Two days ago I wrote about the extraordinary callousness of a group of unassisted birth advocates who brag about “successful” vaginal births despite the fact that the babies died.
The most recent example occurred earlier this week:
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]A woman’s body is designed to produce a live baby, not a vaginal birth.[/pullquote]
…I wanted to tell you ladies that I went into labor NATURALLY ALL BY MYSELF (well after sex that night..) that in itself was awesome bc I have never had that experience before and was starting to doubt my body especially waiting so long! 42 weeks! BUT IT HAPPENED! I labored all through the night and day and PUSHED HIM OUT all 10lb 9oz and 23.5 inches with a 14.5 inch head …
…VAGINAL BIRTH AFTER CESAREAN IS POSSIBLE! UNMEDICATED BIRTH IS POSSIBLE. HOME BIRTHS ARE POSSIBLE. And most importantly OUR BODIES AREN’T BROKEN, THEY WERE DESIGNED TO DO THIS!!! I KNOW FROM EXPERIENCE! lol
The ultimate irony for women who boast about these “successes” is that they are actually spectacular failures. Why? Because evolutionary success is measured by children who live to reproduce, not by how a baby is born. Evolution works on the principle of “survival of the fittest” and the fittest are those who live.
For people so enamoured of what their bodies “were designed to do,” they appear to have missed the incredibly simple, incredibly basic point: their bodies were designed to produce LIVE babies. The unassisted birth advocates preening over “successful” vaginal births are actually spectacular FAILURES. They are so busy exulting over the fact that their bodies aren’t “broken” that they forgot the most important fact; if you “break” the baby’s body, you lose.
Evolution doesn’t care one whit about the process of survival, it only cares about the outcome. Evolution doesn’t care whether a particular animal has black fur or white fur. It rewards the color that offers the best camouflage for the particular environment in which the animal lives. In our current environment, with easy access to technology, evolution rewards those who use that technology to survive. Women who reject lifesaving technology in order to recapitulate birth in nature aren’t winners; they haven’t achieved anything. If their babies die, they are losers.
Evolution doesn’t care that you had a vaginal birth; it doesn’t care that you gave birth without pain medication; it certainly doesn’t care that you had a vaginal birth after a previous C-section. It cares about one and only one thing: whether the baby survives.
Women who let their babies die for lack of obstetric interventions at homebirth or unassisted birth DIDN’T do what “nature intended”; they did the exact opposite. They aren’t successful; they’re failures.
And they’re not responding to natural instincts; they’re defying them. Nearly every female mammal will defend the lives of her offspring to the death. Everyone knows that there is no more dangerous animal than the mother who feels that her brood is threatened.
The woman who consents to a C-section for fetal distress is acting on that primal instinct. She is willing to let herself be cut open if that gives her baby a better chance of survival. The woman who chooses homebirth specifically to recapitulate birth in nature is acting AGAINST that primal instinct. She is more interested in herself and her bragging rights than in the baby’s life. That’s unnatural.
Meg Heket, Ruth Rodley and the other administrators of groups that encourage, support and cheer women to deadly homebirths aren’t merely vile people; they’re losers. Nature isn’t impressed with them; she’s weeping for the loss of innocent lives.
“Women who let their babies die for lack of obstetric interventions at homebirth or unassisted birth”
You forgot to mention freestanding birthing centers.
Congrats on the douchiest and most insensitive article I’ve read all year. I suspect for many this process is one of healing, NOT, as you say, one of success and celebration.
Dead babies are healing?
Thanks for proving Dr Amy’s point.
Nice strawman, but no.
So someone dying an avoidable death is a fair price to pay for someone else’s ‘healing’ experience?
No one is dying an avoidable death.
The death rate at homebirth is higher than hospital birth. At least 2 out of 3, who die at homebirth could have been saved if they had been born in the hospital.
A. That really has nothing to do with what I was saying or the topic of my thread.
B. You can’t drop bombs like that without sources or citations.
C. This study, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/, says otherwise.
This study says the nih says ‘registered midwives’ aka nurse practitioners are better…..but this study was proven grossly wrong! Because its nearly a decade out of date! Turns out that UK midwives have been covering up a bunch of preventable deaths.
http://www.telegraph.co.uk/news/2017/05/20/exclusive-baby-deaths-linked-lack-basic-midwife-training/
Don’t believe me do yourself a favor and googling “morecambe bay hospital scandal”
And the average American midwife is actually less trained and educated than the ones in the UK! Most only have a GED!
http://www.skepticalob.com/2017/02/how-dangerous-is-homebirth-this-dangerous.html
Which means American homebirth aka “natural birth” is way more dangerous.
18 times the risk for brain injury
http://www.skepticalob.com/2014/01/risk-of-anoxic-brain-injury-is-more-than-18-times-higher-at-homebirth.html
And the increased death rates
https://jezebel.com/why-is-home-birth-so-much-more-dangerous-in-the-united-1774223043
A little late to be rehashing this old article. Regardless I would never advocate using an improperly trained midwife for a home birth period.
To play Devil’s Advocate:
If we’re talking about ‘Survival of the Fittest’, then I can ALMOST see the logic of a mother wanting to avoid a C-Section if she plans to have more children – apparently, we’re on the cusp of a post-antibiotic era and C-Sections will become incredibly dangerous to the point where it will go back to being like it was in the bad old days; C-Sections are only performed when the mother’s about to die anyway and the best-case scenario is to at least save the baby’s life.
We’re not quite at the point where antibiotics are next to useless yet but given that having a C-Section will increase the risk of future children – who might be conceived in a post-antibiotic era – needing to be born by C-Section, I can see where mothers who try to avoid having a C-Section are coming from.
Not saying I agree with them. Just throwing that out there – the prospect of conceiving future children in a world without effective antibiotics terrifies me, and I have no clue whether I’m paranoid or whether the possibility is real.
First time commenter on this blog but voracious reader. I just wanted to thank all of you, Dr. Amy and commenters, who have shared your experiences with maternal request sections and the information about risks. I’m currently 35 years old and 20 weeks pregnant with what will be my first child through IVF after other failed IVF attempts/miscarriage.
All of the information I’ve gotten here (and the support you’ve provided without you realizing it) gave me the courage to ask my OB for a section at last week’s appointment. I was terrified and preparing for a lecture. She initially looked at me strangely (probably because she doesn’t get that request often), then launched into when we could schedule, how easy the recovery would be, and how she had two and was back to 100% in weeks. What a relief!
Anyway, I’m actually not dreading birth now because it feels so in my control now. I’m going to know when it will happen and family can join from out of town. I can make sure my house is clean and my legs are shaved!
I was definitely never susceptible to the NCB woo, but this place definitely solidified my understanding of my choice as a feminist choice and the right one for me. So, THANK YOU!
Wonderful for you, Laura.
Yeah, it’s almost like having the option of doing a MRCS is “empowering.”
That is wonderful news! Congratulations!
After all you’ve gone through to conceive and carry the baby, knowing that you have made the choice to have the baby in the safest manner possible has go to be a huge relief and weight off your shoulders.
Every time I read these, I always go home and hug my baby girl extra tight. I can’t imagine losing a child. I had a miscarriage before the pregnancy that “took” and it was devastating. The thought of a stillborn baby or a baby dying right after birth… I can’t imagine. I don’t even consider myself super maternal or anything.
And yet these women, time and again, prove that they care more about the experience than their children’s well-being. My non-maternal “didn’t want kids but didn’t not want kids either” self is mother of the year compared to them. I just can wrap my mind around this. I care more about their dead children then they do. It’s mind boggling.
Why women are unable to have the option of elective Caesars has much to do with finances, be they insurance costs, district health board cut backs (NZ), or lack of trained obs available to do procedure, alongside the current trend that suggests that unless we birth vaginally we have somehow failed.
