Comparing long term risks of vaginal birth and C-section

RISK versus REWARD directional signs

A new paper published yesterday in PLOS compares the long term risks of vaginal birth and C-section.

The paper is Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. In addition to the comparison, it offers an object lesson in the way that researchers frame results in order to lead to a preferred conclusion.

The risk of urinary incontinence from vaginal birth is 10,000% higher than the risk of subsequent accreta.

The authors start with the assumption that C-sections are “bad”:

Rates of cesarean delivery continue to rise worldwide, with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. In the presence of maternal or fetal complications, cesarean delivery can effectively reduce maternal and perinatal mortality and morbidity; however, an increasing proportion of babies are delivered by cesarean when there is no medical or obstetric indication. The short-term adverse associations of cesarean delivery for the mother, such as infection, haemorrhage, visceral injury, and venous thromboembolism, have been minimized to the point that cesarean delivery is considered as safe as vaginal delivery in high-income countries … This notwithstanding, the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies are less frequently discussed with women …

The “worst” C-sections are those done without medical indication simply because the mother requested it:

Maternal preferences are an important influence on decisions about mode of delivery. At present, evidence of longer-term complications of cesarean delivery has not been adequately synthesized to allow fully informed decisions about mode of delivery to be made…

Women typically choose maternal request C-sections in an effort to avoid perineal damage leading to pelvic organ prolapse and urinary incontinence. These poor, benighted women apparently aren’t fully informed, though there is no indication that they are any more or less informed than women who choose vaginal birth. No matter!

Here’s how the authors framed their results:

When compared with vaginal delivery, cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes.

The authors imply that the risks for future pregnancy outcomes are comparable to the decrease in urinary incontinence and pelvic organ prolapse. They’re not.

Let’s look at the four most important long risks of vaginal birth and C-sections: pelvic organ prolapse and urinary incontinence vs. subsequent placenta previa or accreta (the most dread complication of all).

One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies)… Pregnancy following cesarean delivery was associated with increased risk of placenta previa (OR 1.74, 1.62 to 1.87; n = 7,101,692; 10 studies), placenta accreta (OR 2.95, 1.32 to 6.60; n = 705,108; 3 studies) …

In other words, C-section halves the risk of urinary incontinence, and cuts the risk of pelvic organ prolapse by 70%. However, C-section almost doubles the risk of placenta previa in a subsequent pregnancy and increases the risk of accreta by nearly 200%. Those results seem very impressive until you look at the absolute risk.

Using the numbers provided in the paper, I created these icon arrays to demonstrate the absolute risk of various bad outcomes.

Here are the long term risks of vaginal birth:


Here are the long term risks of C-section:


Displaying the data as icon arrays makes it clear that the long term risks of vaginal birth and C-section are not remotely comparable.

The risk of pelvic organ prolapse from vaginal birth dwarfs the risk of accreta from C-section. Indeed, the risk of urinary incontinence from vaginal birth is 10,000% higher than the risk of subsequent accreta. Yes, you read that right, fully 10,000% higher. And the risk of pelvic organ prolapse, while not as great, is still 1000% higher after vaginal birth.

Should we be concerned about placenta accreta as a long term risk of C-section? Of course we should, but we should also put it into perspective. Accreta is a potentially life threatening outcome and every woman should be informed about the possibility before she consents to a C-section. However, the risk is minuscule compared to the life altering risks of pelvic organ prolapse and urinary incontinence.

The authors note:

Although we cannot conclude that cesarean delivery causes certain outcomes, patients and clinicians should be aware that cesarean delivery is associated with long-term risks … for subsequent pregnancies and a reduced risk of urinary incontinence and pelvic organ prolapse for the mother. The significance that women attribute to these individual risks is likely to vary, but it is imperative that clinicians take care to ensure that women are made aware of any risk that they are likely to attach significance to. Women and clinicians thus should be aware of both the short- and long-term risks and benefits of cesarean delivery and discuss these when deciding on mode of delivery.

It would have been more accurate to conclude thus:

Although we must be mindful of potentially catastrophic long term complications from C-section, the risk is dwarfed by the risk of life alterning long term complications from vaginal birth. Since the risk of urinary incontinence from vaginal birth is 10,000% higher than the risk of subsequent accreta from C-section, the choice of maternal request C-section is eminently sensible.


Edited to correct the juxtaposition of the absolute values for urinary incontinence and pelvic organ prolapse.

137 Responses to “Comparing long term risks of vaginal birth and C-section”

  1. Hannah
    January 28, 2018 at 10:08 pm #

    Related but slightly OT, this is a question I’m not sure about asking anywhere else. I have one child born in June by MRCS (high risk of stillbirth combined with NHS and Milton Keynes hospital which Dr. Amy has written about before). I haven’t had any urinary incontinence, but… I think I’ve had, shall we say, the other incontinence off and on. Not sure if it’s a pelvic floor issue or if my muscles have just sort of forgotten how to control that after baby’s head controlled it for so long? Is this a different complication that is talked about even less than usual? It’s not all the time, but every so often, I’ll just have to GO NOW with no warning and I have to drop everything and run. One time, no joke, my first indication that I needed a poo was that I started going (in the middle of a shop no less!). At first I thought it was residual from the iron tablets they had me on that I quit early because they made the problem so bad, but… well that middle of the shop incident was nearly 6 months after the fact. Been trying to work up the courage to go to the GP about it, but when it’s an occasional thing, it’s harder to feel it’s worth the bother…

    • maidmarian555
      January 29, 2018 at 6:00 pm #

      Sounds like it might be a pelvic floor issue? I know it’s possible to have these sort of problems, even if you have a CS. A GP might be able to get you a referral for physical therapy. Iron tablets did really odd things to me when I was pregnant but the issues did not continue after either of my CS births.

  2. Sam
    January 25, 2018 at 6:29 pm #

    I wish I had found this site before I had my baby. I was so scared of a c section (which I ultimately had) for no real reason. I just *knew* that c sections were so bad, so much worse than a vaginal birth, that I definitely didn’t want one. Though here I am 9 months after my c section and all of my plumbing is in perfect working order. Whereas I have at least 2 friends who refused a recommended c section during a difficult labor and a year-2 out they’re both still dealing with pelvic floor dysfunction, incontinence and pain during intercourse.

    • maidmarian555
      January 25, 2018 at 6:42 pm #

      I found the community here after an awful first birth (really late induction, days of labour that apparently wasn’t ‘real’ labour because I didn’t dilate much at all, EMCS). I felt a bit wonky about the c-section at the time and now, almost two years (and another baby via elective c-section) down the line, all I feel is relief. I also wish I had found it sooner if I’m honest.

      • Sue
        January 29, 2018 at 7:20 am #

        It’s so great to see evidence that this community, created by Dr Amy, has helped so many people.

  3. CSN0116
    January 25, 2018 at 11:52 am #

    Do women have access to elective cesarean in Canada?

  4. moto_librarian
    January 25, 2018 at 11:19 am #

    Here’s the other thing. Screening for pelvic floor issues isn’t standard in the United States. You have to bring it up yourself with your provider, and it’s an embarrassing problem to discuss. My nurse-midwife immediately referred me to physiotherapy once I brought it up, but being comfortable enough to do that is no small thing. How many women suffer in silence? I’ll bet that these problems are vastly under-reported.

