Consumer Reports and the reflexive demonization of C-sections

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Once again Consumer Reports deserves a big fat “F” for its series on C-sections.

Why? Because it starts with a conclusion and works backward to support it.

“Everybody knows” that the C-section rate is too high, and Consumer Reports is no different, but as is the case with many pieces of conventional wisdom, what “everybody knows” is not necessarily true.

We should use metrics to evaluate the quality of healthcare, but our metrics should be OUTCOMES not processes.

To hear Consumer Reports tell it, obstetric care begins and ends with C-sections and our priority should be reducing their number. But C-sections are a procedure, not an outcome, and our focus should always be on outcomes. Curiously while the Consumer Reports series on C-section focuses a great deal on variation in C-section rates between hospitals, it utterly ignores the real metric by which we should judge hospital quality — perinatal mortality.

One of the reasons I left the practice of medicine is because of short sighted, simplistic views of patient care beloved on large healthcare organizations and healthcare journalists. I once was notified that my rate of ordering ultrasounds the previous month was higher than average. When I asked the executives in charge of compiling such statistics whether any of the ultrasounds I had ordered that month were unnecessary, they couldn’t tell me and seemed shocked that I even bothered to ask.

I was once notified that my forceps rate was “too low.” That was truly mystifying since my C-section rate was low also (16%) and I hadn’t left a single baby inside a single woman. Instead of being lauded for a vaginal delivery rate of 84%, I was chastised for an operative delivery rate of nearly 0%. That doesn’t make any sense at all.

Of course we need to use metrics to evaluate the quality of healthcare, but our metrics should be OUTCOMES not processes. When we look at the C-section rate and ask if it is too high, what we OUGHT to be asking is whether any C-sections were recognized as unnecessary in advance not whether they were recognized as unnecessary in hindsight.

To understand what I mean, consider biopsies for breast lumps. We know that 80% of breast lumps are benign, but we biopsy 100% of breast lumps. In other words, we have an “unnecessary” breast biopsy rate of 80% … or do we? The fact that 80% are “unnecessary” can only be known in hindsight; it is impossible to say beforehand which biopsies are safe to skip. We don’t don’t judge breast cancer care by the breast biopsy rate and we shouldn’t. We judge breast cancer care by the survival rate.

Just as we should never judge breast cancer care by how many biopsies were actually cancerous, we should never judge obstetric care by the C-section rate. We should judge obstetric care by the survival rate, but obstetrics has become such a victim of its own success that Consumer Reports starts with the completely irresponsible assumption that all hospitals have the same perinatal mortality rates and therefore, we don’t even need to check them. And that is very, very wrong.

When you choose a hospital for obstetric care, you should choose based on which hospital will give your baby and you the best chances of coming through the process of childbirth without injury or death. For better or for worse, there is no consistent relationship between C-section rates and outcomes. While that may mean that higher C-section rates are not better, it ALSO means that lower C-section rates aren’t better, either. Why? Because the ideal C-section rate is the one where all women and babies who NEED a C-section get one, and not too many women and babies who don’t need a C-section end up with one anyway. Notice that I did not say that there would be NO unnecessary C-sections. Given the current state of technology that can only imperfectly tell us in advance which C-sections are necessary, it is better to do many unnecessary C-sections in order not to miss any necessary ones.

When it comes to C-sections, the current Demonizer-in-Chief is Dr. Neel Shah, who practices in the same place where I trained and practiced, Boston’s Beth Israel Deaconess Medical Center.

While a number of factors can increase the chance of having a C-section—being older or heavier or having diabetes, for example—the biggest risk “may simply be which hospital a mother walks into to deliver her baby,” says Neel Shah, M.D., an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, who has studied C-section rates in this country and around the world.

His private remarks to me on the topic of C-sections were particularly irresponsible.

Shah responded on Twitter to a piece I wrote for TIME questioning his sloppy, poorly sourced support for homebirths published in the New England Journal of Medicine. He appeared to be entirely unaware of the published literature on the dramatically increased death rate at American homebirth, and equally unaware that homebirth in the US is typically attended by a second, inferior class of midwife, one who does not meet the basic education and training standards in any other industrialized country. The analogy I used in my TIME piece is that hospitals are like seat belts; most of the time you aren’t going to get into an accident, but if you do, seat belts saved lives.

Shah, clearly stung by my criticism, had this to say:

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[H]ospitals are not seatbelts; they are airbags that explode in your face 1 out of every 3 times you get in the car.

Holy hyperbole! Shah implies that 100% of C-sections are unnecessary, and are performed merely because the system is malfunctioning spectacularly. At a MINIMUM, fully half of those C-sections he derides are medically necessary and a substantial proportion are literally life saving. Yet Dr. Shah implies that obstetricians are performing C-sections for reasons that aren’t merely illegitimate, but are a travesty exploding in the face of unsuspecting mothers.

It makes for good copy, but it is irresponsible medicine.

Dr. Shah knows as well as I do that the increase in C-section rates have been driven by the fact that our knowledge has eclipsed our technology. We know that vaginal birth can be dangerous and even deadly to a substantial proportion of infants. Indeed, Dr. Shah was a co-author on a recent paper that showed that a MINIMUM C-section rate of 19% is needed to be sure that rates of perinatal and neonatal mortality are low. That means that in order to ENSURE that all babies are born healthy, nearly 1 in 5 MUST be delivered by C-section.

Which 1 in 5 babies needs a C-section to be born safely? We can’t always tell in advance because the things that we need to know are inaccessible to us. To reduce C-sections for fetal distress we need to know the oxygen content of a fetus’ blood during labor, but we don’t have the technology to determine that. To reduce C-sections for breech, we need to know which babies’ heads will get trapped by their mothers’ pelvis, killing them, but we don’t have any technology to determine that. To reduce C-sections for cephalo-pelvic disproportion (a baby too big to fit) we need to know whether the diameter of a baby’s head can mold enough to fit through his mother’s pelvis, but we don’t have the technology to determine that, either. When we have those technologies, we will reliably be able to reduce the percentage of unnecessary C-sections to zero.

In the meantime, we do the best with what we have. Obstetricians perform unnecessary (in retrospect) C-sections because we often CAN’T tell in advance the difference between the necessary C-sections and the unnecessary ones. Not surprisingly, we try to err on the side of caution. The Consumer Reports C-section series deserves a big fat “F” because it is utterly irreponsible. It insists that there are too many C-sections being done but offers NO GUIDANCE on how to determine in advance which C-sections are the unnecessary ones. It presumes that the C-section rate is a quality metric when it is anything but. And it is based on the premise that our goal should be a reduction of the C-section rate when our goal ought to be the best possible rates of perinatal and maternal mortality.

The series doesn’t help mothers, doesn’t help babies, doesn’t help obstetricians, but does sell magazines. I guess that’s the point.

  • Ayr

    I just discovered this site today, and I am so glad! An OB with common sense who isn’t afraid to speak her mind.
    I completely agree with this piece, I am having a c-section in a few days because I have severe back and hip issues, that should I give birth vaginally could lead to limited to no mobility in my back. I also found out that while my baby is measuring fine in the head and legs, his torso puts him in the 85th percentile, he is a fat baby. I realize there is a margin of error during scans, but even my doctor was concerned and said it was good I am having a c-section as it is likely he could get stuck in the birth canal.
    I told this to a friend and she completely flipped! She went off on me about how c-sections are so dangerous and unnecessary, and they are just a ploy by hospitals to get more money out of you. She is the kind of person who doesn’t give her kids any kind of medicine at all, and is so insistent on a crazy alternative vaccination schedule, she has been kicked out of two pediatric practices because her seven year old isn’t up to date with shots she should have had by the time she was three. She also told me I should switch doctors and do a home water birth like she did with both her kids. I then reminded her that she nearly lost both her kids during said births because her labor stalled and she wasn’t at a hospital where she could receive care and medicine to keep things going. She shut up then, it amazes me how when faced with facts, people who actually believe this stuff either don’t a reply or they just keep repeating themselves.

    • The Bofa on the Sofa

      Welcome, Ayr.

      • Ayr

        Thank you!

  • prolifefeminist

    GAAAAAAAAAAHHHHHHHHH!!!!

    Just had to get that out. I’m studying (to become an RN) and today my developmental psych teacher posted a section in our online discussion board of the Food Matters video, complete with interviews of a woman from the Gerson Institute, and asked us to comment. Every single student gushed on about how informative it was; I was the only person to say bullshit and address the many stupid claims made in that video (“cooking your food makes your body think it’s a TOXIN!!”).

    Then in another psych class, in the chapter on pregnancy and birth, the textbook references ICAN as an authority on c-section rates, and promotes water birth, home birth, and hospital birth as all being equally jolly. Thank you, Dr. Amy, for the tools to debunk those claims.

    Last but not least, one of my nursing professors (who I’ve always thought was quite reasonable and science-minded) spoke admirably to me after class last week about the Biz of Being Born. I managed to keep myself from vomiting out my ears, and simply mentioned that many of the studies in that film are terribly flawed, and that she ought to read Push Back and check out SoB.

    Some days, I feel like I’m just a tiny raindrop hitting a giant puddle of oil. I swear, if it weren’t for this blog (I lurk here almost daily, but very little time to post these days), I’d probably have completely lost it by now. The woo…it’s freaking everywhere I look, except here.

    • demodocus

      continuing to confirm my belief that most psychologists are crazy

      • CSN0116

        My aunt is a psychologist and she’s fucking nuts 😛

        N=1

    • CSN0116

      Stay strong, friend. I teach my fair share of nursing students when they come to me for their required epidemiology course. I like to blow their minds. We’re currently using “Lactivism” as a supplemental piece for the course (“Push Back” wasn’t out yet ;). They are obsessed. They bring in lectures and PowerPoints from previous nursing classes they’ve taken and pick them apart now. Muh hahahah.

      • Who?

        It’s disturbing that nurses, who are frontline medical carers, seem to be taught so much nonsense and surrounded by such a lack of critical thinking. It’s great that your student are enjoying and taking on what you’re teaching them.

      • The Computer Ate My Nym

        I don’t envy you and prolifefeminist your work, but I’m very, very glad both of you are doing what you are. Teaching people how to analyze data is important and somewhat protective against woo. Nothing so far tried appears to be totally protective, alas.

      • Sarah

        That sounds brilliant.

    • The Computer Ate My Nym

      I would think that cooking food would denature the proteins, making it less immunogenic and therefore look less like a “toxin” to your body, but I don’t have any actual evidence for that claim.

      • Mishimoo

        I don’t have the time to look it up right now, but there is something to do with that. Some people are allergic to raw fruits/veggies but can eat the cooked version. (Some are unfortunate enough to be allergic to all forms)

    • I’m so glad I’m retired.

      I first noticed the creep of the woo in the 90s, and found it amusing, since, in my student days, studying for my RN, we railed about dumbed-down textbooks “for nurses” and wanted to be taught at the same level as medical students. How paradoxical that, as academic degrees began to be required (in my day, there were only 3 year diploma programs) for nurses, science and fact seemed to give way to magical thinking, woo, and “alternative ” medicine. It’s as if chemists gave way to alchemists in the schools.

  • Lizzie Dee

    There has been a case here in the UK this week of a mother who pleaded for a CS throughout her pregnancy, because of a horrible first birth requiring forceps. She had been told that a second birth might also be a problem, but nobody listened to her. She didn’t get her CS, (or maybe she got a late emergency one when it turned out she was right, I am not sure) The baby died.

    Every body is very sorry they didn;t listen. The baby is still dead.

    • Kelly

      I don’t even know what to say. My heart hurts for her.

      • I hope she sues the entire NHS for zillions of UKP.

