Medicalization of childbirth is the best thing that ever happened to women!

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There have been many great moments in women’s history. The invention of the Pill is near the top of the list, simultaneously allowing women to control their own bodies and saving millions of lives. Acquiring the right to vote and laws against gender discrimination are near the top, too.

Yet almost nothing else in medicine has saved lives on the scale that obstetrics has.

Childbirth in nature killed as many women as breast cancer kills today.

Those aren’t my words. They were written by Dr. Atul Gawande describing the history of the Apgar score in a famous piece in The New Yorker.

In certain circles it has become fashionable to denounce the medicalization of childbirth, but the truth is that the medicalization of childbirth is the best thing that ever happened to women.

The maternal mortality rate prior to the advent of modern obstetrics was approximately 1%. If that were still true, 40,000 women would die each year in childbirth (instead of less than 1000). That’s almost exactly the same number of women who die of breast cancer each year.

Think about that: Childbirth is nature killed as many women as breast cancer does today. And it’s far more dangerous for babies!

For most of human existence, midwives cared for women in childbirth, and for most of human existence, the grim death toll did not budge.

Obstetricians took a different approach.

As Gawande explained:

In obstetrics, meanwhile, if a strategy seemed worth trying doctors did not wait for research trials to tell them if it was all right. They just went ahead and tried it, then looked to see if results improved… But the package as a whole has made child delivery demonstrably safer and safer, and it has done so despite the increasing age, obesity, and consequent health problems of pregnant mothers.

Given that it saves so many lives, who would argue against the medicalization of childbirth?

The answer: midwives, who have been out competed by the life-saving advances of obstetrics. They have demonized those advances because they can’t provide them; it’s simple economics.

But it’s hardly persuasive for midwives to frame the issue as “Pay us even though we can’t prevent you from dying.” So in keeping with Marketing 101, they reframed the problem. Just as advertisers routinely promote their products by implying that they will improve your life experiences, midwives promote unmedicated vaginal birth as “Pay us because we will provide you with a better experience.” Over the years they’ve embroidered their marketing philosophy with claims that unmedicated vaginal birth is healthier, safer and superior to medicalized childbirth, though there’s no evidence for these claims.

That’s not to say that modern obstetrics is perfect. Far from it! But the central defect in obstetrics is NOT medicalization but paternalism. It isn’t the life-saving technologies; it’s the conceit that doctors should make choices for women instead of women themselves.

It’s not a coincidence that the heyday of medical paternalism, the 1950’s and 1960’s, was a time of increasing popularity for the philosophy of natural childbirth. Doctors had decided every detail of childbirth instead of leaving those decisions to women themselves. The original goals of the natural childbirth movement were quite laudable: being awake for birth, having a support person present, ending useless procedures like routine perineal shaving and enemas. That’s what midwives and natural childbirth advocates offered and women wanted it.

Those goals were achieved decades ago. Epidural anesthesia allows women to be awake and aware for childbirth AND pain-free. You can bring whomever you want to support you in labor. Routine perineal shaving and enemas went out with giant shoulder pads. Today, if you are looking for the safest, most comfortable, easiest childbirth, modern obstetrics is the obvious choice.

To compete, therefore, midwives have to convince you that you don’t want that; you are supposed to want to experience pain, want to dispense with technology that improves safety, and want to empower yourself through suffering. That’s why they decry medicalization, one of the two greatest achievements of women’s health of all time (along with the Pill).

But the dirty little secret of contemporary natural childbirth advocacy is this: women can’t reclaim their agency from doctors by giving it to midwives. That’s just a different form of paternalism.

Here’s what childbirth would look like if midwives and natural childbirth advocates were not so paternalistic:

  • All possible choices would be represented because women have a broad spectrum of needs and desires.
  • Medicalization would not be demonized; it would be lauded as life-saving.
  • Birth plans would just as readily include maternal request C-sections as unmedicated vaginal births.
  • Pain relief would have a prominent place in birth plans since most women want pain relief.
  • No form of childbirth would be represented as better or more empowering than any other.

But that’s not what contemporary midwifery and natural childbirth advocacy look like. Why not? Because both are shaped by the economic needs of midwives and other birth workers and NOT by the needs of women.

Medicalization of childbirth is the best thing that ever happened to women. We ought to be very wary of those who demonize medicalization in order to improve their bottom line at the expense of women’s health and safety.

  • itry2brational

    Who can be credited with medicalizing child birth? Probably a man. “The invention of the Pill is near the top of the list.” A man.
    “Medicalization of childbirth is the best thing that ever happened to women. We ought to be very wary of those who demonize medicalization in order to improve their bottom line at the expense of women’s health and safety.”
    In that case…
    Men are the best thing that ever happened to women. We ought to be very wary of those who demonize men in order to improve their bottom line at the expense of women’s health and safety.

    • Amy Tuteur, MD

      No doubt women would have discovered medicalization of childbirth and The Pill much earlier if men hasn’t prevented them from attending universities and getting medical degrees. Stupid men!

      • itry2brational

        Faith requires no doubt, and you are most certainly a faithful believer! What can be asserted without evidence can be dismissed without evidence. One could poke so many holes into this fantastical narrative there’d be nothing left of it. No doubt you believe women can do everything better than men.
        Yeah, what’s with these “stupid men” and inventing concepts like liberty, democracy, voting rights, civil rights and then offering their lives up to defend them. What a raw deal. We should all feel a collective pity for the poor womenz. :(**

        • Nick Sanders

          What can be asserted without evidence can be dismissed without evidence.

          Well, in that case, I’m dismissing your claims that it was “probably a man” that medicalized birth, that Dr. Tuteur believe[s] women can do everything better than men, and for good measure that men invented liberty, democracy, voting rights, civil rights.

        • TheArtistFormerlyKnownAsYoya

          Indeed, there is certainly no evidence that men have ever prevented women from attending university!

    • Nick Sanders

      We ought to be very wary of those who demonize men in order to improve their bottom line at the expense of women’s health and safety.

      Well, if we see any of that going on around here, we’ll make sure to tell you first.

      • Azuran

        Someone must have mentioned circumcision somewhere in the comments and the MRA came running.

        • Nick Sanders

          Is that it? I thought it was just that there was mention of something good for women, which can’t possibly be left without “But what about men?”.