    • borkborkbork
      January 25, 2018 at 1:17 pm #

      When I worked front desk in a PT clinic, we had a half-dozen specialists who would work on childbirth injuries and pelvic floor issues.

      Probably 1/2 of the women who called with a referral for that would get so flustered or upset that they would hang up/discontinue the call. You know “I…I don’t feel comfortable talking about this…I don’t know if I can talk to the PT about this. This call was a mistake. I’m sorry. -click-”

      We tried to reassure them that it was a very common thing, and stress our staff’s experience and post-graduate training, and be as comforting as possible. But another 1/4 of those patients who contacted us never showed up for their first appointment. I know this is just my anecdotal experience, but still, that’s like 75% of our pelvic floor patient referrals who were not able to successfully begin treatment due to fear of talking about the problem. I’d guess our clinic was not unusual in this regard.

  5. Ms. Sweaterfan
    January 25, 2018 at 10:31 am #

    I went 10 days postdates then had a 30+ hour induction including 3.5 hours of pushing. I had never really heard about the possibility of long term physical effects from my labor (incontinence, prolapse, etc.) until well after I gave birth. Not one of my doctors or nurses has ever mentioned it to me. The silence of my medical providers on this topic makes me perturbed thinking about it now. I only gave birth this last June though and I have no complications yet but only time will tell.
    I wish I’d been more assertive with my doctor, though I’m not sure I would have done anything differently if I had the birth experience to do over again. Maybe I would have requested my induction earlier? Anyway, I can’t go back in time and I can’t see the future, so there’s not point in regretting something when I don’t even know if there will be any negative consequences. Healthy baby and healthy mom so far 🙂

    ETA: I just remembered that I did have a 3rd degree tear, so I guess saying ‘no complications’ isn’t totally true XP But it’s healed up fine so far.

    • MaineJen
      January 25, 2018 at 11:04 am #

      Well, your baby is beautiful!! But your labor sounds horrific. And I agree, the long term complications of vaginal birth are the best kept “secret” in medicine and midwifery. It’s maddening. There are so so so many things they don’t tell you…like hey! You’re going to bleed really really heavily for a few weeks afterward. Like, two-pads-at-a-time heavily. You’re going to have to sit on an ice pack for a few days. You may pass an alarming-looking clot at some point. You’re going to feel like you’ve been run over by a mack truck. Did I miss any?

      • Ms. Sweaterfan
        January 25, 2018 at 11:09 am #

        Aw thank you, he’s a sweetie 🙂
        Ah yes, the clots. And jeebus help you if you forget to take your stool softener!

      • moto_librarian
        January 25, 2018 at 11:16 am #

        Oh lord, the “alarming-looking clot” took me totally by surprise! It was the size of the palm of my hand, and having had a pph, it scared the hell out of me. I called the CNM and she told me it was okay, but I wasn’t convinced.

        • Kelly
          February 6, 2018 at 6:23 pm #

          Me too. Of course it was in the middle of the night and I had to call the OB on call at the hospital for them to tell me what to do. It scared the crap out of me. It seems though that the postpartums in which I had a clot, I only bleed for three weeks. The one I didn’t have a big clot, I bled for six weeks. I wish they had told me ahead of time though so I wouldn’t get all stressed out.

      • January 25, 2018 at 11:34 am #

        Be prepared to cry if you should look at your genitals the first week or so.

      • Ms. Sweaterfan
        January 25, 2018 at 11:46 am #

        Oh, I remembered one more! I pushed so long/hard that I broke a bunch of capillaries in my neck – I looked and felt like I’d been strangled :O

      • Sarah
        January 25, 2018 at 7:02 pm #

        I had unmedicated vaginal birth and beyond a small tear was a ok. 18 months PP I got a yeast infection which led to a UTI from scratching in my sleep. Another yeast infection and this was all with upper back pain. Also had constant feeling of needing to pee while walking but no real incontience. CNM diagnosed mild bladder prolapse so I saw chiro for back (it helped) and women’s specialist for pelvic floor PT. Only two sessions with PT and both providers gave me exercises at home. Several months later I’m a ok. Apparently issues often hit a year or two PP so be aware be open with your healthcare providers and know that many issues can be treated with competent care providers. It’s a tragedy our maternal system pretty much leaves women to their own devices and I know how lucky I am in many ways.

  6. Steph858
    January 25, 2018 at 9:20 am #

    Reminds me of those articles like these ( wherein the authors try to hype up the benefits of NFP by stating that hormonal contraception increases users’ risks of XYZ (e.g. blood clots, Pseudotumor Cerebri, osteoporosis etc). That’s true in the sense that women who use hormonal contraception will be at greater risk of developing these conditions than, say, women who choose the ‘Lesbian’ or ‘Celibate’ methods of contraception. [Insert disclaimer about how I know that being gay is NOT a lifestyle choice, LGBT people (ought to) have the same rights as everyone else to become parents if they want to, etc etc etc].

    But that’s not really relevant. What those authors SHOULD be doing is comparing the risk between women who use those methods of contraception and ALL women who don’t, because being pregnant will increase the risks of those conditions by a much higher factor than the birth control does.

    • Merrie
      January 25, 2018 at 10:50 am #

      True. A lot of NFP literature seems to carry the assumption that knowing one’s body’s own fertility signs is a great method of contraception which more women would be happy with if they only knew it existed and how to use it, which I think may have some truth to it but it’s absolutely not for everyone. I do think that there are women out there who are struggling with other contraceptives who would use NFP if they knew about it and potentially get better results than with their current contraceptive. But I think it also has a tricky learning curve and a high failure rate within that learning curve, just judging by the number of online threads/groups I have been in with members who were trying to avoid, misread their charts, and got pregnant. I used charting to help conceive my children but I personally don’t want to use it for prevention because of how short my cycles are and consequently how few “safe days” I get per month, and how sometimes it’s even hard to tell if I ovulated and thus if I have any safe days at all–on the cycle where I conceived my oldest child, I initially thought I hadn’t ovulated at all and only figured it out weeks later when I found out I was pregnant with her.

      Any discussion of birth control methods needs to have some of the “These are the risks of this method, these are the benefits; these are the risks of this other method, these are the benefits; these are the risks of no method at all (i.e. high risk of pregnancy with all these other attendant risks).”

    • KeeperOfTheBooks
      January 25, 2018 at 10:53 pm #

      Upvoted by this NFP user! Hear, hear!

  7. fiftyfifty1
    January 25, 2018 at 8:47 am #

    OT: Larry Nassar is 100% to blame for his crimes. But I think pseudoscience is partially to blame for why he wasn’t stopped earlier. Larry Nassar was an osteopathic physician (D.O. degree not M.D.). Osteopathy philosophy teaches that many, often unrelated, health conditions can be treated with musculoskeletal manipulation. It’s basically a blend of traditional medicine and chiropracty.

    I mean multiple girls/women reported him over the years. If he did that in an M.D. training program, somebody would have said “Doing vaginal-rectal ‘manipulations’ to treat leg pain, what kind of bullshit is that?” But within the D.O. community, it had legitimacy.

    • MaineJen
      January 25, 2018 at 9:22 am #

      Oh my god, is that what he was doing??

