Obsessing about the C-section rate is not thinking outside the box; it is the box.

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In a recent piece on HuffPo, Dr. Neel Shah bemoans The Massive Marketing Failure of Motherhood.

He writes:

While over $500 billion is spent annually on healthcare during the last nine months of life, less than $50 billion is spent on the arguably higher leverage first nine months of life.

Might that be because people like Dr. Shah see obstetric care as the perfect opportunity to save money by demonizing C-sections?

The solution to imperfect technology is not forgoing technology; it is improving technology.

Indeed, according to Shah:

… Over the last generation of American moms, we have misguidedly attempted to make childbirth safer by intervening much more than strictly necessary, delivering one in three human beings through C-sections (a form of major abdominal surgery). Although these surgeries are sometimes lifesaving, since the 1970’s C-sections have become 500 percent more common while our rates of childbirth complications have not improved. In fact, they have actually gotten worse. Nearly half of the C-sections we perform appear unnecessary in retrospect …

Oh, the horror! One in three human beings are delivered by C-section. It’s almost like insisting that one in three human beings need eyeglasses … Oh, wait! One in three people DO need eyeglasses. That’s because the human body is constantly failing in important ways. Childbirth has more failure and more deadly failure than most bodily processes.

What’s the solution to our childbirth dilemma? It’s not obsessing over C-section rates. Though people like Dr. Shah appear to believe that they are thinking creatively about maternity care in condemning the current C-section rate, they aren’t. In fact, obsessing about the C-section rate is the opposite of thinking “outside the box”; at this point, it is the box.

What would thinking outside the box involve?

As Dr. Shah correctly notes, we don’t spend too much money on maternity care. The truth is that we don’t spend nearly enough.

Consider the problem of maternal mortality. In light of repeated adjustments to death certificates, it is unclear whether US maternal mortality is actually rising or whether we are finally capturing cases of maternal mortality that we previously missed. In any case, it is not falling.

Many of the causes of increased maternal mortality are out of our control. Childbirth evolved to occur in women in their teens and twenties, but in our culture childbearing is routinely postponed to the thirties and even forties. The cultural imperative to delay pregnancy means that childbearing women routinely enter pregnancy with pre-existing medical conditions, including conditions that would have been incompatible with survival in the past. Women with high blood pressure, diabetes and serious chronic illness now routinely get pregnant and routinely suffer high rates of pregnancy complications.

One of the great ironies of contemporary maternity care is that we have failed to apply what we learned in caring for sick infants to caring for sick pregnant/postpartum women. We have developed a system of triage to direct very sick newborns to the specialized care that they need. We grade newborn nurseries by the services they can provide, from Level I that provides only basic care to Level III that can provide advanced life sustaining support. When a seriously compromised baby is born in a hospital with a Level I nursery, the baby is immediately transferred to a regional facility with a Level III nursery.

There is nothing similar for pregnant/postpartum women. Most hospitals don’t have an obstetric ICU and there is a woeful under-supply of perinatologists trained to care for critically ill mothers. There’s no system in place to seamlessly transfer critically ill mothers to facilities where they can get the lifesaving care that they need. If we are serious about reducing maternal mortality, we would start creating and grading obstetric ICUs and arranging immediate transfer of critically ill pregnant women.

Another key to improving maternity care lies in Dr. Shah’s own words: half the C-sections we perform appear unnecessary in retrospect.

The problem is not that a 30% C-section rate is “too high.” After all, 30% of Americans are nearsighted and we aren’t advocating saving money by lowering the rate of vision correction. What’s the difference between the two? We have sophisticated and highly accurate ways of determining who needs vision correction. When an optometrist tells you that you need glasses, you definitely need glasses. But when an obstetrician tells you that you need a C-section, often you do not. That’s because we are incapable of accurately measuring the risk that your baby will be injured or die during labor.

We know that many babies die during labor for lack of oxygen but we don’t know how to accurately measure a fetus’ oxygen level. We are forced to resort to crude methods like measuring the baby’s heart rate to determine if it is at risk, and therefore are forced to perform C-sections that turn out to be unnecessary in retrospect. We know that some babies will die during breech birth because their heads will get trapped but we have no way of predicting in advance which babies will get stuck and therefore we recommend routine C-section for breech even though we know that nearly all of those C-sections are unnecessary. We know that some babies, particularly large babies, will suffer serious complications from shoulder dystocia, up to and including death, but we don’t know how to determine which babies will suffer shoulder dystocia so we are forced to recommend C-section in many cases where it is unnecessary.

Natural childbirth advocates like to pretend that the solution to imperfect technology is no technology. Since electronic fetal heart rate monitoring has a high false positive rate, we should just stop using it. Since most breech babies will fit, we should just stop doing C-sections for breech. Since most big babies won’t be harmed by shoulder dystocia, we should simply stop worrying about it.

But the solution to imperfect technology is not forgoing technology; it is improving technology. We need to spend tens of millions of dollars (or more) perfecting a way to determine fetal oxygen levels during labor. We need to spend tens of millions of dollars (or more) perfecting a way to determine whether a specific baby in a specific position will fit through a specific pelvis. When we create such technologies, the C-section rate will drop precipitously because we learn in advance which C-sections are unnecessary and stop doing them.

Our perinatal and maternal mortality rates are as high as they are because childbirth is inherently dangerous. Our C-section rate is as high as it is because our technology is relatively primitive. Demonizing C-sections is not the answer and demonizing imperfect technology is simply foolish. The “market failure” alluded to by Dr. Shah is not the high C-section rate; it is the low rate of investment in more sophisticated technology.

Obsessing about the C-section rate is not thinking outside the box; it is the box.

  • Sue

    So, I looked up Assistant Prof Neel Shah’s academic publications list.

    In 2011/12 he participated in a couple of studies on minimally-invasive/robotic surgery for hysterectomy for cancer.

    In 2013 he co-wrote a number of opinion pieces. In 2014 he co-authored more articles related to practice principles and cost-containment, including being 4th of 5 authors for this paper in the journal Obstet.Gynaecol:
    “Obstetrician Volume as a Potentially Modifiable Risk Factor for Cesarean Delivery”. This was a retrospective cohort study attempting to correlate cesarean rate with OBs practice profile. They concluded that “These findings may prompt discussions regarding the role of volume in credentialing and practice models that direct patients to obstetricians with high delivery volume.”
    (I don’t have access to the full paper to see what factors they controlled for).

    In 2015, he was a co-author on the JAMA paper that showed that the old WHO recommended cesarean rate was too low (“Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality”) and the Lancet papers that correlated increased Cesarean access with improved maternal and neonatal mortality.

    His most recent co-authored paper is another opinion piece in Birth 2016: Nurses Count: Tracking Performance to Improve Cesarean Delivery Rates. Regular readers will recognise “Birth” as being the journal of Lamaze International.

    Interesting.

    He doesn’t seem to have been involved in any clinical studies looking at better risk-stratification or outcome predictors.

  • Sue

    What other areas of preventive health, or risk management, or vehicle safety, or pandemic planning, require the response to be precisely matched to the (eventual) risk, retrospectively.

    In real time, with imprecise abilities to forecast the future and imperfect tools for assessing individual risk, preventive solutions HAVE to be over-engineered.

    It must be so frustrating for OBs to be called out – especially by collegues – for acting in the same cautious way that all other clinicians are expected to do.

    • Who?

      I’m reading this and thinking about the flu jab, which might be a bit like the OBs you’re talking about. I had mine a month or so ago-the quadrivalent (sp?) one-a bit later than usual as it came out later than usual. Didn’t even have a sore arm this time.

      No one thinks the flu jab is a perfect drug-people who know a lot about it take a swing at what’s likely to be big in flu world for the upcoming season, months in advance, and concoct their best brew accordingly.

      But it still saves a lot of people from getting sick, thereby saving a lot of misery, and death, and money. The geniuses in the cheap seats complain about the strains chosen, and the timing, but they couldn’t do better, or probably even as well, themselves.

  • Sue

    “Natural childbirth advocates like to pretend that the solution to imperfect technology is no technology.”

    Such basic logic. How does a Prof of Obstetrics make such a fundamental error of logic?

  • The Computer Ate My Nym

    The other problem with statements like, “There are too many c-sections” is that they’re utterly useless. Take it as a given, for the moment, that the statement is correct and there are too many c-sections. Okay, what does that tell us about which ones should not be done? Nothing whatsoever. The only possible useful conclusion to draw is that it would be reasonable to do clinical trials to determine whether certain c-sections can safely be avoided. But a call to reduce c-sections in and of itself with no attempt to determine which ones are unnecessary? That can only cost lives.

    • Squillo

      Exactly. We also know that we do too many biopsies. At least with many biopsies, we know after the fact which ones were unnecessary, and that can inform research into making more accurate predictions about risks and benefits. With c/s, much of the time we have no idea even after the fact whether it was necessary or not, which is a serious handicap in trying to figure things out prospectively.

      • Azuran

        But the whole ‘in-retrospect’ thing is just stupid.
        Saying a biopsy was unnecessary ‘in retrospect’ is absolutely ridiculous: How are you supposed to know if you have cancer or not without a biopsy? When the result comes back as a negative it doesn’t mean the biopsy was unnecessary. It was necessary to get a diagnosis. You now know you don’t have cancer because you had that biopsy.