The cost concerns are so short-sighted. It costs far more to care for babies who are permanently injured by vaginal birth, to compensate families for babies killed by vaginal birth, to cover the future medical needs of women left with horrific tearing, incontinence, prolapse etc.
And when you factor in the person-hours spent monitoring a normal labor–that is, the OB or midwife, the nurses, the anesthesiologist (if she gets an epidural), etc. caring for a woman for 12 or 15 or however many hours–versus the fact that a planned c-section is over and done with, prep time included, in about an hour… the supposed “cost savings” really don’t add up.
And doesn’t better scheduling help with staffing? You don’t need as many people if you don’t need ‘can’t anticipate when this will happen’ degree of coverage?
I also read something somewhere that the long term implications of complicated vaginal births can be expensive long term. Consider reconstructive surgeries women have years after giving birth?
My cousin has a forceps birth last year. She’s had to have reconstructive surgery this year. Pretty sure that if the ideological midwives at the hospital had done a cesarean when it was obvious that my tiny cousin was birthing an enormous infant, they’d have saved themselves money and her extensive pain, humiliation and heartache.
Omg your poor cousin. The risk of forceps is one of the reasons I chose an elective c-section–not only the risk to my pelvic floor, like your poor cousin, but also the risk to the baby: my mom was permanently handicapped by a forceps accident at her own birth.
I completely agree the long-term implications cancel out any cost savings from avoiding c-sections up front. But apparently we don’t care about that in the US, because with the exception of women who were obviously and severely injured at childbirth, by the time most women get around to needing surgery for severe incontinence, prolapse, and other garden-variety birth injuries, they’re probably not on the same insurance plan anymore.
Short-term thinking is messed up.
This same midwife unit has nearly killed more than one of my cousins, put most of their babies at risk and are currently 4/6 with EMCS for births in our family at that hospital in less than 3 years.
Both of the vaginal births involved forceps and in one case major reconstruction and in the other the mother nearly bleeding to death. Midwifery-led care, FTW!
Why the use of forceps is rapidly on the rise in midwife-led units in Australia and the UK when the obstetric associations in both countries explicitly advise against their use is beyond me.
Oh, and the 7th birth there happened in November and it was a routine cesarean for my cousin who had a crash section with her first and her husband was told that he might have to choose between her and their daughter. This was after they left her to labor alone at home for two days because it was ‘early’. Then they tried to pressure her into a VBAC and her husband flat out refused to be a party to it. I guess seeing your wife bleeding out on your kitchen floor does that to a guy.
Sorry, is this a free standing MLU? Or an MLU in a hospital?
Are you saying that midwives are using forceps?
I’ve only ever seen forceps in the hands of consultants and senior regs, I find the idea of midwives wielding them very odd.
RCOG is very clear that instrumental deliveries should not be attempted in free standing MLUs. If you are attempting an instrumental delivery you’ve already decided that the baby has to come out NOW and unless you’re down the hallway from an OR with OB and Anaesthetics, you don’t have an acceptable plan B in case the forceps/ ventouse don’t work…and they don’t work often enough that you definitely need a plan B.
Where I worked ventouse could be done in the delivery room, and by the midwife if it was just a lift out, but forceps were always done in the OR, with everything on hand to convert to CS if it went wrong, and it was always the most senior doc on site called. Anything else just seems insanely risky to me.
WTF are MIDWIVES doing using forceps?! Is that really what’s happening? Am I reading that right?!?!?!?!
Here’s a fascinating article that’s primarily about how the Apgar score came to be, but also has a lot to say about the rise of c-sections and related decline of forceps use. It says that using forceps correctly, so as to save the child without harming the mother (or for that matter the child), is extremely difficult to do and even harder to train other people to do. When forceps are used there is a vast disparity in outcomes because getting all OBs to use them consistently well is extremely difficult. In contrast, c-sections are easy to do and easy to train medical students to do, so you get much more consistently good outcomes.
http://www.newyorker.com/magazine/2006/10/09/the-score
That’s part of it, but equally there’s a lot of resistance to the idea that actually, offering ELCS more widely might be cheaper. I mean, clearly it would reduce the numbers of EMCS and instrumental deliveries, as some women who have those would choose ELCS if offered, and those are the most expensive types of birth.
I have wide “birthing hips”, and I never thought I’d have a c-section because those were for tiny, skinny women, which I am most certainly not. I’ve also always been terrified of surgery having lost two loved ones due to complications, but when the CNM I’d been seeing my entire pregnancy recommended that we schedule an elective c/s because of suspected fetal macrosomia, I cried, but ultimately consented. Yes, I realized that I could die, but my main goal was to deliver a healthy baby, and if this is what was safest for him, my fears be damned. While the team did everything they could to give me an experience as close to a normal birth as they could, no, it wasn’t an ideal experience in that I really don’t remember much about that day or the first several hours of his life, I was so out of it. But, he’s alive, he’s healthy, and so am I, and that is the ultimate goal of birth.
I’m rather large framed and sort of expected I’d have easy deliveries, but that was not to be. The one that was born at 36 weeks suffered a shoulder dystocia, partially because these wide hips didn’t spread as much as they should have (though if the wasn’t presenting face up, it might have been okay.) My 90 pound, 5 foot 6 inch sister, on the other hand, thought she had to poop and pushed out an 8 pound 10 oz baby without even realizing she was in labor.
Baby boy turned out to be 8 lbs 10 oz as well, and not at all the 11-12 pounder everyone was expecting. Hindsight being 20/20, I would have liked to have at least tried to have had him vaginally, but I’m not upset about it, as my CNM requested 4 separate growth scans and therefore we had multiple pieces of data that showed consistent growth and that he was going to be enormous. It seems that he fooled everyone. 🙂
For the record, I did not have GD, but my husband is 6’6 and of Viking descent.
I’m five foot eight, broad shouldered and broad hipped. My six pound nine ounce son resisted all efforts to dislodge him including forceps and remained mid pelvis. The main silver lining (ignoring the fact that we’re both here) is that my mother in law still feels the need to apologise for all her “childbearing hips” jokes. I’m hoping for another 20 years mileage on that one.
My grandmother, five foot two, bird framed delivered five 10 pound something babies vaginally with no assistance whatsoever.
Yes, I realized that I could die, but my main goal was to deliver a healthy baby
If it’s any comfort, one of the biggest and most inclusive studies I’ve ever heard of–every UK birth after 24 weeks over a three-year period, so more than 2 million births–found that scheduled prelabor c-sections are about 20% LESS likely to kill the mother than attempting vaginal birth is. The rate either way is exceptionally low, but vaginal birth can kill you too, and crash c-sections when things go horribly wrong in labor are the most dangerous birth method of all… hence, attempting to birth vaginally is significantly more dangerous than just scheduling a c-section at term.
http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html
That’s a British news article. The study itself was in the BMJ and I have the link somewhere, but am at work and can’t dig it up.
And that’s the proper comparison, the one that’s too rarely done. Everyone talks about how a VB is safer than a C-section, but that’s a post-hoc decision that, as we’ve discussed, puts all of the negatives of the emergency that the C-section rescues onto the C-section. The real comparison is the one you mention – going in with the intent of a VB vs C/S.
Yes, exactly. I’ve heard that the reason we don’t have a study like that one here in the US is that US hospitals are not required, when reporting their stats, to break out emergency c-sections done during labor from c-sections done before labor. It’s such an obvious distinction, and I really wish we had the numbers in the US.
But even though it would be great to have a US study like this, there’s every reason to think this UK study tells us at least roughly what the likely risks in the US are. I mean, when you’re looking at over 2 million births in an industrialized country–when you’re looking at ALL births over a multi-year period–you’re probably getting a picture that’s true enough that you can safely assume it applies in all industrialized countries. Particularly when you’re comparing two industrialized countries that, like the UK and the US, are similar in a bunch of critical ways:
– Similar c-section rates (last I heard it was about 25% in the UK and 30% in the US);
– Similar rates of adult overweight/obesity (it’s 62%/28% in the UK vs. 69%/36% in the US);
– Similarly diverse populations (we’re 80% white with huge pockets of white rural poverty and black and Hispanic urban poverty; they’re 87% white with huge pockets of white, black, and Indian/Pakistani urban poverty).