      • fiftyfifty1
        January 25, 2018 at 9:36 am #

        Yes. And it was the perfect excuse. It allowed him to return to victims again and again. To lower suspicion, he even sometimes did these “treatments” in front of others, trainees etc. (with gloves on and without the boner I’m assuming.) See, nothing to hide.

        • MaineJen
          January 25, 2018 at 10:59 am #

          Holy shit. That’s evil.

    • The Kids Aren't AltRight
      January 25, 2018 at 5:09 pm #

      Are all DOs that bad? I am about 8 weeks along with my 1st, and due to some legislative BS where I live, my OBGYN office closed and I couldn’t get an appointment at another office in the metro before the last day of my 1st trimester, and the doctor, some dude I have never met, is a DO. Should I be worried? I am not 100 percent sure what I can even do if so. The hospital he has priveleges at is well regarded with a top notch NICU.

      • fiftyfifty1
        January 25, 2018 at 6:25 pm #

        No, not all DOs are bad. I would say that the majority don’t even do any of the chiro-type stuff at all. They went to DO school, not because they believe in osteopathic philosophy, but because DO school is easier to get into than regular medical school. Basically, their grades or their tests scores weren’t competitive, but they still really wanted to be doctors. Many are perfectly smart enough but for whatever reason had a bad semester in undergrad, or are bad standardized test takers etc. and so had to go to DO school instead. If your doc completed a standard residency, he should be fine. If you don’t end up liking him, you can always switch at that point.

        • The Kids Aren't AltRight
          January 25, 2018 at 6:43 pm #

          I am worried I won’t be able to switch based on how difficult it was to get an appointment.

      • Heidi
        January 25, 2018 at 7:30 pm #

        One of my OB/GYNs was a DO. I don’t know if she believed in chiropractor stuff or not, but she didn’t seem to have a different standard of care than the MD OBs and never espoused quackery. She was actually the one who made the call for induction at 37 weeks 6 days.

      • kilda
        January 25, 2018 at 7:57 pm #

        I’m going to speak up for DO’s. I’m an MD but I have a lot of med students rotate with me from a local DO school, had colleagues in residency who were DOs, and have colleagues at my current hospital who are. The students all tell me that they don’t put any stock in the musculoskeletal manipulation (except for a few limited things like musculoskeletal pain), they take the class because it’s required, then forget all about it and never use it. The other DOs I have known are a mixed bag like any other group of doctors. They include one who was the smartest guy in my residency class, hands down, and another who took care of my mom while she was in the ICU, and I could not have handpicked a doctor I would feel more comfortable entrusting her to.

        Nassar used osteopathic manipulation therapy as cover for his abuse, but no DO I’ve ever worked with would have bought that bs.

        • Who?
          January 25, 2018 at 8:00 pm #

          There was such a lot of power being wielded though. Clearly Nassar did things in front of people who should have known better, and they didn’t think enough about it to report. And people who did get reports ignored or dismissed them.

          Being a DO was his cover for doing what he did. I don’t know whether there is a community or organisation for DOs (I assume there is) but if so have they denounced him, booted him out, and disinvited him from every event ever again?

          • kilda
            January 25, 2018 at 8:12 pm #

            from Sports Illustrated: A spokeswoman for the American Osteopathic Association said last week, “It has become abundantly clear that this is not an ‘osteopathic’ procedure—which Dr. Nassar’s defense attorney has contended—but a relatively rare treatment that is more often performed by MDs and physical therapists, typically for pelvic floor pain.”

            I think it’s safe to assume that the AOA wants no parts of Nassar and that he is not welcome at any of their events.

    • Who?
      January 25, 2018 at 5:56 pm #

      I shout at the tv or radio every time someone says he’s a doctor: ‘no he isn’t, he’s an osteopath, what is wrong with you people’.

      Everyone who never investigated him needs to go. For being gullible and disrespectful, at the same time.

      Were all his victims female? I’m not familiar with how the gymnastics world works, but did he not have access to young men and boys, or did they not interest him?

      • Sarah
        January 25, 2018 at 7:08 pm #

        DOs are drs. So are dentists optometrists etc

        • Who?
          January 25, 2018 at 8:02 pm #

          Interesting-I don’t think dentists and optometrists are (necessarily) doctors here in Australia. Certainly they don’t seem to take the title.

          • Sue
            January 29, 2018 at 7:23 am #

            In Aus, osteopaths are a bit like chiropractors. Dentists often use the courtesy title “Dr” but optometrists don’t.

            DOs in the US are very different to Aus osteopaths. DOs go to medical school and often do the same post-grad specialty training alongside MDs.

      • Maria
        January 27, 2018 at 6:03 pm #

        Osteopaths are real doctors in the United States and they have the same right to practice as MDs. Their training is pretty much the same as allopathic medical school, just with the addition of osteopathic manipulation. It’s nothing like when naturopaths call themselves doctors.

    • Megan
      February 6, 2018 at 4:15 pm #

      Sorry, but every single D.O. I know would have also said, “What kind of bullshit is that?” I am a D.O., teach at a family medicine residency program and though we use OMT for musculoskeletal issues, I have never once been taught, taught to a student or resident or even seen in an OMT textbook the things that Larry Nassar did. I personally went to an osteopathic school because I was dedicated to primary care and osteopathic schools graduate a large number of primary care doctors and prepare you well for it. The things you assume about osteopathic physicians are pretty insulting.

      • fiftyfifty1
        February 6, 2018 at 4:49 pm #

        “I have never once been taught, taught to a student or resident …[…]…the things Larry Nassar did”

        And yet former residents at his program attest that he DID show and teach them vaginal manipulation. Then when complaints were lodged against Dr. Nassar, these colleagues defended him and told authorities that they were familiar with the vaginal manipulations and that it wasn’t abuse. You may not know these D.O.s personally, but they exist, and he used them as cover. It’s a fact.
        And the things I assume about osteopathic physicians are what I was told by my brother-in-law, a physician who attended a DO school because he wasn’t accepted by a single MD school he applied to, although he was accepted by multiple DO schools (bright guy, but hampered by a GPA pulled down by a wild freshman year.) He cheerfully admits DO schools are less competitive, and that they produce mainly primary care physicians (as the residencies in competitive specialties prefer MD applicants.)

        • Megan
          February 6, 2018 at 5:34 pm #

          So your anecdotes about osteopathic schools from your brother are valid but mine about every single D.O. I’ve ever met are not? I actually do know and teach residents from the Michigan State program and they were not taught these techniques. Sounds like a small minority to be condemned to me and not grounds for accusing the entire “D.O. community” of protecting a molester.

          • fiftyfifty1
            February 6, 2018 at 6:40 pm #

            So you’re certain then that Nassar did not teach Michigan State residents or students these techniques? That the ones who made statements saying he taught these techniques, and later defended him, are lying? Why would they lie?

            Nassar abused victims under the guise of it being a DO manipulation. He billed them for it! That’s a fact. I fully realize that 99.99+% of DOs don’t abuse patients when they do DO manipulations, but the fact remains that he hid his abuse uding DO manipulations as an excuse and his colleagues back him up.

          • Megan
            February 6, 2018 at 8:18 pm #

            I’m saying that Larry Nassar molested many women and taught bogus OMT to others. Larry Nassar is the one who bears responsibility for his actions and those that did not question his actions once they were known are complicit. The stuff he is claiming is valid OMT is not in any textbook
            I have ever used and is not something that is part of any OMT curriculum at any school that I know of and I have had students from almost every osteopathic school in this country. I disagree that his actions are the fault of the “D.O. community.” Abusers use all kinds of stuff to cover for their abhorrent actions. Allopathic physicians who have molested patients use the guise of medical treatment to try to cover their actions as well, yet I would not say that the allopathic community enabled them to do that.