        I like how Shah is plainly saying the main cause of the problem yet it still flew 5 feet over his head: c-section appear unnecessary in retrospect.
        Yea dude, what are you going to do about it? What are you doing to improve our capacity to detect foetal distress more accurately?

        • Squillo

          Right. It’s stupid, whether applied to biopsies or to c/s. My point is that, in a way, it’s even stupider with c/s since it’s not always–or perhaps even often–obvious if there was actually a life-threatening problem or not, as it usually is with biopsy, which is often a simple dichotomy. Thus, it’s even harder to calculate the risks of having/not having the procedure for c/s for some indications.

  • The Computer Ate My Nym

    Childbirth evolved to occur in women in their teens and twenties, but in
    our culture childbearing is routinely postponed to the thirties and
    even forties.

    Slightly fussy correction here, but humans evolved to start childbearing in their teens and twenties. Continuing it through the 40s has been typical for survivors of the early childbearing years since prehistoric times. It’s just the idea of having your first kid at 35 or 40 that’s relatively new.

    • LaMont

      Yes! I just finished the Hamilton biography and what shocked me wasn’t how young the first-time mothers were (late teens and early-mid twenties) but how they just wouldn’t stop having kids! Oddly, that hadn’t occurred to me. Eliza Schuyler Hamilton’s mother had her last child at 47, after 24-year-old Eliza was already married to Hamilton! I couldn’t help thinking to myself, “that is a very long career”…

      • Platos_Redhaired_Stepchild

        Upper class women back then had a tendency to marry earlier and have more kids. Since the Industrial Revolution and the advent of the high fat diet, girls have been entering puberty earlier and earlier. Prior to the 1800’s, the average onset of menarche was around 16 years old. Women also used to ovulate a lot less often. Our stone age ancestors only had about 50 menstrual cycles during their lifetime. The average modern woman has about 450. So the “Founding Fathers and Mothers” were kind of the beginning of the American trend to have Duggar-sized broods of kids.

        • Azuran

          Wow, that’s really a nice theory you have there.
          Which is why women in different country around the world have menstrual cycles varying from every 6 months to one every month depending on the fat content of their diet.
          Seems legit.

        • The Computer Ate My Nym

          It is likely that the historical oddity was the period when menarche was later. Consider, for example, that in “Romeo and Juliette”, Juliette was 13 and considered ready for marriage (and her mother said that she had already had a child by Juliette’s age.) Or that historically arranged marriages often occurred at about age 12 or 13. We’re probably just returning to “normal” now.

          • Irène Delse

            The two are not necessarily antithetical. Until the industrial revolution, most people in Europe and America were peasants living just above the survival level, but there was a small upper class that didn’t lack nutrition – their diet was often too rich in fat and proteins, as shown by the high rate of gout, heart disease and obesity. The very upper crust (royalty and the higher nobility) often married young, as early as twelve, because their priorities were transmitting a patrimony/making useful alliances. People of all other classes often waited until 20 to 25 for women, and 30 or more for men, because they had to gather enough capital to be able to make a living. Typically, a young man had to go through apprenticeship, work for a few years to make a nest’s egg and prove to the parents of his prospective bride that he was a good provider. A young woman, meanwhile, worked at home with her mother or mother in law, doing house chores and sawing the clothes and linen that she would need once she had a house of her own.

          • The Computer Ate My Nym

            I just want to say that I agree with you and that I love this typo: “sawing the clothes and linen”. I’m terrible at sewing and when I try to make clothes it does end up looking like I sawed them instead.

          • Irène Delse

            Oops. Good catch, thanks!

          • Petticoat Philosopher

            Yeah, but Romeo and Juliet doesn’t really reflect the reality of the times so much as it reflects “exotic” stereotypes of Italian and Southern European women at the time. In Shakespeare’s England, these women were highly sexualized in the popular imagination and thought to mature earlier than English women, who generally married in the late teens at the earliest and often later. Shakespeare may have been brilliant but he was as susceptible to stereotypes as anyone else, especially since he didn’t exactly have any experience to counter them. He didn’t go to then places he wrote about and it shows all over the place. (In Othello, he also conflates Moors and Sub-Saharan Africans all the time–having characters derogatorily refer to Othello as “the thick-lips, for example.) We just tend to forgive him for it because those plays are so damn good. So, no, 13-year old girls motherinf children would not have been normal in Shakespeare’s world and, though I know less about Italy of that period, I’m pretty sure it wasn’t what wveryone was doing down there either.

            As for arranged marriages, children of wealthy and powerful families were often betrothed very young but they did not usually marry until their late teens. There are a few examples of royal marriages taking place when the girl was extremely young (the parents of Henry VII IIRC?) but this wasn’t that common and consummating a marriage with a girl that young or impregnating her (if such a thing was possible) was considered rather shocking. (Girls if that social stratum possibly did menstruate earlier because they consumed a lot more fat calories but 13 was considered too young to be a mother by most. And that social stratum was also tiny.) So no, later menarche probably wasn’t just a small blip in time, though it’s always hard to find out for sure because men wrote our history for a while, and they didn’t want to think about that gross girl stuff. Lol

            Sorry, history geek, as you might guess.

    • Anna

      Absolutely! And people with conditions like diabetes probably just didn’t make it to their twenties and start childbearing. And those who were infertile couldn’t be treated in any way. And losing one’s first baby in childbirth was not extraordinary.

    • Petticoat Philosopher

      Thank you. That sentence annoyed me and also surprised me coming from this source. If we evolved to have children in our teens and twenties than why do we stay fertile for decades after? Presumably, evolution had something to do with that too.

      Like you say, women have always had children on their 30s and 40s, it just usually wasn’t their first children. In places where big families are culturally normalized (such as Ireland, where many people still choose to have lots of kids, even if they are not observant Catholics and even though birth control is both legal and socially acceptable there now), they still do. Interestingly, an Irish friend told me that she is amazed at how much fuss there is in this country about women over 35 having kids (people act like it’s a miracle every time a woman that age gets pregnant lol) because in Ireland, that is and has always been normal. (For a long time, it was what women did whether they wanted to or not!)

      In post-war America, it became the norm to start having children very young and to also stop young after only a few. But, as with many social norms of post-war America (such as very young marriage among the middle classes), that was an exception, not the rule and is actually historically novel. (And also as with many social norms of post-war America, there is no public awareness of this fact. The way people did it in the 50s is the way people always did it. Um, nope.)

    • Daleth

      Now for my own slightly fussy correction: this isn’t true…

      Continuing it through the 40s has been typical for survivors of the early childbearing years since prehistoric times.

      Typical? No. Possible? Oh, absolutely. But women, even those who’ve had several kids already, become less and less fertile from age 35 onwards, and especially 40 on. Yes, some women who survived early childbearing have sometimes continued having babies through their 30s and into their 40s since prehistory. But no, that’s not true or typical of MOST women, because fertility naturally declines and the miscarriage rate naturally increases as women age.

  • CanDoc

    Yes. YES! You have written the story of my life here. Thank you!

  • Jules B

    I wonder what the technology would look like, that would allow doctors to test blood oxygen levels during active labour? Seems to me that the real barriers to that kind of technology is the fact that it has to be able to be used on a labouring woman. Kinda like trying to do work on a car while it is driving. (Note: Not saying these barriers should be an excuse to not try to develop the technology…I agree wholeheartedly with Dr. Amy…just that I can see how challenging it would be to create something that might work).

    • attitude devant

      Not sure what you’re talking about here. That technology (continuous monitoring of maternal oxygenizatuon) exists. It’s called a pulse oximeter. It is widely used.

      • Chi

        I think they’re talking about being able to monitor the blood oxygen levels of the baby in labour. Which at the moment I don’t think we can do with any accuracy.

        • attitude devant

          Actually fetal pulse oximetry is a thing too. There were several studies on it 5-10 years ago but it’s fairly invasive (as you can imagine) and didn’t improve outcomes over cEFM so it’s not used.

          • MaineJen

            It involves attaching a monitor to the baby’s scalp, correct? Which I imagine can’t be done unless labor is pretty far progressed, with waters broken already. Or am I thinking of something else here?

          • Anne

            Not quite- the sensor sits against the fetal cheek, which amounts to a similar requirement- the cervical dilatation needs to be 3-4 cm to insert it. And, as AD notes, outcomes are no better than with fetal heart rate monitoring.

      • Jules B

        Sorry, of the fetus not the mother…

  • Amazed

    OK, someone willing to tell me just when humankind didn’t use the best tools available to mitigate risk? I doubt someone thought forceps was such a cool thing, ever, but they used it because it was the best they had. The great thing about planned c-sections isn’t that they’re just this flawless. They aren’t. The great thing about them is that they can lead to a good outcome with complications that are relatively minor compared to the prize.

    When c-sections were less safe, they were less performed. I think Queen Elizabeth the Queen Mother was warned against having a third kid because hey, another c-section might kill her. They used the best tool they had with the best reasoning they had. It’s like today – doctors are more liberal with c-sections but warning that too many of them might cause a long-term harm to a future pregnancy. When the next best thing comes around, c-sections for situations that are considered dangerous on a population level will fall down.

    Plus, I doubt there is a woman choosing a c-section who doesn’t know that it includes a surgical cut. So yes, most of them are well aware that is’s a surgery and every surgery carries risk. They hardly need other lay people to remind them about this.