If anything the UK stats on the risk of maternal death in various types of childbirth are probably a bit better than the US stats would be, since at least everyone in the UK has the right to free prenatal care (so risks are picked up early in more people), and all UK midwives are real midwives instead of CPMs.
I think it has more to do with the “shape” of the interior of your pelvis than with your external dimensions…my mom and I are both 5’1″ and pretty small, and we both deliver babies relatively easily with very little pushing needed (you basically just need someone down the other end with a catchers mitt…). My sister in law is about the same size and her daughter got stuck and she needed a c section. Not a huge baby either. It seems like luck of the draw, to me…
Yeah, my mom was probably 5 feet even on a good day, and got four of us out with little trouble. That being said, most of my short-statured co-workers who are moms have had C/Ss (funny how this comes up in casual conversation), and the two I know who had the easiest births are strikingly tall women…
Dude, if you saw my gigantic hips, you’d never believe I needed a crash section! But there’s more to it than how you can push them out. They have to be in the right position, and robust enough to cope.
Wide birth hips are a myth.
http://thebirthteacher.blogspot.com/2008/12/shes-got-good-birthin-hips.html
OT but wanted to share this powerful image by a woman with endometriosis.
That is brilliantly and horrifyingly accurate. I still thank my mom for being my advocate to get early treatment when I was fourteen/fifteen and my OBGYN for listening. Mine has been controlled as well as it can be through birth control, surgery, and hormone treatment. My mom didn’t get treated until her twenties. She had her hysterectomy in her 40s and by that time the scar tissue and adhesions had fused her uterus to her spine and got tangled in her spinal nerves. I can’t imagine the pain she was in for so many years. Especially when cramping. Just…yikes.
Oh God, your poor mother. That sounds horrific!
It really was. Her doctors thought she had ankylosing spondylitis for years until they got in there and saw that mess.
Before she had her surgery along with being undiagnosed celiacs, from the time I was about thirteen until I was nearly seventeen she was in so much pain and so ill she could barely reach to put her seatbelt on when she felt well enough to get in the car. She still feels guilty that she “wasn’t there enough” when I was a teenager but I don’t hold it against her in the least. Even in the midst of all that she still found a way to get me where I needed to be and it was only right before she had her surgery when I was almost sixteen that I knew how bad it was because she just didn’t have the energy to pretend anymore.
Truth be told now that she’s had a hysterectomy and is now on a strict gluten free diet she says she feels better in her fifties than she did in her twenties and thirties. Definitely better than her forties! So I have a hard time seeing mid-fifties as “old” like many people my age. They haven’t seen a woman in her mid fifties run circles around kids in their twenties in crossfit that fifteen years previous was in the ER once a month minimum because of pain and bizzare illnesses that seemed to have no cause.
I know someone still in her 20s whose uterus and bowel got fused due to endometriosis. I don’t think we were designed for our uteruses to fuse to things, and yet it seems to happen with alarming regularity. Almost as though nature doesn’t actually know, sometimes…
Excellent point that should not have to be made. I can’t comprehend the cruelty and density of these women. It’s idiocy beyond words.
NCB advocates often say fear is bad, when in fact fear is an evolutionary advantage, and may explain why it is common to fear things such as spiders and snakes.
The irony is that the NCB/naturopath crowd has a masterful ability to instill terror in people.
And then use that fear to their advantage/profit.
I fear snake bites, thin ice, car accidents and birth. Basically anything that can kill me.
Yet, they use fear of the medical world, and lies about the safety of medical procedures (like, that epidurals hurt babies) to sell their products.
As The Doctor said, fear is a superpower.
NCB advocates often say fear is bad
And yet they apparently think it’s totally fine to fear doctors and hospitals, and to instill fear in others about those things.
Somewhat on topic: I was chatting with MrC about this blog and the topic of home birth in general. One of the things that upsets me is people being so casual about the lives of their babies, even when it all turns out well. These people have no idea. They haven’t learned from history and they haven’t learned from the tragic events that happen every day. There are women out there, many of whom comment here regularly that would give their left breasts to an easy, exciting pregnancy and any reasonable expectation of having a living baby at the end of it.
After my first few pregnancies ended in death or complicated births, all future pregnancies were met with a mix of excitement and terror. I couldn’t begin to hope for a baby at the end of things because the fact that not all pregnancies end in a healthy baby was all to real for me. Y’all know my history, so I won’t go into it again.
Anyway, I got a little animated and threw up my hands and said “You know, I’d have given up a tit to have an out of hospital pregnancy, let alone a normal, vaginal birth!
“I couldn’t begin to hope for a baby at the end of things because the fact that not all pregnancies end in a healthy baby was all too real for me.”
Beautifully said. I distinctly remember the feeling during my fourth pregnancy–after the first three being a complicated ectopic, a molar (GTD), and a “regular” miscarriage–that the positive pregnancy test increased my odds of having a baby more than, say, a negative pregnancy test. But I never recaptured that feeling of missing a period and thinking, “Yay! We’re going to have a baby!” Lost that innocence for sure. In happier news: That fourth one turns seven this month, and the fifth one just turned four. 🙂
Hugs to BeatriceC and to everyone who can relate to what she wrote.
I vividly remember during my pregnancy with my living son, my husband would hug me joyfully and say, “we’re maybe having a baby!” — this after a loss at 24 weeks and an early miscarriage.
yes! exactly!
My response to the positive test with my youngest kid was “oh, shit”. I was mostly terrified, because by that time I knew how awful my pregnancies were and that my chances of coming out with a live baby were slim, and the chances of me making it out alive were somewhat smaller than most. That pregnancy did almost kill me, and the baby was a fighter, so he survived in spite of being born at 24 weeks and 504g. It was the beginning of the end of my Catholic faith.
Every time I got a positive pregnancy test, I would tell hubby I was “pregnant until proven otherwise.”
Yeah, I don’t have that excitement either after so many losses. A positive test is generally just a prelude to a really horrible few weeks, not months of excitement. I’ve had to tell my preceptors and supervisors about it because I’m very much not myself lately and I want some understanding with my evals. The way I’ve phrased it is “I am currently pregnant” and I’ve cut off their reflexive congratulations by explaining that I am not so much expecting a baby as expecting to need surgery shortly (probable ectopic. Again.)
What I wouldn’t give for a healthy baby…
I’ve “only” had one miscarriage (at ten weeks) but I totally relate. When I got pregnant the second time, I couldn’t really enjoy it. Even after we got past ten weeks, and twelve weeks, I’d heard about enough second and third trimester losses that I still wasn’t really able to breathe easy.
I was lucky not to suffer any pregnancy losses myself, but when she was 24, my sister had to terminate a pregnancy at 21 weeks, due to multiple incompatible-with-life birth defects. I will never forget being at the ultrasound appointment with her that day that they first noticed a problem with the baby. My sister was healthy, young, and as low-risk as you can be. It never occurred to me at that point that a healthy baby was not guaranteed. After that happened to her, though, I saw pregnancy and birth in an entirely new light – my innocence was gone. And when I got pregnant myself many years later, I never took anything for granted – while I was pregnant I called my daughter an “inside baby” who I “hoped would become an outside baby.” I waited until she was born to buy much of anything baby-related or decorate the nursery. So yeah, even without direct experience of pregnancy loss I understood the fragility of it all. So needless to say I do NOT understand these women who “trust birth.”
Eh, wouldn’t it be a success, tho? In terms of the baby being expelled and therefore the mom living to breed again. Many steps to make a successful next generation. Obviously, not going to be as successful as the mom who uses medicine to have live births, but still not a game stopper.
No, because the baby died, so that attempt at perpetuating the species failed. The mother can try again, of course, but that particular attempt was indeed a biological failure.
