The Myth of the Elective C-Section


Cesarean sections have been
hitting headlines a lot lately. We’ve been hearing about the rising c-section
rate, now above
30% and rising
, for months, and in early June we learned that women
have been denied
health insurance coverage because of previous cesareans
. A few days later,
the March of
Dimes reported
that 92% of preterm births were delivered by c-section.

When the media covers the
rising rate of c-section, it’s often ready to lay the blame at the feet of a
woman we’re come to know well over the last few years — the busy career mom
scheduling her delivery between important business deals, penciling in labor
and delivery the way she pencils in a client meeting. As criticism of surgical
birth mounts, the idea that mother-initiated c-sections are spurring an overall
increase in the practice has only become more popular.

In mid-April
(coincidentally also Cesarean Awareness
Month
), Time Magazine claimed that Choosy
Mothers Choose Cesareans
. Euna Chung, a child psychiatrist in Los Angeles, told Alice Park that she planned her c-section before she was even pregnant. Park wrote of Chung,
"a combination of having watched traumatic vaginal
deliveries in medical school and hearing about her mother’s difficult emergency
caesarean experience after trying to deliver vaginally helped make up her
mind." Chung told Time, "I had a fear of going through labor and ending up with
an emergency C-section anyway. I know that’s rare, but I didn’t want to deal
with it." A recent Today show
segment
picked up on this supposed phenomenon, referring to the trend as
"babies on demand." Dr. Judith Reichman, the expert obstetrician on the show
reported National Institutes of Health Statistics that approximately 2% of all
c-sections nationwide can be considered "cesarean deliveries on maternal
request."

While the media likes to use these
stories of maternal demand as attention-grabbing hooks for their reporting on
the rise in c-section rates, other birth advocates and birthing rights
organizations take issue with the "mother’s choice" frame. Our Bodies Ourselves’
recently released book "Pregnancy and Birth" explains that the studies which
produce data like what Dr. Reichman referenced is flawed and not at all
conclusive:

Although some
studies describe an increase in caesareans without any medical indication, the
authors of these studies are clear that these may not represent real ‘maternal
request.’ The studies, based on birth certificates or hospital billing records,
have no way of documenting whether the caesarean was initially sought by the
mother, whether it was based on physician advice or pressure, or whether there
was simply poor record keeping.

These
advocates argue that while there invariably are some women who are choosing casareans without medical reasons, they do not represent a significant enough
percentage to account for huge increase in c-sections in the last decade. In
other words, some moms may be requesting surgical birth, but that has little to
do with the overall increase in c-section rates. Childbirth Connection’s most
recent survey Listening
to Mothers survey reports
that just one woman in 1600 actually reported
having a first c-section because she chose and planned it ahead of time without
any medical reason – a rate far lower than the 2% suggested by Dr. Reichman on
the Today Show.

Does it do any harm when the media,
doctors and others point to mother’s choice as the reason behind higher c-section
rates? These advocates argue that it takes away attention from the how decisions
related to pregnancy and childbirth are really made: often, under intense
pressure from the woman’s physician.
Childbirth Connection explains, "There is a change in practice standards
that reflects an increasing willingness on the part of professionals to follow
the cesarean path under all conditions. In fact, one quarter of the Listening
to Mothers survey participants who had cesareans reported that they had
experienced pressure from a health professional to have a cesarean." Even if
women are reporting a choice for cesarean, Childbirth Connection and others
argue that women aren’t making decisions about their mode of delivery in a
vacuum; rather, they are deeply impacted by the opinions and guidance of their
providers. Lamaze
International explains
, "What women hear from obstetricians
powerfully influences what they think. Some obstetricians think so little of
the risks, pain, and recovery of cesarean surgery that they feel that ‘convenience,’
‘certainty of delivering practitioner,’ and ‘[labor] pain’ justify performing
this major operation on healthy women."
When physicians talk up convenience and don’t give air time to possible
complications resulting from c-section, it’s no wonder women make decisions in
the same terms.