          • fiftyfifty1
            February 6, 2018 at 10:51 pm #

            I never said his actions were the “fault of the D.O. community”, I specifically said they were his fault alone. But recto-vaginal manipulations do have legitimacy in the DO community (even if most DOs don’t personally do them) and that gave him cover. Any reader here can Google OMT and Vagina and read about various vaginal and/or anal manipulation techniques and the multitude of complaints they supposedly treat: abdominal pain, back pain, hip pain, etc.

            Have allopathic docs also used their positions of authority to sexually abuse women? Yes absolutely. But having access to literally hundreds of minors, including the ability to bring them back again and again and again, what better excuse than OMT?

          • Megan
            February 7, 2018 at 7:10 am #

            You can google a lot of things and find them. That doesn’t mean that they are part of any osteopathic curriculum or that they are taught or even known about by most D.O.’s. Those techniques aren’t even in the textbooks we use and as another poster said below, I don’t know a single D.O. who would buy Nassar’s story. You said “But within the D.O. community, it had legitimacy.” and I’m telling you as someone in the community (as much as a community exists) it does not. The AOA has denounced his actions and methods as *not a thing* and his “techniques” are not found in our textbooks or curriculum except apparently as taught to some residents by him personally. So I don’t see how anyone in the D.O. community is legitimizing his actions.

          • kilda
            February 7, 2018 at 8:29 am #

            yeah, thinking of the D.O.s I’ve known, I think fully trained D.O.s would have been less likely to buy his bs. I can see MDs, and nondoctors saying “I don’t know, it’s some osteopathic technique, seems weird but he says it’s legit.” And of course his students bought it, he was in a position of authority, he was their teacher and they believed what he taught them.

            But DOs who’ve been through their whole training? I think they’d say “wth are you talking about? This is not a normal OMT technique.”

            Yes, OMT provided good cover for his actions. But I can also imagine an MD ob/gyn, or a physical therapist using their work as cover for sexual molestation of patients, and we wouldn’t blame the field of ob/gyn or PT in that case, we’d blame the abuser. Which I think is where our focus should be here.

          • Megan
            February 7, 2018 at 10:04 am #

            “Yes, OMT provided good cover for his actions. But I can also imagine an MD ob/gyn, or a physical therapist using their work as cover for sexual molestation of patients, and we wouldn’t blame the field of ob/gyn or PT in that case, we’d blame the abuser. Which I think is where our focus should be here.”

            This. I’d upvote if I had an account.

          • fiftyfifty1
            February 7, 2018 at 9:08 am #

            “The AOA has denounced his actions and methods as *not a thing* ”

            Actually, if you go back to when this first hit the press (Sept 2016) you will find that the AOA’s initial response was quite neutral. They admitted that intrapelvic OMT was a real thing although “not at all common”, praised OMT’s effectiveness in general and especially for athletes, and called the accusations “extremely troubling.”

  8. Sue
    January 24, 2018 at 10:59 pm #

    I just came across the article through social media. It misses some information, and presents selected results.

    For example, the headline could have read “Cesarean delivery protective against inflammatory bowel disease” (Figure 2, OR for “inflammatory bowel disease up to 35 years” < 1).

    Also, the complications appear not to have been sub-categorised by number of procedures pre individual (we know that placental implantation issues are related to the number of repeats).

    The child outcomes look at some selected chronic diseases, but not conditions like seizures or developmental disorders, or intrapartum death.

    The data on asthma seem questionable. In Australia, the asthma rate rose steadily until the 1990s and then plateaued, despite an increasing cesarean rate.

    It seems like adequate methodology, but the chosen outcomes are selective.

  9. Emilie Bishop
    January 24, 2018 at 10:58 pm #

    This article reminded me of a weird conversation with my old obgyn when my son was about 8 months old and I was having pain and bleeding mid-cycle every month. An ultrasound a couple months prior had found a small fibroid and I asked if this was the cause of the bleeding and could we remove it just in case. She refused, insisting my problems couldn’t be from the fibroid, then said she wouldn’t do it because the surgery would mean my next delivery would have to be c-section. Now, this was my doctor of five years, who saw me through a miscarriage, endometriosis, failed fertility treatments, and finally a healthy pregnancy. It was a huge leap to assume I could even get pregnant again (I couldn’t), and a bigger one to assume that after two endo surgeries and contemplating hysterectomy, I was so surgery-avoidant that her argument would be enough to dissuade me. But just like formula feeding, c-sections are seen as a last resort and something to be avoided at all costs. I just don’t get it.

    • Sue
      January 24, 2018 at 11:02 pm #

      Interesting, isn’t it? The radical-NCB crowd want to convince us that the Cesarean rate is OB-driven, for greed and golfing requirements, but OBs seem to be sanctioned for an “excessive” rate, and reluctant to intervene surgically without a strong indicator.

      • January 25, 2018 at 3:50 am #

        OBs are often sanctioned for “excessive” C/S rates. It is normal practice to have frequent departmental meetings to review unusual cases, in all specialties. Doctors who perform C/Ss are often required, if the Head of OB/GYN keeps tight control, to justify their decisions, and can be warned if the rate is felt to be too high. I remember one doctor, who was told (this was in the 70s) that his rate of 20% was too high, replying that in almost two decades of practice, he’d never had a birth that resulted in a child with CP, and he’d rather have done too many C/Ss than too few. Later he was informed that his admitting privileges were being reconsidered.

        • kilda
          January 25, 2018 at 9:00 am #

          I remember being told in residency that if a surgeon doesn’t occasionally find a normal appendix when operating for appendicitis, it means that they’re too conservative about operating. Because you’d rather operate a few times when you don’t have to, than fail to operate when you should. Same principle. I’d rather there be a few unnecessary C sections than a few unnecessarily dead babies.

          • The Bofa on the Sofa
            January 25, 2018 at 11:13 am #

            It’s almost like preventing disasters is better than having to respond to them….

          • January 25, 2018 at 12:00 pm #

            It’s changed a bit since the 70s, with the rise of the lawsuit. Doctors are between the devil and the deep blue sea, because the prosecutor’s first question in a malpractice suit will be “Why didn’t you do a C/S?”

          • Mariana
            January 25, 2018 at 7:12 pm #

            Out of curiosity, if a normal appendix is found, is it still removed?

          • PeggySue
            January 25, 2018 at 7:18 pm #

            Mine was. It was removed when I had an abdominal hysterectomy and right salpingo-oophorectomy, though,not because appendicitis was suspected.

          • Who?
            January 25, 2018 at 7:43 pm #

            My daughter’s was. She was having classic appendix pain and feeling really unwell, and after much prodding, poking, scanning etc the decision was to have a look. It apparently was perfect but the surgeon removed it. Perhaps so there could be no question in future about it, given she had the surgery?

          • kilda
            January 25, 2018 at 8:07 pm #

            My understanding is that they take them out at that point since they’re already in there, the organ has no known purpose, and then you never have to worry about appendicitis.

