people who’ve had surgery before take the c-section a lot easier, whereas those for whom it’s a first hospital experience find it overwhelming. Maybe because it’s BOTH childbirth and surgery and you know nothing about either and you have to adjust to both really fast.

          • Megan

            My shelf eventually went away. Hopefully yours will too.

          • fiftyfifty1

            Hmm. I got my shelf after my first birth (vaginal). I still had it after my second birth (Maternal request CS). I lost it after I lost weight.

            ETA: It’s true that my abdomen still doesn’t look exactly like it did before I ever had kids. But if you want to see something that looks TOTALLY different, you should see my poor crotch.

          • Daleth

            Is your “shelf” the only difference between your pre-baby belly and your post-baby belly? Really?

          • Anna

            Yes, what else should there be? I don’t have stretch marks.

          • Daleth

            Your UPPER stomach protruding over your lower is what you call the shelf? What do you mean by upper vs. lower–above vs. below the bellybutton? I ask because I cannot imagine how one can conceive of anything below the c-section incision still being “stomach” or “belly.” What’s below the incision is your pubic bone and mons veneris.

            And the reason I’m puzzling over this is because it sounds like you are saying that some change in shape of your upper belly is somehow related to an incision that was made several inches below that. I’m baffled.

          • Anna

            You can google it and see how it looks. English is not my native language and maybe I was incomprehensible. Anyway, my skin is protruding right above the incision which is in the bikini line. Looks repulsive. I’m quite certain I wouldn’t have it without the c-section because there’d be no incision.

          • Kerlyssa

            Could you maybe link a picture of a woman with a similar body shape, or draw a picture? I cannot visualize this.

          • Anna
          • Who?

            Having a baby changes your life. I now have one of those, which started in my late forties, and I had 2 vaginal births more than 20 years before. It’s called getting older, and skin losing some of its zing. Some friends who never had kids had that in their twenties.

            It’s hard watching your body change, and it will change more, no matter how much you diet, exercise and even surgically try to adjust it.

          • CharlotteB

            Yeah, I have that. I didn’t know it was a “thing”–it hasn’t gone away, and my son is almost 17 months. Then again, I also got stretch marks, and I’m still 10 lbs above my pre-pregnancy weight.

            I am one of the lucky people who had an incredibly easy recovery–I went for a walk around my neighborhood 4 days after, took tylenol for a week? Could sit on hard chairs right away, etc.

            But I *still* hated labor. Yes it was fast (under 3 hours) but it was very very painful and scary–not because anything was wrong but because everything felt out of control.

            I think women would be wayyyyyy better off if we were told all the likely outcomes, all the risks (VB and CS), and, basically, told that it would likely suck to one degree or another. Then most of us could probably come out thinking Hey, that wasn’t so bad, or at least feel prepared for the bad affects.

          • Anna

            Yes, better prepare yourself for the worst and then think: it wasn’t THAT bad.

          • fiftyfifty1

            Yep. That’s a very common way to look after having a baby. I have had it ever since the birth of my first (vaginal birth). The abdomen is all stretched out, plus most women have gained a little weight. The extra fat and stretched out skin are pulled down by gravity and fold over themselves a bit on the bottom. It happens at the same location for everyone who gets it because the tissue directly below that is not the abdomen, but rather the mons pubis. The tissue of the mons pubis, unlike the tissue of the abdomen, is anchored down to the bone underneath. The border between the abdomen and the mons just so happens to be the same location where a C-section scar sits. For me, the appearance of my shelf got much less noticeable when I lost weight (after the birth of my second, a CS). Still, I’ll never have a taut abdomen unless I were to get a tummy tuck, where they remove those last couple of inches of stretched out skin. But I don’t feel like doing that. Viva la imperfeccion!

          • LeighW

            My stomach looks way worse than that and I had a VB. My stretch marks split and bled, and I don’t have a “shelf”, I have hangy flab I can grab handfuls of.

          • Poogles

            “It’s the direct consequence of surgery.”

            Sometimes it’s just genetics and how a particular body stores fat. I’ve never even been pregnant, but I have that “shelf” – I have ever since I started gaining weight in my belly as a teenager, before I ever hit the “overweight” BMI category – it’s just my particular anatomy and the way my body stores fat.

          • Box of Salt

            Anna “But if I had a magical ability to change one thing about life that would be it.”

            Why?

            What would not having had a c-section fix?

          • Daleth

            Let me just put this really simply: it’s none of your business which way other women choose to give birth. C-sections and vaginal birth are both perfectly good options. When VB is done in the hospital, it and CS are about equally safe (but VB at home or in a birth center is less safe).

            The key thing is this: CS and VB each have a different set of pros and cons, which is to say a different set of risks and benefits.

            If you lack the imagination to understand (i.e., not be judgmental about) why some women prefer “risk and benefit package A” over “risk and benefit package B,” that is something you might want to work on to make yourself a better human being (i.e., a more empathetic, wiser, more tolerant human being).

          • Anna

            And what you are saying is that we should force doctors to perform surgery which they do not consider necessary or beneficial just because some woman wants it? Why don’t you remove your appendix just in case then? Your body, your business. But if smth goes wrong the doctor is to blame who didn’t want this surgery in the first place. I don’t know what you’re accusing me of. I have no authority to allow or not allow women anything. I just don’t get who in their right mind would want to go under the knife for no reason but like you said it’s none of my business. I don’t care really. And I think this whole thing has gone way out of proportion. I stated the obvious fact that c-section being surgery is more dangerous and does more damage to the body than vaginal birth unless there is a medical condition which makes vaginal birth potentially more dangerous than c-section (narrow pelvis, breech etc.) and then the c-section is the lesser evil of the two. Which doesn’t make c-section a nice and pleasant procedure, while vaginal birth CAN be easy and leave no marks on your body. I don’t believe that everyone who’s done it has horrible stretched genitals or smth, just don’t tell me that. I will stick to what I wrote because it is THE TRUTH. If you don’t like to hear it, there’s no way I could help you.

          • Daleth

            And what you are saying is that we should force doctors to perform
            surgery which they do not consider necessary or beneficial just because
            some woman wants it?

            Yes. It is not the doctor’s call which way his patient should give birth. His job is to say, “The risks and benefits of this way are XYZ. The risks and benefits of that way are ABC. You choose.” He might even add, “I personally would recommend this way, but it’s your decision.”

            Remember, we’re not talking about, say, abortion here. We’re not talking about a surgery to which some doctors might be morally, fundamentally, religiously opposed. We’re talking about a perfectly safe way to deliver a live, healthy baby. And which way to do it is the mother’s call, not the doctor’s.