What makes these advocates the
angriest, though, is the implication that doctors who support a woman’s right
to elect a c-section do so because they believe in supporting all of women’s
choices around how they want to give birth. Quite the opposite, says Lamaze
International
:

Obstetricians champion a woman’s right to choose elective
surgery on grounds of ‘patient autonomy’ but deny her right to refuse one.
Access to vaginal birth after cesarean (VBAC) has declined precipitously in
recent years and is currently unobtainable in whole regions of the United
States…Until such time as obstetricians support a woman’s right to refuse as
well as choose surgery, the promotion of ‘maternal request’ cesarean must be
viewed with extreme suspicion.

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Follow Miriam Pérez on twitter: @miriamzperez

  • invalid-0

    Women have no idea how normal the process of birth is and how amazing their bodies are. Unfortunately, neither do doctors.

    I think that media coverage of the elective c-section by celebrities and those “choosy mothers” could work its way into a cultural norm.

    C-sections were 3% of all births like, what, 50 years ago? Now they’re 31.1%.

  • invalid-0

    There are circumstances that require c-sections, and I’m all for that in those cases. But it sounds like many of these women just want to take the easy way out. Child-rearing is a lot of work and a huge time-commitment. If you’re not at least willing to make that commitment to give birth naturally, should you really be having a child in the first place? Especially considering that this is one of the first major decisions you would make regarding him or her?

  • http://www.vbacfacts.com invalid-0

    Unfortunately, there are three different kind of care providers and the rarest kind is the one that genuinely supports VBAC. http://vbacfacts.com/2008/04/13/the-three-types-of-care-providers-amongst-obs-and-midwives/ With the other two types, women have to fight and debate in hospitals in the face of this intense pressure or they schedule the repeat surgery because they aren’t up for the fight and/or the OB “doesn’t do them.” So it’s no wonder that women are opting for a home birth where they can birth in peace. I had a home VBAC and was torn for a long time between a hospital VBAC and a home VBAC. I didn’t feel safe at either location. I looked at everything I had to give up, everything I had to compromise, and everything I had to fight for to birth in a hospital . . . just to hedge my bets. There are so many differences between birthing in a hospital vs. your home: http://vbacfacts.com/hbac/. It’s really, really unfortunate that women have to go to that “extreme” of birthing at home, but in the hospital, normal birth is no longer seen. And here are two examples of women, birthing in a hospital, one who managed to VBAC despite the lies and scare tactics used by her OB: http://vbacfacts.com/2008/05/22/vbacing-against-the-odds/, and the other who wasn’t up for the fight and had a repeat cesarean without medical reason: http://vbacfacts.com/2008/06/03/hospital-vbac-turned-cs-due-to-constant-scare-tactics/. Is it any wonder why women, like this neonatal nurse: http://vbacfacts.com/2008/06/16/neonatal-nurse-has-a-homebirth-vbac/ and myself http://vbacfacts.com/hbacbirth choose homebirth?

  • kirsten-sherk

    A good point, Miriam, and I wonder if you could also comment on another troubling aspect to the discussion: inducing labor. Women are often told that if they don’t go into labor within a week of their due date, they face all sorts of health risks — even if the chances of those risks are small and very manageable. Instead women may feel somewhat compelled to choose a more difficult labor, and then are more likely to face major surgery as a result.


    As Jillz points out, women often have no idea of what their bodies are capable of, and they deserve ob’s who’ll encourage them to try.

  • invalid-0

    Great article and great points. Most women I know who end up with a cesarean section didn’t choose to go there. As cesarean sections become more common, the pressure on a woman to schedule her birth mounts–friends, relatives, employers, coworkers don’t seem to understand as well as they used to that birth comes in its own time, takes its own time, and can be trusted.