    • guest

      HA HA HAHA HA HA HA. Hoo boy, I needed that laugh.

    • Azuran

      And all those people where also probably white. Black people also live a better life now thanks to all the inventions of those white people. So white people are the best thing that ever happened to black people.

    • Irène Delse

      Only men? Tell that to Angelique du Coudray, midwife and midwife instructor in 18th century France, who taught obstetrics at the faculty of medicine in Paris, not only to midwives but also by physicians and surgeons. She wrote an influential textbook, and also invented a life-size obstetrical mannequin to give her trainees some practical experience. Finally, because she traveled in the whole country to teach best practices to rural midwives, she’s believed to have been instrumental in reducing perinatal and maternal mortality during that time.

    • The Computer Ate My Nym

      Um…yeah, about the birth control pill. It was invented by a man–after he was persuaded by a woman, Margaret Sanger, to work on the problem and bankrolled by another woman, Katherine McCormick. Yep, definitely a male conspiracy.

    • DirtyOldTown

      You mean like early c-section pioneer Dr. James Barry?

  • MB

    I’ve searched for a really long time for the right outlet for my feelings about my birth story. I finally found this website. No one on the Bump wants to hear about why I think midwives are bad. Or on Babycenter. People just don’t really like what I have to say, I don’t fit in with all that mainstream natural childbirth ideology. I mean, I believed it too, for a really long time.

    My story does NOT involve death. In fact, it’s pretty mild. But it’s really bothered me for a year now, and I feel that I have to tell it. Maybe this isn’t the right forum. I understand that. But in the end, it feels good to tell someone what I’m feeling.

    I think my anger has as much to do with incompetence as it it has to do with the fact that I was lied to. Midwives are much more bullies than doctors are. Doctors have no reason to bully! If birth isn’t working one way, do it another way, the only goal is to have two healthy patients at the end of the day, right? Well, that’s not the only goal for a midwife: they have an agenda. There’s a right way and a wrong way to “do” childbirth. I didn’t know that when I chose a midwife the act of childbirth is this horrible politicized thing to them. You wouldn’t allow a politician to deliver your baby, would you? Or a clergyman? If, say, Donald Trump was given some training in delivering babies, would you allow him to deliver yours? Heck no! And if a birth happens to go so wrong that even they must finally admit intervention is necessary, they can’t even perform the emergency life-saving procedures anyway.

    I guess in the end, I felt that the midwives that delivered my baby “normalized” risks they shouldn’t have, including gestational diabetes and a LGA baby. They allowed me labor for 28 hours after my water broke. I feel that the trauma of the long birth (due to his 9 lb size) coupled with completely un-monitored “borderline” gestational diabetes caused my baby to be born hypoglycemic. THANK GOD we at least chose to have our baby in a hospital. No midwife would have been able to identify that in our baby. He was sleepy and would not rouse to feed, but otherwise seemed completely healthy. The doctor knew better. Little Scotty spent three days hooked up to an IV drip providing him with glucose. I know now that undiagnosed and severe enough, it can cause brain damage or death. Our baby is completely healthy thanks to the doctor on call that recognized the warning signs.

    Midwives treated me like a barn animal during my labor. The last thing I expected was to be treated without a single degree of respect. I thought midwives treated you the opposite. But my birth was not going according to her plan, it was taking too long, I was suffering too much, and so she treated me like a barn animal. We are not barn animals. I’d like to bring the humanism back to human childbirth. When it comes to childbirth, the laws of Darwinism do not apply to us! As humans our massive brains and immense intelligence has allowed us to evolve our processes and our environments so we don’t have to wait for millions of deaths and thousands of years for our bodies to catch up.

    My next baby will be a c-section baby at 39 weeks (if I make it that long). My water broke spontaneously at 38 weeks exactly w/ the first (dating scan, so dates were quite accurate). The Bump forums would balk and faint. But I won’t put another baby at risk like I did the first. The Natural Childbirth Movement came out of this need to CHOOSE and a mother’s right to know what’s right. Well guess what, I’m CHOOSING c-section.

    And if you don’t like it, well, I guess you can go fuck yourself. MY CHOICE!

    • Azuran

      I do believe you’ve found the right place.
      Sorry your birth was so bad. And no, you don’t need to have a dead baby for your experience to have meaning or be worth sharing.

      I do hope next time that you have a provider who is willing to give you all the available options and info, and be able to work with you all the way and reevaluate the plan as need be with your baby and your best interest in mind.

    • Melaniexxxx

      I’m sorry you weren’t respected and your wellbeing and that of your wee one wasn’t the midwife’s priority! It’s unacceptable for care providers to let their ‘politics’ take precedence but unfortunately that seems to be the NCB thang through and through 🙁

      Good on you for figuring out what you feel wasn’t right, and what you want next time! I think its hard to tease out these things, especially when we have been sold a bunch of lies for so long about natural, midwife only birth being “best”

    • T.

      Hi, MB. Welcome here, you have indeed found the right place.
      I am sorry for your horrid experience. Nobody should be treated like you were.

    • MaineJen

      Welcome! I love your story. I avoided midwives because I didn’t want to be talked out of doing what was best. Like you, my water broke early, and I’m sure a midwife would have tried to talk me out of augmentation/induction. NOPE, I’m interested in safety. I also didn’t want to be talked out of pain relief, or barked at for vocalizing in the wrong way or pushing in the wrong way or whatever. I loved my doctors and nurses.

      And WTH is up with ignoring gestational diabetes? You’re right, that’s incredibly dangerous. Thank goodness you were in the hospital.

    • The Bofa on the Sofa

      Midwives are much more bullies than doctors are. Doctors have no reason to bully! If birth isn’t working one way, do it another way, the only goal is to have two healthy patients at the end of the day, right?

      This is an interesting insight. Yes, midwives put all these value judgements on birth. They’re the ones who say that “your body isn’t broken.” But who ever said it was? Who are the ones telling women that having a c-section means your body is broken? Certainly not doctors. In fact, while midwives are the ones who ignore problems (including GD) as “variations of normal,” doctors will take it even more. To doctors, a c-section is perfectly normal. It’s one of those things that happens, and it’s perfectly normal that some babies are best born by a c-section. It doesn’t mean anything broken. It just is.