        • Lizzie Dee

          Doesn;t work that way. Very few people sue for a dead baby, because there is no award for pain and suffering. A small amount for “loss of earnings” is usually what happens. Damages (even for brain damage) are costed to the penny and most don’t sue as it is very hard to prove “causation”.

          • Dr Kitty

            The Trust admitted liability, so I think that there has probably been a settlement reached.
            But it would be highly unlikely to be above 5 figures.

        • Kelly

          Me too.

      • Azuran

        What surprises me is that her first birth was a c-section. They basically forced her to VBAC. I was under the impression that repeat c-sections are usually the standard.

        • Erin

          I was told at my debrief that because my section was for failure to descend at term and once we had figured out the handwriting a big headed baby, that should I ever show up in premature labour, I wouldn’t be guaranteed a section even if I was say only at 5cms dilated on arrival. I wondered if from his weight he was early…thought I’d seen 5 Ibs somewhere.

          • Dr Kitty

            Erin, that was my biggest fear in my second pregnancy.
            That I would go into labour before my date and that the NHS midwives would delay an epidural and CS and then congratulate themselves if I “achieved” a VBAC.

            So…
            I did everything possible to make sure that wouldn’t happen.
            I told my consultant and midwife that I considered any attempt at vaginal delivery to be unacceptably risky, that I would not consent to any intervention designed to facilitate a vaginal delivery and had them document it in my notes in front of me that we had that discussion and that the plan was for CS delivery barring very precipitous delivery or a life-threatening emergency.

            I also made them document in my notes that I had seen a uterine rupture with a bad outcome, and that I considered TOLAC unacceptably risky because of that experience.

            My birth plan read:
            “I am planning an ERCS.
            In the event that I go into labour my birth plan is for CEFM and
            1) epidural ASAP
            2) CS ASAP
            Under no circumstances do I wish to attempt a VBAC.”

            Then my consultant made sure I was booked for 39w0d instead of 39w4d like the MW in charge of theatre lists wanted.

          • Erin

            At first I just thought she meant if I didn’t realise I was in labour (say contractions which don’t have you falling over because baby doesn’t have my sense of direction and isn’t trying to claw its way out of my spine), I mean I can see it being an issue if you turn up with a baby falling out of you. Couldn’t believe she meant at any point if labour was progressing, especially given my uterus tore slightly during my emcs and all the other issues I had. I really cant think of anything worse than labouring again, just waiting for it all to go wrong.

            Anyway because I’m a masochist, got an appointment with a Consultant obstetrician to see how I could be supported if I got pregnant again. Psychiatrist offered that or more therapy and its the quickest option plus to be fair, she did seem lovely when she phoned up to make the appointment. Really practical, no platitudes and had actually read my notes.

          • Dr Kitty

            Well that is something. If you can find someone supportive that you like, it really helps.

            I’ve recently had a pt delivered at 37w by MRCS for psychological reasons (previous birth trauma)- the date was originally 39w, but kept being moved up due to increasing maternal anxiety as the due date approached. The OB was definitely of the opinion that late prematurity was less of a risk that maternal breakdown. Everything was fine and now baby has safely arrived mum is in much better shape.

            So, even in the NHS, it does happen if you find the right person to fight your corner.

        • Kelly

          I didn’t even think about that. That is just so horrible.

    • Dr Kitty

      http://www.bbc.co.uk/news/health-36048994

      She had a failed vacuum, followed by a failed forceps, followed by an emergency CS…and the baby died at five days old from hypoxic ischaemic brain damage.

      The coroner was not kind in his report at the inquest, but did not find the trust negligent (they have admitted liability).

      Of note, Birthrights seem to be getting on board with MRCS.

      “Elizabeth Prochaska, barrister and chair of Birthrights, a charity which fights to improve women’s experience of pregnancy, said the case was a tragic reminder that medical professionals do not always listen to women.

      “When a woman requests a Caesarean she is asking for the care she has decided is safest for her and her baby. We must trust women to make that decision. Hospital policies which refuse to honour women’s decisions ultimately make birth less safe for women and babies.”

      Instead of documenting that women have concerns about VB and why, and taking steps to prevent sequential use of instruments and prolonged instrumental deliveries, the trust should have said that NICE guidance on MRCS should be followed, and that women who request CS, once advised of the risks, should have their decision respected.

      • Lizzie Dee

        They must have known that this poor woman had very little chance of an easy “healing” birth. What contempt they show for women in forcing them through this – even without the terrible outcome. How do you recover trust, after something like that?

        I was fortunate to escape a similar fate with my second, but luckily they lost their nerve at the last minute. Sometimes being clearly high risk isn’t a bad thing.

        • Erin

          My notes raise questions about my pelvis/baby’s position on the Saturday night. No one said anything to me. He was eventually retrieved on Tuesday morning by emcs. My husband told me recently that they told him they had no idea what state our son would come out in (I’d been leaking amniotic fluid for 81 hours and apart from a pathetic baby sized lump my bump had deflated and contracting for 75 hours) but to be prepared for the worst. They then added insult to injury by saying that because I was so dehydrated, blood pressure all over the place and running a fever, my heart might not be able to cope with surgery.

          He would quite like to visit our local maternity hospital with a flamethrower to rid it of its infestation of deluded, lying and downright malicious midwives.

          Obviously my heart kept on beating and my son came out slightly grumpy but with an apgar score of 9. We got lucky but stories like these make my blood boil.

          My father has extensive small cell lung cancer. He might have six months or six years we don’t know but whilst he can cope with treatment, they intend to keep treating him. Why is maternity so different? Giving me a section on the Saturday night would have saved them a fortune in the long run, given the mental health issues I’d have more than likely avoided.

  • Puffin

    After a recent clinical skills session with an OB/Gyn a classmate and I stopped to talk to her about OB/Gyn as a specialty as we both have interest in it. Since my primary interest is family med, I asked about doing an extra residency year in family-OB. She said one thing that stood out: “A c-section is easy. I could teach you two [first year med students] how to do one right now. What’s hard is knowing when to do one.”It stuck with me.

    Hindsight is 20/20. It’s easy to look back and say “see, baby was fine! You didn’t need that caesarean.” But it’s a hell of a lot harder when an OB is standing there, taking all information into account and trying to decide between a possibly unnecessary surgery or someone dying if s/he is wrong. When I’m on the receiving end I’d rather they err on the side of getting us all through it safely than risk damage or death to me or baby in pursuit of ‘better’ statistics. I’m an individual, not a population. I want my care decided based on what is best for me at that moment, not what looks best on a report.

    • Sue

      That was an important lesson, “Puffin”. The best surgeons are those who know when not to operate, and when to move quickly.

      Being held to account for your outcomes really hones decision-making skills.

    • Box of Salt

      Puffin “It’s easy to look back and say “see, baby was fine! You didn’t need that caesarean.” ”

      Reframe: “see, baby IS fine. The caesarean KEPT the baby FINE.”

      Risk assessment shouldn’t be just “can I get away with this?”

      Risk assessment needs to include: what if I don’t get away with it? Can I live with myself if I don’t?

      And I suspect those who think they can live with it don’t have much of an imagination.

      • Who?

        Quite so.

        Life is not a video game. We don’t get to all jump up alive and do it again properly.

        • DelphiniumFalcon

          This is why I say these “It’s only 15% of women that can’t breastfeed!” or “10% isn’t that high!” need to play classic pen and paper tabletop games.

          You never realize how big 5% is until you’re rolling ones all over the place and all your team mates need to pull your ass out of the fire (sometimes literally) when your thief fumbles a trap disarm or you’re supposed to be tanking and you get a critical hit from an enemy that rolled a twenty twice and then rolled maxed damage. You start feeling like a total dumbass and the load really quick. If you survive anyways.

          A twenty sided die really puts 5% in perspective.

          I’m also legendary for rolling ones. I must have run over Lady Luck’s dog in a previous life.

          • AirPlant

            Nerd moment: That is why I HATE d20 based games. It makes no damn sense that a person would critically fail a skill 5% of the time, even at the very highest level. And then you don’t even get a balanced number of critical successes, in combat you have to confirm the crit and that is just bullshit. Dragon age has an RPG setup that uses 3 d6 and a critical is any time you get doubles and that distribution just makes so much more sense to me.

          • DelphiniumFalcon

            YES! Oh my gosh, yes!

            This is also why I’ve been interested in New World of Darkness or whoever they’re calling it now. D10 based system and its extremely hard to fail in an area you’re actually leveled in. If we ever start it I’ll be playing a Demon…with attacks named after TVTropes page probably.

            And how.well does the Dragon Age setting translate to the system and all that? It sounds like it’d be really fun but I haven’t heard much about it.

          • AirPlant

            I honestly never played the dragonage games, so I can’t say how true the setting is, but I had a truly gifted GM for that campaign and I thought that the established cannon for the world translated well to adventures. The game mechanics were some of the easiest that I have had to learn, and I thought that the system did a good job of encouraging roll playing as opposed to just hack and slash. Unfortunately my table switched to Numinera after that campaign and I think Numinera is one of the more obnoxious settings so I decided that tabletop night was now going to be PLL and wine night.
            .
            You are right about failing trained skills though, I started my first campaign as a wee airsprout with a 3.5 wizard and nothing made me angrier than repeatedly failing intelligence checks. +5 for and inhumanly genius character is not nearly enough when your score range is between 1-20. The only way to be successful is to pour all of your points into just a couple of things, and then wait for your specific niche to come up and even then it can be ruined with one bad roll. After that I just started living the girlfriend cliché and playing the healer. Even if you can’t hit for shit everybody needs the cleric eventually.

          • Roadstergal

            Honestly, that’s why I loved Paranoia. Sure, I failed my roll, but I told a damn good story, so give me the shot anyway? #NotARealNed

          • Charybdis

            Have they rebooted the World of Darkness games? I really liked the Vampire, Werewolf and Faerie ones. Each game had its own set of D10’s that I would use and they were not interchangeable. Ahh…I miss my Malkavian.

            My group played a game that used all the dice (D4,6,8, etc) and if you rolled the max number possible on the die in question, you picked it up and rolled again, adding the next number rolled to the first max number. If you maxed out again, add and continue rolling. The higher the number, the greater your success (or more detailed information was gotten, etc).

          • Charybdis

            I would tend to crit at both ends: roll a 1 for a critical fail or a 20 for a critical hit/damage/win whatever. Often not much in between when it really mattered

  • Adelaide GP

    Dr Amy, you made it into our local newspaper (South Australia) today 🙂 our “Adelaide advertiser” lifestyle magazine ran a front page story about excessive lactivist pressures etc. Your quote was in the final paragraph, really driving the message home, I think the message is getting out there!

  • Julia Wurst

    I recently found this blog and I am so glad I did. I had preeclampsia with my daughter who was born five months ago at 32 weeks. I was flown to a hospital with one of the largest NICUs in the country that specializes in high risk birth. Surprisingly, I was not given an emergency c-section. They gave me steroid shots for my daughters lungs, each needing 24 hours. I had a vaginal birth after 36 hours of labor, an epidural and 30 minutes of pushing. Baby was only 3 lbs 12 oz and I still tore. I don’t even know how many stitches they gave me. Besides losing a lot of blood, ending up with a bladder infection and feeling terrible from the magnesium, I don’t have any long lasting complications. But I did think I was going to end up with a c-section (and would have gladly agreed for me and my daughters sake). My doctors were very patient and as long as baby was doing well they weren’t in an extreme hurry. This idea that OBs want to perform surgery on everyone had me worried but I was met with caring professionals who briefed me on every decision they made. Since then I’ve been EBF, not co-sleeping and only wear my baby when I’m outside of the house. I appreciate this blog as it’s helped reinforce my parenting decisions to simply do what works for my family. The natural/crunchy parents are vocal especially online and you would think that breastmilk and coconut oil could cure anything if that’s all you read. I have nothing against natural remedies, up to a point, but I will not starve my baby in order to only give her breast milk so I can reach some arbitrary goal ( and take a picture of us in a milk bath, while nursing, surrounded by flower petals). I would switch to formula in a heartbeat if I couldn’t continue nursing. Anyways, all that to say, thank you Dr. Amy and the brilliant commenters of this blog.