    Mothers aren’t aware that being born by cesarean section without labor makes asthma in the baby FOUR times more likely. Labor and birth are important in the health of babies and their mothers. We shouldn’t let it go lightly.

    I worry that when my daughter gets to be in her twenties her friends will whisper “I hear that, in the old days, babies used to come our of women’s vaginas!” “No! that couldn’t be, its not big enough” My daughter, raised by a home birth physician, will be able to say “Yep they sure did, cause I’ve seen it”.

    We almost lost breastfeeding. We could loose birth.

    Thanks for the great information.

    Elizabeth Allemann, MD

  • invalid-0

    I agree that this is a very sad trend. These women and babies are missing out on all the gifts a natural birth provides to help with bonding and mothering. A natural birth can be an incredibly empowering experience giving a new mother the confidence she needs to embark on the awesome journey of motherhood. Not to mention the effect of all the love hormones surging through the baby and mother during and following a natural birth. The baby’s entry into the world sets the stage for the rest of her life.

    I know I didn’t realize all this when I agreed to be induced for my first birth. I’m so happy that I got a chance to experience birth the natural way in subsequent births. There was no comparison in my opinion. Of course I would be thankful if a cesarean was actually necessary, but if not I would avoid it like the plague.

    If expectant mothers really new the risks and benefits of all the options, I think the cesarean and induction rates would start dropping considerably.

  • invalid-0

    It is sad that few here have actually read the article which suspects that women in labour are being pressured by their ob-gyns to consent to a c-section, rather than requesting them … that the notion and incidence of elective c-sections is being widely inflated by media hype and doesn’t withstand a reality check.

    If the author who wrote, “… take the easy way out” and accusing women of being uncommited had ever experienced a “natural” child birth, then she would know that the state of being in labour is perhapsw the most vulnerable moment in your life. So you are probably not in the coolest and calmest state of mind to consider matters while your are being pressured (implicitly threatened) to agree.

    Further, who actually has a natural birth? I challenge the author of “… easy way out” to distinguish between vaginal and natural birth. Just because the baby came out through the vaginal, doesn’t mean the birth was anything but natural, by the time all the chemicals have been poured in, the epidurals, the pain killers, the labour inducers, the inevitable slashing of the vagina (episiotomy), et cetera.

    Finally, the woman in labour has a life-long commitment of motherhood ahead of her, by definition! The time in labour or how she gives birth, is a miniscule part of that time. “Easy way out” needs to prove his/her intelligence by finding something genuine to sneer at, rather than disdaining and defaming mothers.

    Being cut nearly in half to deliver a baby, and recovering from a c-section while tending a newborn, is hardly easy.

  • invalid-0

    I agree, most obstetricians have never seen a woman give birth by her own power: interventions such as pitocin, epidural anesthesia, artificial rupture of membranes – all are done routinely on women experiencing a normal birth in many hospital labor and birth units. This is what they learn.

    Fear of birth, tocophobia, has received increased research attention in the last several years. Women have come to believe that operative birth is easier, is more controllable, and is comparable to vaginal birth: after you, you get a baby either way, right?. Media depiction of birth for drama and TV ratings, obstetrician influence, and our cultural buy-in to the superiority of technology leads women to fear the unknown of normal birth, and believe operative birth is safer. Recent studies indicate that’s not the case (see McDorman’s work). Sadly, women’s ‘choices’ are influenced and encouraged by obstetricians, who enjoy significant lifestyle benefits when birth is scheduled. Its commonly accepted that OB is becoming a 9-5 profession.

    Women want a healthy baby and when they’re told either that an operative birth is equivalent, or they have a condition where it might be ‘safer’ to have an operative birth, it’s difficult to question or challenge the childbirth authority. Women give away a life transforming experience without a full understanding of what was lost, for the benefit of someone else who just doesn’t care of know about the psychological aspects of childbirth. When an operative birth is medically indicated, it’s life saving. When it’s not, it’s a crime. Birth certificate data unfortunately often does not provide true indication. The box ‘postdates’ might be checked as reason for the Cesarean, however the woman might be 40 weeks and 5 days gestation, poast her due date but not post dates. Same with the indication, ‘failure to progress”. Labor varies from one woman to the next, yet arbitrary time parameters applied to all women are common.