          • Anna

            Well, in my country you can’t simply order a c-section. Not even in a private clinic. I know that in some countries you can. But I wouldn’t dare really. I know little about medicine, how can I assess the risks and benefits? I wouldn’t dare choose my mode of delivery against medical advise. It simply contradicts common sense.

          • Amazed

            It isn’t this hard. People who can assess the risks and benefits lay them out for you honestly and you choose. We’re talking about a choice between two options that are almost equally safe.

            I don’t feel comfortable with anyone choosing my course of treatment for me. Else, we arrive at this case in the UK from a few months ago, with the hospital ordered to pay millions of dollars because one of their doctors didn’t lay out the risks of vaginal birth ’cause hey, if she told a G-diabet mom with a huge baby that there was a risk, she was likely to choose the C-section and that was against the doctor’s opinion that a non-emergent C-section was bad for the mom.

            I think you can guess why the hospital had to pay the millions.

            Or like this doctor we discussed here about a year ago. He was all “ah, ah, vaginal birth, rah-rah!” C-section was a BAD thing. When reminded that incontinence was a result of vaginal birth and not a c-section, he basically said, “Big deal! Anyone asked those incontinent women if they MIND being incontinent?”

          • Anna

            As far as I know incontinence is in most cases timely and goes away. I had pretty bad incontinence during pregnancy and it was gone completely once the was no longer pressure on the bladder. I read about your Mom in your comment. I can totally understand that the very notion of vaginal birth must make you sick. But I believe it does happen very rarely. And if we look on the other side… In my town a young woman died recently because of anesthetic complications during c-section. She was completely healthy, surgery was due to the baby’s position. I know that there are many out there who want to see c-section as an escape route and easy way out. But it’s not. It simply is not.

          • An Actual Attorney

            Anna, really, please take a deep breath. Most of what you “believe” as common sense isn’t true. Vag birth –> life-long problems with continence in a large number of women. I forget what it is, but it was posted here recently. Read a little more before you keep asserting what you know as “THE TRUTH.”

          • Anna

            Please tell me where I am wrong. Maybe someday the procedure of lifting a baby out of women’s abdomen will become so safe that noone will bother with the old-fashioned birth anymore. But it’s not like that at the moment.

          • An Actual Attorney

            You believe that lasting incontinence is a rare problem, you believe that a CS = inevitable trauma, you believe that a CS is more dangerous overall for mother and baby than a vaginal birth, you believe that your experience of can be generalized to all women….
            And that’s just from memory.

            There are risks and benefits to both ways of getting a baby from inside to outside. And they are roughly about equal, so each woman has to look at her individual needs, desires, and circumstances.

          • Anna

            “CS is more dangerous overall for mother”. But isn’t this a proven fact? Maternal mortality is 3-4 times higher. As for the baby – no, I don’t think that being born via c-section is any worse for the baby.

          • The Bofa on the Sofa

            “CS is more dangerous overall for mother”. But isn’t this a proven fact? Maternal mortality is 3-4 times higher.

            Because women getting c-sections often have health issues that create risks for babies, which is why they are having c-sections in the first place.

            You have to take those out of the comparison

          • Daleth

            “CS is more dangerous overall for mother”. But isn’t this a proven fact? Maternal mortality is 3-4 times higher.

            Uh, no. I think what you’re not quite understanding is that nobody can choose between an uncomplicated VB (vaginal birth) and a cesarean. All you can choose is to attempt a VB and hope it goes well, or to have a c-section before labor or in early labor.

            In other words, of course an uncomplicated VB is safer for everyone than an uncomplicated CS–but it is not up to you whether your attempt at VB will be uncomplicated, and no doctor can predict for an individual patient whether her attempted VB will be uncomplicated.

            All we can choose is (1) to attempt a VB or (2) to have a CS. And a recent study in the UK that looked at ALL BIRTHS (more than 2 million) over a three-year period found that women who attempted a VB were actually almost 26% MORE likely to die than women who chose a prelabor CS. Death was extremely rare in either case, but it was rarer in the “choose CS” group than it was in the “attempt VB” group.

            http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html

          • fiftyfifty1

            ” noone will bother with the old-fashioned birth anymore. ”

            Oh, I doubt it. Women who want large families will still choose vaginal birth. But for women wanting only 1 or 2? Yes, I think it’s possible that most women might choose elective CS. That’s already the case in some countries.

          • Amazed

            Can you really not let go of your “elective c-section is bad, bad, traumatic for everyone, even those who don’t think so!” mindset and actually read what other people write? It isn’t about me and my mom! It’s about a doctor saying, “Meh, no big deal!” about women who deal with NOT-temporary incontinence! A link that has been well established. IMO, this doctor will never lay out the risk of incontinence because to him, it doesn’t matter. And you’ll cheer him on because he’s the doctor, he knows best and he says vaginal is better.

            You say you don’t want to be judgmental but you’re anything but, still insisting that women think a c-section is the easy way out instead of a decision that they simply made based on their own circumstances.

          • Anna

            OK, would you rather have incontinence or die? Honestly? Compared to possible death or severe disability which also might happen after surgery incontinence is “no big deal”. Maybe this doctor has seen more than you have.

          • Amazed

            In the 21 century you draw the lines between the c-section of a woman who simply chooses it (aka has no heart disease or something that dictates the need of a c-section but also makes her more high-risk than most women) and death? For real?

            Please tell me you’re kidding.

            And yes, I’d like to be informed about the risk of incontinence, not have the doctor decide to choose it for me.

          • Anna

            In your comment above you accused me of not actually reading what other people write. Now I have to say the same of you. “In my town a young woman died recently because of anesthetic complications during c-section. She was completely healthy, surgery was due to the baby’s position”. That was what I wrote. Where does it say she was high risk? Who could have known she would react to GA that way? Some fatal allergic reaction. Now you may wonder why they put her under. Because (surpisingly enough) regional anesthetic didn’t work.

          • fiftyfifty1

            Yes, general anesthesia has risks. The risks are now vanishingly rare, but they exist. Anesthesia risks should be part of the informed consent process weighing risks and benefits.

            But I’m not sure how this case relates to MRCS. Need for general anesthesia is actually MORE likely to take place in a trial of labor situation, because in a TOL there is the possibility of needing an emergency crash CS. With a planned CS, the anesthesiologists can take all the time in the world to get the regional anesthesia just right. And if they cannot, for some reason, get the spinal to take, and a woman is a poor candidate for general, why then she doesn’t have to continue through with it, does she?

          • Amazed

            Scary anecdotes are scary. But they are anecdotes. They are the exception. I don’t say “No one should take the most common anti-allergic drug here!” because I happen to be severely allergic to it and found it out the hard way.