    • guest

      I am sorry your midwives treated you so badly. There are some who aren’t like that – I got lucky and had a great set of CNMs. But when I chose them, I didn’t know about all the awful ones out there. It was pure luck that I found the good ones. That isn’t right – we should know what we’re getting into.

    • yentavegan

      Your birth story is welcomed here. You are not the first to be bamboozled by the slick marketing of midwives. Tell your story to others to spare them the humiliation and danger your agenda driven midwives put you through.

    • TheArtistFormerlyKnownAsYoya

      I’m sorry you weren’t able to find a friendly community on places like The Bump or BabyCenter. I expressed that I might have a c-section (didn’t even specify it would be maternal request) on BabyCenter and was jumped upon by many there. Told it shouldn’t be covered, told it wasn’t “necessary” (again, didn’t even say it would be MRCS!). I’m pregnant and on there currently and another poster expressed that she is afraid of childbirth. Every single poster that replied proceeded to gaslight her, telling her that her fears are totally irrational and our bodies are “designed” to birth babies, and that she needs to read Ina May Gaskin. I wanted to jump in and tell her she has every right to be afraid and that her feelings are legitimate, that yes childbirth may be painful and scary, but was too afraid after my last experience. Part of me feels like people like us should speak up, add our voices to the seemingly monolithic forces, but sometimes it’s just too emotionally taxing 🙁

      • Kris

        Ah, designed. Yes. We are also “designed” for postpartum hemorrhage, infection, maternal and fetal death.

    • Kris

      I’ve been a doula for fifteen years, and I’m amazed at this crap. It’s your body, and if you choose to have a cesarean, guess what? Your body. You are in charge of it. I’m sorry you were treated like garbage by your midwives. I’m sorry birth has become such a ridiculous tug-of-war. I’m sorry so many people have demonized medical interventions (why? They are amazing).
      I’m really glad you and your baby are okay. I’m glad you didn’t get an infection from laboring so long after ROM. And I wish you a happy and successful surgical birth with your next baby.

  • BeatriceC

    Back on my “here’s my definition of empowerment” rant: I mentioned the other day that one of the things that makes me feel empowered is being able to repair things around the house without relying on anybody. Between that and the fact that I really just want to show off, I’m going to brag a bit about my latest project. A week and a half ago I leaned against the wall behind the toilet in the first floor bathroom and a chunk of it gave way. Upon inspection it was obvious that a huge chunk of wall was water damaged. I sighed, went to the home improvement store and bought the necessary supplies, then dug out my power tools (and bought one more I’ve been wanting for a while), and set to work. After I cut out the damaged part I realized that to make the repair look nice, I was pretty much going to have to strip the hideous wallpaper and repaint the whole darned thing, including the ceiling, door trim and window trim. In order to save money I used the paint left over from when I did the kitchen a while back, but opposite (kitchen is green with orange accents, bathroom is orange with green accents.) Half way through this project a bird fractured my forearm, and of course it was on my dominant hand, so I finished the project left handed. I did most of it by myself. I got one of my kids to help me take down and rehang the huge mirror, but other than that, it was all me. I’m ridiculously proud of myself and extremely pleased with the results. The first picture is of the giant hole I cut and shows the hideous wallpaper. The second is roughly the same angle. I wish I could get a single, good picture of the whole bathroom, but it’s long and skinny, so that’s impossible.

    http://i301.photobucket.com/albums/nn67/mmsw1/Mobile%20Uploads/IMG_2091_zps5eccmnjn.jpg

    http://i301.photobucket.com/albums/nn67/mmsw1/Mobile%20Uploads/IMG_2120_zpszodnfims.jpg

    • Dr Kitty

      Great job! Looks lovely.
      How is MK doing?

      • BeatriceC

        He’s doing slightly better. The meds the doc prescribed are helping a little bit, but not solving everything. He’s even gained a little weight, which is great.

        • The Computer Ate My Nym

          Did you get a diagnosis when I wasn’t paying attention? Glad he’s doing better, wish things were getting better faster!

          • BeatriceC

            No diagnosis, but they started him on a medication that helps his stomach empty faster and that seems to help somewhat.

    • T.

      Whoa you ARE good at this! The painting looks perfect!

      • BeatriceC

        Thanks. The painting isn’t quite perfect, but it’ll do. There’s some small spots here and there where I got the ceiling with the wall color, but they’re easy to overlook if you’re not looking for them.

    • Mishimoo

      That looks great!

    • MI Dawn

      That looks GREAT! Good job. My skills aren’t quite that good, but I can tile, paint and do some minor repairs with the best of them.

      • BeatriceC

        I grew up working on my parents’ rental houses when tenants moved out or broke things, or got destroyed in hurricanes (most notably Andrew). These are nice skills to have. I complained bitterly growing up, but now that I’m an adult, I’m grateful.

        ETA: Next project is the third floor non-master bathroom. The walls are all in good shape behind the hideous wallpaper (we have hideous wallpaper in a few places), but I have to rip out the shower tile to fix the plumbing in the shower. Since there’s no way I’m going to match 50 year old tile, I will need to rip out of of the shower enclosure tile. Since I’m going that far, I might as well get rid of the hideous wallpaper and paint. I just wish I had an excuse to rip up the floors. The goal is to get this done by the end of July, but I need to let my arm heal.

  • Inmara

    Hospital room where I gave birth was small, rather uncomfortable for moving around and packed with various medical equipment. You know how I felt there? SAFE, because I knew that there is everything necessary to help me or baby if things went south, and OR is down the hall.

    • Mishimoo

      Exactly! The room I was in for the birth of my eldest was right next to the OR just in case it became an emergent situation and it made me feel so much less anxious.

  • Amy

    Probably not a coincidence that there’s a big overlap between those who eschew modern obstetrics and those who claim the Pill is evil.

    • Fleur

      I know the Pill isn’t for everyone (it didn’t suit me) and it can have some really unpleasant side effects, but the level of scaremongering around it is ridiculous. I suggested to a friend that she could discuss with her GP whether the Pill might be a suitable option for her, because she needed both a new contraceptive option and something to help with severe, life-limiting menstrual pain. She said it wasn’t even an option because the Pill is so dangerous. Yet she was happy to carry on taking large quantities of ibuprofen to manage her period pain every month, despite the fact that her doctor had advised her that she needed to stop right away because she had ulcers (not to mention gastric pain so bad that she was regularly doubled over with it). Seems to me that, every time something gets invented that makes some (emphasis on “some”) women’s lives easier, it automatically gets demonised and women are told that they’re silly bimbos risking their lives for mere convenience. Medicalised childbirth, the Pill… I’ve even met women who’ve been led to believe that tampons are “far too dangerous” because of a tiny number of TSS cases a year.