          • Who?
            January 25, 2018 at 8:32 pm #

            True. She’s had her wisdom teeth out as well, so she’s ready to go to space, or Antarctica, should the opportunity arise!

          • Who?
            January 25, 2018 at 8:32 pm #

            True. She’s had her wisdom teeth out as well, so she’s ready to go to space, or Antarctica, should the opportunity arise!

          • sdsures
            January 26, 2018 at 5:20 pm #

            I have congenital hydrocephalus, and as a child had to have several shunt revisions for suspected blockages. A shunt blockage is a medical emergency requiring neurosurgery.

            I’m delighted that my doctor was “overly cautious” (that is to say, got me into surgery that afternoon) about making sure the shunt was working properly; it turns out that during my first revision, the shunt system was working perfectly fine. But had it not been, and had they neglected to check it in surgery, just in case, I’d be dead.

            So yeah, I don’t mind the extra “unnecessary” scar on my abdomen at all. I’d rather check it and have everything turn out fine, than assume “nothing is wrong” and end up dead.

        • Roadstergal
          January 25, 2018 at 12:08 pm #

          “You’ve driven for 20 years without being in an accident. We’re worried about you buckling up with every drive. Seatbelts aren’t without risk, you know.”

          • kilda
            January 25, 2018 at 12:28 pm #

            plus seatbelts are unnecessary on most drives.

    • EmbraceYourInnerCrone
      January 25, 2018 at 10:30 am #

      I had a similar experience, got a CT scand and and MRI, the people reading the scans said I had a probable Adenomyosis in the wall of my uterus. This is especially interesting information as I always had: very heavy periods, very painful periods, multiple miscarriages. My OB disagreed, I asked about the possibility of a hysterectomy as I was in my early forties and did NOT want any more kids. Nope nope nope.

      Its not much of a problem as I am now in my midfifties but I sometimes wonder if those things grow and infiltrate other organs.

      Why couldn’t I just get my uterus removed? No more periods, no more period pain(hopefully), no more bleeding for a week every month.

    • fiftyfifty1
      January 25, 2018 at 6:48 pm #

      “She refused, insisting my problems couldn’t be from the fibroid, then said she wouldn’t do it because the surgery would mean my next delivery would have to be c-section. ”

      I think it’s possible she just spoke sloppily. The problem is not so much that the next delivery would be CS, but that the entire next pregnancy would carry all the same risks of having had a prior CS for no good reason. A scared uterus, whether due to CS or a myomectomy (fibroid removal), is at increased risk of spontaneous rupture and placental problems. The risk is small, but it is real. Scarring the uterus is worth it to have a CS; to remove a lump that isn’t causing a real problem, not so much.

      • Emilie Bishop
        January 26, 2018 at 5:37 pm #

        I get that, but it was the reasoning she used that threw me for a loop.

  10. Merrie
    January 24, 2018 at 10:43 pm #

    It would be extremely interesting to see if there is some way to identify which women will be more at risk of pelvic organ prolapse and incontinence.

    I have had 3 vaginal births and stress incontinence off and on for years, but I went to pelvic floor PT and it really helped! I think a lot of women could benefit.

  11. aurora
    January 24, 2018 at 10:28 pm #

    What I don’t understand is when it’s medically necessary ( Breech, natural birth gone bad etc ) nobody really cares about the risks and “future” complications. The procedure is performed and for the most part everyone moves on with their lives. When it’s straight up maternal request suddenly there is a whole army trying to convince you how dangerous it is and how natural is so much better. Can someone enlighten me?

    • Steph858
      January 25, 2018 at 4:27 pm #

      You think nobody cares about the risks of a C/S in high-risk cases like breech, twins etc? Oh, how I envy your blissful naivety …

  12. CSN0116
    January 24, 2018 at 10:13 pm #

    OT: Patient advocacy help needed. I’ve picked up just the saddest of situations. I’ve become friendly with the mom of twin toddlers who we sponsored for Christmas this past year. She is pregnant with her third baby, totally unexpectedly after Stage 4 breast caner (left undiagnosed for over a year despite her constant complaints, doctor visits, and a clear lump), months of chemo and a double mastectomy. She is getting the shittiest care I’ve ever seen.

    She is 33 weeks and has not had a single blood draw the entire pregnancy. Nothing. No Hep B, no HIV. Nadda. She has not had a GT test. When she asked for one, her doctor told her, “you vomited from the drink last time, so we’re not going to do it this time.” About three months ago they detected placenta previa. Her placenta is low and her uterus tilted. She has had no referral to an MFM and not a single other ultrasound since the previa was first detected (~20 weeks). She with be a RCS. Doctor will not book her a cesarean until AFTER 39 weeks. Like, not even set a date. Her life is complicated and she will require childcare arrangements, so having to wait until the 11th hour is extremely burdensome. At her last appointment her doctor indicated she should be on bed rest but gave no clear indication as to why.

    She is very low income. Her personal life is messy. She was a foster kid from age 3 to 16 and in 14 homes. She lacks cultural competency and agency. But even I am appalled at the way she is being treated. She is a compliant patient and overall easy going in general. Nobody deserves this. She is so worried for her unborn baby, as am I.

    I’ve tried getting her switched but I’m finding resistance due to how far along she is. Our state’s Medicaid policy says that participating OB’s must be in compliance with current ACOG standards for prenatal care. This doc is in violation of tons.What can be done to help her? :/

    • Daleth
      January 25, 2018 at 8:48 am #

      Holy crap. Have you talked to the patient advocate at her hospital?

      • CSN0116
        January 25, 2018 at 10:08 am #

        No. But I can!

        • kilda
          January 25, 2018 at 10:32 am #

          definitely do. that’s appalling malpractice.

    • BeatriceC
      January 25, 2018 at 1:59 pm #

      If she is willing, accompany her to her doctor’s appointments. I have no idea what race you are, but you’re at least well educated. Though if you’re white, even better. I have found, unfortunately, that doctors, social workers, lawyers, hospital administrators, etc., are suddenly willing to be more reasonable when a white, well educated friend or advocate is in the room. And as sad as it is to say, if you have a white, well educated man willing to help, even better.

      • Who?
        January 25, 2018 at 6:01 pm #

        If that man has a well-groomed salt and pepper beard and an air of patient watchfulness, even better. He need not say a word, just look like he’s ready to pounce.

        • BeatriceC
          January 26, 2018 at 2:37 pm #

          As horrible as it is to say, I do notice a distinct uptick in the quality of care I receive when MrC accompanies me to doctor’s visits. He’s 64, mostly white haired, thin, well educated and well spoken. I’m also well educated and well spoken, probably more well spoken than he is, yet his mere presence makes a huge difference.

          • Empress of the Iguana People
            January 26, 2018 at 3:19 pm #

            Blindness apparently being disqualifying.

    • KeeperOfTheBooks
      January 25, 2018 at 11:07 pm #

      My jaw is on the floor. This is so far beyond unacceptable.
      I agree with others who have said that, if it’s okay with her, go to her next appointment with her.
      Also, there should be some sort of patient safety advocate at this hospital. This is a person who, bluntly speaking, is there to try to prevent lawsuits (and yes, to keep patients from being hurt). Find out who this person is, contact them, and tell them what you wrote above. Because that sounds like it has the potential to be one HELL of a lawsuit when/if (and at the rate this is going, sounds more like “when” to me) this mess goes pear-shaped. Is she of a minority race, and does she think that’s a factor? If so, bring that up.
      Lastly, you might consider offering, depending on her family situation and her level of comfort with you, to stay at the hospital during the first couple of nights after the baby is born in order to give her support and help with baby, especially if she’s delivering at one of those gawd-awful Baby Friendly hospitals.