    • MaineJen

      So Queen Elizabeth was born by c section? Isn’t that interesting…

      • Amazed

        A home c-section at that. Of course, that was hardly the homebirth CPMs are envisioning. It was done by a doctor. A real male one.

        I think Princess Margaret also arrived via the emergency route.

        • BeatriceC

          Yeah, it might have been a “home” birth, but there’s a vast difference between the typical person’s living room a a suite of rooms in a palace that had been converted to an operating theater (unless I’m getting my monarch’s birth stories mixed up).

          • Bombshellrisa

            Like the stupid meme that the home birthers posted after the royal babies were born. It was a pic of Kate the duchess with her baby and it said “give birth like a Queen, with a midwife”. They don’t mention that the midwife was first a nurse then trained to be a midwife and that the birth happened in a hospital. With doctors present.

          • Dr Kitty

            The obstetrician who attended the Duchess of Cambridge during her L&D with Prince George received an honour (a knighthood, I think) and I doubt it was because he sat in the corner knitting.
            I have my doubts that Prince George’s birth was as easy and natural as is largely assumed.

          • demodocus

            now i’m imagining my ob knitting on break 🙂

          • Bombshellrisa

            Mine does cross stitching, she made stuff for her office

          • demodocus

            🙂 I’ve brought my knitting into the office and he admired my sock but he didn’t say he does any. (We knitters usually do.)

          • Bombshellrisa

            You have a point there. I knit and crochet and so some embroidering. I have met more yarn addicts because I bring my work everywhere.

          • sdsures

            I would hope that level of media intrusive veness stops.

          • Sarah

            Indeed, they don’t bother pointing out that she had her first one with one of the most senior obstetricians in the country present. Also, Ms Cambridge isn’t a queen yet…

          • Petticoat Philosopher

            And that’s pretty much the standard way to give birth in the UK…

    • Amy

      And of course, the other thing is that we have much more reliable methods of planning pregnancies today. And most women don’t want more than 2-4 kids, so delivering that first or second baby via c-section isn’t as much of a problem as it would be for a woman not using contraception.

  • Allie P

    Blah. I got into it on FB with a friend who posted that horrific old opinion piece by the chick and her doula from the Atlantic in 2012. You know the one — where she said it was safer to give birth like her great grandmother, because like, the Netherlands, and also sonograms don’t improve outcomes? I posted easily half a dozen studies disputing her points, and my friend came back to me saying “just because anesthesia isn’t risky doesn’t mean it’s needed” and also a link to a Henci Goer piece. What even is the point?

    • Angie Young-Le

      Honestly there isn’t much point. A couple weeks ago I had the same situation with a friend who was preaching breastfeeding. We had to settle on “agree to disagree” as she was starting to get defensive and angry. The best you can do is try I guess.

    • Well, she probably thinks of herself as a feminist. Doesn’t that mean all women get to choose? Painkillers are almost never strictly necessary, but we still give them to people with all sorts of really painful things going on and insurance pays for it. Isn’t providing women the choice to access painkillers during a very painful episode a rather important thing to do?

      If she doesn’t want anesthesia or analgesia, she doesn’t have to have it. That doesn’t mean she can or should remove that option from other people.

      • LaMont

        Amen! We can’t let this “pain relief is not needed” nonsense stand unchallenged for the readers of the thread. That mentality is drives the idea that women derive their personal integrity from their ability to withstand pain and birth babies old-timey-style. It’s sexist and terrible and you don’t need to be super combative about it if that’s not your speed, but at least a readjustment of the viewpoint is in order so people don’t nudge closer to the “yeah, doctors are terrible and you get your power back by denying everything they do!” idea when they see this nonsense.

    • Allie P

      I said “needed” has nothing to do with “wanted” , and that’s when I got hit with the Goer. And then i stepped away from facebook. But it’s exactly what this post is about. The idea that any problems with technology is solved by going back to the stone age!

      • guest

        Hey, I don’t *need* ibuprofen when I have a migraine, but I sure as fuck want it, and I will bite anyone who tries to take it away from me.

        • Amy

          I envy you. Nothing works on my migraines but triptans. Even opioids don’t get rid of them, though they do help more than OTC painkillers.

          • guest

            Yes, my migraines are pretty mild in the world of migraines, and so far they do respond well to OTC stuff. One time I couldn’t get to it right away, and I ended up shaking in my office, unable to stand up to walk home, seeing arcs of blue lightning in my head. It’s miserable stuff.

          • sdsures

            Have you peeps been assessed for Botox for migraines? I’ve been getting it for a couple years now on the NHS, and it has made a big improvement

        • sdsures

          I have chronic migraines, and was so angry about something yesterday that I bought gum, so I wouldn’t bite anybody.

      • MaeveClifford

        I’ve had a long and storied history with orthodontics and dental surgery, so I’m pretty inured to mouth/tooth pain. But it’s funny how pain relief (novocaine) is just administered as standard, unless there’s an allergy. There’s a whole subset of “gentle” or “sedation” dentistry which has grown up around people’s fear of even being AT the dentist. Nobody advocates yanking teeth at home in response to that fear. I’ve had two surgeries with local only, because I wanted to be able to drive home afterward. Also nitrous makes me sick. But hey, if someone needs to be under completely for a tooth cleaning, it’s wonderful that the option exists.

        Meanwhile, the rhetoric around childbirth has gone to the complete other extreme. Recently on FB I saw a birth announcement posted by the proud grandpa. No stats, just the fact that his daughter in law had delivered “all natural.” Madness. I had no particular wish to feel the extraction of all four third molars, for instance, but I probably could have done it. The one where the root broke off wouldn’t have been fun, but I *could* have managed it. It was more pressure than pain after all 🙂 And it was very quick. But imagine if I had posted about my “all natural” dental procedure on FB. Imagine if my father-in-law had crowed about my achievement of forgoing pain relief in that circumstance. People would think I/he was nuts. Yet for a much more agonizing, much more prolonged experience, women’s choice to avail themselves of pain relief is suddenly this moral issue. My choice to have an epidural was made for the same pragmatic reasons to have novocaine during dental procedures: it’s going to be painful, and I’m not particularly interested in suffering for no reason.

        • Dr Kitty

          My poor #1 munchkin has two teeth that need extracted. They are hypoplastic without proper enamel formation and have big cavities despite only having erupted three months ago ( all her other teeth are perfect).

          Damn straight she will be having a GA for the extraction. I think the risks of anaesthetic outweigh any pain or trauma from an extraction under local.

          I say this as someone with a dental phobia- she deserves a better experience than I had.

          • demodocus

            Poor kid. Good luck on the extraction.

          • MaeveClifford

            Most definitely. When I got my first supernumerary tooth extracted, I was under general, in a hospital. I was seven, and it was all very exciting, but slightly scary. It probably would’ve been terrifying if I had to be awake for the whole thing.

            Hope your kiddo heals quickly. Keep the popsicles coming!

          • Who?

            Poor litle one, hope it goes well. They should be able to lift them out without too much drama while she’s asleep.

          • BeatriceC

            Poor kiddo! Hugs for both of you. Hopefully it all goes smoothly with no misery from the GA.

          • sdsures

            Hugs for kiddo!

    • The Computer Ate My Nym

      If it helps any, epidural anesthesia during labor is associated with a lower rate of PPD.

      • sdsures

        No kidding! Pain is depressing, especially if it goes on for a long time like healing from a tear would.

      • StephanieA

        I’ve said before, I feel like I would have PTSD from my second labor without an epidural. It was horrific and excruciating. I heart epidurals.

    • Irène Delse

      Heh. I have a friend who didn’t want an epidural before going into labour. She even told me she was annoyed at her OB for detailing to her the pain-relief options. Then, after the birth of her daughter, she admitted she was glad she could get an epidural as soon as she came into the L&D room with strong and already painful contractions.

  • CSN0116

    Why are people always quick to label c-sections as “major abdominal surgery” — to make them sound all scary. Major surgery is like quadruple bypass or something. I have never known a single woman to die during a scheduled cesarean (the emergency ones I know can happen for reasons that were already putting the mom’s life at risk). The procedure takes less than an hour. And my pain never went above an 8, and was a 1-2 just a few days later. My appendectomy hurt worse for whatever reason…

    • momofone

      My tonsillectomy was way worse than my c-section. And the result wasn’t nearly as snuggly.

      • CSN0116

        Oh God, I’ve refused a tonsillectomy for years and years now. I used to get repeat strep throat and was advised to have the procedure – no freaking way! I watched my sister do it as an adult. OMG! NO! The strep has subsided; haven’t had it in years. One of my better calls LOL. That shit looks too painful for words. She was incapacitated for at least 8-10 days.

        • CharlotteB

          I had it as an adult. NOT fun. Especially because the good painkillers made me nauseous and throwing up seemed like a terrible idea, so I quit taking them, which also sucked. I got it done in November and since I needed to eat soft foods afterwards, I ate A LOT of pumpkin pie minus the crust. It’s been 7 years, and this last thanksgiving was really the first year I was able to get excited about pumpkin pie again.

      • Bombshellrisa

        I have never seen someone for from complications of a c-section, I have seen someone from complications of a tonsillectomy.

    • AA

      In medical terms, it is classifed as major abdominal surgery. Of course, during vaginal birth, you’re also expelling a giant object from your body, which is dangerous as well…we need artificial uteri, y’all. ;Where are my flying cars and external uteri?