      • Anna

        Yes, this mongering is frustrating. I always want to tell people who demonize c-sections, epidurals, the Pill beyond belief just this: “Stop driving cars and flying airplanes. This is dangerous, you know.”

        • I don’t have the figures to hand, but it’s more dangerous to get pregnant than tp take the Pill.

      • Azuran

        I’ve had a friend who wouldn’t use tampons because she thought it would make her lose her virginity. A stupid reason, but hey, anyone is free to use whatever they want. However, her constant complaints about how menstrual pads are horrible kinda made it really annoying.
        She also complained a lot about menstrual pains and weakness from anemia due to heavy bleeding, making her miss school and work often, but wouldn’t take the pills because she didn’t want to fuck up her body with ‘fake hormones’.
        (and then wouldn’t take painkiller because you need to take them with food, and she wasn’t hungry in the morning, yea, she’s quite a number)

        Eventually she got on the pill when she got a boyfriend. She’s now taking it continuously and regretting her teenage stupidity over the matter.

        • guest

          Did she also never have a pelvic exam because it would be losing her virginity? I mean, virginity is a made-up concept anyway, so you can define it however you like, but there seems to be a lack of consistency there.

  • Old Lady

    Medicalization likely saved my breech twins and me from injury or death. It also likely saved my third from infection because they were able to induce after my waters broke and I didn’t start contractions on my own. I am very grateful for my healthy babies because of modern obstetrics.

  • Megan

    OT: I think it was Heidi who asked about weaning off the bottle at night when there is a lot of volume being consumed as nighttime calories. I happened upon this link while looking for on this website and thought it might be useful. Wanted to post it in the original convo but can’t find which post it was in, so I’ll post it here and hope you see it.

    http://drcraigcanapari.com/learned-hunger-nighttime-feeding-stop-night-feeding/

  • BeatriceC

    The whole “if you suffer terribly and your body actually works that means you’re empowered” bit drives me bat shit crazy. That’s not empowerment. It’s just not.

    • The Computer Ate My Nym

      Of course, “you suffer terribly and your body works” could also describe a number of other situations, such as recovering from the flu or surviving puberty that are rarely described as “empowering”. And you have about as much control over whether you can give birth without aid as you do over whether you can produce interferon when needed or whether you get acne as a teen.

  • MaineJen

    “…you are supposed to want to experience pain, want to dispense with technology that improves safety, and want to empower yourself through suffering.”

    Exactly. This was confusing and distressing to me when I was pregnant for the first time. I wasn’t “supposed” to want pain relief, I was “supposed” to want intermittent monitoring because…reasons. It didn’t make sense…because it was BS.

    • Azuran

      I guess I’m supposed to stop taking painkillers when I have my period. Cramps are empowering!

      • AnnaPDE

        Oh, totally. Just ask my grandma.
        When I went to the doctor because of difficulties in getting pregnant, he suggested checking for endometriosis due to my very heavy and painful periods, and booked me in for a laparoscopy. I told my grandma, and she basically mocked me for being a “kids today” kind of weak-ass, after all she passed the same cherry and walnut sized clots with lots of pain for decades, and was fine just taking a paracetamol occasionally. Then she went on to mock my (other parent’s side) aunt, who would vomit and pass out from period pain in younger years. Turns out I had medium-grade endometriosis, and fell pregnant the first cycle after it was removed.
        Imagine granny’s surprise when I told her that this kind of stuff does run in families, and maybe she and my aunt both had endo too. After all she’d had a bit of trouble falling pregnant with my mum, and my aunt ended up having adoptive kids. But hey, let’s just suffer and not even try to do anything against it, everything else is decadent, right?

        • Sullivan ThePoop

          I had vomiting and passing out from severe period pain when I was young. I did not have endometriosis. They never actually found out why. I got pregnant young and never had bad cramps again.

          • Inmara

            I have always had painful and heavy periods (without endometriosis or other visible health issues, I had no problems conceiving); it could run in family because my mother and maternal grandmother had too. For grandma it was especially hard, she completely shut down a few days every month because of heavy bleeding and debilitating pain. Once in my early 20s I started to take ibuprofen for the worst days so I could work and otherwise function. After birth, my period is somehow shorter but first days are still painful – last time I missed the wearing out of first ibuprofen and finally got to know how it is that you want to vomit due to pain, it was not so bad even during labor!

        • Who?

          To be fair to Grandma, there probably wasn’t that much to be done back then. And ‘normal’ is a wide designation, wider still when the alternative is, well, nothing, or at best tea and sympathy.

          Mum (late 70’s) does this thing where she says something horrible is ‘normal’ and I say ‘who cares?’. If it’s normal but horrible and and could be made better, I’ll take better, thanks all the same. Stoicism was the only alternative to incessant complaint back in the day, and for many is a habit. Unfortunately it can feel judgy from our end.

  • demodocus

    I like my ob; even when he sent me down to the shrinks’ it was “Will you go?” with worry in his voice. He’s never been the least condescending.

    • Tori

      That warms my heart, mine was the same. Even in labour everything was discussed with kindness and humility. I felt in very safe hands.

  • Jennifer

    Sorry this is a bit OT but I always wanted c section on demand. My ob gyn talked me out of it (yes an MD didn’t want a c section shocking to some people). Anyway she was absolutely convinced I would have a simple vaginal birth and I did. It was so easy! I know this is not the case for everyone but she explained based on my baby size and position (he was 7 lbs and very low) and physical condition (tall, very athletic ) my only problem may be the baby would come too quickly and my labor was super fast and painless (had epidural ). But this is what I wonder: was she “paternalistic?” Before I talked to her I was 100% wanting c section but she was so convinced and obviously more educated than me I gave in. I’m glad I did because recovery was nothing. I didn’t take more than a couple motrin. I see what you are saying about giving a choice but I feel like if she didn’t steer me one way I would have a scar and longer recovery. On the other hand she did an episiotomy that I think was unnecessary because pushing was only 20 minutes. The baby s heart rate dipped so she didn’t want to take chances. I know this is all anecdotal but I feel like as a patient it is hard because I want autonomy and choice but at the end of the day I have to admit I know nothing compared to an MD. I guess you need a provider you can trust.