  13. crazy mama, PhD
    January 24, 2018 at 4:04 pm #

    I’ve been thinking about this a lot lately, because my second kid was born by VBAC; he’s 5 months old and I still leak pee during exercise. (I didn’t have any incontinence during pregnancy, so I’m fairly certain it was the 2 hours of pushing that did it.) With my CS, the first few weeks of recovery were much more difficult and painful, but by 5 months out, everything was fine aside from a little numbness around my scar.

    • moto_librarian
      January 25, 2018 at 10:12 am #

      You might look into physiotherapy. I was also having stress urinary incontinence, and physio has pretty much eliminated that problem. If only it worked with the bowel issues. Sigh.

  14. Emil Sinclair
    January 24, 2018 at 3:22 pm #

    I remember reading a few years ago that there was some evidence to suggest that c-sections were not as protective against prolapse as initially thought. Of course, I can’t remember where I read that. Am I just incorrect?

    • 3boyz
      January 24, 2018 at 6:26 pm #

      Yeah I’m one of those who wants a lot of kids, so it has been important to me to avoid c sections. I did have a c with my third and hope to VBAC next time around. That said, while I obviously don’t want to create more risk for future pregnancies, there is no possible way I would put that ahead of what’s going on in the current pregnancy. Actual baby trumps hypothetical future baby. Also, I wouldn’t attempt a VBAC if I wasn’t a good candidate. But I am. My first two were vaginal, and my c section was unconnected to labor (in fact, I was not in labor at all, something concerning showed up during a routine NST for GD and I was immediately admitted and taken to the OR).

    • 3boyz
      January 24, 2018 at 6:26 pm #

      Sorry, wrong reply. Meant to reply below you 🙂

    • fiftyfifty1
      January 24, 2018 at 8:37 pm #

      Elective CS is actually very protective against prolapse. The evidence is strong. Maybe the studies you remember had to do with urinary incontinence? The issue with measuring the effects of birth mode on urinary incontinence is that there are so many types of urinary incontinence: urge incontinence, stress incontinence, overflow incontinence, functional incontinence etc., while the only one that relates directly to mode of delivery is stress incontinence. So the protective effect looks smaller because of all the “noise” from the other types.

      • kilda
        January 24, 2018 at 9:02 pm #

        I’ve never given birth and I have stress incontinence. It’s annoying as hell. I can only imagine if I *had* given birth, how much worse it would be. At least it only comes into play when I have a cold and am coughing a lot. If I’d actually ever pushed a baby through there, my uterus and bladder would probably be somewhere near my knees.

      • Emil Sinclair
        January 24, 2018 at 9:22 pm #

        Maybe that was it, thank you. It was about 5 or 6 years ago, I remember reading something (not an actual study) and then only days later I had a patient who was 32 presenting with a rectocele, she had given birth by caesarian a few months before, and in my mind I connected her with what I had read. I’m not sure if I was confused then, now, or both, but it’s good to get an update on what the evidence actually says.

        • fiftyfifty1
          January 25, 2018 at 8:31 am #

          And another thing that can make things hard to sort out is pre-labor CS, vs CS after hours of pushing. They are 2 very different situations, but some (low quality) studies lump them together.

          • Roadstergal
            January 25, 2018 at 12:11 pm #

            It’d be great to have someone do a study of prelabor vs post-labor C/S. I wouldn’t be surprised if the outcomes of the former are massively better, but it’s important for women to have the information to make their own decision on whether to try labor or not.

    • AnnaPDE
      January 24, 2018 at 10:54 pm #

      There’s the problem with the stats that usually all CS are lumped together, from the “before a single contraction” kind to the “50 hours of labour and kid’s head was already visible when he got stuck” kind. The former will be very very effective in protecting the pelvic floor, the latter not really.

  15. Roadstergal
    January 24, 2018 at 2:31 pm #

    Not to mention that the risk to future pregnancy only comes into play _if you want future pregnancies_.

    If you want just 1-2 kids, that SHOULD be part of an honest risk/benefit analysis.

    • Sarah
      January 24, 2018 at 2:34 pm #

      Or even if you want 7 but this is the 7th.

      • fiftyfifty1
        January 24, 2018 at 8:48 pm #

        Although I doubt that there is an OB alive who would encourage a woman who has already had 6 uneventful vaginal births to have a 7th by CS without medical reason. By that point, “saving the pelvic floor” is no longer in play, so what would be the benefit that would balance out the additional risks of surgery? (Of course it’s all hypothetical as I doubt there are any woman wanting a CS in this circumstance either.)

        • Sarah
          January 25, 2018 at 3:05 pm #

          Who’s to say the hypothetical woman didn’t have a disliked experience in her 6th birth that she simply doesn’t wish to repeat? I mean yes, there aren’t a lot of women having 7 children in the developed world so this exact set of circumstances may never have happened. But there’s nothing to say a woman couldn’t have had several uneventful vaginal deliveries, but found something sufficiently traumatic about the last one that she no longer wishes to deliver vaginally.

          • Mariana
            January 25, 2018 at 7:22 pm #

            My grandma had 4 babies vaginally (at least 2 at home) and the 5th was a csection. For some reason labor was not progressing and she had a csection.

          • KeeperOfTheBooks
            January 25, 2018 at 11:14 pm #

            A blogger I read who has ten (yes, ten) kids once wrote very honestly about the horrible anxiety she had leading up to the birth of kid #10, and how no one, doctors included, would take her seriously: she couldn’t possibly be anxious about labor and delivery even though several of hers sounded pretty hellacious; after all, she had ten kids! Nope, the problem must be that she had those kids. She wasn’t “allowed,” so to speak, to be plain terrified of labor and delivery.
            I read the post years after the fact, and wondered, given her age and the fact that this would likely be a last or second-to-last kid, whether a MRCS might not have been a good idea for her, but then I doubt she could have gotten anyone to take her seriously if she had asked for one. Sigh.

          • Who?
            January 26, 2018 at 12:27 am #

            Zsu over at Are They All Yours has just had a baby-number 10? It was a hospital transfer, and she was glad to have the epidural. She mentioned she wasn’t looking forward to labour, and in this post she mentioned being traumatised by the delivery of the last baby.

            She and baby look great.

            So multiple labours don’t necessarily make next labour any less scary.

          • Sarah
            January 26, 2018 at 2:57 am #

            Which is terrible really.

    • Cat
      January 24, 2018 at 3:21 pm #

      That was basically the entire conversation with the consultant about my MRCS in a nutshell:
      “Do you plan to have lots of children?”
      “God, no.”
      ” Well, that’s your answer, then.”

      • Cat
        January 24, 2018 at 3:32 pm #

        (Funnily enough, before I had my daughter, I was quite keen on having two kids, whereas now I don’t want another (unless I decide later along the line that she’d really benefit from a sibling). Before I had her, I loved kids in the abstract; now, I love her specifically and can’t feel any great longing for a faceless, hypothetical second child whom I haven’t met. Possibly I’m just weird though – most families that I know wanted a second kid precisely because they loved their first so much and wanted more like that!)