    • Sue

      Welcome, Julia. Your rational and pragmatic views are held in common with many here.

    • prolifefeminist

      Welcome to SoB, Julia. I had my son at 31 wks and had pre-e as well. With previous pregnancies I was very woo-leaning (home birth, etc). I credit this blog with opening my eyes and keeping me from choosing to use a home birth midwife, who I know would’ve discouraged the testing that my OB ordered that saved my life and my son’s. I know this because when I developed pre-e signs at term with my previous pregnancy, my home birth midwife told me to use Rescue Remedy and cream of tartar with lemon juice to bring down my blood pressure, and said it was fine to go more than two weeks overdue. Thankfully, I transferred to OB care at 16 days past my due date, and had a healthy baby via c-section.

      Dr. Amy has saved more lives and more sanity than I think she could ever realize!

      • Julia Wurst

        Prolifefeminist, wow, what a story! I’m so glad you and your baby are alive and well. It’s so scary to really think about what could go wrong. I am ashamed to admit that The Business of Being Born completely wooed me. I must have watched it three times. My husband was worried about me! We met with a midwife early on in my pregnancy and she struck us both as cold and kinda odd. (My OB is kind, funny and saved my life.) OBs and midwives don’t work together where I live at all. She mentioned getting some tests done but made it sound like they weren’t that necessary and up to me if I wanted to get them. When we left that meeting my husband told me he didn’t like her at all. That was the end of that. Plus, she would have been at least $5000 out of pocket! Thankfully we didn’t have that kind of money or I may have looked into another midwife. My experience has definitely de-wooed me…And I feel so foolish for falling for a Ricki Lake “documentary.” A few of my friends have had lovely home birth experiences, one with a video set to calming music and I thought, I want that. Ugh. Anyways, if there is a baby number two, I will be in that OB office talking about my pre e risk factors and hoping I can carry to term. Anyways, happy to have found this blog!

  • Lurkerette

    The C-section rate where I delivered has one of the highest in the region, at about 22%. It’s also the one with the Level III NICU; anything complicated gets transferred to it. Looking into this in my last pregnancy was an early clue that a lot of the rhetoric about C-sections was overly simplistic.

    It’s reasonable to believe that for me, then a first-time mom with few risk factors, I’d be better off w.r.t odds of vaginal delivery at a hospital that could afford to give me lots of time because the staff was prepared for anything, than at a hospital where risks of complications would mean a transfer.

  • Glia

    I will never, ever know if my c was necessary. I had a perfect, pink, screaming baby, who they pulled out butt-first during a planned c. The only way I could have known whether a section was truly necessary was to not have had one, and take the much higher risk of damaging or killing my baby. I am perfectly happy to take a bit of ambiguity of not knowing if I needed the c section I had over the certainty of needing one I didn’t have (or had in the midst of a preventable emergency) any damn day from now to forever.

  • Valerie

    I think this just about sums up for me how useless their hospital rating system is:

    “The data do not include information on some factors that may increase C-section risk, such as pregnancy-related high blood pressure, diabetes, obesity, or other chronic diseases. ”

    Of course the CS rate of a hospital is going to reflect the population of women they are serving- what kind of crappy analysis doesn’t take that into account?

    • Roadstergal

      “The data do not include the information you need to properly analyze the data.” Basically.

      I notice that they don’t mention maternal request as even deserving consideration. Silly women, we know what’s best for you. You want to jam a baby out of your vagina, no matter what you _think_ you want.

    • Puffin

      I think it’s also important that a lot of C-section rates reported are overall instead of primary. Some hospitals don’t allow or have very strict “risk out” rules around VBAC so they’ll have a higher total c/s rate even if their primary c-section rate is no higher than another hospital in the area that is more open to VBAC.

  • guest

    I will never know whether my daughter would have survived vaginal labor, and I don’t care. What matters is that she and I (and her twin) survived the c-section and are all in good health. I dare anyone to examine her and find anything wrong with her that could be attributed to the c-section (on me, at least, an exam would reveal the scar, but I am more than willing to bear it as the price of giving her the safest birth).

    • The Bofa on the Sofa

      Remember what we can learn from outcomes:

      Vaginal birth:
      Comes out ok: a c-section was not required
      Does not come out OK: a c-section might have been a better alternative

      C-Section:
      Does not come out OK: a c-section wasn’t enough
      Signs of a complication, but comes out OK: a c-section was required
      No sign of a problem, and comes out OK: ???? Says nothing. Could have been born vaginally? Maybe. Not necessarily, though.

      Notice that there the only outcomes that tells us that a c-section was not required is to have a successful vaginal birth. It is not possible (as in, logically not possible) to determine that a c-section that was carried out was “not necessary.”

      This is always the challenge, and similar to what Dr Amy refers to in the article: OK, if there are too many c-sections, who has had a c-section that you can say did not need one?

      • guest

        Exactly. Our outcome was exactly the outcome we wanted. The process was not the process I wanted, but it was the best choice with the information available.

      • Megan

        And what mom is willing to take the chance that their CSection is the one that was necessary but wasn’t done and her baby dies? Not too many…

      • Roadstergal

        And what does one count as ‘ok’? I remember that woman whose story was all over the ‘net about a year ago, as “They wanted to force me into a C-Section, and I showed them it wasn’t necessary!” Her baby spent time in the NICU, and she had a severe PPH, if I recall correctly. I wouldn’t call that ‘ok,’ but apparently, the Vagina Uber Alles brigade did.

        • BeatriceC

          Stories like that make me angrier than I can describe. No the delivery was not okay. The baby was sick and the mom had a life threatening complication. That could have been avoided if the process hadn’t been elevated to some religious rite instead of focusing on the outcome.

        • BeatriceC

          Oh, and do you know what I would have done for a healthy baby I got to take home right away? I would have sold my soul for that opportunity. I never got it. I had three dead babies and three preemies that ranged from “really sick” to “social workers trying to get me to consider funeral arrangements” (and two ectopic pregnancies, but I usually don’t mention those since the losses were so early on). The fact that women would *intentionally* subject their babies to that kind of illness is just beyond my comprehension.

        • The Bofa on the Sofa

          I’m reminded of the anti-vax mother who boasted how she showed up those doctors after her kids caught pertussis, going through months of coughing so hard they were vomiting and the parents having 6 months with almost no sleep.

          See? No vaccine needed!

    • demodocus

      I probably have a scar, too, from the stitches after pushing out my kid’s big head. ‘course no one but my obs actually know.

      • Sarah

        And it doesn’t matter anyway, because only scars on your abdomen count. The state of your vag is an irrelevance.

        • demodocus

          Oh, I have some fun ones, elsewhere that have do with my natural grace. 🙂 The lower one put a cramp in my love life for quite a while. ETA, it hurt to have sex until the skin stretch out some.

          • Sarah

            But at least you didn’t have to have a section, so that’s all that matters really.

          • demodocus

            considering that I didn’t care how he came out, i’m not sure why it matters, but okay.

            I already have 2 scars that people point out at when I wear a bathing suit, so a 3rd would not be a big deal to me.

            The hurting during sex mattered to me. The incontinence for months mattered to me. The stitches that took forever to heal and were a pain literally and figuratively to keep clean mattered to me.
            The guest’s experience is different; i get that. I was just trying to point out that vaginal birth leaves a mark too.

          • guest

            I wasn’t complaining about the scar, anyway – I’m perfectly happy with it as the price for ensuring my daughter’s safe birth. I was just noting that yes, if you examined me you would be able to tell I had a c-section. Doctors can also tell if someone has given birth vaginally, no question about that. But the point was that if you examine my daughter, you canNOT tell she was born via c-section.

          • demodocus

            🙂

          • Sue

            “if you examine my daughter, you canNOT tell she was born via c-section”

            Exactly, guest. Nor what type of milk she is fed.

          • guest

            Especially since she was fed both breast milk and formula. It’s not like her left arm is a “formula arm” while her big to is a “breastmilk toe.”

          • Sarah

            Yes. And I was joking. I don’t think the sort of person who thinks huffing the baby out of your vag is all that matters is likely to be a regular commenter here!

    • Michael Ray Overby

      Identical?

  • TheArtistFormerlyKnownAsYoya

    Ok – I’m pregnant. I’m considering a c-section to protect my pelvic floor – from what I can tell, we just can’t predict what kind of damage there may be from a vaginal birth. 3rd or 4th degree tearing can only be known about after the fact. I’m guessing protection of pelvic floor muscles and prevention of (possible) incontinence does not a “necessary” c-section make. I also desperately want to avoid a situation where I end up needing an EMERGENCY c-section – which can’t possibly be known about until it happens.

    I tried discussing this with my OB, and he told me he thought a vaginal birth is better for healing time, but if I really want a c-section he will schedule one. My question is – how am I to trust my OB if he says he doesn’t think I need a section? Given that it seems that not enough are being done when they should, how can I possibly trust his judgment? It makes me feel like the right thing to do is to err on the side of caution here and get one no matter what, because I don’t know whether I’m going to be given one if I really need it.

    • AA

      I think it would be best to ask at the next appointment again. Also ask at what gestional age he plans to schedule the C-section (in absence of a medical change that requires the baby to be delivered earlier). I would also ask what will happen if you go into labor earlier than the scheduled c-section date.

      • TheArtistFormerlyKnownAsYoya

        Good questions, thank you!

    • MaeveClifford

      If your OB is saying at this point that he doesn’t think you need a caesarian, he’s saying that you don’t have any medical indications that would necessitate one *at this time*. So you’re not carrying twins/triplets, you don’t have any chronic infections such as HIV or Herpes, you haven’t had multiple previous c-sections, etc.

      Problem is many of the indications for a caesarean aren’t apparent until close to or even during birth. Your baby could suddenly flip breech, you could become severely hypertensive.

      The fact that doc is willing to schedule a MRCS for you should be reassuring. If he’s willing to do a c-section simply because you want one, why would he hesitate if there was a medical need?

      • TheArtistFormerlyKnownAsYoya

        That is an excellent point – thank you.

    • cookiebaker

      From what I understand, the pregnancy itself does most of the pelvic floor damage, so a c-section might not preserve all the function you’re hoping it will. Unfortunately, you won’t know ahead of time how pregnancy and birth will affect you. I’ve been lucky, I’ve had 6 vaginal births and no incontience issues. I mention it just to let you know that a vaginal birth doesn’t necessarily have to equal total destruction. I hope you get exactly the kind of birth you want and if sceduling a c-section gives you peace of mind, then I hope you’re able to do it.

      • TheArtistFormerlyKnownAsYoya

        I’m worried about the pelvic floor being ripped away from the pelvis during birth, things like that. Prolapse, eiher right away or later. My grandmother had prolapse surgery in her 80s. I know due to pregnancy that general area is probably not going to be the same no matter what. My mother had quick easy births but my brother and I were both normal sized babies. My boyfriend was a huge baby and had shoulder dystocia. The complete unpredictability of what damage and how severe is making me wonder if I should just schedule one, to be safe. My OB saying we could do it if I really wanted did make me feel a lot more relaxed. I might be just fine, like my mother – or I might not.