      • Irène Delse

        Definitely. Artificial uteri all the way.

        • LaMont

          Some OT Vorkosigan Fangirling (mildly spoilery?), brought on by the idea of a world where artificial uteri are the norm. After thinking more about the Vorkosigan Saga and this site simultaneously I had a terrible idea. What if one of Miles’ daughters ended up rebelling and going full woo, deciding to not use the replicator for her own children? I wouldn’t wish that on poor Miles (or Cordelia, or Ekaterin, or whichever daughter LMB would have to sacrifice to this lunacy) but the thought made me laugh a little. I’m a fictional sadist.

          • I think Cordelia would shut that down triple-quick. None of her granddaughters are going to risk themselves and her great-grandbabies for non-scientific reasons!

          • LaMont

            Cordelia’s “Come to Jesus” talks are the *best*. I just hope that, should she take this conversation on herself, that she’d succeed in getting Ekaterin to talk Miles down off the roof while she goes to chat with the granddaughter :).

            (Spoilers for characters-who-exist and pairings)
            Anyway I swear that when I think about the next-gen Vorkosigan Saga cast, mostly I don’t want stuff this catastrophic to happen. All I *really* want is for Ivan/Tej’s first son (named Padma, or Simon, presumably) to be an ambitious, powerfully intense person who they have no idea how to deal with, and for Helen to be the first reigning Countess b/c Alex seems to have less than zero interest and she’s the intense one.

          • Alex would be the count, he was born first. I don’t think you can get out of hereditary jobs just by being uninterested lol.

            No, I see Helen as breaking into the Service Academy as its first female cadet and kicking the snot out of all the other ensigns.

          • LaMont

            True, Alex was born first, but also there’s the whole “Count’s choice over Count’s blood” thing where technically a Count can pick his heir regardless of primogeniture, it’s just that most Counts pick their first sons (I would *love* to know who Count Vorhalas is going to pick, he seems to still be going strong last we heard from him). I was *dying* for Miles to not get roped into being the heir but got over it when I realized that it would just kill Aral to have to name Ivan instead – also, talk about uninterested! Ever since Lord Dono torpedoed the whole system, though, you’d think that allowing women to run districts would at least be up for discussion… Also, have you read the latest entry yet (Gentleman Jole and the Red Queen)?

          • I have indeed! And yes, I loved it lots. I’m so glad Cordelia got another book devoted to her.
            I’m also not sure Alex isn’t interested so much as just a little more laid back than Miles. He didn’t get enough screen time for us to tell, honestly.

          • The Computer Ate My Nym

            He didn’t get enough screen time for us to tell

            I’m very sorry, but my first thought was “tsk, tsk: don’t you know screen time is bad for children”.

          • LOL.

          • LaMont

            I agree re: Cordelia, absolutely!! And b/c of GJRQ, I’m less interested in the continuing desegregation of the service than I probably should be b/c I feel like that’s settled(ish); what I want is a shakeup in that Council! But I know that the political stuff isn’t where LMB usually goes. As for “more laid back than Miles” I feel like that goes for most characters, though admittedly combining Miles’ DNA/influence with Ekaterin’s is just combining overt energy/craziness with stealth energy/craziness. God I love these characters 🙂

          • The Computer Ate My Nym

            I’m rather disappointed that they had Ivan and Tej have kids. Their personalities are such that I’d expect them to be a childless via indefinite procrastination couple. Having them end up with kids and not even that long after their marriage seems like a cop out to the “everyone must reproduce” thing.

          • LaMont

            I mean, Mark and Kareen appear to be the holdouts on reproduction (thank god). While I would like for more people to hold out, in theory, I just find Ivan so funny and anything to fluster him is a-ok in my book! Plus I feel like foot-dragging on marriage doesn’t necessarily equate to foot-dragging on reproduction. I could see the marriage step as being like “well, got over that hurdle, now I have a reasonable adult life to execute!” (This may be what I am covertly hoping for in real life)

            Also the idea of Padma (Simon? meh, probs Padma) Shiv Arqua Vorpatril being this hyper-badass who Ivan has no idea how to handle just tickles me to *death*. (As laid-back as Ivan/Tej are, this kid *would* be 75%+ hardcore badass by blood).

          • The Computer Ate My Nym

            Also note that, on some level, being laid back is an act of rebellion for Ivan and Tej. It’s their own personal form of being a badass and defying he world’s expectations. And now their kid is going to have their example to rebel against. And a number of second degree relatives as role models. Uh-oh.

          • The Computer Ate My Nym

            Or one of Cordelia’s daughters…

      • Are you nuts

        Yes! How in the year 2016 have we not figured out a better way?!?

      • Nick Sanders

        The problem with flying cars is I’ve seen the way people drive.

        • MaineJen

          Good point. Do we really want to bring a third dimension into the mix?

        • guest

          Which is why I’m way more interested in the emerging driverless car technology. Can’t say how well it’s going to work yet, but it could revolutionize driving.

          • Monkey Professor for a Head

            The trickiest thing about driverless cars won’t be the technology required, it will be getting people to trust it.

          • Deborah

            Trust cars. Cars are as safe as life gets.

          • Amazed

            I trust cars. I just don’t trust the idiots who think the middle of the road is a wonderful place to show up all of a sudden. Walking, of course. I should know. I was such an idiot. Twice. At least the first time I get the excuse that I was a tween. Both times the drivers managed to stop before hitting Idiot Me. And since the one who actually stopped to check on me (because we had a collision anyway and I did perform a flight in the air) was scared shitless that I might be hurt despite having zero responsibility for the impact, I gather that some drivers might prefer not to sit in a car that can hit such an idiot, even if they aren’t the ones driving. And it’s hard to make a car foolproof. I am not an idiot… usually, yet I chose to cross the six lanes on foot. I doubt a guard can be invented for the likes of Idiot Me and the majority of people would really, really prefer not to hit us.

            But yes, cars are as safe as life gets. Alas, Idiot Me is part of life and was NOT safe. I mean, how safe is to stop all of a sudden, traffic all around and all because a girl has a bout of bad idiocy, a suicidal wish ot whatever? And you cannot NOT stop. You see her, you stop. It’s an instinct, not a thought-out choice. In fact, it’s less trustworthy than threatening a c-section. Unless it’s a true emergency, doctor and mom actually have the time to think.

          • Erin

            I would have more faith in this if I didn’t live with a software developer. Look at your operating system update history…it’s full of security and bug fixes. Annoying enough on your computer, potentially lethal in a driverless car.

            Certainly here I would hate to be programming a car to drive on our roads, no middle lines, sharp right / left hand corners because the road follows the lines of “interesting” fields and of course wildlife who think the middle of the road is an awesome place to hang out, not to mention joggers, dog walkers, cyclists, horse riders and pheasants.

            If Google’s car couldn’t “see” a bus, it’s unlikely to spot a pheasant until it’s smeared all the over the windscreen.

            Software Developer husband whose software is out there doing all sorts of scary stuff like stopping Oil Rigs from blowing up thinks we’re many many years way from being able to do it right.

          • I also live with a software developer, and frankly that’s why I would trust driverless cars! Yes, bug fixes and patches come out regularly, but they’re usually for pretty small stuff. The big stuff gets caught (ideally) in a QA environment, and driverless cars will have a ton of testing before being released to the road.

            I don’t expect them to be perfect. That’s not a fair standard. I do think it won’t be that hard to make them better than your average human driver who will have bouts of Idiocy as Amazed pointed out. We may never get it perfect, but I’d still trust a Google car over Random Jane or John Doe Driver.

            Google’s car can’t “see” a bus with its camera (processing video images is actually really CPU intensive and hard), but it can use LIDAR and SONAR to “know” that there is an object there and not hit it.

          • Who?

            My bil is working on driverless trucks for open cut mines. Last time I talked to him they were trying to work out a foolproof way to stop them driving over a cliff. Which seems more like a mine design problem than a truck problem, but the pile of rubble at the bottom of the drop is the same whatever the trouble is.

          • guest

            Actually, I think it will matter for driverless cars. Growing up in earthquake territory, I recall an incident where a police officer or state trooper was reporting to work in the wee hours after a moderate quake and he drove right off an overpass that had collapsed because he couldn’t see it. We’d ideally want driverless cars to sense those sorts of things too, because there will always be disasters.

          • guest

            True.

          • Azuran

            True that. We have lots of snow in winter where I live. I can’t say I trust a car to be able to follow a snowy road or being able to foresee a patch of ice. (not that I put that much trust in other people’s driving)
            I don’t know what kind of technology those car use, but you can’t use your reserve cam half of the time in winter because it’s always blocked by the snow.

      • CharlotteB

        Wouldn’t surgery to repair a 3rd/4th degree tear also be major surgery? Or is it not classified that way?

        Obviously, it’s different, but I’m curious about that.

        Oh, and I don’t care about the uterus bit, I just need science to perfect StarTrek-style beam-out births. With a few exceptions, I found having a human parasite kind of cool, but the removal process leaves a lot to be desired, I think. Although being able to check on the baby and see it would be neat.