            There will be always those who show a bad or unexpected reaction to something. No one denies that it happens. But my impression is that you’re big on poo-pooing the risks of vaginal delivery – including the one of incontinence, yes – and focusing on those of the C-sections, including the one of a worse-looking belly. You spent quite the time convincing us how devastating a c-section shelf was, so I wrote about it. It doesn’t surprise me that you think it’s horrible – that’s what’s happening to you, after all.

            I am quite stunned that you’re so flippant about a life-changing and humiliating, well-known complication like incontinence, though. And since I mentioned my mom, I must add that her case it actually a good one. She manages to hold it on (barely and painfully) until she gets to the loo… usually. Others are not so happy.

            The moment a woman is pregnant, her risk in general rises above her risks when not pregnant. And with full information, she must make the choice she feels comfortable with. She. Not you, not I and certainly not a doctor who thinks, “Well, if I tell her the truth, she might choose a C-section and that’s bad for her!” right before she takes out a damaged baby. Or a doctor who scoffs at the risks of vaginal birth. Why not – HE isn’t likely to experience them!

          • Monkey Professor for a Head

            In fairness, incontinence can be pretty debilitating. I remember seeing a woman when I was a Med student who had had a colostomy because of faecal incontinence due to childbirth. She thought it was a big improvement.

          • Anna

            Yes, I submitted a link to young women with colostomy bags after birth in the UK myself in the comments to another article. Vaginal birth can have horrible consequences.

          • Monkey Professor for a Head

            Surgery to correct incontinence has risks, including death. Thousands of women choose to take that risk in order to treat incontinence. They clearly don’t see incontinence as “no big deal”.

            In fact there are plenty of medical treatments which are not life saving and have a risk of death (small perhaps, but present). Pain medication can kill, but that doesn’t mean that people with severe or chronic pain should be denied it. Breast reconstruction post mastectomy, or indeed any reconstructive cosmetic surgery has risks and isn’t strictly necessary, but people choose it anyway because they feel that for them the benefits out way the risks.

          • Daleth

            What I don’t understand is why you “believe” something that it’s possible to verify. I mean why do you hold an opinion on a FACTUAL MATTER (e.g., how common incontinence is in women who have given birth vaginally)? Why not go read some studies and inform yourself? Until you have done so, you have no basis for having any belief or opinion on the matter at all.

          • Anna

            Why? Why are you so willing to believe that all women who birth vaginally (or at least most of them) have incontinence and shredded genitals? ” And I would far, far, FAR rather have my incision scar than have torn-up genitals”. Now you are talking about incontinence as almost inevitable. You haven’t provided links to any studies or anything either. Looks like you just WANT to think like this. Studies dedicated to the dangers of c-sections vs vaginal are numerous. Most of them cocnlude that having no contraindications vaginal is safer. That’s the official position of the WHO, for instance.

          • Daleth

            Now you are talking about incontinence as almost inevitable.

            No, I’m not at all. I’m talking about RISKS, not inevitability. I preferred knowing that I would have a competently performed surgical incision rather than risking a horrible tear. Every vaginal birth, especially a first birth, carries that risk. The risk of a 3rd or 4th-degree tear is only about 4%–not even close to “inevitable”–but that’s still 1 woman in every 25, and most importantly it is a much higher risk of pain and fecal and flatus incontinence than I personally wanted to take with my own body.

            It’s all about what risks you are willing to take with your own body, your own health, your own life and quality of life. Saying “I would prefer the certainty of a surgical incision to the risk of a horrible tear, even though the risk of a horrible tear isn’t super high”–is my decision. Not my doctor’s.

          • fiftyfifty1

            “But I believe it does happen very rarely.”

            You are wrong about that. This problems are actually quite common, and vaginal birth is the cause. Having a pre-labor elective CS is strongly protective against need for future pelvic surgery. For every 8 women who have a pre-labor CS rather than a TOL, you prevent one recontructive pelvic surgery (hysterectomy/urethral sling etc.). And the reconstructive surgeries are much longer and riskier than simple C-sections.

          • Anna

            What about those who had the emergency CS? How could their pelvic floor be damaged if they didn’t push? Is this reconstructive surgery as invasive as the CS or just on the surface? Laparoscopic perhaps?

          • An Actual Attorney

            The definition of emergency CS is that it has to be done _right now_. Often that call is made in the course of a vaginal birth attempt, while a woman is pushing.

            Second, read what fiftyfifty1 just said — the recon surgeries are longer and riskier. They are worse than a CS.

          • fiftyfifty1

            “How could their pelvic floor be damaged if they didn’t push?”

            Pelvic floor damage starts to happen even before a woman pushes, as the baby engages and starts to move through the cervix. Pelvic floor damage is not the same as perineum tearing (1st, 2nd degree etc.). Perineum tearing is *part* of the tissue damage (or your preferred term, trauma) of vaginal birth, but only a small part of it. Other tissues that frequently tear include the ligaments that suspend the uterus and the levator ani.

            In my case, the hospital midwife initially congratulated me on only having a small first degree perineal tear. But it soon became apparent that I had also completely avulsed my levator ani off the bone. And that I had done nerve damage. And that I had torn down the ligaments suspending my uterus. This damage did not occur with pushing, but before that.

            This is why when they look at pelvic floor outcomes, the worst outcomes are women who delivered vaginally. A bit better is women who started labor but had emergency CS. Much, much better is women who had a CS before ever going into labor.

          • Empliau

            This is on the wince-meter right under Dr. Amy’s illustrated guide to tearing. I am so, so sorry that you (and others) have had these consequences.

          • fiftyfifty1

            ” Is this reconstructive surgery as invasive as the CS or just on the surface? Laparoscopic perhaps?”

            No, it’s not just the surface. It involves deep repositioning of the organs in question. If the issue is a prolapsing uterus, the uterus will need to be removed (hysterectomy) as surgical attempts to resuspend the uterus have not been successful. For the bladder issues, some sort of sling or mesh will typically have to be placed. The surrounding tissues are just so overstretched (think of a very old swimsuit with stretched out and holey fabric) that it’s not like you can just “tighten” the tissues without reinforcement. If it is the rectum that is prolapsing, then the back wall of the vagina needs to be cut through, repositioned and restitched.

            The surgeries are long, bloody, and must occur under general anesthesia. And afterwards there are *lifelong* lifting and exercise restrictions. Despite the restrictions, nearly half of all of these reconstructions will fail and another reconstruction will be needed.

          • Anna

            Thanks. Thanks for both of your answers. It has been extremely interesting and informative. But still, as a doctor, would you advise all patients pre-labor CS? Or would you consider such particulars as shape and width of pelvis, size of the baby, mother’s age?