        • Anna

          I think the answer for you is a TOL but on the condition that as soon as smth doesn’t go strictly according to plan you go for the section, not waiting till it becomes a true emergency. Cause emergency c-sections are sometimes called that because you already went into labor but it doesn’t mean they were truly urgent. Your Doc seems to be very understanding and open-minded and if he already suggests scheduling one he will perform it at your slightest hint, but if I were you I would still give it a try, what if you are the one destined to have a really easy labor, 4th degree tears aren’t that frequent and the consequences of major surgery are unavoidable and life-altering. On the bright side I had pretty bad urinary incontinence and infected urinary tracts towards the end of pregnancy, after delivery (by c-section) it vanished altogether.

          • TheArtistFormerlyKnownAsYoya

            What is TOL? The other thing that frightens me about going into labour is the possibility that my OB won’t be on staff at the time. What if I get a non-section -friendly doc?

            I already had mild incontinence due to a fibroid that’s worsened barely 3 months into pregnancy. I’m sure it’s all downhill from here 😉

          • Charybdis

            TOL is a Trial of Labor. Basically, you get to go into labor to see if you and baby can tolerate the process.

            At three months along, you have time to talk with your OB about your concerns and explain that you would prefer a CS.

          • Jen

            That terrifies me too, especially if it’s combined with one of those nurses whose purpose in life is to postpone the epidural until it’s too late to have one.

          • TheArtistFormerlyKnownAsYoya

            Yep. There’s a tale about an anesthesiologist in the area where I live (wish I knew which hospital) who made sure he was “busy” until it was too late because he didn’t believe in c sections. It’s very scary knowing my fate is in the hands of people like this. How am I supposed to trust that the right decisions will be made?

          • Michele

            If you are only 3 months along, you may have to wait a bit longer until you can get on the “schedule.” I can’t remember exactly but I think it was end of 2nd trimester/beginning of 3rd trimester before my hospital’s C-section schedule was opened up for the time around my due date. Since your OB is willing to schedule you it may just be a matter of waiting until the schedule is actually available.

          • fiftyfifty1

            “I think the answer for you is a TOL but on the condition that as soon as smth doesn’t go strictly according to plan you go for the section, not waiting till it becomes a true emergency. ”

            But her concern is pelvic floor. By the time it becomes clear that pelvic floor is going to be a problem, the baby is already out.

          • Sarah

            Mmm, and EMCS is likely to be rougher on everyone than ELCS. I’ve had one and I’m fine, so you know I’m not mindlessly demonising here, but it would be completely reasonable to prefer to avoid one!

          • TheArtistFormerlyKnownAsYoya

            Yes I prefer to avoid an emergency c section, absolutely.

        • yentavegan

          I purposely chose a low-key non-alarmist (woo-ish) ob/gyn for baby number 5. But when my due date came and went I called her and said I want to have the baby today. She said “Do you want to be induced?” I said “No. I want a c/sec.” She complied with nary a complaint. Asked and answered. My message to you is keep asking for the c/sec. Mention it at every appointment. It will be in your records.

      • fiftyfifty1

        “From what I understand, the pregnancy itself does most of the pelvic floor damage,”

        Pregnancy itself can cause mild urinary incontinence. But the worse outcomes (3rd and 4th degree tears, fecal incontinence, avulsions, pelvic organ prolapse etc) are outcomes that are due to vaginal birth and are prevented by a pre-labor CS. Maternal request C-sections are not for everyone and do absolutely have risks, but there is no question that they are protective of the pelvic floor.

      • Daleth

        I mention it just to let you know that a vaginal birth doesn’t necessarily have to equal total destruction.

        She probably knows that–I’m pretty sure we all know that not all vaginal births cause such damage, and even that most vaginal births don’t cause it. The problem is that no one knows whether it will “equal total destruction” for you personally until after the fact. It sounds like TheArtistFormerlyKnownAsYoya isn’t comfortable with that uncertainty, or to put it another way, doesn’t want to take the risk.

        From what I understand, the pregnancy itself does most of the pelvic floor damage

        What FiftyFifty1 said below. Pregnancy can cause some mild damage, but the worst kinds of damage are caused by vaginal births. Not that ALL vaginal births cause them, of course–most vaginal births don’t cause such damage–but when those bad outcomes happen, it’s because the woman birthed vaginally.

    • fiftyfifty1

      If you are considering a maternal request CS, you should read (if you haven’t already) the book “Choosing Cesarean” by Hull and Murphy. A maternal request CS (MRCS) can be a good choice for some women, but they need to be a good candidate (not planning a large family etc).

      • TheArtistFormerlyKnownAsYoya

        I am in the middle of reading it – I got a recommendation from someone here a few months back. It’s a fabulous resource.

    • moto_librarian

      Did you actually tell your OB that your concern is specifically protecting your pelvic floor? Generally, a vaginal birth is a shorter recovery time, and if you didn’t specifically mention your pelvic floor, he might be thinking of it strictly in these terms. I know that a lot of people don’t think that this is a “necessary” reason to ask for a c-section, but it absolutely is. I have my first appointment with a pelvic surgeon in about a week to discuss a rectocele that is increasingly problematic. I gave birth vaginally to two small babies (both under 7 lbs.). I had a cervical laceration with my first, and 2nd degree tears both times. Had I known that this would happen to me, I would have given serious consideration to a MRCS. This is having a serious impact on my quality of life on a daily basis. Have a frank discussion with your OB about it. You won’t be sorry.

      • TheArtistFormerlyKnownAsYoya

        Thank you…this is what I’m afraid of. People saying things will “probably” be ok is not reassuring. The cost is very high if things are not ok. He didn’t ask why I wanted it, I’m very early on so I didn’t think it was important to discuss in depth at this point but I will bring it up again next visit.

        • moto_librarian

          Other things to think about: How many kids do you think you want? If you think 1 or 2, then a primary c-section isn’t as big a deal as it would be for someone aspiring to have a large family. Are you comfortable with the very slight increased mortality risk (and it is indeed tiny) to yourself? How old are you? Older women (40s) are automatically more likely to have a c-section anyway, so planning for one in advance might make good sense.

          Good luck with whatever you decide! I hope that we can start to be more honest about the morbidities associated with vaginal birth.

        • Roadstergal

          There’s also a question of how likely something is vs your tolerance for it. If your tolerance for affecting your continence/sex life is basically nil, a small risk might still be more than you’re willing to take – and as moto_librarian mentions, considerations leaning towards VB like family size might not be relevant to you.

  • AirPlant

    I am not a doctor, I am just an engineer, but when I see something broken I want to fix it. Like I can’t even turn it off, I just rehung a door for my friend the other day because it was making me crazy.
    .
    So when I first heard that the section rate was too high (even just rolling with the assumption that that is true) I always thought that the reason was that doctors are compassionate people who see a suffering woman and the possibility of danger and they take the tools they have at their disposal and fix it.
    .
    From that perspective seeking to lower the section rates feels a lot like asking a doctor to go against their instincts and their professional calling and their very humanity and do nothing for a baby who may be in real danger. I think that would be incredibly hard to have to function inside of those constraints. It makes me feel very lucky that I chose machines and not people to work on.

    • guest

      I need you to come visit my apartment, lol.

      • AirPlant

        I love the challenge! My husband is made of thumbs so I am responsible for most of the traditional man chores and it is just so satisfying to take something broken and make it less broken 🙂 The best part is honestly when I get to show off in front of my inlaws. They are the type who like their women beautiful and useless and over the years they have made plenty of comments about how unsatisfactory I am on the beauty front. Clipping in a hair bow and making big blinky eyes while fixing whatever halfassed project their idiot firstborn failed to complete is pretty much the next best thing to giving them the finger and peaceing out.

        • BeatriceC

          MrC and I have our areas of expertise. I won’t touch electrical unless my life actually depends on it and if I was in a position where I couldn’t afford an electrician. MrC is skilled with that sort of stuff. He’d rather let a small dog chew off his toenails than do anything carpentry, drywall or flooring related. I skilled with those things. The plumbing falls to whomever gets irritated with the problem first, or happens to be around when something needs to be tended to right then. We both work on our own cars.

          The trouble is there’s so much stuff that needs to be done because of the age of the house, and between medical stuff and figure skating stuff, we both stay very, very busy, so the non-emergent stuff gets ignored.

        • guest

          My main problem is a light fixture that burnt out, and I cannot get the glass dome off. I know how it’s done, but I just am not strong enough/it’s too stuck. But there are other things…

          The stupid lightbulb went out right after the last time I had a handyman over. I can’t call him for just one thing.

    • BeatriceC

      So when are you coming to San Diego? I have 4300 (or 4700, depending on which set of plans you believe) square feet of 51 year old house that needs some TLC. I have a large, comfortably appointed guest room plus a nice pool and back yard to hang out in when you’re not compulsively fixing things. I’ll even feed you anything you want, provided I’m not allergic to it.

    • Sue

      “seeking to lower the section rates feels a lot like asking a doctor to go against their instincts and their professional calling and their very humanity and do nothing for a baby who may be in real danger”

      Very perceptive, AirPlant – that’s it exactly. No clinician wants to think that they have harmed – or failed to help – a patient, let alone a vulnerble newborn. An OB or science-based midwife’s instincts are always to anticipate and circumvent harm.

  • Elizabeth A

    Right, so – I had a clearly necessary, life-saving c-section.

    I had sought obstetrical care at a hospital with a highly-regarded practice of CNMs, and great stats for natural birth, very low c/s rate, etc.

    I had then presented with a complication at 29 weeks. The highly-regarded practice of midwives loaded me into an ambulance and sent me to a hospital with a c/s rate in the range of 50%. That hospital had a Level III NICU, you see.

    I didn’t, in the final analysis, deliver until 32w4d, at which point the ambulance drivers wouldn’t even contemplate driving me to my first choice hospital, because it was too far away and didn’t have appropriate NICU facilities. They drove me to the big hospital with the staggering c/s rate, where they treated me with care, and (importantly) with all necessary speed. It appeared to me that they began preparing for my case the moment the EMTs radioed to say what they had in the truck.

    So I had a c-section, which I guess is bad. Except for the part where DD and I would be dead without it. And except for the part where DD is healthy, happy, smart, and gorgeous. What was I supposed to get that wasn’t handed to us by that hospital with the massive c/s rate?

    And hospital 1 has a low c/s rate that’s propped up on their ability to transfer complicated across town, and by ambulances not bringing them certain kinds of cases because they can’t handle them.

    • BeatriceC

      No hospital without a level 3 NICU would touch me with a ten foot pole. Even with my middle son, who was maternal request, there’s no chance a less well equipped hospital would want me given my history to that point. I also delivered at hospitals with sky high c-section rates. While my first c-section was as relaxed as any 32 week delivery could possibly be, my second was intense. I mean people pushing meds while they were running with my bed to the OR kind of intense. But that hospital had really high CS rates, so they were bad. Or something.

    • 3boyz

      Yup, the hospital where I had my third baby (which was my only complicated pregnancy and only c-section) has a high rate because they have the top nicu in the area, so all the complicated cases go there- those would be exactly the cases that are more likely to need a c anyway. They were perfectly happy to deliver vaginally, and it was the plan with me, but while the were prepping me for induction, I had a placental abruption, so right to the OR we went. They even told meme while still on the table that I am a great candidate for vbac (2 previous vaginal births with no issues, section due to specific situation, not my body or labor, etc). So they are hardly “cut happy” or whatever names might be hurled at them based solely on their rate. It’s everything to do with the patients they get.

  • lawyer jane

    “Dr. Shah knows as well as I do that the increase in C-section rates have been driven by the fact that our knowledge has eclipsed our technology.”

    This is a pretty profound statement about medicine, I think. In some cases, the risk of throwing extra treatment when the technology has been eclipsed by knowledge at the patient might not be worth it – I’m thinking about highly invasive treatments at the end of life, or chemotherapy with horrible side effects that only prolongs life a few months. The benefit just isn’t there. But when we’re talking about reducing infant/perinatal mortality, then obviously it is there.