    • RudyTooty

      Just because you’ve never known a single woman to die during a scheduled cesarean, doesn’t mean it doesn’t happen.

      http://www.wnem.com/story/30914193/woman-dies-during-c-section

      Because it happens so rarely, that few of us would ever know a single mother who dies during a scheduled c-section. But the rate is not zero. And it does happen. Part of informed consent for surgery is including the risks of death, and people accept those risks.

      Let’s not use anecdote to prove a point – midwives are notoriously good at it:

      “I’ve never known a woman to have a [vbac rupture/breech head entrapment/severe PPH hemorrhage/etc] at home.” This is how midwives sell their services. With this nonsensical anecdata.

      • CSN0116

        Apologies. Would never imply it’s zero; just implying that they’re not the horrifically painful health hazards that they’re rumored to be.

        • Erin

          Think it does vary. I was too busy being a suicidal mess to know whether I was in pain or not (I think not but can’t be sure and I’m a 100 percent my back to back labour hurt far far far more) but a couple of my friends had horrible infections after theirs and suffered for a long time.

          • RudyTooty

            It really is impossible to make any sort of sweeping statement that encompasses everyone’s experience, isn’t it? Some women will have easy c-sections, some women will have easy vaginal births. Babies fare well or not well after both cesareans and vaginal births. There is no way to eliminate all risk. And there is no way to guarantee that birth will be perfect – not with a candle-lit home water birth, not with a scheduled, planned, straightforward c-section either.

            We want most women and their babies will do well. But I would love perfection for everyone – who wouldn’t!? Women deserve accurate information regarding the choices they have to make around childbirth, and not be sold some risk-free, perfect (distorted) version of reality – and that goes in both directions – for more intervention, or less.

        • guest

          I found mind horrifically painful, though. I don’t think of “major abdominal surgery” as requiring high risk of death from the procedure. I think of it as having to do with the size and depth of the incision. So biopsy =/= major, laparoscopy also not major. An appendectomy has a smaller incision than a c-section (at least mine is smaller) and it’s still categorized as “major,” so cutting open a woman’s abdominal cavity *and* uterus to forcibly remove a fetus or fetuses seems pretty major to me, regardless of how much pain she experiences later, and regardless of how likely the surgery is to kill her (we already know pregnancy has a high death rate without medical assistance). I had serious bruising around my mons pubis after the c-section – way more traumatic to my body than the appendectomy (both were emergencies, but the appendix probably more urgent to my personal health).

          • CSN0116

            I hear ya.

            Allow me to reframe: why no quick to horror stories of painful vaginal birth recoveries. My second degree tear and hemorrhoids after my first vaginal delivery made me cry, daily, for over a week. Going to the bathroom took my breath away it was so painful.

            I have seen women, especially around VBAC, brush off 4th degree tearing and vaginal reconstruction… all for the sake of happiness over a vaginal birth.

            That shit hurts so bad, but nobody really talks about it :/

          • guest

            Well, for me it’s because I have never had a vaginal birth, but I’ve had abdominal surgery twice! But have read vaginal birth horror stories. It’s true women are told to steer clear of them when they are pregnant.

          • demodocus

            and keeping those damned stitches clean!

          • TheArtistFormerlyKnownAsYoya

            My mom is way into the natural birth stuff. She said she had to have an epidural with no pain relief because I had the cord wrapped around my neck and had to get out asap, but it was “just fine”. I’m sure – SURE – she must have had pain and a rough healing after that. I imagine that would be awful! I shuddered and said “I may just go straight to c section” (currently pregnant) and she said “oh NO, you don’t want to do THAT!” I’m baffled as to why an epidural with no pain relief, and the pain of healing after (not to mention the increased possibility of serious tearing) is just ok with so many women. I mean, to each their own but it’s not really ok with me. I would have considered that a traumatic birth.

          • FEDUP MD

            I had an umbilical hernia repaired laparoscopically and it was many times more painful for recovery than either of my 2 sections, including the emergency one. Not sure why, but I would not put my laparoscopic surgery in the “not major” category.

          • guest

            Well, as I said I don’t think the “major” part hinges on the level of pain experienced. How could it? Pain is so subjective and variable. I think it’s a classification best left to the surgeons. I am not one, but my sense has always been that it refers to the size of the incision/depth of cut or something similar. It’s probably related to some idea that risk of infection/complication is small with smaller incisions (though there’s always a risk, of course). Maybe a surgeon or other healthcare worker who knows can weigh in.

      • 3boyz

        I just had my first c-section 3 months ago (third baby), and it definitely is major abdominal surgery, and found recovery to absolutely miserable, even though there were no complications. Not that vaginal birth is a walk in the park, but given the choice, I’d pick vaginal. I had a placental abruption this time, so obviously it was necessary and I’m glad the procedure was available to save me and the baby, but it was absolutely a sucky experience. And my doctor agreed. When i told her how hard a time I was having, she reminded me, in those exact words, that I’d just had major abdominal surgery. I do hope to VBAC next time. I’m told as long as I wait at least 18 months, I’m a good candidate.

        • I think that’s one of the differences between emergency and planned C-section, too. Anecdotally, recovery seems to be harder for emergent C-sections than planned ones.

          I’m sorry you had a sucky experience, and I’m glad you and your kiddo came out of it okay.

          • FormerPhysicist

            It makes sense – and it was that way for me. It was much easier to recover from a no-labor c/s than from unproductive labor + c/s.

          • Amazed

            It does make sense indeed. In fact, you had both kinds of births for the same baby. And it’s a well-known fact that even a mere headache is usually harder on someone who is already exhausted and in great pain than someone who just has a headache.

          • 3boyz

            It does make sense that planned would probably be easier to recover from. Although this was an emergency, I actually wasn’t in labor. I had to have a lot of NSTs in the third trimester due to a bunch of complications that cropped up, and the morning boychik3 was born, I was getting a routine NST, the results were concerning, but still not an immediate emergency, however the doctor sent me to the hospital to be induced. I was admitted, hooked up to the monitor and IV, and the induction was ordered (as was the epidural, my second birth was unmedicated and that was sucks too) when the tracing went haywire and I began to bleed, so off to the OR it was. So it was a crash section, but I was not in labor either.

        • Jay

          That’s just it though, you DO have a choice. Any woman who wants a vaginal birth can have one, even if every doctor on earth tells her it’s too risky. She still has that choice.

          Those of us who want an elective c-section often do NOT have a choice. Doctors and hospitals can refuse to let us make this choice and can FORCE us into vaginal births. I can make any other choice about my vagina that I want, except the choice to completely avoid the risk of 3rd and 4th degree tears.

          • guest

            While I am for maternal-request c-sections, I am pretty sure there are other things doctors would refuse to do to your genitals in the US. Female circumcision comes to mind. It’s not unheard of to refuse to do a requested surgery (plastic surgeons occasionally need to, if they’re ethical). What needs to happen with the MRCS is moving it from the “crazy request” category to the “rational choice any woman should be allowed to make” category.

      • Daleth

        That’s such a sad story. How terrible for the family.

        While c-sections as well as operative deliveries are considered possible risk factors for amniotic fluid embolism (which is what that poor woman died of), to quote the Mayo Clinic, “It’s not clear… whether operative deliveries are true risk factors for amniotic fluid embolisms or are used after the condition develops to ensure a rapid delivery.”
        http://www.mayoclinic.org/diseases-conditions/amniotic-fluid-embolism/basics/risk-factors/con-20035462

        In other words amniotic fluid embolisms happen during otherwise uncomplicated vaginal labor too, and it’s not clear whether the reason that they occur more often in conjunction with CS/forceps/vacuum is because those procedures actually increase the risk, or just because when such embolisms happen those procedures are done to deliver the baby ASAP.

        Part of informed consent for surgery is including the risks of death, and people accept those risks.

        The crazy thing is doctors don’t have to get informed consent before attending a woman’s vaginal childbirth. They don’t have to tell her about the risks of tearing/pelvic floor damage, the risks of shoulder dystocia and other causes of oxygen deprivation for the fetus, or anything else.

    • guest

      I loved my c-section, but it was definitely major abdominal surgery. This was achingly evident when I tried to do a sun salutation 18 months after mine.

    • Azuran

      I think it just depends on your definition of ‘major’
      Any open abdominal surgery should be considered a major surgery by itself.
      Then you can probably have a scale for the severity of those abdominal surgery.
      An uneventful planned c-section is probably as minor as an open abdominal surgery can be. But it’s still abdominal surgery.

      Individual perception of the severity of the surgery can also be biased by your experience. I admit I don’t really consider c-section as major abdominal surgery because of my job. Cats and dogs generally recover super fast after a spay, we don’t even keep them over night where I work. When I do a c-section we even send the pet home as soon as they wake up (1-2 hours post-op) because keeping the newborns at the clinic overnight is a massive risk for their lives.
      I’ve looked at a video of a planned c-section on a human and I admit it looked like a walk in the park compared to an animal c-section.
      Even when I do what I consider major abdominal surgery, most pet will leave the hospital 24-48 hours after surgery. And most will be all jumpy and full of energy.
      I dunno, maybe humans are just wimpy :p

      • Irène Delse

        Maybe our anatomy sets us up for painful recovery? I mean, quadrupeds don’t have to support the weight of their upper body on their pelvis, so there’s one less issue with surgery in the lower abdomen. (Or maybe it’s irrelevant. I’m just thinking out loud.)

        • Azuran

          I guess standing upright is probably a huge part of the problem. I really have no idea.