        • Empress of the Iguana People
          January 24, 2018 at 3:48 pm #

          I can understand that.
          In my case, I always wanted 3, and when I had my son, I still wanted another, partly out of plain wanting, partly to give him a sib to lean on for when his oldish parents pass away (My parents passed away 8 and 2 years ago), and partly to diffuse my anxieties. Mom died before Grandma, but at least Grandma had her other kids to hug all the closer when they came for a visit.

          • Cat
            January 24, 2018 at 4:26 pm #

            I worry about the ageing parents thing, especially as I’m a single mother. On the other hand, I’m aware that my parents’ experience of losing their own parents was made much worse by the fact that they each had a living sibling who refused to share the burden at all, only turning up at the funeral in the hope of getting something in the will, so I guess families are still luck of the draw. I really sympathise with the anxiety point too. On the other hand, before motherhood, I got a second kitten for that precise reason and found that I just ended up with the same anxiety multiplied by two…

          • Empress of the Iguana People
            January 24, 2018 at 8:38 pm #

            True in both cases. We can’t know beforehand. My husband’s anxiety did double, but i think it’s made up for in that mine more than halved.

        • EmbraceYourInnerCrone
          January 24, 2018 at 4:25 pm #

          I love my daughter to the moon and back,and if I had been able to have her earlier I might have wanted more kids, but having one has been great. When we traveled we were able to show her all the interesting things and really enjoy spending time with her. When she broke her arm hiking we could spend all the time needed for her surgeries with her without feeling like we were shortchanging other kids. We had time and money to take her to hobbies and classes she wanted to take. We were able to help her with living expenses in college, she was lucky enough to cobble together enough scholarships to pay her tuition.

          And as she used to tell me, she has friends who don’t like their siblings, she has friends who don’t have anything in common with their siblings.

          • EmbraceYourInnerCrone
            January 24, 2018 at 4:28 pm #

            And I honestly used to want to brain people who looked at my 6 month old and asked ” SO when you gonna have another one?”

          • Tigger_the_Wing
            January 25, 2018 at 6:18 am #

            Oh, yes. “FFS, I’ve barely recovered from having this one!” And then brain those who comment about ‘trying’ for one of the opposite sex to the one(s) you already have.

            And my husband’s maternal grandmother (herself a mother of seven) was the worst. When I had my second son seventeen months to the day after the first, you would have thought I was the cleverest mother on Earth (“Two boys! They’ll be great friends!”) – for about a month. Then it was “When will you try for a daughter?” When I got pregnant again almost immediately, it was “There are ways of spacing your family now, you know!” Until she became the first (and only, as it turned out) great-granddaughter, then I was brilliant – but then she wanted to make sure we were completely done; no talk about a sister – girls evidently don’t need sisters. Too busy clearing up after their big brothers, I suppose (Cynical? Moi?!).

            When I got pregnant again in the nineties, you’d have thought we’d done it just to spite her, the fuss she made. When we discovered that I was having twins, though, she was over the moon – the first twins ever! The last photograph I have of her is the one with the twins in her arms, as proud as if she’d had them herself.

            I cannot understand the obsession some people have with the choices of others. It’s none of their damned business!

          • Cat
            January 26, 2018 at 3:43 am #

            I got asked whether I was planning a second child exactly ten minutes after I announced my pregnancy with my first. I’m not joking: the conversation went “oh congratulations! Who’s the father? When are you due? And are you going to have another?”

          • Claire Secrist
            January 24, 2018 at 6:41 pm #

            I stopped at one because I can barely keep up with her, and being pregnant with her almost killed me. Almost nobody has believed these were “good enough” reasons. When I was being admitted due to HELLP, a nurse was scolding me that I owed my still unborn kid a sibling. I feel like any reason is good enough, but apparently I’m alone here.

          • January 24, 2018 at 7:09 pm #

            Whaat? Yeah, “I don’t want another kid” is plenty of reason for not having another kid. Why do so many people see “I don’t want to” as an invalid reason? It’s completely valid.

          • Claire Secrist
            January 24, 2018 at 7:22 pm #

            Your guess is as good as mine. I really don’t know.

          • Namaste
            January 24, 2018 at 7:19 pm #

            That’s truly messed up. I’m an only child, myself. The idea that we are inherently damaged goods pisses me off to no end.

          • fiftyfifty1
            January 24, 2018 at 8:41 pm #

            ” The idea that we are inherently damaged goods pisses me off to no end.”

            Yes, especially because there are actual scientific studies that show it is not true.

          • Sue
            January 24, 2018 at 11:05 pm #

            First child, last child, unwanted child, child of blended family, single child, middle child – everyone can find excuses for their issues, or everyone can blossom.

          • StephanieJR
            January 25, 2018 at 10:58 am #

            There are plenty of times where I wish I was an only child…

          • January 25, 2018 at 12:10 pm #

            Bit of a rant here.
            One person wants “lots of children”. Another finds even a single child overwhelming. Yet another spends years and a fortune trying desperately to get pregnant without success.

            It wasn’t all that long ago that a woman learned to live with the hand nature dealt her. There’s no absolute “right” to either having or not having children. Technology helps; be it fertility treatment or contraception, but there are limits and the bottom line is that it’s under our own control only to a point. I’ve seen women who wanted big families have to deal with infertile husbands, or some gyn problem which makes childbearing, especially repeated childbearing, very risky. And I’ve seen the other end of the spectrum, too. And everything in between.

            One woman’s blessing is another’s curse. It takes maturity to accept that, sometimes.

            Rant over.

          • MaineJen
            January 25, 2018 at 12:42 pm #

            If modern medicine has taught us anything, it’s that we *don’t* always have to live with the problems nature gives us. And isn’t that a good thing? I try not to judge people who don’t want to live with what nature gave them.

            If I’d tried to live with what nature gave me, I’d be legally blind and I’d have no teeth left. …………yay?

          • Roadstergal
            January 25, 2018 at 12:14 pm #

            I’ve never wanted to be an only child – I love my siblings and I’m lucky to have them.
            But that’s not a given! We’re all different. No mom ‘owes’ her kid a sibling. She either wants another kid or not.

          • Cat
            January 26, 2018 at 4:04 am #

            As other people have said, you don’t need a reason. However, as reasons go, “I think my child would probably prefer a living mother” is an excellent one.

          • Claire Secrist
            January 26, 2018 at 9:07 am #

            Hell yeah it is! It’s kind of a sign of how deluded people are about pregnancy and childbirth. They’re certain I won’t die, even though the proof I almost DID is right there.

          • Cat
            January 26, 2018 at 3:37 am #

            Your daughter talks a lot of sense! I’m very fond of my brother now that we’re adults but he was completely vile to me until our mid-teens, and we still don’t have anything much in common. I know plenty of adults who are estranged from their siblings or who only have contact with them by letter once or twice a year. I have other friends whose siblings let them down in the most brutal way possible when they came out. I have one close friend who is fond of her brother but lies awake at night worrying about the fact that she’ll almost certainly be financially responsible for him when their parents die, which may mean that she can never afford a family of her own. Another adult friend has a close relationship with her sister, but the sister is very much the dominant personality and my friend seems to have made a lot of big, life-altering sacrifices to keep the peace between them.