As we frequently say, nature doesn’t do perfect, it does “good enough”, and nature has a high waste rate. This is one example of that.
Didn’t she need repeated help at the hospital to have living children? It’s quite possible she’d never have any that lived.
Yes and no.
Yes:
-The mom who gives birth vaginally to a large, dead infant is not dead and therefore can continue to raise the previous CS child who may reproduce one day.
-She may be able to reproduce in the future which could improve her fitness.
No:
-After a repeat CS she would have had 2 offspring that could have reproduced some day and will always be at n-1 for her maximum number of offspring.
-Depending on the effects a prolonged, unattended labor with something happening that required emergency medical attention, she may have suffered internal damage that will reduce her total number of pregnancies and total number of children.
– She or her partner may not be psychologically able to deal with another pregnancy after a traumatic stillbirth.
-Additionally, she wasted 40 weeks of pregnancy + postpartum recovery + the energetics involved in pregnancy and fetal development by choosing vaginal birth over live infant.
From an evolutionary standpoint, my biggest concern would be that she may not be able to reproduce again. In that case, she would go from n >= 2 offspring to n=1. If she just wanted two children and can’t reproduce after this baby, her net reproductive success dropped by 50% . If by valuing a VBAC more than an infant she killed one offspring and prevented one other sibling from being born, her net reproductive success dropped by 66%. One dead baby + 2 siblings not born = 75% drop.
At the risk of sounding crass, she’s not a dead-end, but she’ll always be behind of where she could have been.
It’s only an evolutionary improvement over both mother and baby dying, IF the mother already has at least one living child or goes on to have at least one living child.
OT – My 2 year old’s feeding therapist closed her practice and we just had him evaluated by a new one. She says he has a tongue tie that’s contributing to his breathing and swallowing problems and speech delay and that we need to have it fixed. She also tried to attribute his whole body being weaker on one side to the tongue tie although a PT has said it’s neurological. His SLP says that his speech problems are not articulation-related and could not be caused by tongue tie. His ENT says he does have a mild tongue tie, but the breathing and swallowing issues are caused by his diagnosed airway defect.
We have a dentist, but the feeding therapist wanted to send us to a different dentist she works with regularly who does these operations. (I know a number of local moms who’ve had lip and tongue ties lasered by him.) When I told her I was going to ask our ENT for a second opinion, she said, “Doctors aren’t well educated about tongue ties.” (Really? An ENT?) Then I looked up the author of an article she gave me to read and the woman is a former cranial-sacral practitioner who identifies as a “home birth and breastfeeding advocate.”
We have very limited options for feeding therapy right now and I’m tempted to stay and see if I can make it work, if it’s possible to keep the good and ignore the bad, but … at what point would you run for the hills?
Push back and see what happens.
If it is “laser the tongue tie or else” run for the hills.
It is entirely up to you whether you decide to go for laser or not, but just see how the feeding therapist responds to the idea that you won’t.
That might give you the best idea about whether you can work together, seeing how a potential conflict would play out.
Does your little guy have cerebral palsy?
That makes sense. The ENT is willing to coordinate a frenulectomy while he’s under anesthesia for another doctor’s procedure, so if we decide to correct it we will go that route.
RE the cerebral palsy – we don’t know. If he does it’s very mild.
Good plan. Definitely arrange painful procedures for while already out for something else.
The thing about unilateral weakness being related to tongue tie is rooted in cranio-sacral therapy. As I understand it, the belief is that “blockages” to energy flows in central meridians cause problems distant to those blockages.
Woony tunes, in other words.
I think that whatever happens, you need to be clear that you are not open to “alternative” or “complementary” explanations or treatments. Allopathic medicine or bust!
Again, that little push back might be enough to either trigger alarm bells or lead to a compromise you can live with.
I hope that time and therapy will sort your son’s issues out.
Best wishes for a good outcome.
I would be inclined to ask the ENT SLP and/or dentist for a referral, or recommendations if it doesn’t have to be so formal. I’m guessing that you have a good relationship with the dentiist, SLP and/or ENT, based on the length of time you have been consulting with them? If so, tell them that you have some reservations about the new therapist, based on her “bedside manner” if you will and that she is pushing for an intervention that you do not think will help your son and you are not sure of her being a positive, helpful asset for your son’s treatment team.
Did you get a copy of the old feeding therapist’s file on your son? I would be inclined to get a copy of his medical records from the previous therapist so you can see and have the complete picture of her course of treatment. If you can deal with the new, wooish one for a bit and politely and firmly address her woo bias and state that you are happy with the other professionals on your son’s team and your son gets on well with them too, then you can search for a replacement. She *might* turn out to be wonderful and
I agree about pushing back. The new therapist reeks of anti-doctor woo. I’ve had to go toe to to with doctors more times than I can count, but it’s never fun. I find it’s most effective to channel my inner toddler and ask “why” over and over and over again.
Gut feeling: Run now. Don’t walk.
You have a team to work on complex issues and a new person who has seen you once wants to change everything while speaking disrespectfully about your trusted advisors? No.
How on earth can a tongue tie cause a weakness in your leg?!
From what I can tell from what she said and what I’ve been reading online, the idea is that the frenulum connects to fascia that form a web throughout the body and so if the frenulum is restricted it can spread tension to other parts through the fascia. I’m not a doctor so I don’t know how much of this is based in actual science. Also see Dr. Kitty’s response below about energy blockages.
Anatomically, fascia doesn’t work like that…if that helps at all.
Don’t worry; it’s not based in any real science.
Fascia is a tough coating on the outside of muscles and organs. You’ve seen it before on chicken breasts – it’s that clear-white shiny layer right above the muscle that you can pull off with a sharp object. That leads to reality check number one: you can rip it off with a fork tine or a needle. It’s a biological tissue, not a steel cable.
Fascia is all over the place, but it doesn’t form a web any more than our muscles form one giant web. Muscles are much stronger than fascia. This leads to reality check two: if fascia is a web, so are your muscles and organs. If that’s true, pulling on your tongue should cause your leg or arm to jerk. Mine doesn’t; I just tested.
Finally, the body still uses basic laws of physics. Think of the weight of half of your son’s body. For the tongue tie to be affecting half his body, the tissue holding his body overly tightly would have to be supporting all that weight. In other words, that little band of tissue under the tongue would be supporting at least half your son’s body weight. Reality check three: Does his tongue tie get worse when he picks up a toy? Does it disappear when you put him in a pool? If this sounds absurd, it’s because it is.
Other people’s legs don’t jerk when they pull on their tongue???
You need to run a wide spread test. Just don’t give them warning so they can breeze their legs.
My husband’s legs do right now, but that’s because he’s being a goofy nitwit. 🙂
I have mild hypertonic (tight) CP that affects my right side. I don’t have a tongue tie. I feel quite angry at your feeding therapist for buying such a load of crap.
Ironically, my twin sister has mild hypotonic (floppy) CP that affects her whole body. I guess that means that she should have her frenulum made bigger some how….
now i want chicken… must defrost some
It’s not an actual science. Read this and other articles, great overview of available evidence https://www.painscience.com/articles/structuralism.php
Er…no. I’m a pathologist and I perform autopsies on people, so I’ve dissected very many bodies in great detail over the years.
Fascia is definitely a thing-your muscles are covered in it and it keeps them separate from each other. If the fascia all connected, you’d end up as a complete biomechanical failure-any movement you made involving muscles would trigger a whole load of other jerky movements, you’d be like a marionette puppet.
The fascia doesn’t connect-in fact, read up on fascial compartment syndrome. This is a condition where the pressure rises in one compartment (a compartment is the confined space surrounding an individual muscle enclosed by the fascia)-the rise in pressure can be caused by muscle swelling or haemorrhage. This then puts pressure on the nearby compartments and presses down on nerves and vessels. Its a surgical emergency and the pressure needs to be released quickly. If all the fascia connected into one large web, compartment syndrome wouldn’t exist as the pressure would equilibrate through all the compartments.