          • fiftyfifty1

            It’s not my decision to make. Each woman will have different goals, values and risk tolerance. As a doctor, your job is to give women accurate information and tell her how it relates to her personally. For instance, if a woman is 40 or over having her first baby, you should let her know that 50% of women like her will need a CS anyway, but also talk about whether she desires to try for another baby quickly before she is no longer fertile and the inadvisability of getting pregnant again immediately after a CS. For a woman who wants a large family, you need to spend a LOT of time talking about the life threatening consequences of placenta implantation problems that go along with repeat CS (accreta etc) and the risk of uterine rupture. Yes, you should let women know whether their babies are big or small, and whether they have a roomy pelvis or not. Whether she is in one of the groups that are more prone to 4th degree tears (Asians, those with short perineums etc.) She should know that the risk of stillbirth goes up as the weeks go up. She should know about typical recovery times but also recovery times if there are complications.

            As I have written before, with accurate unbiased information, many sensible intelligent women will choose to try for a vaginal birth. And other equally sensible intelligent women will choose MRCS. There is no “right” choice, it depends on a woman’s circumstances and values.

            We are a long way from providing the full informed consent that I believe is ideal, even in countries where MRCS is allowed.

          • fiftyfifty1

            “As far as I know incontinence is in most cases timely and goes away. I had pretty bad incontinence during pregnancy and it was gone completely once the was no longer pressure on the bladder.”

            The incontinence that some women experience during pregnancy due to the uterus pressing on the bladder is a very different beast than incontinence due to pelvic floor birth injury. Pelvic floor injury incontinence is neither rare nor “timely” and it doesn’t go away.

          • An Actual Attorney

            “I know little about medicine”

            Yes, we figured that out.

          • Anna

            Why should I if I’m not a doctor? I’m not like the NCB who think they’ve done research and know all. What I’m saying here is common sense: listen to the Dr, don’t opt for surgery if you can avoid it, don’t expect surgery to be a breeze and leave no marks on you inside and out.

          • An Actual Attorney

            You are making pronouncements based on your “common sense” that aren’t supported by medical evidence. It’s fine to not know anything about medicine, but stop making pronouncements for other women as if you do.

          • Azuran

            It’s not ‘against’ medical advice. It’s a discussion with your doctor. If vaginal birth is really contrindicated for you, then of course your doctor will strongly recommand a c-section. If your particular situation makes it that c-section is more dangerous, then of course vaginal birth will be more strongly recommanded. I wouldn’t advice going against your doctor’s medical advice either.
            But if you are a healthy woman, with a healthy baby and both options are possible, then it’s your doctor’s job to explain to you the risks and benefits for both of those options and have a discussion with you to figure out with you which option is better FOR YOU.

          • fiftyfifty1

            Don’t you find it a little strange that MRCS are “against medical advice” in your country but are completely consistent with medical advice in other countries? Doesn’t that seem to contradict your idea that CS are obviously, objectively and inherently inferior and a bad idea medically? Especially because these other countries have good obstetric outcomes?

          • An Actual Attorney

            But it’s not the truth, or “THE TRUTH.” There are actual studies on this, done with n >1. It’s not as simple as you wish it was.

          • Charybdis

            It’s not “for no reason”. It is to deliver a baby, your baby, in a safe manner. Do you feel the same way about women who have prophylactic masectomies because they have both copies of the gene or do you think they should have to wait until they find a lump and/or find something on a mammogram?

          • fiftyfifty1

            ” I just don’t get who in their right mind would want to go under the knife for no reason but like you said it’s none of my business. I don’t care really. ”

            Actually, it appears you DO care. Clearly you are upset about it.

          • SporkParade

            It’s not “for no reason.” It’s just for reasons that aren’t specifically related to pregnancy, such as a history of sexual trauma, a traumatic vaginal birth experience, deciding that the minute risk of passing on GBS or herpes is still too high a risk, or, hell, just preferring the predictable risks of C-section to the unpredictable risks of vaginal delivery. And while some people have an easy time of vaginal delivery, that is by no means the rule, and it’s incredibly paternalistic of you to suggest that women should be forced to accept the risks of vaginal delivery just because permanent disability isn’t guaranteed.

          • Azuran

            it’s all a matter of relative risk. Your chances of Maybe some day having an appendicitis and then the risk or severe complication from the appendicitis itself or the surgery to remove it are lower than the risk of putting the entire population through the risk of a preventive appendectomy.

            You are recommending putting everyone through surgery in order to potentially avoid a small number of surgery. But the majority of people would never have appendicitis to begin with so they never would have needed any kind of intervention.

            In the case of birth, the woman is pregnant and the baby will need to come out one way or another. Something is going to happen.
            If a woman (or a man) can chose to have a surgery to prevent having more kids even though we have multiple highly effective, non surgical and very safe contraception methods (even way safer than vaginal birth is), why can’t women decide to have surgery in order to have her baby?

          • Who?

            Vaginal birth is hard, even when it’s the easiest it can be, and like all major life events, leaves a mark on your body. Did you know your cervix is a different shape after you’ve delivered a baby through it? So a doctor, examining you, could tell you’ve had a baby.

            I’m sorry your cs was such a shock, but can I suggest that giving birth vaginally might have been similarly challenging, had things gone that way? It’s an extraordinary thing to see a human emerge from your loins, even when you know it’s going to happen.

            I hope you find a way forward to feel better about your experience.

          • Anna

            Well, I don’t in the least regret my c-section, I had a rare but dangerous condition of SPD (Symphysis Pubis Dysfunction) which makes vaginal birth out of the question. I could barely walk towards the end of my pregnancy and rolling over in bed gave me sharp pain. I am grateful to my doctor who explained me everything and insisted on the c-section. I might have damaged my pelvis really badly and had to learn to walk anew had I tried for vaginal birth. So clearly I am not spending my time moaning about unnecessarean and evil OBs heading for golf games. I am grateful for having been rescued. But I do wish I hadn’t had this condition and had had a regular birth.

          • Who?

            You’ve been through a lot, and it’s really early days.

            And it’s fair enough to feel sorry about what might have been, hopefully that feeling will recede.

          • Anna

            Thanks. I do feel a lot better now.

          • Monkey Professor for a Head

            I agree that doctors should not be required to provide medical care which is not beneficial. But vaginal birth and c sections both have risks and benefits, and one is not overwhelmingly “better” than the other. So in this instance I think it’s appropriate to take the patients opinion into account.

          • fiftyfifty1

            “I agree that doctors should not be required to provide medical care which is not beneficial.”