    • Well…my first section certainly felt like major surgery. It took over 2 hours, involved an inverted T incision on my uterus and an extended incision on my skin. I lost a lot of blood. And my recovery was awful. Some people around me thought I was malingering because it was “just” a C section and (insert anecdote of someone else who handled it better than I was). I don’t share this to participate in the Birth Story Olympics, just to say that like others have noted, it’s tough to generalize.

      • An Actual Attorney

        Wow — that sounds really hard and probably scary.

        • It was rough. It took them a really long time to get the baby out and he was in pretty bad shape when they finally did. He went to NICU and they ultimately had to knock me out with Ketamine when my spinal started to wear off.

          • An Actual Attorney

            Daaam

      • Megan

        The circumstances surrounding and during the CS definitely help determine how bad the recovery is. My first CS, accompanied by a large PPH with an extended hysterotomy incision for my asynclitic OP baby after 4-5 days of attempted induction, was infinitely worse than my planned prelabor RCS with an OA baby. The first time around, my recovery took months and I too got the, “it was just a CS,” line. The second time, people were shocked at how quickly I was back to normal and thought I was exaggerating about how easy it was. (Seems you never have the “normal” recovery in some other people’s eyes.) CS recovery is never universally easy, nor is it universally difficult.

        • You’re exactly right. There’s just no way to generalize about it. Your first one sounds awful and I’m glad to hear your second was better. That’s how it was for me too — the second time was so much easier, for both me and baby, that it’s hard even to think of them as two iterations of the same procedure.

          • Megan

            My first was not fun but not as bad as yours. I’m glad be both got the better end of the deal the second time!

      • demodocus

        ouch. (understatement of the year?) My sister’s scars look like that, but they were two different surgeries 6 weeks apart. (c-section, followed by hysterectomy for the cancer they found at Nephew’s birth)

        • Ouch indeed! I hope your sister is doing well.

          • demodocus

            Well, she’s still around 9 years later, and she’s got a job. The cancer went into remission, came back, and is now in a holding pattern for the last year or two.

    • An Actual Attorney

      Although my boss (a 75 yo man) told me that he was back at work the day after all his kids were born and was asking my colleagues if they really thought I needed that maternity leave anyway. My office is on the opposite side of the floor from his, so I went back and started loudly venting to someone about how I was planning to have my abdomen cut open, then my uterus cut open, other gory details, sewed back up, and then I’d have a freaking baby to take care of.

    • Daleth

      YES! The only reason it’s “major surgery” is because technically any surgery that goes into the abdomen, chest or skull is called “major.” But there is a massive difference between a 20-30 minute operation done while a woman is wide awake and a four or six or ten-hour operation done under general anesthesia!

      If you want to talk about real major surgery, ask about my grandma’s hip replacement or comedian Tom Green’s retroperitoneal lymph node dissection (a 6 to 10-hour operation in which the bowels are removed and set aside so that doctors can locate and remove abdominal lymph nodes to which testicular cancer has spread).

      • Sarah

        My section felt fairly major, I must say. But then so did exiting a human from my vag.

      • BeatriceC

        I think this is another place where we have an insufficiency of terminology. A CS is major surgery macaques it involves cutting a fairly large incision into the abdomen and then another incision into a major organ. That’s a big deal. It’s routine and fairly quick so many people do fall into the trap of thinking it’s minor because it’s not like that 8 hour marathon where doctors rebuilt my son’s hip or other hours long procedures. I do think we’d be best severed by updating our language to reflect that who,e it’s still a big deal, it’s not as big of a deal as many other operations that are performed on people every day.

    • Sue

      I agree wholeheartedly!

      Cesarean section is much more invasive than laparoscopic surgery for a hernia repair.

      BUT – “major abdominal surgery” includes liver or bowel or kidney resection in critically ill people.

      Caesareans in healthy young(ish) women are nothing like the severity or complexity of those conditions.

      • Lisa Cybergirl

        Ugh, had open inguinal hernia surgery last week!

    • Anna

      But they are technically. I do get your point though, some people just seem to enjoy overdramatizing the procedure, making it sound as complicated as heart transplantation or whatever. Because of such morons I felt like a wreck for 6 months after mine scared to make a physical effort or lift anything cause I had just had “major surgery” until my Dr laughed out loud in my face saying there were practically no traces of it left.

  • Kelly

    OT: So last week we thought that my 8 month old had edema in her left leg. We were able to get into three doctor’s appointment within a week and it turns out she does have hemihypertrophy which is where one side of her body grows faster than the other side but hers is not bad. We are still having to get her tested every six weeks for certain tumors but the genetics doctor has never seen a case of cancer in a child who has what she called an idopathic hemihypertrophy. This doctors visit has made me feel so much better and they did not seem too worried and so I wasn’t either. Although as a sidenote, I was a disaster coming into the office. The only thing I was able to do right was to get there on time. I forgot all my paperwork and my phone, didn’t have any of the doctor’s names, and lost my driver’s license again. They even thought I was a first time mom. I have never been so embarrassed in my life.

    • BeatriceC

      Huge hugs. This might be overstepping but I do have a lot of experience keeping medical stuff for kids organized even when I’m falling apart. What kind of computing devices do you have? I have an iPhone 6s Plus, an iPad and a MacBook. I use apple products because of how easy it is to move information between devices. I keep a folder for each kid on the laptop. I bring my phone and iPad to all doctors appointments. I take pictures of everything. All test results, visit summaries, images, everything. I have my iPad out typing notes during office visits and use my phone to audio record what’s being said. When I get home I dump everything on the laptop to organize it, but if for some reason I can’t, it’s all still on the phone and iPad. I carry a purse big enough for the iPad so I can bring it with me to all appointments. I don’t have to remember anything, and that takes a lot of stress off my shoulders. Once a year I request copies of all medical records and a CD of all images. I go through those and make sure I haven’t missed anything throughout the year and update the folders accordingly. It’s so much easier to just grab my iPad and go than to have to remember paperwork or rely on my memory. And if I forget my iPad I have my phone and can access my files through my iCloud account, so that’s a good back up.

      Of course this is just what I do. You don’t have to go all apple all the time, but the point is that if you make friends with technology you can make your life a lot easier. I like apple for a variety of reasons, but I’m sure that android and Windows would allow you to do the same thing.

      • Kelly

        No you are not overstepping at all. I think this is a great idea. I do have androids but I do have an Amazon cloud I am sure I could upload to. This was also my first time dealing with all of this so any tips to help me not look like a fool are welcome. I always like to listen to what other people do and then take ideas.

        • BeatriceC

          My biggest thing is to record as much as possible. You *will* forget stuff. You will get a ton of information thrown at you at once and there will be stuff you forget or stuff you think you understand but then you get home and realize that you really didn’t. I ask any new doctors if they are ok with me recording them and tell them why. I’ve never been told no. The other big thing is find a way to keep yourself organized and stick with it. I’m lazy and forgetful. As we were fond of saying in grad school “mathematicians are the laziest people on the planet, but we are efficiently lazy”. This drives pretty much my entire organizational philosophy. The less I have to do and remember, the better.

          • Kelly

            I agree. Dealing with my kids while talking to a doctor also does not help. I have gotten better at asking the “dumb” questions to make sure I understand. I tend to stress out about the procedures of the visits than the visits themselves. I think having it on my phone or tablet with access to the cloud will help me have many options to get to my information as well. Although it would help if I would stop losing things like my driver’s license. This will be the second time in six months that I would have lost it. This would also help my husband because he gets more stressed out about this than I do.

          • BeatriceC

            Oh boy do I know that feeling. To be honest, it took me some time to settle in to the way I do things now. iPhones didn’t even exist when my kids were little. I learned some lessons the hard way and was lucky enough to have older, more experienced moms give me advise along the way. Forgive yourself for not doing everything perfectly. These days dealing with a medical crisis is old hat for me, and I just go into “that” mode. It was really always that way. Give yourself some time to figure it all out. And never hesitate to ask if you need help (rich coming from me, I know). I’m always around if you need to talk.

          • The Computer Ate My Nym

            Re forgetting stuff: One of the things I remember most vividly from my pediatrics rotation is medical school is the attending saying, “If you diagnose the child with something serious, you’re lucky if the parents remember the name of the condition after the visit is over. Be prepared to explain everything again the next visit and make the next visit soon.” It’s horrific to find out something is badly wrong with your child and it is expected that you won’t be absorbing much information after that.

    • demodocus

      *hugs* This kind of thing can make grandmothers a wreck

    • Chant de la Mer

      Glad to hear it was better than expected. I looked it up and was rather worried about you and your daughter. Thanks for the update and I hope things continue to be tumor free for her.

    • Amazed

      You shouldn’t feel embarrassed. You were a worried mother, that’s all. May good luck keep following your little one!

    • swbarnes2

      The thing I always figure about doctors is that they’ve seen worse. They probably have some story about a dad who forgot his pants or something like that.

    • The Computer Ate My Nym

      Meh, you got to the right office on time. Close enough. The paperwork can follow.

      Hope all is well with your little one!

    • An Actual Attorney

      I’m happy for you that it all seems manageable with your daughter. That is good news.

  • Actually, there’s a movement of people who advocate for eye exercises leading to “natural vision correction.” I won’t dignify them with a link, but it’s a thing that exists. My local natural foods co-op offers free classes in it.