    I’m hopeful that women will start seeking their own childbirth knowledge and trust their bodies to give birth. Choosing the right provider makes a huge difference in birth experience as well. Its worth the effort to ‘shop around’ and find a provider who is willing to encourage the woman herself to become knowledgeable about birth.

  • invalid-0

    I just wanted to let people know, that fear of pain is no reason to opt for a c-section. I have had five pregnancies and birthed six babies. All that Hollywood hype about the drama and pain of birth is just that, hype. In a normal birth there is no pain (except for the stretching at the very end of labor, but some women don’t even find that to be so bad). Rather than pain, in a natural birth, there is normal muscle contraction, no different than you would feel while doing stretching exercise or a mild work out. Yes, an under oxygenated working muscle can be painful, but that comes from not breathing properly and working against, instead of with, your body or obstetric medicines which cause the uterus to hyper contrat. Fear causes tention. Tention causes pain. Society sets up a woman to be fearful of the overall experiance of childbirth. I have gone into my births relaxed and full of joy, and my births have been absolute pleasure, and that is what all women should expect! I reccomend the book “Childbirth Without Fear” by Dr. Grantly Dick Read to all women who would like to experiance a joyful normal birth of their baby. I would also like to thank all the midwives and doulas out their who take the time to help women have the joyful births that are not regularly possible within the confines of a hospital.

  • invalid-0

    Krandal, you are correct. Many women define natural birth as any birth that takes place vaginally, no matter the circumstances. I diferentiate a physiologically normal birth and a pushed along “natural birth”, by using the term “normal birth” for a naturally progressing birth, without drugs, physical restraint (being hooked to IVs and monitors and not allowed out of bed), eppesiotomy, Pitocin, interventions and all the undue fear and stress that are not a normal or necessary part of childbirth.

    By the way the “slashing of the vagina” is not inevitable. I had one with my first birth and after that went with midwives whenever possible to avoid having another one!

    By the way, you are wrong about the birth of a child being a miniscule moment in time. A bad birth sticks with you and for many of us, seeking out a normal birth afterward is a cathartic healing experiance, essential for the healing of our wounded souls. A good birth experiance stays with you as well, for the rest of your life. Some of my births have been so wonderful, so pleasureful, so full of dignity, so overwelmingly joyful, I still dream about giving birth. I still yearn to do it again. Do you understand how magnificent birth can be? It shapes your dreams and your outlook on the future. Never underestimate the power of a good birth experiance.

  • invalid-0

    A home birth physician? Awesome! We need more people like you Dr. Allemann.

  • invalid-0

    All this talk about everyone getting C-sections is just opportunites for greed-driven big-pharma to make more money. Yeah, C-sections are necessary SOMETIMES. It has ALREADY been PROVEN that vaginal delivered babies are more alert from day one. It wasn’t all that long ago when women had to FIGHT to MAKE hospitals have birthing rooms. We had to FIGHT the then male-dominated medical industry to keep our mid-wives. If you want to have a C-section (and assuming you have are healthy enough to have a vaginal delivery), you need to ask yourself: Am I going to have a vaginal delivery because I want my child to be alert (NOT downed out for a week from the anesthesia), and want it to have a healthy start in life from day one, and want the closeness and humaness of a vaginal delivery. OR Am I going to have an a greed-driven big-pharma cold, un-feeling, egotistical surgeon knock me out and cut me all apart because I am so NARCISSISTIC that I would rather have a downed out for a week baby, than a baby who is alert and has a healty start in life? What may seem like is CONVIENENCE, is not so good for babies, no matter what capitalist-pig, male-dominated Big-pharma people say. That has ALREADY been PROVEN. Seems to me like this notion is all about NARCISSIM and BIG PHARMA.