    • Azuran

      It’s totally ok for a doctor to recommend one choice more than the other. That’s what they are there for and they do know more than us about medecine.
      So yea, if she has all indications that you were most likely to have a very easy vaginal delivery, of course it’s her job to properly inform you of what she thinks is best for you (same thing with doctors who will strongly recommend c-section for other cases) Why would you need a doctor if he wasn’t going to tell you his honest medical opinion or if you decide not to listen to it.
      But the important thing is that in the end, it’s still your choice.

      And medicine is not like math, where everything follow rules and equation. It’s basically a million shade of grey, where nothing is ever certain. There is no magical equation that works on anyone for any kind of medical presentation.
      Doctor often have to make decision on the spot with very little information, and often different doctors will make different decision based on their personal experience and sometime gut feeling. If she did the episiotomy, then she most likely honestly felt the benefits outweighed the risks.
      But yea, you need a provider that you trust and one that you are willing to work with. Nobody wins if it’s a constant confrontation.

    • Megan

      It depends on how the provider provides you with information. If they provide risks and benefits of each choice, it’s fine to let you know that one choice is preferred in their professional opinion so long as they leave the ultimate decision up to you.
      And anecdotally, who knows what your recovery from a scheduled CS would’ve been. Mine was easy. And many posters here have had horrible recoveries from vaginal deliveries. That’s why the decision should be based on conversation and shared decision making between a provider and the patient.

      • Anna

        Sorry to disagree with you but the easiest c-section recovery is pretty tough compared to the recovery from uncomplicated vaginal delivery. I was someone with the best c-section recovery on my ward, I got up without any particular discomfort next morning (surgery was in the evening), got to pee on my own at once which surprised the nurses who said it was very untypical and people had to be catheterized again and again, had no problems with the incision and could walk around pretty much the next day. And still I looked and felt very different from the women who had been lucky to have the regular birth. And I don’t know where I would have been without the painkillers. I will say more. My relative had a difficult vaginal birth at the same hospital two days later. She tore, couldn’t get up right away and in two weeks she developed high temperature and had to be readmitted. At that point I thought how lucky I had been to avoid such consequences. But look at both of us now, a year since. My relative has healed completely, nothing reminds her of the birth. You see, vaginal tissue tends to heal pretty well. And I will have my scar for a lifetime. She also started exercising earlier and is in better shape than I. What I mean is if nothing indicates that vaginal birth is likely to end in disaster for mother or baby or both it is pretty reasonable on the part of the Doctor to recommend it leaving the final word to the woman but explaining everything clearly.

        • Azuran

          Short and long term recovery is different for everyone with both c-section and vaginal birth. Just because your c-section was harder than her vaginal birth doesn’t mean you can apply it as a general rule.
          Some people will have painful sexual intercourse for months after a vaginal birth, Some will have varying degree of urinary incontinence. Some, like my friends mother, will need abdominal surgery to repair her pelvic floor.
          Different people will care more of less about different risks or short/long term complication. Which is why everyone should be able to chose which complications they would rather face.

        • MaineJen

          “Vaginal tissue tends to heal pretty well” if it’s stitched properly, and if the tear is not 3rd or 4th degree.

          • Azuran

            And technically, her relative also has a scar. It just happens to be on her vagina.

        • corblimeybot

          Vaginal tissue might heal easily (mine certainly healed very well), but my pelvis has never recovered from vaginal birth. I have bouts of pelvic pain that required physical therapy, and I am unlikely to ever be pain-free.

          I am reminded of my birth pretty often, because my pelvis injuries are permanent. My delivery was on the complicated side, but my ob-gyn told me that she refers women to pelvic PT pretty regularly.

          Edited because I hit enter too early: No one could know that my delivery would be complicated, until it was too late, either. An uncomplicated vaginal birth might result in a better recovery time as a rule, but no one is guaranteed that uncomplicated birth.

          [Insert disclaimer that anecdotes aren’t data.]

          • guest

            I had an “easy” vaginal birth with both of mine and am still reminded quite regularly of their births – every time my husband and I have sex. It is depressing to me that I will probably always have issues and have to be careful every time I have sex. And for the record, I can tell exactly where the scar tissue is from each birth. I really feel that women are not given the full truth of what can happen. When childbirth comes up in discussion and I tell about my experience, someone always tries to play it off like it’s not that common. I just make the point “where would you rather have a scar?” It make me rage that this is blown off as no big deal and not something to be concerned with.

        • Dr Kitty

          Tears and episiotomies also leave scars.
          Perineal tissue heals no differently to abdominal tissue, it’s just that it is in a less visible place.

          Most of us see our bikini line every day when we get dressed, but require a hand mirror and a yoga pose to get a good look at our perineums.

          Case in point, I examined an elderly lady with a learning disability, because her carers were worried about “growths” on her vulva.

          Nowhere in her extensive medical history was a pregnancy mentioned.

          She had a large episiotomy scar.
          The “growths” were puckering around the scar and some hyperplastic scar tissue.

          I asked her if she had ever had a baby.
          Oh Yes, but the nuns had taken it away, and told her not to talk about it.

          Mystery solved…and a scar that definitely lasted a lifetime.

          • BeatriceC

            I tore with OK and had a large episiotomy cut because of the SD. About ten years later my boyfriend at the time (before MrC), was going at things rather aggressively, and “missed” with one of his thrusts. I got stabbed , for lack of a better word, in the perineum and it tore right along the scar. It was not pleasant, to say the least.

          • Empliau

            OW! You poor thing. I am wincing for you.

          • BeatriceC

            Morphine is a nice way to get through the pain. I just had to live until I could get to the ER. I was bleeding far more than I expected and they took one look and gave me morphine via IV every two hours until they could get it repaired and get me discharged. They sent me home with vicodin, but I didn’t need it.

          • momofone

            I nearly just crawled under my desk on your behalf.