Next you’ll be telling us the spiritual Dem Bones isn’t a good way to learn about our skeletons.
This is why I love the comment section on Dr Amy’s blog. People here are actually knowledgeable about these things.
This sounds like the classic conflation: ‘”I’m good at one thing” (feeding therapy) therefore I am by definition good at everything related to feeding therapy (like craniosacral tongue ties).’ It is common amongst professionals of all stripes and physicians and nurses aren’t immune but are usually more cognizant of what they DON’T know, rather than making assumptions about the expansiveness of what they DO know.
If no other options, I think I’d just be clear and say, “We appreciate your concern, but we’re paying your for feeding therapy and aren’t interested in alternative medicine-style options that contradict our entire team of other clinicians.”
Hrrrm…this sounds eerily reminiscent of a chiropractor telling somone that *all* their problems are related to spinal subluxations. I just don’t see how it would physically work.
Some women believe they are choosing a better life for their child with a vaginal birth, though. The NCB leaders downplay the risks and exaggerate the benefits and many of the women I talked to online going this route (or trying to persuade me to) truly thought it was best for the health of the baby. It’s not true, but they were at least intending to act on that primal instinct.
I can see the hype, but the proof is in the pudding. If you walk into any school – any age you want pre-K through adult education – you can’t figure out who was born by emergency CS, planned CS, induced vaginal birth, spontaneous vaginal birth or any other outcome I missed without asking the people you see to tell you.
Doesn’t work at the mall, doesn’t work at churches, doesn’t work at conferences. There’s no clear distinction.
Totally agree, but I was getting pounded with messages about avoiding c-sections, not doing the GD testing, etc., etc. because it was “better” for the baby in various ways. People believe a lot of crazy shit, and it took me a while to sort out the truth because some of them had what appeared to be convincing research links. When I got pregnant I had no idea all this shit was out there, so I was kind of blindsided. I mean, I still planned a hospital birth, tried for unmedicated vaginal but with a “we’ll see how it goes” attitude, and got the c-section, all the recommended infant treatments (vitamin K shot, hell yes, hepatitis as soon as the babies put on enough weight, etc.) and even switched to formula at six months – but sometimes I was worried that I was putting the babies at risk for future health problems. I know better now, but it wasn’t a nice time.
I stumbled across an anti-vax book at a local baby store and was out of my mind with fear for a couple days over some of the stuff I read in it. I did more research and determined the book was fear-mongering non-science, but I was raised to be skeptical. Not everyone is.
It’s tough when people you see as health professionals are telling you otherwise. And not even CPMs, but CNMs here, midwives in other countries, some OBs – VB is always better, the WHO says to breastfeed because of all the awesome health advantages, etc. Women are just bombarded with this. 🙁
birth is about the baby, its not about a womans vagina or her healing experience, It is about 1 thing, that beautiful baby.
Well, no, the woman’s life and health matter too. A hospital birth is better for those too though.
I read about these groups, and I thank God I didn’t check them out when I was looking at a VBAC. I’m sure I would have been told all kinds of garbage and encouraged to fight my doctor at every step.
These people are why I won’t admit to, and even flat-out lie sometimes, about my two VBA2Cs. I never even knew these freaks existed when I stated discussing the probability with my OB. Had no idea what ICAN was …I just knew that, ideally, we wanted a large family and I wasn’t comfortable with having more than three cesareans. There were strict rules for the VBA2Cs and I was heavily monitored, of course in a hospital. Each one worked. There was no party for my achievement afterward and I didn’t feel accomplished, “whole” or “vindicated”. I was always clear to my OB that my hope for vaginal birth was not a political statement. I signed paperwork to happily be swept away for a cesarean, at his discretion, at any moment. Whatevs. It was just a trial to buy me out of more cesareans and into more pregnancies, ideally. I’m now utterly embarrassed to be a VBA2C mom. It “means something” to all the wrong people, and means NOTHING to me. As stated, I publicly deny ever doing it 😛
Thank you so much for sharing your story.
As an OB at a hospital that freely offers VBACs, and offers VBA2Cs with optimism but trepidation, it seems that about half of patients have your reasonable pragmatism: Hopefully vaginal, but first priority is healthy mom/baby.
And then there is the other half, who get all the air time, who desperately need/want a “healing vaginal birth”… and so I’m sorry you end up lumped in with them.
Sometimes I feel like a need a “healing caesarean birth”. Seriously. I mean that. My first was so horribly traumatic. I labored for three days and it ended in a c-section anyway. I told my OB on the very first visit that no way in hell did I want a VBAC. I want a repeat caesarean. The biggest reason is that I can’t stand the thought of another baby going into distress and second I want to enjoy the birth on some level. I want to be strong enough to hold my son after he’s born.
Ditto. I’m not a VBAC candidate anyway (classical incision) and sometimes I fantasize about a smooth, on-time c-section without days of labor first. But then I remember that another pregnancy and birth could still go wrong in all sorts of ways and there are no guarantees.
I never wanted a vaginal birth and my OB let me have an elective CS. My mom spent two months trying to talk me out of it, swearing up and down that it’s a major surgery and I’d regret it. This despite the fact that I was either a shoulder dystocia or at a transverse type angle and her OB actually reached up inside her with her hands and turned me so it’s not like her labor was easy or anything (and she agreed we’d both have died if she’d stayed home).
After I had it, even my mom agreed that I made the right decision, for me at least. They flew out to Japan to be with me about 2 weeks early, we got ready for the baby to come, I went in on my scheduled day at 9 am and they took her out around 1:30. It was easy…no stress. I had all the control. I really didn’t want to deal with randomly going into labor or getting induced and then ending up with a CS anyway.
I far preferred having more or less complete control over my daughter’s birth than dealing with extra unknowns. I don’t recommend it for everyone but I totally support elective CS’ if someone says they want one.
Chatting with some mummy acquaintances today.
Experiences ranged from planned CS and loved them (yes, that is me) , to gave birth in the hospital car park at visiting time, to such a horrendous forceps delivery that she can’t bear the idea of ever getting pregnant again, and almost everything else you can imagine.
Almost everyone had something they regretted about each birth (except me, but I stay quiet, because manners).
I think the only other person who had a birth story she was 100% happy with was the mum who didn’t realise she was pregnant with her third until late second trimester, laboured for less than an hour and didn’t have any stitches, compared to her firs two miserable pregnancies and long, difficult labours!
Also, I have to tell you this, I saw a lovely 90-something year old patient.
She told me she used to drink olive oil during all four of her pregnancies and attributed her easy deliveries to that.
Her three eldest were born at home “the doctor arrived just after they were born and shook my hand” and the youngest was born at hospital, just after the NHS was founded “as soon as I was up on the bed, there he was, and it was great to have someone else change the bed and bring me a cup of tea!”.
Even the woman who had easy, straightforward and essentially unattended labours opted for a hospital birth as soon as it was available!
Sorry, but you are a Dr. yourself… You know all the “brutal” stuff that happens during the CS, step by step, what exactly did you love about your birth? I don’t mean this question as offensive. I am just trying to deal with my own issues I guess. It’s just that when I think how I was cut layer after layer of tissue, all the visible and hidden wounds that my body bears, it freaks me out.
Anna, I’ve been at a lot of births.
I assisted at a lot of C-Sections, and I saw the difference between a calm, elective CS where mum and baby were well and a “smash and grab” emergency section where one or both were in dire straits.
I’ve seen a bad outcome from a rupture during a VBAC first hand.
I’ve held a presenting part off a cord until the CS could be done in a cord prolapse.
I’ve been there when a post-dates intra-uterine death has been diagnosed.
I’ve held a woman’s hand as her placenta was manually removed without anaesthetic.
I’ve been at shoulder dystocias, assisted fourth degree tears being repaired, looked after women with severe PTSD or physical symptoms following difficult vaginal births.