            I agree. For instance if a woman comes into an OB’s office and says “I am planning on having a huge family, and I also want a Maternal Request CS for all of them”, the OB should be able to refuse. But I doubt it would ever come to that. Women are typically capable of making good decisions for themselves if all the facts are explained.

          • the wingless one

            Are breast implants or nose jobs medically necessary? Do doctors do them?

          • toni

            It’s nothing like having your appendix taken out for no reason. The baby has to come out one way or another. It is safer for the baby to come out via c-section and slightly riskier for the mother but an emergency c-section is riskier than an elective one. So it’s perfectly reasonable to request an elective in advance to avoid the possibility of a crash c-section (and reduce the chances of stillbirth, instrumental delivery and future incontinence as well). Why do you care if a woman prefers to have the baby come out one way or the other? If she would rather risk uterine adhesions over a sever perineal tear? They are both reasonable choices that should be left the mother IMO.

          • toni

            “But if I had a magical ability to change one thing about my life that would be it.”

            Seriously? You must have a great life!

          • toni

            I didn’t see the part about your weird dreams when I first read your comment. And I just realised my comment sounds super snarky… apologies.

            I had bad dreams about my first child’s birth for a while and it was as close to the ideal natural, easy birth as you could get. No tears, no complications, and less painful than I expected. It was still traumatic enough that I would cry remembering it for several months.

          • LeighW

            Because you would have preferred a vaginal birth means someone else can’t prefer a c-section? That’s rediculous.

            I’d much rather have another scar on my stomach than the franken-vag I have now

          • Daleth

            I think we should just leave the right to decide on the mode of delivery to medical professionals and not any woman’s choice.

            Did you really just say that women should be forced to give birth in a way they do not want to give birth? How is forcing women who prefer c-sections to deliver vaginally any more justifiable than forcing women who prefer VB to have c-sections?

            If you truly believe what you wrote there, you have zero respect for women’s bodily autonomy. My body, my choice–none of your business.

          • Anna

            How could anyone force you? Certainly not. But it would be BETTER for women to listen to what docs advise because they don’t advise it out of the blue. They really know better.

          • Dr Kitty

            Think about MRCS.
            You can certainly be forced to labour and have a vaginal birth!
            If no one will perform a MRCS, that is exactly what happens.
            It happened to one of our Canadian posters, and she had a very difficult time getting an MRCS in her second pregnancy, particularly since she’s already had a “successful” vaginal delivery, despite the fact that she had absolutely no desire to repeat the experience.

            My doctors advised me of all the risks and benefits if vaginal birth vs CS and left the decision to me. They didn’t advise one course or the other, because both were reasonable options, and someone else in my shoes, with different priorities and preferences may well have made different choices.

          • Daleth

            If you think (and I’m quoting you) that “we should just leave the right to decide on the mode of delivery to medical professionals and not any woman’s choice,” you’re saying we should force women to give birth in a way they don’t want to.

            Because you’re saying that c-sections should only be allowed if there is a medical indication for it (breech, multiples, etc.), not “just because” the woman whose BODY it is has a preference about which way she wants to give birth.

        • Roadstergal

          …and the question is also who bears the problems. Moms, as adults who have been the prime planners through this process, sometimes choose to take on greater risks since the kid, who’s just coming into this world and hasn’t a clue about risk/benefit tradeoffs, can hardly be expected to be an active participant in the discussion. It’s quite a startlingly generous and kind way to look at the process, when I read about women who went with the prelabor C/S for that reason.*

          *(note that this is not meant to talk smack about women who choose to try a VB in the hospital)

          • Megan

            Not only are moms the primary planners but they, as full grown adults, are also physiologically more able to handle a physical insult than a newborn baby.

          • Kathleen

            I actually JUST had this discussion with a friend of mine who is far more crunchy than I and loves all that “trust birth” stuff. It was regarding the newborn who ended up with a fractured arm and oxygen loss. And she was talking about the problems she’d had with her emergency c-section and how it was just awful and blah, blah. I think I scored some points with those who were sort of agreeing with her when I asked why it wasn’t just a ‘natural’ thing for a fully grown woman, and the MOTHER, to prefer for HER to have the complications/pain/etc. than for her newborn to have it. There is nothing I can think of worse than having a child be in pain/sick/hurt in some way and how many parents would say – I wish it were ME. I never got an answer from her and she now blocks all of my posts regarding home birth complications (and other similar topics). And I’d rather go through surgery, take any risks, take any pain, rather than NOT have a healthy, whole baby (as far as I can accomplish that).

          • demodocus

            God knows when the toddler and I fell a few months ago I spent weeks, (okay, months) wishing I’d been the one with the broken limb and him with the bruises.

          • Megan

            This reminds me of a recent conversation I had over email with my previous online birth group. One mom was having difficulties with her cosleeping, breastfeeding son nursing multiple times a night and no one getting any sleep. All of our babies are around a year old, clearly physically able to make it through the night without a feed. She asked for help and I responded with our story (just a “this is what worked for us but every baby is different”), that included weaning night bottles and a few nights of CIO, after which, we were all sleeping great. After that it’s been radio silence from her. The only other mom willing to even converse with me after that also used CIO (and incidentally, is the only other one with babies sleeping through the night). Funny how as soon as you do anything differently than these AP types, you are such a “threat” to their philosophy that they won’t even speak to you.

          • AirPlant

            I was hate reading the other day some “Gentle Sleep Solutions” that were posted on the internet and one of the was literally “cancel your plans for the day and catch up on sleep with your child. Call in sick if you have to.”
            This could be a hysterical and overblown reaction but what the hell? You are telling me that it is better to lie about illness and risk my job than it is to let my child cry? Avoiding a short period of distress is more important than the job which I use to pay bills and feed said child? I literally cannot believe that anybody could be stupid enough to give that advice.

          • No, silly, if you *really* loved your child you wouldn’t need a job. /sarcasm

            The inherent privilege and sexism of this kind of advice is staggering.

          • Megan

            Ugh. That is stupid. We were initially going to try something more “gentle,” the “Sleep Lady Shuffle.” I quickly realized that not only was it much worse for my child to see me standing there watching her cry but not pick her up, but I realized the process could take weeks. CIO took us 3 nights (and really only the first was bad). I’m not saying it was fun or a cake walk but it sure beat dragging the process out for weeks and I’m sure the total tears involved was actually less with CIO.

          • mostlyclueless

            I never used any version of CIO and the total tears involved getting my daughter to sleep through the night was zero.

          • Megan

            I never said CIO was right for everyone. In my post above I even mentioned that every child is different. I wasn’t trying to say everyone should CIO and I’m sorry if it came across that way. I was only pointing out that it’s a silly thing to stop speaking to someone over since we all deal with any parenting challenge differently and that CIO is what worked well for us.