          • Roadstergal

            Oh damn. 🙁

          • guest

            Maybe I’m just a really hairy monster, but I can’t see my c-section scar everyday because it’s under my pubic hairline. Or maybe everyone else is just more into personal grooming than I am. I tend to the parts of the garden that affect my hygiene, but the rest can do what it likes.

          • The Bofa on the Sofa

            I can’t see my c-section scar everyday because it’s under my pubic hairline.

            I have mentioned it before, but I have never seen my wife’s c-section scar. And you can believe me, it’s not for lack of looking in that area. It’s just not noticeable, because, as you note, it’s under the hairline.

          • guest

            Mine is also much thinner and smoother than my appendectomy scar from 20 years earlier (though it is longer).

          • Roadstergal

            I wonder about whether the emergent nature of a C-section influences the scar. I’ve had two planned surgeries on a very visible part of my chest/shoulder, and it’s hard to see the scar if you’re not looking for it. It seems reasonable to me that a planned pre-labor C-section allows a doctor more time to make a neater cut that will heal better?

          • guest

            That does seem like it would be the case, but I had an emergency c-section and have a very low scar. It may be longer than is currently the norm, though. It wasn’t a crash section, though, just urgent.

          • fiftyfifty1

            Mine is an inch above my hairline. Guess it depends on the person.

          • guest

            Absolutely. That’s why I surmised I may be a particularly hairy person. There may be reasons to locate the incision higher and lower in each case as well.

          • Azuran

            Or maybe the incision just end up in different places depending on the size and shape of your pregnancy belly and your body type.

          • guest

            Okay, sure. Have I said anything to the contrary?

          • Azuran

            No, I was just adding to the discussion, not trying to contradict you or anything.

          • guest

            Okay, cool. I wasn’t sure if people were interpreting me as saying c-section scars aren’t visible for everyone or something, which was definitely not my intent.

          • Margo

            Scars. She probably had scars. Poor woman. A lifetime of scars.

          • Anna

            Poor woman… She must have a scar on her heart too…

            Yeah, that’s it, we just don’t see our private parts that often. Besides births without tearing and episiotomy still take place? Or is it so very rare that it’s not worth mentioning? Cause every woman I know who wants a vaginal birth hopes for just that.

          • fiftyfifty1

            Births without tearing or episiotomies can and do take place. But that doesn’t mean the vagina/vulva area looks the same as it did before. Not at all! The crotch of someone who has given birth, even if there was no tear, looks obviously unlike the nullip crotches of college age students (the type that are so widely represented in, ahem, photos).

            The only way to have a baby and still have a nullip body afterwards is to adopt or use a surrogate.

          • Anna

            I think we are all very much influenced by glossed over photoshoped images these days whether it be of stomachs or vaginas. It seems like just the Doctors who perform routine examinations that know what a real body looks like.

        • Megan

          All I said was that no one can know what kind of recovery they will have and that applies to both vaginal or cesarean deliveries. Neither is easier across the board. YMMV. What exactly are you disagreeing with? That my CS recovery was easy? (Incidentally, I had my foley out in hours, walking as soon as my spinal wore off, took painkillers for 1-2 days only, back to my trail walking routine by 2 weeks without any pain at all. And I still have my pelvic floor intact.). The scar is something I might’ve cared about after my first delivery but I can’t be bothered to care about it now. It’s just a reminder of the days my beautiful babies were born.

          • Anna

            You have to spend X hours in the ICU, you are limited on exercise and physical activities for 2 months or so, you have to be very careful lifting things. I know these are trivial “complications” but they are unavoidable. When someone chooses vaginal birth or a Doctor recommends vaginal birth they hope that everything will be almost perfect, a small episiotomy at most. Since birth is not mathematics it doesn’t always work that way and unpredictable things happen. But statistically chances are that for a woman who has no medical issues recovery from vaginal birth will be easier and faster.

          • T.

            I don’t plan on giving birth, ever, but I would prefer all you mentioned about CS over the even small chance of a 4° degree tear. I have read too many stories about fecal incontinence to want to risk it.

            And that is the point: it is a personal choice. Some women are ok with the trivial complications of a CS in exchange of passing over bigger complication of VB.

            I live in a country with a planned CS rate of 25%. A lot of women I know have had CS, often two or three of them. That is their choice, and a good one for most.

          • Anna

            And that is the point: it is a personal choice. Some women are ok with the trivial complications of a CS in exchange of passing over bigger complication of VB.

            And there are other women. Women like me, who are made uncomfortable by the very idea of being cut open and for whom it results in massive psychological trauma.

            Certainly any woman can make her choice if she has that choice (I didn’t) but the Doctors are there exactly for this purpose, explain everything as clearly and honestly as possible and if a woman with no issues still insists on having a c-section so be it because forcing VB on a woman who is not inclined on it might result in psychological trauma for HER. Jennifer’s Doctor did a good job when she talked her out of medically unnecessary surgery. At the same time as I understood nothing had been imposed on her, she made her own informed choice and all turned out well. She only started having second thoughts when she read about possible horrible consequences of VB and started thinking how likely it might be for her to end up like that.

          • T.

            I agree with you, but I don’t think that Jennifer is wrong in having “second thought”. From her post, it simply looks like she was uncomfortable about having changed her mind after her doctor spoke with her. I can understand being sort of hyper-vigilant on such a topic, because some doctors are indeed paternalistic, though her seems not to have been.

            If her doctor (as it seems to have happened) simply pointed to her how she was unlikely to have problems with a VB for a lot of reasons, and explained that, in her particular case, that would be an easier option for her and as such she changed her mind, then it was 100% fine IMHO. That is what doctors are for.

            She is also perfectly allowed to think about how it could have gone badly and be glad it hadn’t (the same apply for a woman who has chosen CS and had a simple one, she is allowed to think about what could have gone wrong, and hadn’t).
            When you make a choice being aware it had bonus and malus, it is ok to be glad the malus hadn’t happened, but that they could have.

          • Megan

            Did you read my experience with my CS at all? Sorry, but you do not have to be in the ICU after a CS unless there are some pretty horrific complications. I stayed in a regular old LDRP room and was discharged early on day 2, just like I would have if I’d had a vaginal delivery. Also, because I felt so good, I was able to go back to exercising at 2 weeks afterwards (with my doctor’s approval) and I started picking up my 20 lb toddler as soon as I got home (also with my doctor’s approval because what else can you do). Anyone hoping their birth will be “perfect” is likely to be disappointed. Any delivery can be great or not so great regardless of mode of delivery. I’m sorry you were unhappy with your CS but please stop projecting your experience on to others. Everyone will have a different experience with either kind of delivery. How to deliver should be based on shared decision making between a woman and her provider.