For ME, a planned, pre-labour C-Section removed a lot of uncertainty.
A lot of complications were off the table entirely, and even if I was at higher risk of bleeding or infection, my babies were less likely to suffer oxygen deprivation or physical trauma.
I was never a good candidate for vaginal delivery, and knowing that I could opt out of a long, difficult labour and likely failed vaginal delivery was something I was happy about.
I’ll freely admit to being a little bit of a control freak.
I liked having a date and time, knowing exactly what would happen and when. I liked meeting my babies clear minded, pain free and well rested. I liked chatting to people during the anaesthetic and surgery because it wasn’t an emergency.
With the second, I liked being able to plan a delivery date to fit in with my daughter’s schooling, and to arrange childcare for the day of my son’s birth.
I’m also no stranger to surgeries, and didn’t find the recoveries difficult at all.
Having repaired perineal tears, nature is perfectly capable of brutally tearing through skin, muscle, nerves, sphincters and fascia. No thank you, I like my pelvic floor and sexual function as they are.
It’s ok not to love your C Section.
It’s ok not to love your vaginal delivery.
So anyway, part control freak, part bad risk, part seen too much. Those are my reasons.
I understand totally if you feel differently.
That’s it…the control freak thing. Me, too.
I suspect most women who request CS’ would describe themselves as control freaks. Scheduling a CS just removes so much uncertainty. It gave me peace of mind. I KNEW when baby would arrive. I knew when to stop working and was able to fully mentally prepare myself.
And I think not being scared of surgery helps, too, especially if you’ve had prior abdominal surgeries. I don’t fear surgeries and I understand surgery recovery and how I react to it. I think that makes elective CS’ more attractive, too.
The last thing I wanted was to randomly go into labor and then get converted to a CS. THAT would have traumatized me. And I’m pretty sure pushing a baby out of me would’ve traumatized me, too. Why? Because I feared labor. I think that’s why a lot of women feel traumatized by their CS – they feared it so it was the worst outcome. For me, it was the reverse.
That really IS nice, the plan and control thing. My OB insisted that I go into labor and the CS be done right after that even though she knew I would be needing one. Honestly that sucked. I still had to wait in uncertainty, having my hubby take me to the hospital daily for examinations to see if I was anywhere near labor. My Dr. wanted to make sure the baby was “ready”. Frankly speaking I have no idea as to how necessary that was. So I had the CS at 40+1. I just kept thinking God if I’m having the section anyway why not do it at 38 weeks? It would have spared me and my poor tummy quite a lot!
Probably the 39-week rule at your hospital then—without a “medical reason,” the hospital disapproves of CS before 39weeks, and (I think) OBs can get in trouble for violating that rule.
Not 39week rule… Probably about having a lower proportion of elective vs emergency CS.
If you wait for labour to start, by definition it is an emergency CS, because it is unscheduled.
That is how you can say “30% of my patients need CS, but 95% of my sections are emergencies.” Which matters if you are being pressured to reduce your CS rate, because in theory you can’t prevent emergencies…
So it’s all about the pressure to keep the c-section rate down that Dr. Amy often mentions. Not a good thing definitely.
My OB told me there is enormous pressure on her to keep ELCS numbers low.
Absolutely it would’ve been so much less stressful for you. I consider what they did to you close to torture, honestly. What the hell is the medical reason for doing that? I bet it’s exactly what Dr. Kitty said.
Thank you for your detailed and kind reply. Difficult vaginal birth is smth rarely mentioned. Perhaps the difference between you and me is that you’ve actually seen it many times and I have a very vague idea of it. So the section looks more acceptable to you in comparison. On the other hand, all the videos of vaginal birth I ever managed to find appeared quite positive and non-violent, and then there are the c-section videos… that I don’t even want to watch.
I think you’ve got it exactly.
Even the nicest spontaneous birth and easiest labour didn’t look like it was an experience I would savour, and I’d pick an elective CS over any of the horror shows I saw, so that is what I did.
I have plenty of patients who have never seen their bad perineal tears. Not when it happened, not in the immediate healing period, and not since it all faded to scar tissue. Felt, yes. Seen, no.
Abdominal scars are more obvious (at least for a while) and don’t require a hand mirror and a yoga pose to see, but that doesn’t necessarily mean more damage was caused.
I know CS looks like people are ripping and tearing with their hands, and it looks awful, but it is better to stretch muscles apart like that than to make bigger cuts in them and it causes less damage and heals better.
I’m not sure if i’d want a video available to the general public if my child’s birth was anything other than “positive and non-violent.” My fairly mild complication (I had a perineal tear that required stitches, upper end of 2, maybe low 3, i think) was not something i’d want to actually see.
This is why my own OB chose a cesarean. She said she’s seen the damage that vaginal birth can do. She told me this after I had chosen a cesarean for a variety of medical reasons and had promised her we wanted no more than three children.
I loved my cesarean. It was not violent AT ALL and my recovery was easier than that of my appendectomy when my appendix burst and they had to do a proper cut rather than laparoscopic. Much easier.
A significant proportion of female OBs and Gynaecologists choose MRCS while midwives very rarely do. I find that very interesting.
I suspect it’s because physicians are focused on outcome; midwives are often more concerned about process.
I suspect it’s also to do with the fact that physicians would have much more experience in treating incontinence and pelvic floor injuries than midwives do.
The birth of my first surviving child involved forceps to dislodge the stuck baby. It was classified as “mild/moderate” shoulder dystocia. Still, there was enough pelvic floor damage that I deal with stress incontinence to this day. Actually, I was just bitching of Facebook about how I have a cold and the constant sneezing and coughing is causing me to consider adult diapers, as even the overnight pads aren’t absorbent enough to catch all the urine being forced out when I sneeze.
I know this wasn’t a question directed at me, but I can give you my non-Doctor perspective.
I was TERRIFIED of labor. I had a very bad gall bladder surgery and recovery at 20 years old (ended up being TWO surgeries and a 9 day hospital stay). After a gall bladder removal, you’ll hear all these anecdotal stories from women about how gall bladder pain is as bad as or WORSE than labor pain. I can affirm gall bladder pain is hellish and I had it for SIX MONTHS before they figured out what it was (bc I was 20 so too young for it) and by the time I had it removed, my liver was failing. It was a EXTREMELY traumatizing experience. The surgery FIXED me.
I also have had gastric bypass surgery. I lost 160 pounds. Again, surgery HELPED me.
In other words, surgeries to me are wonderful, healing things.
The thought of labor pain going on for an unknown amount of time, labor starting at a random time, and then possibly TEARING…omg…tearing sounded HORRIFIC to me.
So basically, the idea of labor was actually traumatizing to me. So while I understood what a CS entailed, for me, the benefits (choosing the date, choosing WHEN I would be in pain, etc) far outweighed the risks.
Gastric bypass carried a 1% death rate when I had it and about a 3% risk of serious complications. It was worth it to me because I wanted that surgery.
The risks of a CS are much lower than that…and vaginal birth has its own risks, so I didn’t feel a CS was particularly risky.
Soooo…basically the worst I can say about having it was I ended up with a Dural tear (not dangerous and easy to fix and NOT a CS complication…an epidural complication), and I hated how my tummy looked for a year because of how I was stitched up. But I’d always planned to get a tummy tuck after my daughter was born, so I didn’t care about the scar or stitching anyway.
So basically…like the natural birth crowd, I decided that my birth of choice was worth some additional risks and I didn’t care that they’d be cutting through my muscle. The how’s and why’s didn’t matter to me because the benefits for ME outweighed the risks.
I’ve been contemplating tummy tuck ever since my daughter was born. Not very nice stitching either. But I’m DEAD scared of surgery. And it has to be GA, not spinal, which makes it even more scary. So I started working out like mad and dieting, wearing compression belt etc. It fixed my tummy quite a lot and I am not thinking about plastic surgery anymore. 9 months postpartum my tummy started to look more or less decent in clothes at least)
Goodness, nine months is still early days!