          • crazy grad mama

            Here, have a cookie.

            That’s what you want, no? Some kind of reward for the luck of the draw that gave you a child who sleeps easily and well?

          • mostlyclueless

            I don’t have a child who sleeps easily and well. I just chose to do something other than CIO to deal with it. I comforted her every time she woke up at night, multiple times per night, for two years. And when she finally stopped needing that, there were no tears involved.

          • crazy grad mama

            If you’re not approaching this with the attitude that your choice not to CIO somehow makes you a better parent than those of us who did, then I apologize for the snark. It’s just that your “zero tears” comment sounded an awful lot like an attempt to invalidate the experiences of those of us for whom zero tears was literally impossible.

            I’m glad you found an approach that worked for you and your daughter.

          • mostlyclueless

            I don’t know who the better parent was, but you had a choice and zero tears wasn’t impossible, it was just a different choice than the one you made. CIO isn’t the only option.

          • Who?

            You have no idea what you’d do with a different child in different circumstances. You made one choice you’re pleased with, and that’s great. Another time and place might call for a very different choice, that you would also be pleased with.

            If this blog is about anything it’s about respecting informed decision making, even when the decision is one you believe you would never yourself make.

            CIO, Ferber, controlled crying are all perfectly respectable parenting choices. They offend the principles of some parents, who are entirely free to consider and reject them if they wish, preferring to manage the issue (which perhaps they don’t identify as an issue, but just as an incident in their parenting journey) in a different way.

          • mostlyclueless

            What’s your point?

          • Who?

            My point was that you seem either very defensive about your choices, or very intolerant of the choices of others.

            And that life goes on a long time and the hill you’re prepared to die on today is unlikely to be the same hill you’d choose to die on in other circumstances, unless of course you are extremely rigid and unable to learn from experience.

          • crazy grad mama

            Excuse me, you do not parent my child and you have no right to say what he is like, nor to call me, his mother, a liar when I make a statement about his personality. And nobody in this thread said CIO was the only option, so I’m not sure where you’re getting that from.

          • mostlyclueless

            You said zero tears was literally impossible. I said it wasn’t. You can make whatever choice you want, but don’t pretend that you chose to CIO because you didn’t have an alternative. You did have an alternative. You just chose not to use it.

          • fiftyfifty1

            “You said zero tears was literally impossible. I said it wasn’t. ”

            This only shows that your experience is limited. “Zero tears” really is literally impossible is some cases (like with my first child), and it is next to impossible in other cases.

            But the larger point is why some mothers get so hung up on “zero tears”. What does it symbolize for these mothers? And why is the focus always baby’s tears, and not the tears of anybody else?

          • The Bofa on the Sofa

            But the larger point is why some mothers get so hung up on “zero tears”.

            I agree. When I compare the description above (2 years of getting up a couple times a night to gently comfort them, with no tears) to what we had – 8 months of getting up to comfort them, a day or two of CIO, and then 16 months of sleeping through the night without having to get up, I’d take the latter any time.

            I don’t see how getting up a couple times a night for years is a good thing at all.

          • fiftyfifty1

            Oh not a couple of times per night, “multiple times per night”. And having that be somehow highly meaningful to your self image and worldview.

          • Who?

            Maybe it’s partly how you frame it, but I’m with you-sleep deprived is not cool.

          • Inmara

            Some babies are crying when their diapers are changed. Some babies are crying when they are being dressed. And definitely all babies are crying when getting vaccinated, at least during the shots. So, are we aiming to zero tears or to fulfill what babies actually need?

          • Hilary

            Some babies have colic and cry no matter what you do.

          • fiftyfifty1

            “Some babies have colic and cry no matter what you do.”

            This is true. And yet another reason that AP’s insistence on “zero tears” is so dysfunctional. CIO opponents tell new mothers that crying is harmful to babies and that it means that you “haven’t been able to learn to comfort your own baby”. It’s cruel. It’s bullying.

          • Who?

            How many of these kids learn to turn on the waterworks as they get older to get what they want, as mum will do anything rather than let them cry.

            Tears are also pretty personal-my son didn’t cry tears for the first year or so, my daughter always cried big tears from day one. Was he less upset than her, with his appalling reflux? No, it was physiological.

            The whole idea that a child must never be allowd to cry is grotesque for all concerned.

          • fiftyfifty1

            “How many of these kids learn to turn on the waterworks as they get older to get what they want, as mum will do anything rather than let them cry.”

            I suppose it’s a possibility, but it’s all conjecture. Sure I know plenty of bratty manipulative kids who have AP parents, but I also know some really nice kids with AP parents. Likewise kids of CIO parents. I know some angels and I know some devils.

            So unless we were to get some real evidence that AP sleep practices are bad for kids, I don’t care either way. If a parent is able to attain “zero tears” and wants to do so by whatever means they choose, they are welcome to it. But they need to stop bullying other parents by implying that other choices damage kids or are a sign of a parent who has failed.

          • Who?

            It’s true the best we can ever do is knock off some rough edges according to our own values.

            Which is perhaps why all the discussion about the best parenting methods is fruitless, if sometimes interesting.

            Setting hard and fast parenting rules ie ‘my child will never be allowed to cry’ is going to be pretty tough on the primary carer, regardless of the effect it has on the child. Perhaps from that space it is inevitable they will be judgy of others, since the parental sacrifice will need broadcast and acknowledgement to be of value.

          • fiftyfifty1

            “It’s true the best we can ever do is knock off some rough edges according to our own values.”

            Ha! I like this.

            “Setting hard and fast parenting rules ie ‘my child will never be allowed to cry’ is going to be pretty tough on the primary carer, regardless of the effect it has on the child.”

            Yes, I’m much more concerned about the caregivers. I believe that there are many effective ways to parent children in every area from sleep, to food, to schooling, to potty training, to activities. What’s damaging is telling new parents that there is only one way, and if they deviate they have harmed their children (or don’t really love them).

          • Who?

            ‘Be kind to yourself, your partner and the baby’ is my only advice to new parents.

            From there, good things will follow.

          • crazy grad mama

            I said zero tears was literally impossible FOR MY CHILD. When he was tired but otherwise full/comfortable/clean/etc., parental intervention just made him more upset.

            You have also made the very big assumption that I didn’t try anything but CIO.

            If you can’t see how utterly offensive and ridiculous your statements are, go back and replace “zero tears”/”non-CIO” with “breastfeeding,” and “CIO” with “formula.” Imagine someone saying, ” I couldn’t breastfeed. My baby struggled to latch and it just wasn’t working.” Would you say, “It is possible. Don’t pretend that you didn’t have any alternative to formula.”?