  • invalid-0

    I find it frightening how drs are pressuring women to induce labor when they are not even really overdue. I had my 3 girls at home with a midwife because I did not want to have to fight the drs and medical staff at a very vulnerable time (20, 24 and 29 yrs ago) a friend of my daughters came to see me for acupressure to help start labor as she did not want to be induced–I found out that she was actually only 4 days over her due date! I told her acupressure only works if the baby and her body are ready–it did not work but she did listen to me and not allow the induced labor for the next day–she waited another week and guess what? The baby was only 7 pounds–if they had induced the week earlier she would have been too early! I wonder if this has something to do with the increased rates of under weight babies–they are so quick to blame it on teen moms and smokers. And of course induced labor often leads to c-section as it is almost always more painful and hard to breathe with. ANd this is not the only case of this rush to induce labor i have heard of lately. My sisters 2 daughters just had babies last spring and she told me how totally different the births were–one in a hospital and the othter in a birthing center with midwives–guess which was painfula nd difficult and which went smoothly? I will say to the woman who posted that labor is not painful –it is painful if one cannot move around and get into most comfy position. I was only comfortable on my hands and knees as I had a lot of back labor–I am sure the drs would not have bothered to assist my babies in that position as my midwife did and I would proabably needed pain killers if I had to lay on my back with feet up!

  • http://vbac.angelahoy.com invalid-0

    Funny how doctors try to limit a woman’s right to choose to give birth at home…yet they allow women to choose major surgery when, in the vast majority of cases, the woman would do just fine without it.

    The answer here is economics. They and the hospitals make far more money on c-sections than they do on routine vaginal births.

    Hypocrisy and greed.

    Angela Hoy, author –
    DON’T CUT ME AGAIN!
    True Stories About Vaginal Birth After Cesarean

  • invalid-0

    Ms. Kennedy:

    Some women have easy labors. You are very lucky that yours were easy and painless. Please don’t insult women everywhere by saying that the tsunami of pain that many of them feel during childbirth can be resolved through breathing techniques. It can’t, and anyone with sense should know better than to say it can. You lucked out. You don’t know what you are talking about when you belittle other women’s labor pains.

    I don’t care for pushy doctors, but if women want to make an informed choice about c-sections or pain management, I have no issue with that. There is a moralistic undertone to the claims that a woman who doesn’t opt for natural, extremely painful childbirth is missing out on a beautiful experience. For women who have c-sections, epidurals, pitocin or episiotomies, having a baby is beautiful too.

  • invalid-0

    You have no right to judge anyone else’s choice in giving birth. I think it is great that more women are being given the choice of C-section. I seriously doubt many consider being cut open and stapled up “the easy way out”. I would rather think that most choosing this are much like me truly frightened of vaginal childbirth for some reason. I watched 2 of my friends go through this. They both wanted “natural childbirth” but instead ended up with pitocin in their veins, needles in their backs and hours of agonizing labor ( one epidural never worked and the other only numbed one half of her body) only to end up with very scary emergency c -sections. After which one baby was in distress from laboring too long. Both had elective planned c -sections for their next children although vbac was an option for them. Why should I not have the choice to enjoy the birth of MY child the way I choose? Certainly not because some women feel that because their child came out through a vagina they have made more of a “commitment” or sacrifice for their child. I also doubt that you will find any statics that support people who choose c-section are less commited to their children.

  • invalid-0

    Julie

    You are obviously against c-sections, but what about pitocin, epidurals, or pain meds during delivery? These can actually cause babies to be less alert then a quick c-section delivery because of the lenght of time administered. Are these things narcissim too? If so then I guess what you mean to say is that the only true selfless way to give birth is with none of the above. You need to do a little more research on the safety of c-section births. If you want to have a natural childbirth I think that is fabulous. If I want to have a c-section then it is none of your business. Birth choices are personal and my choice does not affect you. Please do not say that it drives up insurance costs. We all know that really has nothing to do with the real problems with out healthcare system.