Yeah, I pretty much get it now. I had VERY unrealistic expectations as to how my body would look 1 to 6 months postpartum. All those pics of celebrities looking great in 2 weeks, you know. And then a lady in a public loo thought I was pregnant and that was after 5 (!!!) months. I wish Dr. Amy would write about it someday, so that less new mothers would be traumatized by their bodies not bouncing back immediately.
I HAD to get a tummy tuck. I had a lot of extra skin because I’d lost so much weight so I always planned to get rid of it…there was no compressing it away in my case. After the CS, my doctor anchored my stitches into the muscle, like he was supposed to, but the way he did it created a horrific pouch. Before I had the tummy tuck, my surgeon said they might not agree to do it ( the TT) because I was so anemic and I nearly cried. I begged her to do it, no matter what. I was actually getting horrendously depressed about how I looked. I’d lived with extra skin for like 7 years but the pouch? I couldn’t do it. It HAD to go. I love my tummy now, though.
I don’t know how to ease your mind about GA. Personally, I don’t mind it (funny for a control freak like me actually), but I can understand the fear. It just feels like going to sleep though and it is SO FAST.
I know you asked this of Dr. Kitty, but I’m a different doctor who also requested a CS, and I come from a different perspective than she does. My situation was that I had already given birth once vaginally. The birth that caused a lot of pelvic floor damage (including avulsion of my levator ani from my ischial tuberosity…in other words, I tore the right side of my pelvic floor completely off the bone and this is something that can never be reattached.) I couldn’t sit for weeks. I needed help to climb stairs and get in and out of the shower. Even standing was painful. I had to put my weight on my left foot only. I had (and have) both urine and stool accidents. My uterus is falling out of me, because its supports have been torn away. My vulva looks and feels nothing like it did before. My anus buldges/hangs down out of me. And I was a healthy, athletic woman with a small baby.
I have assisted at c-sections, and I have sewed up pelvic floors, and I have assisted with pelvic organ prolapse surgeries. Of these, the CS is what squicks me out the least. Yes, there are cuts in various layers of tissue that need to heal. But this is less brutal in my mind than layers of tissue that were stretched to the point that they busted apart. Tissue that explodes is never the same.
So for my second child, I requested an elective CS. My CS recovery was SO much easier than my vaginal delivery. I could enjoy my baby. and now, it’s like it never happened. I healed up 100% perfectly….but my pelvic floor can never be the same.
I personally am not a control freak. I HATED the idea of having a scheduled date and time rather than a surprise. But it was a price I was willing to pay. In the end, I went into labor a few days before my scheduled date anyway Luckily, I was right next to the hospital, so I still had time to have my CS.
So for me, that’s my story of why I chose (and loved!) my CS.
“My uterus is falling out of me, because its supports have been torn away.” God, that’s brutal! I can only imagine the extent of the trauma during birth(((
“Yes, there are cuts in various layers of tissue that need to heal.” It’s not just that. They are supposed to take the uterus and smth else out of the body, aren’t they? The image of this being done has been haunting me for a long time but I didn’t manage to find out if it’s true or not cause the info on the Internet is controversial. Is is true? Does it happen to all women during CS or just in case of complications?
I’m no medical person, but i don’t think they normally remove the uterus. The baby and its placenta, yes, but those need to come out one way or another.
“They are supposed to take the uterus and smth else out of the body, aren’t they?”
Typically no, they don’t take the uterus or any other body part out of the body. They just cut through the skin and fat, move the muscles to the side, then cut through the peritoneum (a fabric-like fibrous layer) and then uterine wall (which is very thin at the time because it is so stretched out). Then they take out the baby and then the placenta. Then it is all sewn back, layer by layer.
After the baby is born, in rare cases it might be necessary to lift the uterus up and out to be able to get a look at the back side of it. For example, I assisted at a VBAC attempt where all of a sudden baby started to show a lot of distress. The OB let the woman know that this could be the sign of a rupture and so brought her back for an emergency CS under general anesthesia. But when he went in, we didn’t see a rupture (it turned out to be a probable cord problem). But to be 100% sure that he wasn’t missing anything, after the baby was born he did lift up the uterus to carefully check the back wall. Another time that I saw a uterus externalized was in the case of a woman with a deformed uterus and abnormal ovaries. The OB wanted to get a photo for her medical chart should she need further surgeries on the area.
5 layers of tissue cut. That’s probably why I couldn’t feel my abs for 6 months I guess. However it’s a relief to know they don’t take anything out normally.
FWIW, my friend’s all-natural VBAC trashed her abs in a way the (emergency) CS hadn’t. It’s of course not going to be this way for everyone, or even most people, but I couldn’t help noticing how much harder her recovery was from the VBAC – the abs, the stitches in the area where you sit/urinate/defecate, the vaginal bleeding for weeks… and that’s not counting the time her VB baby spent in the NICU.
I’m six months post CS number two, and while I’ve been doing my usual pelvic floor, core and back exercises I have to do every day (my spine is wonky) I’m only just starting to feel that my core is coming back.
However, I know from CS#1 that it will come back over the next six months.
I was told that they took my uterus out. I don’t know why though. Maybe it had something to do with having a transverse external incision but a vertical uterine incision?
“transverse external incision but a vertical uterine incision” – how odd… WTF? But indeed they would have to take it out in that case cause it wouldn’t be physically possible to make a vertical cut through that narrow horizontal line. I don’t even know what kind of uterine incision I have. Will ask at my next appointment.
I think they would have told you if you had a vertical incision, since it would affect your ability to have a VBAC in future. Low transverse is the default unless there are complicating circumstances. Doesn’t hurt to ask and make sure though.
You know what is weirder? Vertical external incision but transverse uterine incision. That is what they do in low resource settings, because a vertical skin incision bleeds less, and if you don’t have a blood bank that matters. Seen it in India as a medical student.
I trained under a very old (and very good) OB who preferred to do them that way. I’m not sure why. Obviously, he would defer to women who wanted the regular “bikini cut”, but if she didn’t care, he did the skin vertical. I, myself, wonder if I wouldn’t have liked a vertical better. I never wear a bikini. And as I’ve mentioned before, although my CS recovery did not involve any pain, I was bugged by the numbness of my skin that lasted for nearly 2 years. Looking at the dermatome patterns, a vertical incision would reduce numbness, no? I certainly would have swapped a vertical scar for no numbness.
They took mine out because it tore downwards when they were retrieving my son, said they wanted to check it thoroughly but it had been contracting for a long time.
They exteriorised my ovaries both times to have a look at them (because of my history of endometriosis and cysts), asked me specifically for consent during the surgery both times, and the anaesthetist both times had something on hand to give me if I felt woozy or sore while they did.
First time I felt a bit woozy until the medicine kicked in about a minute later, second time I didn’t even notice because I was holding my son, and still a bit shocked we’d had a boy, so I don’t think I got anything.
Unless they are doing a tubal ligation or there is a problem the uterus and ovaries, they usually stay on the inside.
I had a cervical laceration during my first delivery that had to be repaired in the operating room. In trying to process what had happened afterwards, I read part of an obstetric textbook describing how the repair is done. I would have taken a CS over that any day.
I’m probably the last person to be offering advice but what helped me was a full and frank disclosure by my sister in law of the harm her 11lb baby did exiting her body during a fast labour. I felt similarly to you, ( actually asked a hysterectomy because I couldn’t bear the thought of that scarred and revolting thing inside me…you can probably imagine the response) but whether its stretch marks, scars from tears or surgery I’d put money on the fact that 99 percent of us are scarred by motherhood. Reading up afterwards about 4th degree tears made me realise that in the grand scheme of things I got relatively lucky and my sister in law did not.
I can see the appeal of a planned section given the unpredictable nature of birth and had I known what I know now, I would have fought for one.