          • mostlyclueless

            If you never learned how to comfort your child, then yes, of course, you never had any alternative other than to leave him alone to cry.

          • The Bofa on the Sofa

            It’s not about not knowing how to comfort the kids. After having our kids learn to self-soothe at night, we didn’t NEED to comfort them.

          • mostlyclueless

            I thought the person I was responding to was explaining that CIO was literally her only option because her child cried whether she comforted him or not. Why are you redirecting the conversation to talk about yourself? Do I need to point out, again, that your children could have learned that without being left to cry alone at night without any comfort? This is getting repetitive.

          • crazy grad mama

            Are you thinking that my kid cries every night? Like some of the folks up thread, CIO meant 4 nights of crying while he learned to make the transition from tired to asleep. For all the months since then, he hasn’t cried unless he’s sick or uncomfortable. If he cries now, we know something is wrong and respond quickly.

          • The Bofa on the Sofa

            Do I need to point out, again, that your children could have learned
            that without being left to cry alone at night without any comfort?

            Maybe, in another year they could have.

            Or, with a little bit of CIO, they did it quickly.

          • crazy grad mama

            Wow. Well, I’m glad to see that my initial impression of you was accurate.

          • mostlyclueless

            Likewise!

          • crazy grad mama

            Well, your impression of me seems to be a fiction that you’ve made up in your head, but cool.

          • fiftyfifty1

            mostlyclueless, why is it so important to you that a baby be “zero tears”? You accuse parents of having “never learned how to comfort your child”. Really?
            My son was easily comforted by both my husband and me– after his shots, when he would hurt himself, if he was hungry, or scared. But when he was *tired*, comforting just made it worse. All the normal soothing made him cry more. What worked was CIO. Within 3 days we could put him in his crib, give him a kiss, he would smile, close his eyes, fall right to sleep and sleep all night.

            And now, as a tween it is the same. During the day, he is an open, loving kid who still loves to snuggle. And at bedtime he says goodnight, gives each of us a kiss, and goes off to his quiet bed with cool crisp sheets, and falls asleep.

          • Hilary

            Seriously? Who says that?? Yikes.

          • fiftyfifty1

            Who says that? Why mostlyclueless says it. It’s her way of bullying parents who don’t mirror back her sleep choices.

          • LeighW

            Just have to stop feeding the troll

          • the wingless one

            Oh so you’re one of those eh? Do your farts smell like roses?

          • fiftyfifty1

            ” but you had a choice and zero tears wasn’t impossible”

            With my first child, as I describe above, “zero tears” was never a choice. This child cried for long periods when tired, whether comforted or not. We decided to give CIO a try and it worked great for all of us within 3 nights.

          • Megan

            I’m truly glad you found something that worked well for your family. I just don’t understand how “I comforted her every time she woke up at night, multiple times per night, for two years” equals “zero tears.”

          • fiftyfifty1

            But Megan isn’t talking about your child, she’s talking about her own. It sounds to me like she looked at her own situation, decided that tears were inevitable for her child with any of the choices she could choose, and chose the method she thought would work best for her child and her family. And it worked. Great!

            You looked at your situation, decided that you didn’t want tears, and that there was a solution for you that didn’t involve tears, so you went with it. Great!

            I myself have 2 kids. They were totally different. One child, when tired, would not stop crying for long periods, even when comforted. This child never slept well in our room or bed, waking frequently and crying for long stretches all over again. We decided on CIO and it worked extremely well within 3 nights. Great! My second child had a very different personality. Might wake frequently, but would settle immediately as long as someone was nearby. That worked fine for us, and we never felt the need to CIO. Great!

          • Fallow

            Agreed. I’ve know a family or two who faithfully tried every single gentle technique in the book, until they nearly drove themselves insane. They put more effort into these gentle sleep techniques, than I have probably put into anything in my life. Until they gave up and did CIO, and finally their lives changed.

            CIO is not the sort of thing that would have worked with our child, but it clearly has its place.

          • Inmara

            For f’s sake, I’m in maternity leave and I still can’t afford to catch up sleep with baby because he’s napping long enough only in stroller so I’m stuck with a lovely 2 hour walk every day and then some short naps for baby indoors which are not enough for me to even fall asleep.
            After roughly a month I’m planning to sleep train him for longer naps indoors, and hopefully we’ll get to only one night feeding instead of two. I’m using “Healthy Sleep Habits, Happy Child” as my baby sleeping Bible, and I suspect that AP crowd hates it because author always emphasizes well-being of mother and family too.

          • Megan

            That is basically the method we used though I didn’t read the book. I initially felt bad about it but now my daughter seems so much happier and better rested so I think my worry was for nothing. Plus, it’s nice to be able to sleep at night while pregnant!

          • Inmara

            I just thought, what would these crunchy parents do when their toddler will whine for Coke instead of organic kale smoothie? They for sure will let him/her cry it out because a child NEEDS healthy food but WANTS sugar. The same is with sleep, baby NEEDS uninterrupted sleep and parents sometimes need to resort to some crying while healthy sleep habits kick in.

          • mostlyclueless

            For what it’s worth I never let my 2yo CIO but she’s also never had a Coke. Not everyone who doesn’t CIO has problems with boundaries.

          • demodocus

            cio didn’t work so well on my pigheaded child in his first year either. Fortunately, he’s a good sleeper by nature, but he needs his lullaby

          • Gatita

            CIO was a complete failure for us. Three hours of screaming every night with no extinguishing. We caved. Later found out he had a problem with lactose and once we cut out dairy from his diet at age three (with his pediatrician’s blessing) he finally slept through the night. Kids are all different. There’s no formula that works for every child. It would be a lot easier if there were.

          • SporkParade

            I found different things worked at different stages. During the newborn stage, there was a point where I realized that I just needed to let Baby Spork cry a bit before he fell asleep because anything I would do would just make it worse. At 4 months, the Ferber method was a godsend. At 12 months, only CIO worked for nighttime separation anxiety (the Ferber method would have made things worse).

          • Hilary

            Agreed. And I would do stricter sleep-training with my son if he didn’t have sleep-related medical problems.

          • Bugsy

            Their children won’t whine for Coke, or at the very least, they’ll revise history as such. That’s what I found from my crunchy friend – her kid was always perfect, she never mentioned any honest parenting difficulties, but when she did, it was always couched in “my son is a high-needs child (and look how awesome I am in that I’ve overcome it).”