  • invalid-0

    Sherry

    I am so glad you had great child birth experiences. Let’s be honest and admit that you are the exception and not the rule. Childbirth IS painful. Please do not add to the misconception that those who do not choose an all natural childbirth are somehow less of woman.

  • invalid-0

    Angela

    I truly do not understand what some women find so threatening about women who choose c-section. You DO have the right to have your baby in your home if you want. You have the right to have an all natural delivery if you want. Why should I not be given the choice of c-section if I feel it is best for me? I think that some doctors do push for c-sections when they are not needed or wanted and this is unfortunate. Any doctor who performs a c-section on a woman who chooses it is not being greedy.

  • invalid-0

    As someone who went through a C-section (not my choice, obviously), I am baffled why it is supposed to be the “easy way out”??!??

    A C-section is major abdominal surgery. It is very painful, takes a long time to heal, and leaves a huge, ugly scar on your belly.

    Also, to minimize the amount of drugs getting to the baby, most women undergo C-section with merely a spinal block–ie an epidural. ie you are “awake” and conscious the entire time while they are cutting you open! This is incredibly terrifying.

    While you can’t feel any actual pain below your breasts due to the spinal block (which you are praying frantically doesn’t wear off before they finish the operation), you can hear the surgeons cutting and discussing how much you are bleeding, and you can feel them tugging and dragging your body from side to side to get the baby out. You can feel them pulling your muscle layers back together afterwards.

    And you can’t move during any of it.

    Then you have ongoing pain for weeks while you are trying to recover from surgery AND take care of a newborn at the same time. It hurts to walk, move, pick up the baby. If you lay down in bed, you basically can’t even sit up again without someone helping you—I ended up sleeping on the couch for weeks after my C-section because the only way I could get up by myself was to grab the back of the couch and haul myself upright that way.

    Who in their right mind would “choose” this?

  • invalid-0

    I truly hope that every single one of you here shouting about “natural birth,” “big pharm,” how women should give birth the way YOU think they should, realize that you are in every way, shape, and form just as bad as a doctor who pressures a woman into a C-section. Perhaps we could begin to operate from the assumption that women besides the fine, upstanding, obviously above-average intelligence commenteres here, also do their own research and make their own choices? And perhaps we could find it in ourselves to believe that just because someone else chooses differently than we might, that does not make their choice wrong?

    The Internet Mommy Brigade is completely out of hand. You do this with birth (before you ask, I had a vaginal delivery,) you do this with breast feeding (did this,) you do this with co-sleeping (this, too.) Your actions make it embarassing for mothers like me to offer opinions and advice, because you are so busy dispensing with the judgment and contempt. And it is all you do.

    Please go find something else to do.

  • http://herveryown.typepad.com/herveryown/ invalid-0

    Love this post. I’ve long had a suspicion about this whole “elective C-section” business, as doctors (aside from plastics) rarely cut you for the sheer fun of it, and let’s face it, insurance companies are hardly going to pay for insanely expensive procedures that aren’t necessary. Do you really think my insurance company would shell out $36,000 just because I asked them to?

    When my husband and I were leaving the hospital, I said “I thought I would feel worse about the c-section, emotionally. I really wanted to go the cooter route. I believed I could do it, but this…was okay, too. I know I wasn’t pressured. I know the doctors did everything they could to avoid it. It’s okay.”

    I was completely at peace.

    This lasted for two weeks, or until I read a magazine article about how hoooooooorrible C-sections are, and how doctors always push gullible women into them, and this whole “eeee, fear of pain!” business and the phrase “NORMAL birth,” which by definition means that my birth was abnormal, or maybe I’m just an abnormal woman, and I thought “Jesus Christ, so THIS is what women think of me when I say ‘Yeah, I had a c-section’?” and I got kind of cranky.