          • momofone

            “You have to spend X hours in the ICU, you are limited on exercise and
            physical activities for 2 months or so, you have to be very careful
            lifting things.”

            This was not my experience at all. No ICU, limited only by what I felt like doing.

          • Monkey Professor for a Head

            It would be highly atypical for a woman to spend any time at all in ICU after an uncomplicated c section. Perhaps you are confusing ICU with the recovery area in the operating theatre.

        • Erin

          I have to disagree. I got up and dressed myself 4 hours after mine (which was an emergency after a long labour). I honestly don’t remember ever feeling anything more than what I would describe as discomfort. Like you I had zero issues peeing (I just ran the tap and thought about fountains), I think that was probably my only sensible action in hospital. I didn’t need pain killers. I took the anti inflammatories but only on the advice of a midwife.

          On the other hand, I have friends who had what were described as “uncomplicated vaginal deliveries”. They still have issues with sex and described having pain for far longer than I did.

          Now fair enough, my mental issues might have done a great job of distracting me but even when I repeatedly punched myself in the stomach in the hope of rupturing something after my husband threw out every single painkiller I’d been stockpiling (I know…) or climbed stairs 24 hours later, I don’t remember pain.

          I’d say that the physical side of my recovery was exceedingly easy and that’s including comparing it to all my friends and family who had vaginal births.

          The mental side, well that’s a different story but I can’t really blame the section for that.

          • Anna

            Yes, mental issues arise too. I hate it that there is a visual reminder that my body gave birth. I don’t want to look like a woman who gave birth, I don’t want to be any different from my girlfriends who didn’t. And that is the inevitable negative side effect of a c-section.
            But what I was talking about is that with the c-section there are limits you can’t go past. You have to spend X hours in the ICU, you are limited on exercise and physical activities for 2 months or so, you have to be very careful lifting things.
            I was actually in high spirits right after mine, I was so happy it was all over but physically I didn’t feel like my usual self for 3 days or so.

          • momofone

            My experience was completely different. I talked to my OB throughout my pregnancy about not wanting a c-section, but in the course of monitoring we discovered that his placenta was deteriorating. My OB (who was wonderful) very kindly and straightforwardly told me my options: try induction, because he knew I didn’t want a c-section, but with a Bishop score of zero, I was likely to end up needing a section anyway, or schedule a section for that afternoon. We unhesitatingly went with the section. It was not about me, though I could not have had a better experience. I had no ICU time at all. The next day I was sore, but up, showering, walking (of course the things they want you to do), with Tylenol. I had heard horror stories about how awful recovery was, and for me that was not the case. My tonsillectomy recovery was far worse and took much longer. My son was in special care for a little over a week, and by the time we brought him home I was pretty well back to normal, just the same kind of tired anyone with a week-old baby is.

            My experience with my perception of my body was very different as well. My son was born after many (many!) years of infertility, and for me, having him at all was one of the few things my body had done right. I have a classical (?) incision, easily visible, and I love it. For so long, I didn’t think I would ever have the body of someone who had given birth, and now I do. I am very glad I didn’t give birth vaginally. I have no pelvic floor issues and sex was never an issue, which was important to me.

            It’s such an individual thing, of course, but it was a great experience for me in so many ways, and if we had had more babies I wouldn’t have hesitated about having another c-section (VBAC would not have been an option for me, but I never had any interest in it).

          • Anna

            “For so long, I didn’t think I would ever have the body of someone who had given birth, and now I do. ” This sounds uplifting. Thanks for sharing your perspective, it was very interesting to read! I was someone who fell pregnant right away and I have no idea what it is like to fear that you will remain childless. I know that women who have struggled with infertility treat all these issues i. e. method of delivery, bodily changes very differently. I guess I have to learn to appreciate what I have more instead of craving for what can’t and couldn’t be.

          • Erin

            The thing is though, virtually all women who have babies have that visual reminder.

            The friend of mine who had the easiest birth experience also has a stomach which is essentially one giant stretch mark.

            My breasts have not quite recovered from being full of milk and given my age, probably never will.

            I also never went to ICU afterwards. I was just put into a “recovery” room with a midwife who made sure my blood pressure was going back up and that my temperature was coming down. Fed me tea and toast once I’d reached a relatively human level and gave me breastfeeding “advice”. I had to wait for someone to be discharged before there was a bed for me on a postnatal ward so would have been somewhere similar after a vaginal birth as my waters had been broken so long, they didn’t want to discharge me for at least 24 hours regardless of method of delivery.

            As for limits, I saw them more as a guidance rather than rules. I mean they told me I whilst I was sat crossed legged on the floor at 10 days post partum that I couldn’t push the pram. I almost choked on my cup of tea and kept quiet about the fact that I’d been doing exactly that an hour earlier.

            Sure, I didn’t start doing anything heavier than walking coupled with the exercises that the hospital gave me for the first month or two but I don’t think I’d have been weight lifting after a vaginal birth either. I run and do pilates now though and I think my core is almost back to where it was before it got stretched out by a baby.

          • momofone

            It’s not inevitable, or necessarily negative. It sounds like for you it has been, and I’m sorry that’s the case for you, because it sounds very difficult.

          • Megan

            No woman has the same body after having a child as she did before having a child. Things stretch out and change. After my first child I was very upset at my new body and I desperately wanted to look like the old me. Now, after my second I’ve kind of come into my own and realized that my body has done a wonderful thing for me by gestating two beautiful babies after multiple miscarriages. My scar is a continual reminder of the wonderful days I got to meet my daughters for the first time. I am far more accepting of my body now that I ever was before children. In the words of Taryn Brumfitt, creator of the documentary “Embrace,” “This body of mine is not an ornament, but a vehicle.” I’m very sorry that you are upset at the effects of having a child. I hope you can make peace with it. Our culture tells us that women must look a certain way to be acceptable. My resolve to deal with my body issues is a direct result of having daughters. I see them as beautiful and perfect and I don’t want them to hate their bodies the way I was raised to. To help them, I had to learn to love myself (and it’s still a work in progress).