          • demodocus

            explains my duplex neighbor. her toddler *never* makes as much noise as my toddler, in her world

          • Daleth

            I used “Healthy Sleep Habits, Happy Twins.” It was a godsend. My preemies slept through the night (9 hours) for the first time at less than 4 months old.

          • Bugsy

            We used the singleton version of that book; it was great for us as well. Although crunchy friend nearly had a stroke when she heard I was adopting a parenting method she perceived to be so “cruel.”

          • KeeperOfTheBooks

            DD’s ped recommended that book–it’s awesome!
            Said ped also recommended CIO at 3 months, which worked extremely well for our particular family.

          • Inmara

            We’re not yet in need of sleep training for the night because baby is falling asleep just fine with some minor soothing. Naps could be trickier because he simply can’t stay asleep for more than 40 minutes if sleeping in crib so I’m walking with stroller. We’ll see when weather gets rough, maybe then he’ll sleep better in crib or I’ll have to sleep train. I follow advice from book to not sleep train colicky babies until 4 months of age so there is still time.

          • KeeperOfTheBooks

            Oh yeah. I didn’t follow it to the letter, but it gave me some good ideas. I’m not suggesting that everyone should CIO that early–it’s just what worked best for our particular situation. 🙂
            DD absolutely refused to go to sleep ever since she was a couple of weeks old; she’d fight tooth and nail to stay awake. Bedtime, and three naptimes, consisted of me swaddling a furious baby and then rocking her for up to an hour to get her to just. fall. asleep. Same thing for any night wakings. And she’d scream and fight it the whole time–it wasn’t exactly a pleasant newborn snuggle time!
            At her 3 month appointment, I nearly broke down at the ped because I was so tired from spending upwards of 4 hours every day just fighting to get her to sleep. Ped said “sleep training.” 3-5 days later, DD was going to sleep on being put down after a nice snuggle and everyone was happier!
            It wouldn’t work for everyone, but it worked beautifully for us.

          • Inmara

            Oh my, you really had it hard! I see this pattern of not wanting to fall asleep in naps, when baby wakes up and decides that it’s more fun to be in my company than to fall back asleep. But your scenario really was the classics of need for sleep training.

          • KeeperOfTheBooks

            I hated the idea at first, because I’d swallowed every bit of the AP stuff and was sure it would lead to DD hating me, but as it happened, things got a lot better between us (I also had PPD) fairly shortly thereafter. I think she no longer saw rocking and snuggling with me as a way to “force” her to sleep, so she could enjoy it more, and I could enjoy it too rather than feeling like it was a battle I had to win and on which outcome was contingent my ability to eat/pee/catch up on chores. Instead, I could say to myself, “Okay, we’re going to read a story or two, and then I’m going to cuddle her for fifteen minutes or so and enjoy the baby snuggles, and then I’m going to put her down and I can take care of some of my needs.” She, on the other hand, seemed to feel…I dunno, more in control? Hard to tell in a baby that young, but she’s always been stubborn!…and after the first few days, would cuddle down in her bed contentedly when I set her there, chatter to her toes for a few minutes, and then pass out. It was pretty cute. 😉

          • Anna

            You and many here keep running to extremeties. Certainly compromising your baby’s health is not an option. She did have this c-section in the end, so obviously she wasn’t willing to take any risks with that. But having surgery CAN be extremely traumatic, horrifying experience especially for someone who’s never had one before. She doesn’t have to LOVE her c-section or her c-section scar or her c-section shelf. She needn’t fell overwhelmingly grateful and all that exxagerated hyperpositive stuff. After all it was she who made the sacrifice of her body not the doctors. If she loves her baby and is not too bitter to carry on that’s just enough for now. She will get over it with time. But a friend hadbetter telling her that they understand and value her feelings instead of impying she doesn’t love her baby enough and is somehow selfish. Have you ever been in the OR as a patient yourself, may I wonder?

          • Amazed

            While I do agree that surgery can be extremely traumatic and that the woman in question did have one, showing that she valued her baby’s wellbeing over her level of comfort, I have a problem with the inconveniences of a c-section being brought into a conversation about a fractured arm and oxygen deprivation. I don’t think I’ve ever been oxygen deprived (at least I have no memories of such a thing) but I have suffered fractures with long-term effects and everyone who compares it with the crushing of their birth dreams and the short-term effects of a c-section (as far as I get it, that’s the case with Kathleen’s friend) is severely missing the point. I don’t know of short-term damages lasting for 16 years (that’s how my ongoing issues with my first fracture have lasted this far).

          • Anna

            Sorry you had a hard time. My point is everyone has their own story. For this woman her c-section has been the most traumatic experience SO FAR. Maybe she has nothing to compare it with (like me). Anyways, she got past herself and had the damn section! She doesn’t say she wishes she hadn’t. She simply states it was not a nice experience for her.

          • Angharad

            When I was about 8 or 9 my eyes developed a weird infection and the doctors weren’t sure if they’d be able to cure it or if it would make me blind (they did cure it and I have no lasting effects). I remember after I was diagnosed and the doctors said they weren’t sure what my prognosis was. I was sobbing and saying I wished it hadn’t happened to me. My mom held me on her lap and she was crying too. She said, “I wish I could take this from you. I’d give anything if I could have the infection and your eyes could be healthy.” C-sections are basically the only time a mother is able to actually bear the burden of a risk for their child, and I think that’s beautiful.
            I apply the same thinking to accepting other interventions, such as episiotomies and instrumental deliveries. When my daughter’s heart rate started looking bad during delivery, I was happy to have the doctor do anything necessary to get her out. The forceps really did a number on me and it took about 10 months before I wasn’t in daily pain, but I would do it again in a heartbeat to keep her as safe as possible.

        • Angharad

          That’s why I want a c-section for any future babies! If I have to have a poorly-healing incision, I would so much rather deal with that on my abdomen than on my genitals! However, I would still take that over a dead or brain-damaged baby. It’s all about trade-offs.

          • mythsayer

            I chose a CS for my first and only child. I asked for it. The doctor isn’t the one who brought it up – I did. Because I’ve had surgeries before and know how to heal from those. But I’d never felt labor and had no desire to do so and I REALLY didn’t want to tear. I loved my CA. One of the best choices I ever made.

          • Blue Chocobo

            Even a well healing incision, and in a situation where there was no perceivable increase in risk to the baby.

            If you have to have stitches, they will be easier on front than underneath!

      • mythsayer

        I chose one. Scheduled it weeks earlier. I preferred the risks to a c-section to those of vaginal birth for myself. I figured the risks to the baby were pretty similar but I didn’t want to tear, nor did I want to be in pain for hours only to get unlucky in the end and get a CS anyway. So I totally agree with you. I think choice is key.