    Apparently, I’m still kind of cranky.

    For the record:
    1: I wasn’t afraid during labor, and it didn’t hurt.
    2: My hospital has a phenomenal vag vs. C-section rate.
    3: The doctors followed my “Low intervention, pls!” birth plan down to the letter…
    4. …and then circumstances (complications) conspired against us, and I ended up with a c-section.
    5. If I hadn’t had a c-section, I believe my other option would have been to wait for fetal demise and have the doctors remove them from my body a less pleasant way.
    6. Anyone who believes a c-section is some magical pain free romp through a field of tulips was clearly offered better drugs than I got.

    Commenters:
    If you had a vaginal birth, I’m totally happy for you. It’s neat! But I am curious why you must use terms and phrases that automatically denigrate women who did not have an experience quite like yours.

  • http://www.momstinfoilhat.wordpress.com invalid-0

    One of the physicians who teaches women’s health at my medical school offers elective cesarean to every single pregnant mother in his practice. This includes every medical student who gets pregnant and is on the school insurance. One student told me that he offered it to her three times, with no medical indication, before she was done with her second trimester.

    He told our ob/gyn interest group that he thinks his practice of offering elective cesarean is compliant with the ACOG position statement on elective cesarean, but I disagree. The ACOG statement is clearly talking about maternal request. It states that the physician should consider the risks (totally absent in many cases – this physician believes in his amazing surgical hands, a cesarean is just as safe as a vaginal birth, and he told our group so in no uncertain terms). They have edited the opinion, which used to advise the physician to educate the patient. It does state that fear of childbirth pain or unavailability of anesthesia should not motivate elective cesarean:

    “If her main concern is a fear of pain in childbirth, then prenatal childbirth education, emotional support in labor, and anesthesia for childbirth should be offered.”

    It says nothing about if the main motivation is having a baby during banker’s hours. The ob/gyn professor made it very clear why he preferred it. “Twenty hours of labor or twenty minutes, and the baby is on the mom’s breast and I am on my way home.” He made it clear he doesn’t like “labor sitting” and called ob/gyns who stay for labors “glorified midwives” with a sneer.

    Needless to say, I am not inviting him to speak to the club this year.

  • http://www.momstinfoilhat.wordpress.com invalid-0

    I just read the other comments. Some of them are fantastic, but I am really disappointed in the mommy wars tone to some of the other posts.

    No one doubts that there are women who had emergency cesareans. No one is saying that women should suffer a fetal demise rather than get a medically necessary cesarean section.

    Most of the snarly anonymous comments on here are hypocritical and infuriating. Don’t say other women are judging you when they are not. Answer individual comments, don’t rail against the invisible online mommy brigade. I think it is infuriating when people pretend like they are the underdog when they are not. Less than 5% of women choose to birth with a midwife, more than 80% choose anesthesia. How are you some sort of downtrodden minority?

    Yes, some women think breathing techniques and continuous support work in labor. Crazily enough, there is research to support this. Some women would rather choose a natural birth. Tearing into these decisions viciously and then claiming to be a victim is really not improving the discussion.

  • invalid-0

    If a woman goes to a doctor and requests a c-section, this will be granted to her without question and in some cases without any discussion of the risks associated with it.

    Women who want to have a natural birth are bombarded with the risks of this, about how the baby is probably too big, and a myriad of other problems that might occur.

    Women who choose vaginal births over a c-section feel threatened because they feel that they have to fight *very* hard to have their choice respected and the more women choosing a c-section is more validation for the doctors who promote them as the best way to have a baby. (I’m not saying this is “right”, just that it’s one of the reasons)

    It also seems absurd that a surgery which has been shown to be more dangerous than vaginal birth (when not done for medical reasons) is still a choice at all. I don’t think there’s a single other major surgery that people can simply choose to have because it’s more convenient, or simply a personal preference.