    I’d be willing to give it a try, but find it unlikely they’d be able to help with the astigmatism I have on top of being nearsighted.

    • Kelly

      I wish it would actually work. I am quite blind and spend a lot of money on my vision.

      • Angie Young-Le

        Same here. I can only see clearly about 6-8″ in front of my face without glasses and my lenses (not including frames) can easily cost 700$. I really wish it would work.

        • Kelly

          I wear contacts all the time but it costs me $400 a year for the appointment and contacts. I am sad that I can’t even make out facial features without some kind of eye wear or read very well at all. My husband is also very blind but prefers glasses so that keeps down on costs. I am just waiting for our kids to start going blind starting in about fourth or fifth grade which was when we started having issues. I am a good candidate for lasik but I don’t have the money upfront to pay for it.

          • Dr Kitty

            In theory, you don’t need glasses, you just need a piece of paper with a pinhole you can look through.
            Much cheaper, more natural than those prescription lenses, and with none of the risks of lasers.

          • Kelly

            Ughh that sounds miserable.

          • MI Dawn

            OMG. I LOVE LOVE LOVE my lasik. I was blind as a bat (lying in bed couldn’t see the alarm clock 6 inches from my face). It’s been worth every penny saved in contacts, solutions, etc for the past 14 years. Since I’m getting older, I now use reading glasses – usually only at night, when my eyes are tired, or in dimly light restaurants – but the ability to open my eyes and see clearly is a miracle.

            We had younger daughter done at age 18 because she inherited her mother’s eyes. Knowing she could be in a strange room, wake up to a fire alarm and get out safely without worrying about glasses or contacts was a huge relief to her father and me. Now, 8 years later, she is noticing some changes that could be handled with repeat surgery (mostly night-driving related) but they aren’t bad enough to bother her so she’s not worrying about it yet.

          • Kelly

            I’ve got to save up for my breast reduction first and then it will be the eyes.

          • demodocus

            This I understand. 🙁 my boobs never shrank after weaning #1 THey started growing again when I got pregnant a solid year later.

          • Kelly

            Mine didn’t this time either but I think it is because I gained weight after the birth this time.

    • The Bofa on the Sofa

      The nonsense of “cupping” is old. Martin Gardner trashed it in Fads and Fallacies in the Name of Science published back in the 50s.

    • Irène Delse

      Natural vision correction? Speaking as someone who was nearsighted since childhood, and now needs progressive glasses thanks to age, I’m appalled. Bad vision can really incapacitate a person. I had started having trouble keeping up in school when I was diagnosed.

      The twist, here, is that eye exercise *is* appropriate therapy for some forms of eye problems, like strabismus. Looks like the quacks have hijacked the idea.

      • If I could slow down or stave off deterioration of my vision by doing this, I’d volunteer in a second. Yet I suspect I’d just be wasting time I could be spending lifting weights, or wanking on the Internet. Things I really enjoy.

    • Bombshellrisa

      Someone bought me the book about that. Glasses make your eye muscles weak, that is the whole problem according to the book.

      • Just like how interventions cause birth complications?

        • Bombshellrisa

          Exactly the same vein.

        • Azuran

          It’s all a scam by optometrist and Big Lenses.
          No one needs glasses, no one ever did.
          They just make it up to sell you glasses. It start with a weak prescription. Using the glasses will weaken your eyes so the next time they can sell you a stronger and more expensive prescription. And each time you go back they just keep making your eyes weaker and weaker so they can cash on you for the rest of you life.
          Wake up sheeple!

          • MI Dawn

            Blame it on Franklin, who supposedly invented bifocals. Obviously no one ever wore glasses before that…right?

          • Irène Delse

            Glasses for reading were already in use in Medieval Europe around 1300, starting with Italian scholars and monks. And the ancient Greeks and Romans experimented with rock crystal lenses as a way of seeing things bigger. The Arabs pursued that avenue of enquiry too and made important optical discoveries.

          • MI Dawn

            I know. I was kidding. Should have put a laugh emoticon in, I guess. 🙂

          • Irène Delse

            It’s all right, I’m always happy to give kudos to the Ancients whenever appropriate. 😉

    • Cartman36

      Shut the front door. LOL!!

  • BeatriceC

    I’d like to see a comparison of the rise of c-section rates to the drop in maternal and perinatal mortality and morbidity. I wonder how close to a “perfect” inverse slope those two lines would be.

  • Sarah

    Imagine if there were some reasons why we might be seeing more complications now than we did in the 70s…

    • Amy M

      Yeah, even though we have imperfect tech, its still better than what we had 40yrs ago. Now we can actually SEE the complications that we simply missed before u/s and genetic testing, among other things. Of course, we’ve all seen the CPM types advocate for less tech use, because if you don’t see it, it isn’t there, just like in the old days…wait, what?

    • Irène Delse

      Definitely. When I was born, in 1969, there was no ultrasounds and no fetal monitoring. Turns out I was a big baby, I got shoulder distocya and the nurses and OB had a tense few minutes before I could be delivered. Scared the heck out of my mother, too, especially since I was quite blue and the doctor had to give me oxygen with a mask that was made for adults (no infant-sized ones, I don’t know why). Luckily, I had no sequelae, but maybe today, my mother would be offered the choice to deliver by c-section due to macrosomia. As she needed an episiotomy for the dystocia, and had serious bleeding after that, I don’t think that facing surgery would have seemed so much more “major” to her.

  • AA

    In light of the discussion of induction at 39 weeks during American Congress of Obstetricians and Gynecologists 2016 Annual Clinical Meeting, the ARRIVE trial is very important as well.

    https://clinicaltrials.gov/ct2/show/NCT01990612

    I am not really surprised that recruitment is taking so long–the number of study centers is relatively small and the enrollment goal is high.

    2018 here we come…

    • Valerie

      I’m not sure if it was this clinical trial or something else, but my SIL was recruited for a study on induction at 39 weeks. She told me her insurance would not pay for one (unless it was medically indicated) before 41 weeks, so she declined to participate.

  • Mel

    I’m still trying to figure out how people decide a CS is “unnecessary” in hindsight when we know so little about direct markers for maternal and infant well-being in the hours and days after birth.

    As a medical consumer, I am not comfortable putting off a CS until the baby is moribund. I don’t want to vaginally deliver a baby who needs resus if a CS would have given a thriving screaming baby. I feel like both of these statements fit under the “No shit” level of obviousness, but I want to be sure everyone is on the same page – especially medical managers who might be tempted to reduce CS rates on the backs of infants.

    • FormerPhysicist

      My 3 children came out perfect. And I don’t consider any of their c/s deliveries to be unnecessary in retrospect.

      OT. Hooray for the LPN knowing when medicine is an art and not an exact algorithm. Oldest has moderate sore throat, swollen glands, pus-filled throat, lethargy … Daddy has strep. Strep going around the schools. Rapid culture was negative for strep. Well, okay, but she’s done this before where ‘there’s no strep” but two weeks later she has a scarlet fever rash. We got antibiotics. I’m usually good with watchful waiting, and I know antibiotics are useless for viruses … but strep just doesn’t present typically in this kid.

      • Mishimoo

        Hope she’s better soon! Strep is awful and weird presentations are so frustrating.

        • FormerPhysicist

          Now that she’s been on antibiotics for 20 hours, she’s totally chipper and only the tiniest bit of any symptoms. I <3 modern medicine.

          • Mishimoo

            Modern medicine is the best! So glad the antibiotics are working and she’s feeling better.

    • The Bofa on the Sofa

      It is logically impossible to say that a baby born successfully by c-section would not have had a problem without one. The only way to say that a c-section was not necessary is to not have a c-section and have it turn out ok.

      • Sue

        Even beyond that: the only way is to have a large number of people with the same indications for C/S (ie same concerning features) not have C/S and turn out OK.

    • Megan

      Exactly. I had my second CS not because my daughter was felt to be in immediate danger but because I had gestational hypertension and we wanted to get her out while we knew she was in good shape and risk was as low as possible for both parties. Had we waited or had I insisted on a VBAC it might have led to a bad outcome. My second CS was preventative medicine and that’s awesome!

      • CharlotteB

        When we were prepping for birth, both my husband and I came to the conclusion (despite the woo-filled birth class) that if the doctors/CNMs said that we might be looking at a C-section (either during labor or before) we’d just go for it, because there didn’t seem to be any point in waiting around to see if things got bad or worse. All the stuff I read suggested asking for more time, asking what the worst case was, etc, but we figured that there wouldn’t be any point in prolonging the wait.

        Didn’t matter in the end, but I was glad we were on the same page that way.

      • Fleur

        Quite. I don’t see why preventative medicine is only viewed as a bad thing in the context of birth. Back when I was pregnant and spending a lot of time lurking in pregnancy and childbirth forums, it used to scare the living daylights out of me how many women said they’d refuse a c-section unless it was absolutely necessary and, by “necessary”, they’d mean that the baby basically had to be dying before they’d consent. Their choice, of course, but I wonder if they have really taken in the fact that, if the gamble doesn’t pay off, the consequences are forever.

        • Megan

          No kidding. Even the day between my hospitalization for my escalating BP and my scheduled CS (which, in my doc’s defense, I asked for to get our house ready) , I worried about my daughter dying even though I knew it was a slim chance of that happening.