Hi Erin! I just read the reply from fifryfifty1, surely vaginal birth can be no less brutal. Like you I couldn’t bear the idea of smth being wrong with my body now both inside (sewn up uterus, muscles, etc) and out (repulsive uneven scar 6 inches long with skin overhang above it). My therapist diagnosed me with postpartum depression (mild) and narcisstic personality disorder (moderate). I used to be really obsessed with how I looked before I got pregnant. And I am the sort of person who likes everything to be nice, clean and decent, and a CS is anything but nice, clean and decent. Then there’s the social stigma . Vaginal birth is glamorized and glorified, whereas CS is demonized all the more. For people who already have issues with that like you and me it adds pressure.
I can’t say that my vaginally birth was particularly clean and decent – you have pretty much no modesty left by the end and there are fluids (and worse) everywhere. I was so glad for that shower afterwards!
Plus I had a episiotomy, which meant that for several weeks it was difficult to wipe after using the bathroom (water and dabbing are the key basically). So that wasn’t neat and clean either. And I got off lucky compared to women with 3rd and 4th degree tears.
I’m not sure there’s anyway to have a clean decent birth. Some mess is inevitably involved.
I think birth (any kind of birth, even the most easy one) is a humbling experience which shows us how little depends on our effort and/or ambition. It shows us how weak and helpless we may be.
As far as being “damaged”… Well, just remember that you could have gotten a 4th degree tear and then you’d have been “damaged” “down there”. Your vagina is perfect bc of the CS though. So…silver linings. I think it’s the glamorization of vaginal birth that makes people forget that it can permanently damage your pelvic floor and it can basically deform your vagina if the year is bad or stitched up wrong.
Not Dr Kitty nor answering for her, but while I think it’s ok to feel as you do, some people just aren’t grossed out by that kind of thing. I had a section and I’m not. Also I’d hazard a guess that people who do feel as you do are less likely to be doctors- you probably wouldn’t last long if you felt that way about wounds, tissue damage etc. People just get bothered by different things. I briefly worked in an STI clinic in a clerical capacity, and the specialist nurses there both thought feet were revolting. Ooze from chlamydia was nothing though!
I often get patients apologising to me that I have to examine their genitals.
Because women are absolutely socialised to think that vaginas and vulvas are ugly and dirty.
I can honestly tell them that I would much rather do their smear or take out their coil than look at an ingrown toenail.
I do not like feet either.
You did quite a lot of reproductive organ related stuff before GP didn’t you? It seems to be a common theme for clinicians dealing with that type of thing not to like feet!
When I was in slow early labour with my first, I was in hospital and could feel the remains of my mucus plug going. I wanted to be helped to the toilet to clean up, but the obstetrician arrived and needed to examine me quickly. She said there wasn’t time for me to wash first, so I apologised for the mess as I would usually prefer to clean any body part before offering it for examination. Just out of respect for the person who has to poke around me. She said it didn’t matter about all the blood and gore, she didn’t get into medicine for the views. I thought that was a very sensitive and well chosen response, but in retrospect she was probably just grateful she didn’t have to look at any feet.
I’ll tell you the dirty little secret of motherhood: We all have many, many moments where we want a “redo” of whatever just happened. “If I only just….”, or “If I knew then what I knew now…”, is just a fact of life of motherhood. Sure certain moments could have been better if X, but X didn’t happen, so we just keep on going, making the best of things. What makes a good mother isn’t one moment, or even several moments, but that we’re in it for the long haul, doing our best, screwing up more than we care to admit to, and getting up the next day and doing it all again.
It’s not just motherhood. It’s life in general.
Although I don’t want any more kids, I also sometimes wish I could try again and have a birth where I didn’t feel so lost and confused. Mostly I would like one where I could hold the baby immediately after birth, and take him or her home with me right away. I don’t need to be “empowered” or whatever and there’s no guarantee a second birth would be any better, but it would be nice to try again. Well, except for the part where I really don’t want anymore kids.
YES YES YES. our son is a planned only child (even though he was the third pregnancy that was the “charm”) but there are times I wish the same thing!
Your hospital “freely offers VBACs, and offers VBA2Cs”, but does it offer elective c-sections? Why are so many hospitals trying to force women into vaginal births these days?
I doubt hers does if she is Canadian. There is an entire FB group dedicated to helping women who want cesareans try and get them and some of the stories are heartbreaking. It’s the same in Australia. If you want a ELCS they basically make you do a psych consult.
My body is broken and I don’t care as long as I get to come home with a baby to snuggle. I’ve had all vaginal births, but starting with the 4th, every labor has needed augmentation because my uterus no longer contracts effectively on its own after so many pregnancies. I’m thrilled to let my doctor’s wisdom guide my body through the labor safely. The only question I have during labor is, “How’s the baby doing?”
This process over outcome mentality just makes me sick. I keep thinking about that tiny little baby slowly dying inside his mother and I just want to cry.
My body is broken too. I needed fertility treatment, never went into labor and had two c sections. Breastfeeding didn’t work very well either. .. but I have two.living children and that all that counts. I’d never have living children if it weren’t for interventions.
Hello, fellow fertility-treatment mom! I remember reading about a woman who’d gone the whole nine yards with fertility treatment, including donor eggs, and chose an elective c-section for the baby she was finally so blessed as to be expecting, because as she put it, “a c-section feels like getting a police escort through childbirth”–in other words, it felt like the safest way to get from nonparenthood to parenthood.
That really resonated with me and I chose the same way of giving birth.
My csections were not elective and I would have gladly had a vaginal birth if things had worked out. Not because I wanted a birth experience, but because I’m really afraid of surgery. It didn’t work out as I planned, and I’m glad I could have a csections when I needed it. As I’m glad that fertility treatments were there, and formula!
It’s heart-breakingly awful. We took our munchkins exploring around the area we want to move to, the scenery was beautiful, and poor baby Isaac was still in my mind. I can’t fathom caring more about the process than the outcome.
I had augmentation too – second bub was getting stressed and I was getting tired, so my CNM asked if she could start it. With the third, I was getting tired so I asked for augmentation, the monitor confirmed that my instinct that my contractions were starting to be a bit off, and I got what I wanted. It’s so cool that we can use pitocin as a bit of a helping hand.
Edited to add: Isaac shares a name with one of my miscarried siblings, which is part of why it’s smacked me so hard.
I don’t know if my body is broken or not. My children were born vaginally and all, but now I have a rectocele and vaginal vault prolapse. Does the magical vaginal birth cancel out the pelvic problems? Who should I ask?
Disgusting. It’s all about ME ME ME. The dead baby was just a footnote, hardly mentioned but hey at least she got her wish of him coming out of her vagina.
Where did the idea come from that the body is “Broken” somehow if labor doesn’t start spontaneously, if an epidural is used, or if the baby doesn’t transit the vagina? Needing a little extra help to ensure a safe outcome doesn’t mean the body is “Broken,” it means a little extra help was needed. There’s nothing wrong with that. The majority of doctors don’t do these things for kicks (Which isn’t to say that there aren’t a few bad apples out there who do them for kicks and/or kickbacks.) They do them because it’s their job to send the mother and the baby home healthy, and because in the grand scheme of things, the method of birth is pretty unimportant.
Anecdotal, of course, but my body didn’t get pregnant without help; I’m not sure why I ever thought it might do labor and delivery that way.
Where did it come from? It came from midwives who can’t do C-sections. It’s a way to create guilt and then monetize that guilt.
Point taken, Doc. Silly me, I should have remembered: When in doubt, follow the Benjamins.
After 5 miscarriages I felt like my body was broken. I didn’t “trust birth” as my body had pretty much already screwed me over. When I found out my son’s head was likely around the 95th percentile I didn’t hesitate to ask for a scheduled c-section. I’m so glad my OB was understanding. Now I have a happy baby and a really neat scar.
The only word I can come up befitting this situation is: monstrous.