  • Fleur

    I had a c-section back in February of this year. It was recorded as “by maternal request”, so no doubt plenty of people would judge me for having an unnecessary section, but there were a number of factors that gave me serious concerns about a vaginal birth. My family history is pretty worrying – consistently very large babies for at least three generations, a mother who could only give birth to live babies by c-section, another close relative who ended up permanently in a wheelchair after giving birth. A growth scan about ten days before my due date suggested that the baby was nearly 9 lb but, by the time I had my section, I was nearly 2 weeks overdue. At my last appointment with the midwife, the baby’s head still hadn’t engaged properly – I’d experienced severe shooting pains for about ten days which I was told were signs of the head engaging, but these suddenly stopped and didn’t come again. I also have some personal issues which meant that I was likely to become distressed during labour. Yet neither the family history nor my own personal factors had been recorded in my notes (despite my raising them multiple times) and I was repeatedly told that I must, must labour as long as possible at home before I turned up at the hospital (which left me panic-stricken that, if there was a problem, it would be detected too late). All my instincts were screaming at me.

    Eventually, I managed to get referred for an appointment with a doctor at the hospital. It was a surreal conversation because she started by telling me that she couldn’t recommend a c-section for legal reasons and that they carry a lot of risks, but she then went on to “lead” me to say that I wanted one (I’m a lawyer so I know a leading question when I hear one). When I did, she absolutely beamed at me and said to my mother (who was my birth partner) “you must be so relieved”. It was obvious from her behaviour that she thought that a c-section was the right decision for me but that it was going to have to be recorded as purely my decision against medical advice.

    The c-section wasn’t pretty (big baby, awkward position) but I’m so glad I didn’t just roll the dice and see how a natural birth went. No regrets.

    • BeatriceC

      Middle kid was also “maternal request”. I simply could not mentally handle another vaginal delivery. Prior to him I’d had to deliver a set of perfectly healthy-in-utero twins who would die moments after birth because at 18 weeks the doctors couldn’t stall labor any longer. Then I had a vaginal delivery at 36 weeks with a moderate shoulder dystocia that left the baby very sick and me with significant pelvic floor damage, then I had another late term miscarriage at 16 weeks, for the same reason as the twins, which was also delivered vaginally. I simply couldn’t do it anymore. My doctor considered my mental health to be just as important as my physical health and was totally on board with a MRCS. At 32 weeks labor could no longer be stalled, and the on-call OB attempted to convince me to deliver vaginally, as the potential for another SD at that early gestation was unlikely. My actual doctor went ballistic on the on-call doctor. He actually came in himself and we had a very relaxed, happy birth. Just ignore the NICU team in the corner. I could not have been happier.

      • Fleur

        I’m so glad your doctor backed you up – it would have been an act of extreme cruelty to force you to deliver vaginally again after everything you’d been through. My mother was nearly bullied into a vaginal delivery with her third baby. This was after a devastating vaginal birth resulting in a baby who never came home from hospital and injuries so extensive that she was not expected to have another child, then a traumatic emergency c-section with me. She stuck to her guns (no healing VBAC for her!) and later received a personal apology from the consultant – the baby’s estimated weight was significantly out and he would most likely have torn her to shreds. Even if she’d been wrong, the cruelty of trying to make a woman relive the very worst 48 hours of her life when an alternative exists takes my breath away.

    • Daleth

      FWIW, I’m not going to judge you at all–I’m going to high-five you for knowing what you wanted for yourself and your baby, and insisting on getting it! Yay you!

      • Fleur

        Thank you! I appreciate it.

    • Jen

      I’m not going to judge you, I’m jealous of you! You got the birth you wanted, rather than being forced into a vaginal birth to lower the hospital’s c-section rate.

      • Fleur

        Thank you! 🙂

    • Jessica

      This is crazy to me. I asked my OB late in my pregnancy whether he performed maternal request C-sections, purely out of curiosity. Without hesitation he said yes. He further said what would be the benefit of denying a woman a MRCS – what if something went wrong during labor and the doc has then denied the woman a C-section which could have prevented the injury to her or her baby? A few weeks later he recommended I have a C-section for a suspected LGA baby who had not engaged and whose head size was estimated to be 97th percentile, in part because of the exhaustion I experienced in my first labor. (I declined and had a successful vaginal delivery with a shockingly fast second stage.)

  • MaineJen

    I ran into a facebook meme yesterday touting some hospital’s c section rate of 13%. All the crunchies were coming out of the woodwork cheering “way to go hospital!!” and “This is how it SHOULD be!1!”

    I left a comment asking whether this hospital had a NICU, because if not, they probably send their complicated cases somewhere else.

    Someone came back at me with “Yes they have a IIIB NICU, but this stat is only counting the Low Risk women!!1!”

    And I was like WTF? That is so misleading. A rate of 13% for low risk women sounds just about right, but the meme made it sound like 13% was the Overall rate. RRG.

  • MaineJen

    “We don’t don’t judge breast cancer care by the breast biopsy rate and we shouldn’t. We judge breast cancer care by the survival rate.”

    Haven’t I seen grumblings in the news lately about ‘unnecessary pain and worry’ from unneeded biopsies? I would rather get an unnecessary biopsy than have an undetected cancer, but the current recommendations for breast cancer screening seem to be leaning in favor of Less Frequent Screening, Fewer Biopsies, and Potentially More Undetected Cancer. Or am I just interpreting this wrong?

    –Approaching age 40 and totally unsure when/if I should get a mammogram now.

    • mythsayer

      I am SICK of doctors saying “we might hurt you more if we do xyz.” Except tha they know I have some kind of autoimmune/connective tissue disease that is t being treated so I’m getting worse. Worse means they are hurting menu doing nothing. So the idea that a test could hurt me MOREis laughable.

    • The Computer Ate My Nym

      If you don’t have a specific risk factor 40 is probably too young to start regular mammograms, but talk to someone who knows your actual medical history and preferences with respect to risk and benefit of the procedure.

      Note on bias: I’m not sold on mammograms in the 40-50 range because breast cancer in young women tends to be more aggressive so less likely to be picked up at an asymptomatic stage by mammogram. Also, the life expectancy for a middle class white woman in the US is now over 80. That’s a lot of years for radiation damage to accumulate. I really want MRI based screening to become practical for all women, not just BRCA, but that’s probably a good decade away.

      • Phoenix Fourleaf

        Screening procedures do carry risk. If the benefits don’t outweigh the risks, then we need to reconsider. People are so emotional about breast cancer screening, but I think we need to follow the science. If the science shows us that screening isn’t saving lives, than we need to switch gears and do something else. It is a waste to spend so much time and effort on something that has been shown not to work.

    • MI Dawn

      Pop over to either Respectful Insolence (Orac) or Science-Based Medicine (David Gorski). There are a lot of posts about mammograms and appropriate screening. Dr Gorski is a breast cancer surgeon who cares about SBM, not what the popular idea is. You’ll want to read his articles about lead time and screenings.

      • MaineJen

        Cool! Thank you…

    • namaste863

      Unnecessary pain and worry? If I ever find a lump I won’t be able to get it biopsied fast enough. Ive had enough experience with breast cancer in my extended family to know that finding a lump is scary as shit. If it turns out to be nothing, terrific, but I personally say treat it as cancer until proven otherwise.

      • Monkey Professor for a Head

        I had a benign breast lump a few years back, and I was the same – I absolutely wanted it biopsied. The minor pain of the biopsy was nothing compared to the stress of not knowing (particularly for my husband, who lost his mother to breast cancer.)

    • DelphiniumFalcon

      This is just my anecdotal input but where I’m at in the hospital for registration is where most people with scheduled radiology appointments check in, including screening and diagnostic mammograms.

      Most women when they hear “abnormal” or “mass” can’t get back in to do their diagnostic with possible interventions like ultrasound guided biospies fast enough. Even just the two day to a week it takes them to get back in takes a toll on them. Once they get the all clear it’s like a 1,000 lb weight was lifted off their shoulders when they walk out. The body posture is completely different from when they walked in. Even if it’s a biopsy that hasn’t been analyzed by pathology yet, just the fact that it is being examined seems to put them more at ease since they’re doing something to head off what could be a life changing event. I can’t comment on the medicine, though. Just the patient reaction

      It’s nerve wracking for them when they check in but I’ve noticed it’s more nerve wracking for the women they have to wait longer.

    • Mishimoo

      I don’t know if you’re interpreting it wrong, but if you are, I am too. Nanna B (my husband’s grandma) has had some pains in one of her breasts, went off to have a mammogram and further testing. There is a mass connected to a lymph node and instead of having it biopsied, her doctor said “Oh we can leave it for 3 months and then scan it again”. She has a history of basal cell carcinoma and squamous cell carcinoma, I just think it’s irresponsible to not do a biopsy on an unknown mass. Dying happens and she is 88, but dying of cancer is torture and I don’t want that for her.

  • demodocus

    Suburban hospital P probably has a much lower c section rate than urban hospital M, in part because P sends all their complicated cases to M. This is what I was looking at if I’d gone into labor before this month. Now I’m going straight to M, which doesn’t bother me in the least.

    • The Computer Ate My Nym

      This is an issue for any consumer comparison of medical care. Another classic is that surgeon A has a lower post-operative mortality or complication rate than surgeon B. Is that because A is a better surgeon or because B takes all the complicated cases and A refuses to operate on anyone who isn’t an “ideal” candidate? No way to know with most surveys. Not to mention the horror that is the consumer rating of doctors. And don’t even get me started on direct to consumer advertising of meds, which is now my go to for when I need an example of actual big pharma evil.

      • MI Dawn

        Exactly. My OB, back in the day, had a high c-section rate and high complication rate. Was he a lousy doctor? No, he was the OB that everyone sent their high-risk patients to. So yeah, when you’re dealing with high level multiples (triplets, quads, etc), women with cardiac disease, kidney disease, blood diseases, you’re going to have high c/s and complication rates. OTOH, nothing fazed him. He’d seen it all. He was great, and I loved him.

      • Roadstergal

        I am firmly in favor of any regulation reducing or banning direct to consumer advertising of meds, and I work for Ebul Big Biotech.

        • demodocus

          Some of those ads were confusing, too. Still not entirely sure what allegra is for, besides windsailing over wheatfields or whatever that commercial was doing.

          • Roadstergal

            OMG, the ones that always confused me were the Rogaine ones. I seriously thought it was something to do with impotence or incontinence, the way they were tiptoeing around the actual condition! I had to look it up afterwards.

          • demodocus

            now those are some money makers; not vaccines!

          • The Computer Ate My Nym

            Yep. I asked a pharma rep once how they decided which products got direct to consumer ads and they flat out said that it was the big money makers. Now, I don’t have a TV so I sometimes end up seriously out of the loop on what is and is not actually happening in pop culture, but I’ve never heard of a DTC ad for a vaccine. At least, not from a drug company. I think the CDC might be campaigning for flu vaccines or something, but their motive is to have less, not more, work.

          • Nick Sanders

            I’ve seen commercials for one vaccine that I can think of, a 13-valent pneumococcal vaccine that was being marketed to seniors.

          • Charybdis

            I’ve seen a few for the shingles vaccine.

          • Nick Sanders

            There’s some posters for that in my GP’s office. They feature people who are I guess supposed to look concerned or worried, but really look more like they want to glare you to death.

          • Nick Sanders

            Honestly, if an OTC pill let me windsurf across meadows with enough skill to write in cursive on the tall grasses, like in that commercial, I’d probably try it at least once, almost regardless of what it was supposed to treat.

          • Roadstergal

            But can you throw a football through a tire swing? Or sit in an entirely separate bath from your partner?