            Of course, I know other people who have great sibling relationships, but having siblings certainly isn’t a magic ticket to a golden childhood…

      • The Bofa on the Sofa
        January 24, 2018 at 9:56 pm #

        Yeah, I wonder about that. They bemoan the increase in the number of MRCS, and worry about potential risks for future pregnancies. But how many people choosing MRCS are planning to have lots of kids? I really don’t think those choosing MRCS are planning on lots of kids.

        Given that US family sizes are decreasing, the impact of CS on having lots of kids isn’t that big of an issue. You have to control for the planned size of family in determining if it is a problem or not. If the increase in CS frequency can be matched by the decrease in the number wanting 2 kids instead of 4, then the long term impact of CS on family size is basically irrelevant.

  16. J.B.
    January 24, 2018 at 2:03 pm #

    I’m a little confused by the labels on the charts. These are increased risks relative to the other option right? There are cases of placenta previa w vaginal birth and incontinence with c section? It would be interesting to see absolute risks compared.

    • Dr Kitty
      January 24, 2018 at 2:26 pm #

      No- those ARE absolute risks.
      PP and PA are rare, POP and UI are common.

      For each 100 CS 7 fewer women will have a prolapse, and 4 women will have urinary incontinence.

      You have to do 200 CS to get an extra PP and more than 500 to get an extra PA case…

      • J.B.
        January 29, 2018 at 1:27 pm #

        I get that, but there are 4 different things being compared and two separate charts listed. To me it would make more sense to compare all 4 charts side by side. Is there no incontinence at all with c sections or only a very thin line like was shown for PA? Is there no placenta previa at all for vag, or just a very thin line for that?

  17. moto_librarian
    January 24, 2018 at 2:02 pm #

    I’ve made a lot of progress at coming to terms with what vaginal delivery did to me, but articles like this still overwhelm me with anger. Not a single healthcare provider said a damned thing about the long-term risks of vaginal delivery. Sure, tearing was discussed in an off-hand way, but I can assure you that I didn’t get any information about the realities of serious pelvic floor damage. I cannot have a bowel movement without splinting. I still buy baby wipes, not for my kids, but for me, to clean up when I have smearing from the dysfunction caused by nerve damage. The damage has ruined date nights with my husband, outings with my children, and caused me a lot of anxiety at work.

    Most women don’t want large families. I knew that I never wanted more than two children. And knowing what I know now, I resent the deliberate misinformation campaign surrounding childbirth. I should have had the opportunity to weight the real risks and benefits of delivery method.

    • Sarah
      January 24, 2018 at 2:35 pm #

      You’re right to resent it. Your anger is justified. You’re entitled to speak about your pelvic floor damage, and your date nights matter.

    • BeatriceC
      January 24, 2018 at 3:49 pm #

      I’m right next to you on this couch. I’m 42. My oldest is a few months away from 19. I still can’t laugh without peeing myself, and there’s a chance surgical intervention will help, but no guarantee. He has permanent nerve damage from the shoulder dystocia he suffered. Other than the little skin flap that would go away if I lost the extra 80 pounds I’m carrying around (50 of which I gained in the last year when I quit smoking), I’m not aware of a single long term effect of my c-sections. There are some long term health problems in the youngest, but that has everything to do with being born at 24 weeks and nothing at all to do with mode of delivery.

      And I resent the ideology that led to the nurses pooh-pahing clear signs of distress for hours, until it was actually too late to do a CS, which would have avoided both the nerve damage to the kid and the damaged pelvic floor and urethra in me.

    • attitude devant
      January 24, 2018 at 5:35 pm #

      I’m really sorry. You’ve been through so much. And you’re hardly the only one.

    • fiftyfifty1
      January 24, 2018 at 9:24 pm #

      Yep, the “can’t keep it in, but can’t get it out” poop club. It’s not a fun club, although I try to keep a sense of humor about it. What you say about making “progress at coming to terms with what vaginal delivery did to me” resonates with me. The first few years were the hardest, for sure. It was such a huge adjustment.

  18. FormerPhysicist
    January 24, 2018 at 1:49 pm #

    Long-term effects of my c-sections on my babies and me: we’re alive. I couldn’t have any more than three, but that’s because I couldn’t survive another pregnancy, nothing to do with the c/s.

    Negative long-term effects: Possibly the reason I couldn’t get an IUD after #3, possibly not. It’s okay, loved the tubal better. And I hate the weird flappy way my abdomen bulges over the bikini scar. But that would go away if I lost the excess weight.

    Repeat – long-term effect – we are alive. No c/s -> no formerphysicist, no kids.

    • kilda
      January 24, 2018 at 8:57 pm #

      well, if you were dead you wouldn’t be able to get an IUD either, so they’re even on that one. But I suppose if you were dead you’d be spared that weird flappy abdomen bulge thing. So there’s that.

  19. ukay
    January 24, 2018 at 1:27 pm #

    I was hoping you would cover this article. It got my blood boiling today when a respected magazine blared about it with the headline „CS increases probability of future miscarriage“. The information you get here about the cons of vaginal delivery are nonexistent or have to be coaxed out of most healthcare providers and articles like that make it so much worse. Thanks for clarifying.

  20. L.
    January 24, 2018 at 1:23 pm #

    Just after I turned eighteen, I had surgery on my left eye. I was offered two choices of how the surgery could be done. A month before, I had been a child, but now the doctors explained the pros and cons of each option. The choice was entirely mine.

    Twenty years later, in the decision of how to give birth, I am treated like a child.

  21. EmbraceYourInnerCrone
    January 24, 2018 at 1:23 pm #

    What the hell do they mean by this phrase?: long-term childhood outcomes (of C section)

    Do they mean the supposed bullshit “outcomes” of obesity, diabetes, etc?

    How about the fact that the “outcome” of NOT doing a C-section can be, for the baby, lack of oxygen, brain damage, shoulder dystocia or death?

    • Sue
      January 24, 2018 at 11:07 pm #

      They don’t seem to have looked for the long-term outcomes of intrapartum hypoxia, interestingly.

  22. fiftyfifty1
    January 24, 2018 at 12:49 pm #

    Do we even have evidence that women asking for MRCS are not being informed of the risk of CS? I know I was. At length.

    Women going for vaginal birth are the ones not informed of the risks. But those risks are “natural”, even God-ordained because of Eve’s sin I guess….

    • CSN0116
      January 24, 2018 at 12:59 pm #

      In one of the many conversations my OB and I had before my first VBA2C, I’ll never forget him telling me, “You know, L, vaginal birth is not without a lot of pain and lengthy recovery too. It’g going to hurt afterward.” (I was trying for a vaginal birth to voluntarily get back to work faster).

      Boy, was he right.

      • Roadstergal
        January 25, 2018 at 12:25 pm #

        I have three friends who had picture-perfect vaginal births with easy recoveries. And friends who have had horrorshows where they were torn and bleeding for over a month (one whose abdominal muscles were so wrecked she had trouble sitting up). It seems like it’s rolling the dice to go VB – maybe super-easy, maybe horrific – and a prelabor C/S is more controllable/predictable, despite being more difficult than the ‘best’ VB?

    • Sue
      January 24, 2018 at 11:08 pm #

      Conversely, how many women are adequately advised of the long-term effects of vaginal birth?

Leave a Reply

You must be logged in to post a comment.