          • demodocus

            Definitely; I worry when i don’t feel kiddo moving for an hour or so. Even if i’m distracted by something else. (Plus, I suspect she takes longish naps for a 36 week fetus)

  • Madtowngirl

    I think it would be awesome to improve technology and postpartum care, regardless of the impact on c-section rates. And the instant my baby was determined to be breech, I consented to a c-section. Turned out, she was jammed in my ribcage, so it was necessary. But was not interested in putting her at risk because it “might” be unnecessary. I’m happy to put myself at higher risk, rather than play roulette with my baby’s life.

    • Glia

      I feel exactly the same way. I’ve been asked if I wish I had the option of a vaginal breech birth, and I said I would not have taken it if I did, because the risks to me with a section were mostly either things that could be fixed, or risks to hypothetical future pregnancies I didn’t even know if I would want. The risks to my baby were neurological damage and death. I was unhappy about it at first, but never conflicted.

      I am happy that there has recently been more talk of making c-sections better for moms, and not just a focus on eliminating as many of them as possible. Sometimes I feel like NCB advocates WANT c-sections to be horrible. Certainly, the NCB pushers only tried to make me feel worse about it. It was my medical team that helped make my section actually turn out to be wonderful (and it really was a great experience). Of course, I would still rather have a terrible c-section over a damaged baby, but the fact of the matter is, my OB cared a lot about trying to leave me with a positive experience as well as a healthy baby. NCB told me to do things that might risk the latter in favor of the former.

      • Kelly

        Have you seen this article about “natural” c-section. http://www.telegraph.co.uk/news/2016/05/19/new-natural-caesarean-procedure-allows-baby-to-deliver-itself/ It seems like a new option if a person is the right candidate.

        • Erin

          I don’t know if it’s me (am currently having a slight battle of wills with the hospital to agree to a general anesthetic in writing rather than essentially patting me on the head and telling me I want to see my next child be surgically removed and then holding them whilst they’re covered in my blood) but that’s pretty much my idea of a nightmare.

          Brilliant if you want it, just like rooming in and all the other stuff “Baby Friendly” brings with it but horrific if you don’t.

          • MaineJen

            I’m in the “no thanks” camp as well, just because of the general squik-factor. I don’t do well with watching invasive procedures.

          • Erin

            The sad thing for me is that I would have loved that with my son, well probably not the crawling out as that’s too Aliensesque (had I been in a condition to have it) but now I’d rather pull my own finger nails out.

          • AnnaPDE

            You don’t see the incision (for me unfortunately, for most people luckily), but I hope you get your GA if you want it! Also, baby can do all the crawlies with the screen up, get wiped down at the paed’s table in the corner, and then get to you nice and clean to snuggle and distract you from the 20min of sewing up, if it’s just the view you mind, and not the knowledge of being cut up.
            The anaesthetist offered to put me under just because I was talking a bit fast before the procedure, so it’s apparently not that rare that elective GA happens.

          • Anna

            You needn’t even be under GA to not witness your own surgery. I wasn’t very happy about witnessing myself being cut open so I had a spinal + this thing called sedation which is something similar to GA but not so “heavy” and without the aftereffects of GA. If I were to have another c-section I would definitely be having it that way again cause to me it’s the best of both worlds. I slept throughout the surgery having funny dreams and I woke up without the nausea and chills which typically occurs after GA. Yes, I didn’t get to see my daughter right away but my mental health counts more than that.

        • Irène Delse

          It sounds… interesting. Although I don’t see the benefit in slowing down the removable of the baby from the uterus. “Letting baby come out naturally, mimicking a normal birth”? This, to me, looks like a recipe for tears and infections. And I’m not even a doctor.
          Apart from that, there’s the skin to skin contact that can benefit many women, but that can be done anyway. In fact, I think I read here about someone having a very relaxed c-section and getting to have the baby on her immediately? Looks like someone has rebranded contemporary practices for CS under the label “natural”.

          • Glia

            I don’t know if it was my story you read that with, but that is quite similar to what I had. Very calm and sweet, my partner took pictures over the drapes, I had the baby on my chest for the rest of my surgery. I even nursed him on the operating table. I had wanted to hold him and feed him right away originally (before I knew he was breech), being able to do so even though I had a c-section helped me feel better about the c-section more than I would have expected.

            I don’t think I would want what the link is calling “a natural c-section” though. I read another article about it where doctors were discussing some of the down sides. The big one is it means you leave mom open longer, so increased risks for infection and blood loss. Also, mom has to scrub in, same as the doctors, and for me, I really wanted skin to skin right away, which seems like it would be harder that way.

          • Dr Kitty

            My two were lifted straight out of my abdomen and into my arms for a cuddle and the drapes were lowered so I could see them being delivered (my husband got photos). It’s pretty much NHS SOP for elective CS with nice pink babies, and I enjoyed it, but they did check that it was what we wanted- no one forced it on us. Well, I burst into tears as soon as I saw them both, but it was lovely.
            No delayed cord clamping or pulling them out slowly though.

            The US seems to have a thing about restraining patients on operating tables which just doesn’t happen here.

          • An Actual Attorney

            My cs was 11 weeks ago. My arms weren’t restrained, but they didn’t lower the curtain. Actual Baby went to be checked at the side of the room (she was preemie) and then handed to me still in the or. I know she wasn’t bathed for a day or so because her temp and blood sugar wouldn’t stabilize, not for the bonding. But, you know, she was a preemie with potential zika exposure, so all I cared about was healthy.

          • Azuran

            I didn’t know they restrained patients. But honestly that wouldn’t surprise me or really shock me. You can imagine the things they probably saw happening in OR over the years. They probably at least once had someone who started really freaking out and threw herself on the ground with her abdomen open to get away. Or someone who tried to grab her baby and caused a loss of sterility or hurt herself or the baby by pulling on it.

          • Megan

            Things may be changing as far as CS go at least. I was restrained the first time but not the second. (Of course, the first time I was a complete mess after a prolonged induction attempt.)

          • guest

            I wasn’t restrained for my c-section, although they did have my lay my arms out wide and perhaps if I had not cooperated they would have.

            I didn’t get the immediate cuddle or even an immediate viewing of the babies, which was disappointing, but it was an urgent, unplanned section.

          • Old Lady

            My twins had almost immediate ‘skin to skin’ (well, they had to take turns) with their father. This seems like a bad idea that offers no benefit other than superficially appearing more similar to birth. The experience for my Caesarian was very calm and I was much more present than I was for my VBAC where I was exhausted and in pain.

          • AnnaPDE

            Check out the work of Nicholas Fisk (obstetrics prof at UQ). Luckily we don’t have to rely on how safe this procedure sounds to a non-doctor because he’s done studies about it,and found that the minute or so extra time makes no difference when it’s not an emergency.

        • Megan

          Its also sometimes referred to as a family centered CS. Only done for non-emergent CS. Usually includes mom being able to see baby delivered if she desires, delayed cord clamping, skin to skin and first breastfeed in the OR and not separating mom and baby unless necessary.

          • Kelly

            I have heard of those but not where they allow the baby to push its way out. I thought it was interesting idea to help mothers feel involved the way they wanted or envisioned.

          • Megan

            Yeah that is a newer thing I think. I had a family centered CS but they had to extract my daughter so she didn’t work her own way out. I think my pelvis is just not all that forgiving.

        • KeeperOfTheBooks

          I had a family-centered/”gentle” CS. I didn’t want to see her born (wouldn’t mind watching someone else’s, but couldn’t watch my own CS), and didn’t care about cord clamping one way or the other. The baby getting themselves out would have squicked me pretty badly.
          In my case, it was baby on my chest within a minute or two (I also don’t care to have a goopy baby on me) and nursing/snuggles from there on out. Absolutely lovely, and would adore doing so again. Of course, it wasn’t an emergency situation, either.

        • AnnaPDE

          I had one, it’s great. (We skipped the slow head-out bit because kid’s head was nicely stuck in my pelvis and needed forceps to guide it out.) My OB was very clear about how she prioritises this nice kind of stuff waaaay behind safety, but when it’s safe she wants to make it nice for all involved. Luckily the guy who studied safety with this method (N. Fisk) is a Prof at our local uni, so there’s also advice and training on hand.
          But even if you want a bog standard CS, you don’t get strapped, restrained or anything around here.

          • Kelly

            That is awesome, I didn’t realize that it wasn’t a brand new thing. I like how they are giving woman those moments whenever possible. I would think that this would work against the vaginal birth only crowd though because doctors are giving woman more choices to have those moments with their baby even with a c-section.

          • AnnaPDE

            Haha, yes, it does rile them up quite a bit. Just google “maternal assisted caesarean Wesley” and you’ll find my OB’s Facebook page. The comments she got for one of these procedures that she posted pics of were nicely split into a few categories: “how cool for the mum”, “ick! I couldn’t do it!”, “why isn’t she/dad wearing a cap?” and a bunch of Brooke-like people going “oh noes, this makes the mum an active happy participant, which will make C-sections more popular, therefore it’s bad!” — funny how suddenly the oh so important benefits for the baby of skin to skin, delayed clamping and starting to breathe while still attached become irrelevant the moment he/she can have them during a CS…
            We were chatting and joking about exactly this effect during my CS, and about how much effort it takes to answer patiently and professionally to this kind of crap.