        • The Computer Ate My Nym

          If I could make one change to the laws governing medications in the US, I’d probably repeal the “supplement” loophole. But if I got to make a second change, banning DTC ads would be it. They’re flat out worse than useless.

  • Linden

    In other news in the UK, on BBC News: “‘Risk of death’ warning over access to caesareans”

    A senior coroner has warned of a risk of future deaths if the NHS favours vaginal delivery over caesarean sections on the basis of cost.
    Cannot insert link to it, because I am a numpty.

    • Sarah
    • Fleur

      I hate the way cut-backs to maternity and post-natal services are being dressed up as “what’s best for mum and baby” in the UK right now. I was informed that I should expect to be discharged from hospital 24 hours after my c-section, which I was told was the healthiest option because it would stop me getting a blood clot. I’m a single mum and wouldn’t have someone at home 24/7, so I hung on in there until just over 48 hours (and was made to feel like a bed-blocker/ problem patient who wasn’t coping with motherhood). I made sure I kept moving my legs and took some walks on the ward so, no, I didn’t get a blood clot. In the 80s, my mother was in hospital for 10 days after her third baby who was an elective c-section with no complications. I suspect that’s too much, but surely there’s a happy medium between that and one night?

      Sorry, that was a very OT, UK-centric rant (but good to get it off my chest).

      • In my day, in the NHS, NO ONE who could not guarantee that there would be another person with the new Mum and baby 24/7 for the first ten postpartum days was not discharged from hospital until the tenth day. Midwives had legal responsibility for their patients for ten days after birth, and, if the patient was suited for early discharge, she was visited by the district midwife at least once a day. That was in 1975, and everyone in the NHS was complaining about how badly service had deteriorated.

        • Fleur

          Yikes – it’s frightening how far we’ve come (and not in a good way). Thanks for sharing your experiences.

      • AnnaPDE

        A UK friend discharged herself after 24 hours after her C-section because she’d been put into an 8-bed ward, had the baby dumped on her and spent the night awake, in part due to the screaming babies around her and in part due to being terrified of dropping/smothering the baby, as the nurse never came back to take it. She figured that even alone it would be safer at home.

  • The Computer Ate My Nym


    [H]ospitals are not seatbelts; they are airbags that explode in your face 1 out of every 3 times you get in the car.

    Yes, but that’s because you’re driving an unreliable clunker that gets into an accident about 1 time in 3* and by “explode in your face” the writer means “deploys appropriately saving the life or health of you and your ‘passenger’.”

    *Some caveats apply.

    • Steph858

      And the Natural Birth [TM] movement would have you disable the airbags in the Alleged Car to prevent them from deploying at inopportune moments – thus also preventing them from deploying in actual accidents. Because to their minds, no airbags at all are better than airbags that sometimes go off because you hit a pothole (as opposed to another car).

  • Zornorph

    I didn’t want a C-section with kiddo because it meant I’d have to pay extra to the lovely surrogate mum and she’d have to deal with the recovery. Having said that, if the doctor had suggested the slightest need, I’d have been signing on the bottom line in a heartbeat. And if it had turned out after that fact that it hadn’t been needed, I’d be too busy cuddling Kiddo to care.

  • Sue

    “I was once notified that my forceps rate was “too low.” That was truly mystifying since my C-section rate was low also (16%) and I hadn’t left a single baby inside a single woman.”

    Love it!

    • The Computer Ate My Nym

      Yes, but if they’d lauded you for having a low c-section rate that would be admitting that you did a good job and then where would their excuse for not giving you a raise be? And if you had to be given a raise that would cut into the hospital’s bottom line.

      • Sue

        (clarification – not me – I was quoting Dr Amy)

    • cookiebaker

      The “hadn’t left a single baby inside a single woman,” had me laughing over here!

  • My2Angels

    I love these posts bc they show how the NCB, attachment parenting, crunchy crowd truly is almost cult-like. I’m not a scientist or doctor but just doing ancestry research has made me completely unable to understand the thinking of antivax, all natural parents. Many of my ancestors (& most anyone’s for that matter) buried multiple children and remarried multiple times bc their spouses died at early ages. So, I think it’s crazy to say “that’s how people lived hundreds of years ago” (which is an actual thing I hear crunchy people say!- has anyone else heard ppl say this to?!?!??)

    But, coming from someone who has had two c sections (1 early induction before thanksgiving , only dilated 5 cm in 12 hrs & the doctor did 2 c sections around 5:30-6:00 pm when office hours shut down) (1 planned elected c section but went into labor early, they let me labor 13 hrs before delivering and they were planing to let me labor 3 more until office hrs were over but I began progressing too quickly so they bumped the “planned” c section up to “in 15 minutes”). In hindsight (yes, I know hindsight was explained in the article), I think my c sections were mostly due to doctors’ convenience and not so much to risk. I have two healthy sweet children so I’m not complaining but I do think there is a % of c sections that TRULY are performed for doctors’ convenience. But, I would imagine that no doctor in his or her right mind would allow the paperwork to appear that an unnecessary c section was performed. So, I think it would be incredibly difficult to do any research on the stats for that.

    • Clorinda

      Whenever somebody tells me that most c-sections are about a doctor wanting to go on vacation or get to a party or go golfing, I ask them what golf course is open after 10pm on a Friday? My first c-section was performed around 8 pm on a Friday after 2 days of Cervadil (sp???) and pitocin. I was still closed up as tight as can be. They recommended the c-section and my husband and I took an hour or so to decide to do it. When you figure in prep time. surgery time, recovery time that my doctor came to see me during, and then leaving the hospital, he wouldn’t have gotten to anything until after 10 pm. He WAITED until we had made the decision.

      I can’t remember if it was that one or my second one, where we had to wait on the OR until the woman laboring to deliver twins was done. Yeah, those evil doctors who push c-sections on everyone was letting a lady deliver twins vaginally but taking the precaution of doing it in the OR just in case they needed to do a crash section. And if it was my second one, they had let me go post dates to see if I could go into labor on my own for a VBAC and when I was showing signs of variable (mostly low) amniotic fluid they still let us decide after bringing in a portable U/S machine and having the doctor perform it and explain exactly what he could see and give us precise risk assessments with numbers and everything, so we could make an informed decision.

  • AnnaPDE

    I don’t know if my C-section was necessary or not – but I didn’t want to try it the “natural” way. My obstetrician, instead of trying to talk me out of it, made it a really good experience. (And yes, baby’s heads was huge.) Did I hurt the hospital’s stats? Should they just have refused their OR?

  • crazy grad mama

    I’m deeply disappointed—I’ve read other articles by the author of the Consumer Reports piece, and I had a higher opinion of her than that.

  • Amy

    Not only that, the Monday morning quarterbacking of some of those “unnecessary” cesareans is often dead wrong. Take the ICAN crowd– to them, EVERY c-section is unnecessary (hence their stupid portmanteau “unnecessarean”), and the solution to c-sections is for everyone to have a home birth. I was told time and again that my c-section was unnecessary, by women who’d never even met me. In retrospect, given the baby’s positioning, it was most definitely necessary.

    • ICAN is really reprehensible. I belong to an online group for women who have or have had placenta accreta/increta/percreta, and so many of them are either blaming themselves or their doctors for having had an “unnecessarean” that put them at risk for accreta.

      Meanwhile, ICAN is right there, co sponsoring blood drives with Hope For Accreta, holding these women up as exemplars of what is wrong with c-sections, pushing VBAC, and further encouraging an adversarial relationship between women and their health care providers. They are using percreta survivors–women with ongoing health complications, premature babies, multiple surgeries–to make a larger point about the evils of C sections, and it just leaves a bad taste in my mouth. These are women who went through truly traumatic births, who already blame themselves for the harm to themselves and their babies, and there’s ICAN, basically saying “yep, you did this to yourself. Should have avoided that first C section! Sucks to be you!”

    • Sarah

      I might start a group called ‘ICAN, but why on earth would I want to?’

      • Roadstergal

        “ICAN, but I’DRATHERNOT.”

        • Sarah

          ICAN, but THERE’SNOPOINT.

          • Charybdis

            ICAN but WHOASKEDFORYOURDAMNOPINON.

      • guest

        ICAN’T STANDPEOPLEWHOBULLYWOMENOUTOFC-SECTIONS.

    • Madtowngirl

      My c/s was also one of those that was necessary in retrospect. She was breech and yes, breech babies can be delivered vaginally and be fine. I wasn’t willing to take that risk, which turned out to be a good thing, since her head was stuck in my ribcage.

  • Marie

    I think I’ll just stick to reading CR when I’m buying appliances.

    OT: one of my rather lactivist FB friends posted that breastfeeding saves the average family $2-4K a year. Obviously formula costs money, but is there any truth to this or is that just a made-up number? I’m currently breastfeeding. I’ve shelled out cash for nursing bras, nursing pads, milk storage bags etc. not to mention the insane amounts of food I’ve been eating. I don’t buy formula but BFing certainly hasn’t been free.

    • CSN0116

      I’ve fed five babies Target’s infant formula.

      With it being available in bulk sizes; weekly sales; coupons; Cartwheel; and 5% discounts for linking a Red Card to your debit account – I have never spent more than $50 per month to feed a baby. In the early months it’s less, and in the last month it’s less as baby is weaning to table milk.

      Overall, it costs me about $500 per year to formula feed, plus $20 in bottles.

      $2-4k would be if you’re buying name brand ready-to-feed, or specialized formulas like Nutramigen, Alimentum, or Neocate. In no world does normal formula feeding cost that. NO.

      • Mac Sherbert

        My babies liked to eat to nurse for 30-45 minutes at a time the entire time I nursed. It also took me that long to pump a few ounces. As a SAHM that was an inconvenience, but no way could I have done that and worked. So in my case I say it’s cheaper only if you consider your time free.

      • cookiebaker

        I agree. A huge 3lb tub of generic powdered Similac is $23.98 at SAM’s. We use 2/month, so about $50 per month to feed my 9m old daughter.

      • Inmara

        Unfortunately I’m stuck with the unicorn sparkles(TM) formula and at the height of consumption (when I stopped to breastfeed but had not yet introduced solids) it was slightly more than 30 EUR/week. But that lasted only for 2 months tops, because now with 3 solid meals per day, our formula consumption is reduced by half. If baby could tolerate cow milk, that price could have been reduced to half or more. Also, set of bottles/nipples, sterilizer and cleaning brush all came around 150 EUR max, and bottles can be stored for use with next baby, the same with sterilizer. Sure, EBF in my case could have been substantially cheaper because I’m having year long maternity leave and even most LCs are volunteers and consult free of charge, but that was not a viable option for us.

    • CSN0116

      And yes, the continuously over sighted fact that nursing mothers may “burn extra calories,” but they need to consume extra calories.

      Extra calories come from extra food.

      Extra food costs more money.

      Not to mention all the other paraphernalia – bras, tanks, pads, creams, shields, pumps, storage devices, covers, pillows, teas, herbs, consultations…

    • Zornorph

      Obviously, I FF my kiddo. Doing some back of the envelope math, I’d say it cost me about $1,200 for the year. Formula is a bit less expensive in the Bahamas, so that helped, but I was getting the Similac powder stuff. Also, from about 6 months on, he was eating some regular food as well as formula. I also bought a crapload of bottles so I could go a while without having to wash them all. I didn’t have to rent a pump and I had maximum flexibility if I needed to leave him with a baby-sitter.

    • Amy M

      I spent about 2K on formula the first year, but I was feeding twins, so about 1K/baby. We needed bottles, other than the formula, most of which were given to us as gifts. So yeah, it hiked our grocery bill some, but nothing like what your friend is suggesting, even with twins.