          • Daleth

            Thank you for that wonderfully thoughtful post. I love this quote: “In the words of Taryn Brumfitt, creator of the documentary “Embrace,” “This body of mine is not an ornament, but a vehicle.”

          • Megan

            I really love Taryn’s message. She is fantastic. I am excited for Ebrace to come to the US in September.
            http://bodyimagemovement.com.au/watch-the-embrace-trailer/

        • Dr Kitty

          Anna, though, sometimes it is about timing.
          Someone who spends 24hrs in an unmedicated labour and 24hrs after delivery in hospital before going home will have spent the same amount of time in hospital as someone who goes home 48hrs after a planned CSection, and probably a higher percentage of that time in severe pain.
          I certainly never had pain past about 4/10 after day 3 post op (although I took the good drugs).

          I went to IKEA four days after my second CSection, and 10 months later yes, I have a scar, but literally no other reminders. No stress incontinence, no sexual dysfunction, nothing.

          Given how many referrals I do every week for pelvic floor physio for new mothers who are still having issues with leaks or pain months after the birth, just because you don’t have a scar or had an easy vaginal birth doesn’t mean you won’t have long term reminders.

          • MB

            So true. Scotty was in the special care unit for three days after our vaginal birth. Due to the difficult labor, I was kept along too. We went in on a Tuesday, but weren’t released until Saturday. I don’t think the c-section mothers had to stay as long. I couldn’t walk for weeks. I also still have issues of a sexual nature which I am still not ready to go to a doctor about. I really do believe that some type of monitoring of my gestational diabetes would have prevented his issues with glucose. I also believe my labor was unnecessarily long and difficult. Why do mothers need to physically suffer through such terrible labors? I just don’t understand what we are trying to prove here.

        • Amy

          Since we’re all sharing stories, I’ll chime in. Both my kids were born via c-section, one after two failed inductions and an undetected asynclitic presentation (in other words, they should have just planned a c-section at 39 or 40 weeks), and the other after PPROM and 31 hours of labor. The first was non-emergent, planned out the night before (after the second induction failed), low-key……and I was in a lot of pain, needed a refill on my opioid meds, and took several weeks before my core muscles were good for much. The second was a VBAC attempt turned emergency and I had the easiest recovery ever, barely more than ibuprofen for pain, totally fine caring for a newborn and toddler.

          I’m one of three, all born vaginally. My mom has said that both my birth and one of my sisters’ were fairly quick, 8ish hours of labor total, easy recoveries. I don’t know if she had episiotomies for either although that would have been standard in the late 70s I think. My little sister, though, never dropped and several doctor-family-friends have said that were the same birth to occur today it would have been a c-section. Labor was much longer. My mom said the nurses were pushing down on her abdomen from the outside so hard that she had bruises for the next week or two.

          Short version: so many variables, every birth is different.

          • guest

            I had an emergency c-section that went as I expected (having had an appendectomy, I was familiar with many of the sensations). But when I looked at myself a couple of days later, I found I was terribly bruised on the lower abdomen and mons pubis. I guess a lot of pushing was involved to get one of the babies out – maybe twin A had dropped and needed to be push up? I have no idea. I just wasn’t expecting to be bruised like I’d been repeatedly punched.

    • lilin

      It depends on how she told you. If she just informed you of the risks and benefits of each choice, and told you in her professional opinion (which is what you’re paying her for) which one she thought was better, it’s probably fine.

      If she told you you’d been “brainwashed” or that there was a vast conspiracy that got you to want a c-section, or that a c-section would make it impossible to bond with your baby, or pretended that childbirth doesn’t hurt, or in general the risks of one and glossed over the risks of another, it’s an abuse of authority.

    • lawyer jane

      It’s not “paternalistic” for medical professionals to convey their professional, medical opinion! Yes, you go to a doctor because they are experts. That does not mean that you don’t act as your own informed advocate. But it does mean that the doctor is there to tell you their medical, professional opinion (which is likely more informed than yours). And imagine the opposite scenario: your OB said, “fine, you can have a c-section” and did not tell you that you’d probably do fine without it. What if you ended up with a complication you never anticipated, such as placenta previa in your next pregnancy? You’d probably feel pretty mad, right, especially if in retrospect you decided that you would have had an uncomplicated vaginal birth?

      • lilin

        I guess the paternalism comes in when a medical professional pretends that one is “morally” right–empowering, self-sacrificing, brave, independent, strong–and the other is morally wrong.

    • Jennifer

      I had none of the complications described below but just reading them makes me think c section all the way. I know this totally contradicts my own experience. I’m not planning on another kid but if I did I really have no idea what I would do.

      • Azuran

        I think many people like the predictability of a c-section. It’s a very standardized procedure with very well known short and long term effect.
        You get a c-section, you know you get a scar, and you basically expect some core muscle weakness and standard abdominal post-op recovery.

        With vaginal birth, it can go anywhere very vast without any warning or any good reason. So there’s a lot of unknown and a lot that is left to just dumb luck.
        Some people will prefer a known more limited risk of standard complication to the more variable and potentially more severe risk of vaginal birth.

      • Jennifer

        I’m sorry to turn this thread into a C-section vs. vaginal delivery debate, but I looked it up and it is medically recommended to suggest vaginal over planned c section if mom and baby are otherwise healthy. So my MD was following guidelines. And interestingly this says sexual dysfunction is the same for both. I really don’t care about the “natural” way. I just wanted the least pain/most benefit and my doctor seemed sure of this and she was right. However, even I am having second thoughts, lol.

        http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Vaginal-Delivery-Recommended-Over-Maternal-Request-Cesarean

        • Anna

          I think you have nothing to have second thoughts about. God, to be honest I am jealous of your bith experience, it wouldn’t have been better with a c-section, trust me. It might be only a bit worse but it still would be worse.

        • swbarnes2

          On the other hand, the ACOG paper is not all “C-sections are way worse, here are all the reasons why you really need to be doing your best to talk your patient out of this harebrained scheme”. If you want four more kids, then planning a c-section for non-medical reason is a bad idea, but other than that, the policy paper’s recommendation for vaginal delivery is not all that emphatic.