    • demodocus

      as someone pointed out a while ago, you have to start paying directly for the kid’s food sometime anyway; just wait for the teenage growth spurt!

      • BeatriceC

        I’m sure somebody else did as well, but I recall making that statement a while back. At the time I was exasperated by my grocery bill. I don’t buy any organic foods, but I also can’t buy the expensive convenience foods because of my allergies. All those broke, singer mother years taught me to be a very good shopper. But still, my grocery bill is my single largest monthly expense. I spent almost $200 on Monday and my refrigerator and pantry are nearly empty again. I won’t make it to the end of the day without shopping again.

      • cookiebaker

        I’ve said that, too. I feed my 9-month-old generic formula for about $50/month and we spend way, WAY more than that per month to feed her teenage brother. That kid never stops eating!

        • demodocus

          I suspect we spend more than 50 a month on my toddler’s food, lol.

          • Charybdis

            Apples aren’t *that* expensive ;P

          • demodocus

            Depends on how many you go through! :p

          • Charybdis

            This is true, as is the apple variety preferred. Some are pricier than others.

          • demodocus

            *ALL* the apples are mini-bard’s

      • BeatriceC

        I thought of this comment today watching my 14 year old eat lunch. His idea of a “light lunch” was a ham and cheese sandwich with about 1/4 pound of ham and three slices of cheese plus an entire frozen “family size” container of mac and cheese. Then he washed it down with about 16oz of whole milk. After that he was still a little hungry so he had a half a pound of blueberries, a banana a red bell pepper. An hour after he finished lunch he was *starving to death* and ate two large cucumbers, another banana and about 1/4 cup of peanuts.

        • demodocus

          O.0

          • BeatriceC

            Well, keep in mind he’s also an athlete. This was his lunch after an intense four hours of figure skating practice. His daily schedule is intense. He runs a couple miles in the morning, has breakfast and does school work, goes to the ice arena, skates for 3-4 hours, has lunch and does more schoolwork, has a snack then does off ice training*, and sometimes skates another hour or two. Then he hangs out with friends in the evening which often times includes skateboarding, basketball or swimming. The weekend training schedule isn’t quite so busy, but he walks/runs a lot of places instead of taking the is or getting a ride.

            *off ice training is strength and flexibility training, jump/spin training and ballet.

        • Charybdis

          But the growing!!! And the skating!!! Can’t expect them to live on air. Or be hydroponic.

          • BeatriceC

            lol. Yeah, I described his schedule in a different reply. I’m pretty sure he needs about 15,000 calories per day to break even, given his activity level. As much as he eats (and it’s a lot of junk, but a lot of good stuff too), there’s not a single visible fat cell anywhere on him. The kid has abs, biceps, thighs and calves that would make any male model jealous.

          • Charybdis

            This one is mine. About a year and a half ago.

          • BeatriceC

            Handsome fella!

            Wanna see something cute? I was digging through old photos and found this one:

            http://i301.photobucket.com/albums/nn67/mmsw1/stuart1-1.jpg

            I think he was about 5 .

          • Charybdis

            Giraffe costume? So stinking cute.

          • BeatriceC

            Lol. That program was to the “you got to move it” song from the movie “Madagascar”. I wish I could find picture of his first program, when he was four. The music was “when Irish eyes are smiling” and it was a little leprechaun costume. He’s working on a new program now. He’s trying to figure out how to do an arrangement of somethings g by Metallica or Nirvana. He’s now at a level where lyrics aren’t allowed, so it’s more difficult to do.

          • C.

            Found this video of Metallica instrumental numbers, might help? http://m.youtube.com/watch?v=_rTQF81vZNM

      • Sean Jungian

        Count me as one of those trying very hard to reduce my grocery budget any way I can, what with this teenage boy in my home. It’s like a swarm of locusts.

        I live in a very rural area. We have one grocery store in a 40 mile radius and I happen to live only a few blocks from it, however the prices there are easily a third more than if I were to go to the bigger cities (an hour’s drive away). Now that gas is less expensive, and I have a more reliable vehicle, that’s a better option for me, although I’m very conflicted because I am a big believer in spending my money locally to keep this community alive and thriving.

        I finally set up my chest freezer last weekend (I’ve had it, in the box, for 3 years but never used it because until just a month ago my fridge freezer was adequate). It’s already half full. I can’t ignore sales and couponing or bulk purchases anymore. I am determined to cut my food budget by $100 a month. There’s only two of us, which makes it hard to buy bulk when you might not use it all before it goes bad.

        • BeatriceC

          Try having three of the creatures! I spend an average of $225 per week on groceries, and that’s shopping only sales, buying produce at the Arab market that’s 50-75% less expensive for produce than any of the chain supermarkets, buying meat in bulk when it goes on sale (bought 50 pounds of chicken a few weeks ago when it was 29 cents a pound…would have bought more if they let me), and doing everything I can to buy as cheaply as possible. But with three teen boys, one of whom is an athlete (daily schedule described previously), they just eat enormous amounts of food. Due to restricted refrigerator space, I do have to go to the store daily for the two gallons of milk they drink in a day, and I pick up other things I run out of on those trips. Otherwise, I buy in bulk and only on sale. I’d never manage if I wasn’t right fisted in the grocery store.

          • demodocus

            Mine walked into a door frame today; he seems to have inherited my grace. his chances of being an athlete are looking slim, lol.

          • BeatriceC

            Or he’s a budding ballet dancer. I went to a high school for the performing arts. The ballet dancers were the klutziest people on campus. I know it’s counterintuitive, but it’s true. I once asked one of the dancers I was friends with about it and he told me that it’s because the first thing they teach you in ballet classes is “don’t look down, the floor will always be there”. Well, that’s all well and good until you’re in a space that isn’t an obstacle-free flat surface.

          • demodocus

            lol. That’s the ground, though. Walls and trees are vertical! His father once walked into a tree beside the sidewalk in our school’s quad. As a senior, so he should have been very familiar with it!

      • Old Lady

        This was the thing I also realized. Compared to every other developmental stage but toddler, I’m getting off cheap (and easy) with just formula.

    • AnnaPDE

      Here in Oz, the unicorn sparkles formula is $30 for about a week, the cheap stuff is $15. Even if you do the expensive option for a whole year, it’s just about $1500.
      In contrast, my slightly bumpy start to BF was $270 for the pump, $400 in LCs (the first $200 of those were the hospital’s LCs blaming my starving baby for laziness while ignoring his tongue tie), and about $120 in supplements now that I’m 4 months in.
      I’m enjoying this BF gig and have the luxury of a good family income, so it’s worth this expense to me, but I wouldn’t call this a big financial advantage. Of course, if things go smoothly, it’s probably just mum’s extra food to pay for.

    • Heidi

      I buy a 3 pack of Up & Up Advantage formula approximately every 6 weeks. Each 40oz. container starts out at $23.49 without any sales. With my Redcard debit card, I get a 5% discount that brings it down to $67 for 3 tubs. Then since I buy 3 at a time, I get a $10 gift card from Target, which makes it really $57 since I can put that gift card towards buying formula the next time. That’s only around $500 a year. I feel like him being at 4 months, he’s probably eating the maximum amount of formula as he ever will since he can start solids anytime now. If I need convenience ready to feed formula, I use those $5 checks both Similac and Enfamil will send if you sign up with them and can get either a RTF 32 oz. bottle or 6 nursette bottles for $2.

      On the other hand my husband and I spend anywhere from $75 to $125 on groceries a week. I’m sure we spend in excess of $5,000 on our own food!

    • Elizabeth A

      The math that lactivists use is a little whacked out.

      When my first child was an infant, I was partly in school, but I also spent a few months doing a full-time internship for an hourly wage. My working hours were limited to my daycare hours (just reality for lots of moms). So the time I took in the middle of the day to pump (2 x 20 min breaks per day, 5 days per week) added up to $130/week.

      Plus the cost of the pump ($300), hands free bras ($50), and batteries.

      Plus, I was starving hungry the whole entire time, right up until weaning, which added an uncalculated amount to our household food costs. A lot of greek yogurt, single-serving containers of shelf-stable organic milk, and granola bars.

      How much was formula supposed to cost? Because I suspect the cost of pumping time alone could have covered a hefty supply.

    • ElaineF

      I bought all the gear with my first child, and needed only a couple of replacement pump widgets when breastfeeding my second. Therefore the out-of-pocket to breastfeed him wasn’t much above the cost of the extra food, which maybe amounted to the equivalent of an extra dinner a day, I would imagine $1-3 a day.

      Now the adverse impact to my career from pumping at work, that I can’t quantify. I don’t work in a breastfeeding-friendly environment and I went to much more effort to pump than anyone else I’ve ever worked with. I don’t know whether some of the problems I’ve had at work are linked to that or not. My suspicion is there’s some degree of a connection but nobody will come out and tell me.

    • Angharad

      Assuming a baby drinks an average of 32 ounces of formula per day for a year (which seems generous to me considering newborns don’t drink that much and older babies don’t have to drink that much once they start eating solids), $4000 would be $0.34/fluid ounce. The only formula I could find in that range was ready-to-feed extensively hydrolyzed formula. I would estimate a true average cost of formula around $1000-$2000, which can’t all be counted as savings.

  • Rachele Willoughby

    “I was once notified that my forceps rate was “too low.” That was truly mystifying since my C-section rate was low also (16%) and I hadn’t left a single baby inside a single woman.”

    I just about died laughing at this.

    • anotheramy

      Me, too!

    • Amy

      What’s especially funny is that if Dr. Amy were still practicing with those numbers, she’d be the doctor that the crunchy crowd would be recommending to their friends if they “had” to have a hospital birth (due to costs, reluctant spouse, not “trusting birth” enough, whatever) and wanted a sympathetic provider with low intervention rates.

    • LaMont

      No, Rachele!! You’d be an actual casualty of Dr. Amy’s forceps use!

    • namaste863

      I’m very puzzled by this. Granted, I’m a social worker, not an OB, but wouldn’t a low forceps rate be a good thing? Isn’t that a sign that you’re doing something right, thereby preventing the need for forceps? What the hell do they possibly have to complain about?!

      • MaineJen

        Right? Aren’t forceps…a bad thing?

        • Elizabeth A

          I sometimes suspect that c/s rates have been driven up by a decrease in the use of forceps and vacuum.

          When you’re training someone to do a c/s, you can watch everything and let them know if they’re starting to go wrong. The same cannot be said of giant salad tongs with only one set of hands on them. I don’t want to be a nervous resident’s first time with the forceps, and I doubt anyone else does either.

  • namaste863

    Ive been looking at some of the data on these woo sites, and almost always C Section rate is the metric they use for patient safety. The whole time, I’ve been thinking “Who cares about the damn C Section rate? I want to know who’s alive and who’s dead.” C sections are a great tool. If some of them are unnecessary in retrospect, well, it’s not ideal, I suppose, but when two lives are at stake, isn’t it better to be safe than sorry? The important thing is a healthy mum and kiddo, NOT what hole is used to extract said kiddo.

    • LaMont

      Also as a stats person, it offends me that “hospital X has a high C-section rate, therefore going to that hospital CAUSES C-sections” is a thing a real doctor would say (it always annoys me, but when doctors do it, it’s worse!). Hospitals that treat more complicated, higher-risk pregnancies will have higher rates. Unless you do a control for risk factors, you can’t isolate location as a cause for the procedure being done. I imagine that if I walk into my gastroenterologist’s office I have a *much* higher risk of getting an endoscopy than if I walk into my OB-GYN’s office. Someone should dive into that disgraceful situation.

      • namaste863

        There’s that, too. I took Research methods and Stats last semester (Hooray grad school). The final exam was a case study that we were to rip apart based on what we’d learned over the course of the 13 weeks. The first thing they drilled into us was “Correlation is NOT causation.” 2nd was “Look for poorly controlled variables.” As for the exam, it would’ve been easier and less time consuming to say what WASN’T wrong with the study. It was truly a crap design. I got a solid A, for the record, in both the class and on the exam.

        • LaMont

          After taking statistics, I often describe it as “the science of explaining why whatever someone just said is wrong”.

        • People who wrong their hands about the C section rate always claim to be talking about “low-risk” pregnancies, but they never seem to define “low-risk.” Is it a medical term of art with a very clearly defined meaning, such that it is actually a useful thing to control for, or is it just (as I suspect) shorthand for “not twins, not breech, mother not too fat or old?” Because there are a lot of people who are “low-risk” right up to the moment they’re not. How do you classify the ones for whom things go pear-shaped with no warning?

          • Roadstergal

            I think of ‘low-risk’ as a poor quality composite Dx for an uncomplicated vaginal birth. Very poor quality, and should be superseded with better.

    • Anna

      “Who cares about the damn C Section rate? I want to know who’s alive and who’s dead.” Well, I don’t want to sound like Janet Fraser or somebody like that now but there are so many more aspects besides being alive or dead. I guess I can say that I still haven’t fully recovered from my c-section which was 11 months ago both physically and emotionally although I did get better and am continuing to get better. My body is still disfigured though. I still can’t wear what I want but just have to wear whatever disguises the overhang above the scar. Sex has become embarassing and unwanted (by me, hubby doesn’t seem do care but what do I know about his real thoughts on the subject though? Have read SO much about husbands being repulsed by their wives disfigured stomachs… ugh). And my c-section was necessary, actually there even were A NUMBER of indications. So I know that it spared me a lot more suffering than it brought. But as for the women who know they have suffered in vain… I can pretty much imagine they’re outraged. They are not statistics, they are living people with feelings and all. I do hope that technology improves even more in the nearest future and this problem of “unnecessarians” goes away altogether.

      • BeatriceC

        On the topic of body changes. I don’t know if it will help you or not, but I’m hoping it might. I’ve had two c-sections. There’s a small overhang but not much. My sister (the one with the precipitous labor and accidental toilet birth), has a stomach that’s far more “disfigured” than mine. Her kid is 24, and while she wears a size 3, you can still grab handfuls of saggy stomach. There’s so much overhang that she actually makes a game of making her stomach do a wave by grabbing each side with her hands and pulling. I’m a bit overweight (and by a bit, I mean 80 pounds overweight), but I still have a flatter tummy.

        So all that to point out that the stomach issues are just as likely, if not more likely, to be caused by the pregnancy itself and not the method of delivery. I do hope you can feel better about your body soon.

        • Anna

          Thanks! I am working on it and it does improve, just somewhat slower than I would like it to and with the summer coming soon it makes me feel a bit down. Certainly I am not 100% sure it was caused by the surgery but all the vaginal birth girls I know don’t have any issues with stomachs, they DO have health and aesthetic issues, but not of the sort that would be visible to a stranger’s eye.

          • BeatriceC

            Well now at least you know of somebody who has very obvious tummy issues with a vaginal birth. Some of us are just not lucky with the genetic lottery. My sister got lucky in that she’s super skinny (95 pounds pre pregnancy), blonde, blue eyes, flawless complexion, but unlucky in that her skin simply doesn’t have the natural elasticity to bounce back into shape after having been pregnant, even after 24 years. I got lucky with the great elastic skin, but unlucky with being built like a linebacker and prone to packing on extra pounds. Hopefully you’re just taking a little more time than your friends to bounce back. But even if you wind up more like my sister, I’m sure you’ll still look fantastic.

          • Mac Sherbert

            Here’s another example. ” Surprising photos: This is why these incredibly honest photos from elite athlete, Stephanie Rothstein Bruce, are even more inspiring – they show a real woman’s body”. http://www.dailymail.co.uk/femail/article-3503904/Professional-athlete-mum-Stephanie-Rpthstein-Bruce-shows-real-effects-having-baby-tummy-incredibly-honest-photos.html

          • Sean Jungian

            That was incredible, I wish more women would do this and show the truth. It doesn’t make her ugly in the least. It’s just her body.

          • Amy M

            I carried twins, so my stomach was really stretched out and 7yrs later, still is wrinkly and I have a fat pad there that won’t go away. I didn’t have a C-section, its entirely down to the pregnancy. Meanwhile, I have a friend who had 3 pregnancies, 3 vaginal births–but Diastasis Rectii after baby #2. I think she had surgery to correct it after baby #3.

          • Erin

            I’ve recently started pilates plus returned to running (best therapy in the world) and I’ve already noticed a distinct improvement in my stomach.

            A friend had a forceps delivery in theater plus v. bad diastasis rectii coupled with loads of stretch marks and her body is in a far worse state than mine.

            I think it’s luck just like every other aspect of childbirth.

          • Anna

            Yes, mine looks way better than it did too! I don’t know though if it ever will be “normal”. My obgyn says it will bounce back eventually, but my trainer thinks that it will only be flat if I get anorexic thin. Not something I would opt for( Surgery out of the question as I hate the very idea of surgery anytime soon. So hoping for the best.

          • Squillo

            Be kind to yourself. Eleven months isn’t that long. Things may change, or you may find that your belly (and other perceived physical imperfections) bother you less as time goes on. The bicycle tire that was left on my then-very thin and toned body after my two (vaginal) births seemed awfully awful for a while, but a few years down the line it stopped being at all important to me. A gift of middle age, maybe. YMMV, of course. Best wishes!

          • Daleth

            all the vaginal birth girls I know don’t have any issues with stomachs, they DO have health and aesthetic issues, but not of the sort that would be visible to a stranger’s eye.

            In case it helps, my perspective on that is that I would MUCH MUCH rather have a scar and overhang on my belly than have a completely destroyed vagina and lifelong incontinence! I care more about what I and my husband experience in the privacy of our bed than about what strangers think of me in a bikini.

          • Mac Sherbert

            There’s a post by Dr. Amy where a professional dancer (?) posted about the workout she did to get back into shape after her c-section. It was a very interesting post and I really wish I cold find it again. She talked about how the order of abdominal exercises mattered and I think she said the some are actually more likely to cause the c-section pouch.

          • nomofear

            Sahrmann series is the one I know. They were developed by a lady physical therapist.

      • Montserrat Blanco

        I do not see it as “suffer in vain”. I had a CS and I do not like my scar, to the point I am wondering about a surgical procedure to correct it, so I get it about the aesthetic effects. I wanted (and wrote it here) a vaginal delivery. That said when the time came and my son was delivered I would not have accepted a vaginal delivery under no circumstance. The reason for the radical change? My son had a much higher risk of lasting issues if he had a vaginal delivery, so I happily consented to the CS. Most CS are performed because the baby is at a higher risk, I would not consider it “suffering in vain”. I call it “I prefer to bear the risks and side effects myself, get my baby to my arms as safely as possible, I will put up with the pain, the recovery and the complications”.

        A healthy mom and a healthy baby is not all that matters… Until you have an unhealthy baby, then it is all that matters.

        I got a healthy baby. Now I care about the look of my scar, instead of having a REAL problem I am left with a looks problem. I am extremely happy about that problem.

        • Anna

          I do think it is a blessing that instead of making wills when pregnant and if managed to survive walking around with prolapsed uteruses and fistulae for decades as women used to just some 100 years ago all we have to worry about is how quickly our bodies will bounce back. However looks problem IS an issue for many with all these modern high standards.

      • Mac Sherbert

        Very true. My body changed with each pregnancy. I know after my first baby I just thought the c-section belly was a thing, but then I couldn’t get pregnant again. I went on this insane health kick, lost 25 pounds and worked out and my stomach looked better than it did before baby. Now I’m back to needing to that again, but there is this indentation that I don’t think will ever go away from the 2nd c-section. Sometimes it bothers me, but I tell myself it’s a battle scar and I know that the c-section was needed. So I try to look at it as me taking the hit for my girl. Also, at 9lbs plus a Natural birth could have really messed up something else.

        So much is about luck in life and balance. I don’t get stretch marks, but then I suffer from infertility and endometriosis. I think I could trade the painful periods for some stretch marks and be happy.

        • cookiebaker

          I’ve never had a c-section, but I did have an emergency appendectomy and have a very prominent 6″ scar on my lower right belly. It’s thicker on one side from an infection and it has an indent even though the surgery was 18 years ago. When I got pregnant for the first time, it was the first place to grow stretch marks because the skin didn’t stretch well. I don’t mind my scar. That surgery saved my life.

        • Mariana

          I think our bodies change with age, regardless of babies and csections. I think the best is just to accept it and move on with life. My husband and I aren’t lingerie models, and we are totally ok with that. We are healthy and happy and our bodies work just fine, what else could I ask for?

      • Anne

        I have a different view of my c section scar. I had a c section for my first because she was breech. I hated my scar. At three months old she was hospitalized for a week because she was still at the developmental level of a newborn. After a month of tests we were given a horrific terminal diagnosis. My hated for my scar immediately turned in to love and gratefulness. I thought, once she is gone, every time I look at that scar I will know she was really here. That diagnosis has since been retracted, though she is profoundly disabled, and I have since had two more children by c section. My scar is even uglier than it was before, and I have a big hump of skin that hangs over it that you can see through my clothes even though I am very thin, but I love it even more. It’s the way my children came in to this world, it is a symbol of my devotion to their health and well being, and therefore it is beautiful to me.
        It really is.

        • Anna

          I am very much moved by your story. Can’t possibly imagine what you’ve been through. Hope your daughter is doing well now.

      • Charybdis

        “But as for the women who know they have suffered in vain…”

        That, right there is the rub. How do they *know* they have suffered in vain? Because their baby is not damaged by hypoxia? Because some women can (and do) deliver breech babies vaginally? Because the baby was 6 and an half pounds instead of 8 or 9 pounds so the mother might not have torn? Because everything was fine in the end? Because the mother’s coccyx didn’t fracture? Because babies are MEANT to come through the vagina and anything else is unacceptable?

        No one is saying that everybody is happy about having to have a CS, nor should they be, if it truly is a sticking point with them. But the flip side is that vaginal birth DOES have risks and often can have devastating side effects, That apparently no one talks about, nor are they presented as potential future issues for the woman. Things like incontinence, both urinary and fecal, prolapsing bladders and uteri, tearing of perineal tissue, tearing of the cervix, rectoceles, tearing muscles clean off of the bone, breaking the tailbone, etc.

        You can be upset and angry about having to have a CS (general you….not specifically YOU), hate the scar and feel like the whole thing was disappointing, and that is fine, as it was your experience with the process. But being disenchanted with the experience should not mean that it is put out of reach/request for women.

  • Squillo

    My experience with CR as a media relations professional many years ago was that they wanted to apply simplistic metrics to answer complex questions. That may work well to determine how reliable a dishwasher is (although I have my doubts about that too), but not so much for determining the risk/benefit ratio for health services.

  • CanDoc

    I feel your pain.

  • Megan

    And what if a woman just wants a CSection? What’s so wrong about that? It’s ok for me to get breast implants electively but not have an elective CSection?

    • Angharad

      Well you see, breast implants help you conform to society’s standards of beauty, so that’s A-OK. Elective C-section is just a personal choice about what you want to do with your family and parenting, so it’s everyone’s business.

      • LaMont

        Also, breast implants are for a man’s sexual pleasure, but a C-section might help you preserve your own sexual pleasure. It’s very important that a woman starting a life of motherhood understand that her own pleasure should never be thought or spoken of. (Or any woman, regardless of “maternal” status)

  • Nick Sanders

    Didn’t CR get bought by a woo-group a few years ago?