    And yes, I have had a c-section myself.

  • invalid-0

    I’m so glad I read this article. I’ve been hearing a lot about the “c-section boom” and the articles always made me feel guilty for choosing a c-section for my second child. My first pregnancy, I was induced, had a long labor in which I stayed dilated at a 2 and effaced only 50% for approximately 12 hours. It was only until I said “enough is enough” and requested an epidural that I was finally able to progress to where I could push. After 2 hours of pushing, I ended up with a c-section anyway, as the baby failed to descend enough. I don’t have a problem with the c-section, my problem was with the induction. But aside from that, I’ve heard from two doctors that both said that odds are I would end up in the same situation if I tried a VBAC, as they first baby was coming down sideways and they feel there is a problem with the birth canal that prevents the baby from descending properly. I am choosing a c-section for the second one, and yes, I will admit, it’s a little convenient (my husband is getting deployed a month before my due date and I’m not thrilled at the idea of going into a long labor by myself. This way I can plan for care for my first child, etc) but it is by NO means easier. Like somebody said before, it is major surgery. I think those who are against c-sections, and I used to be one, do not understand fully what is going on with those who choose to have them, and it is unfair to judge them. There were no problems with my first one, he came out alert and perfect. I especially liked the part of the article that stressed fully informed choices. I feel I was pressured into the induction with my first child, but I have been given all the options and information with this one (and I am ASKING, which I didn’t do last time) and I feel that a c-section is my best choice. And that’s ok.

  • invalid-0

    Thank you. Natural birth can be extremely painful–pain with a purpose, but pain nonetheless. Suggesting that natural birth is akin to a workout (I’m a fitness instructor and I’ve had a natural birth) is kind of ludicrous in most cases, though I say congratulations to the mama who has the luck of an experience like this.

  • invalid-0

    Ya know Julie, some choices aren’t about narcissism. And not all babies are “downed out for a week from the anesthesia” after a c-section.

    Seems to me you oughta try for a second to understand how women who have c-sections feel instead of judging them unfit. Maybe ask a few of ‘em.

  • invalid-0

    Yes c-section rates have gone up, but fetal and maternity deaths have gone down. A good friend of mine had an ‘elective’ c-section but given that her baby was in breech and stubbornly refused to move, the ‘natural’ alternative would have resulted in an exhausted mum undergoing an emergency c-section not being aware what was going on rather than a well-rested mum making the decision.

    • invalid-0

      Actually if you read the research fetal and maternal death rates are up for the first time since the 80’s. And the US ranks near the bottom of infant and mother mortality of all industrialized nations.

  • invalid-0

    antidense, courtesy precludes me from telling what I’d really like you to do with your comment, so I’ll just say this: I made the commitment that my daughter’s life and health were more important than my own, let alone than my birth experience. If you think caring for an infant while recovering from major surgery is the easy way out, I’d like to come live in your world, because apparently, surgery there is a lot less painful than in mine.

  • invalid-0

    That you can read an article that says, in very clear language, that “approximately 2% of all c-sections nationwide can be considered ‘cesarean deliveries on maternal request'” and throw around words like convenience and for God’s sake NARCISSISM is astounding.

  • invalid-0

    Lucy — I completely agree and share in your experience. There are moments that I question what happened — what if… But, I labored at home for nearly 20 hours planning to have our first baby there with our beloved midwife. When he went into distress, she made the decision to transfer us to the hospital. Once there, after trying to help delivery using a vacuum extractor, the doctor recommended a c-section and my midwife agreed. It was not the birth that I wanted for him, but I made the best decision I could at the time for the health and safety of my child. I am still recovering emotionally and physically from the experience. But, my son is healthy and I am so happy to be his mother. I gave birth to him (regardless of the intervention) — I took care of him during pregnancy for 42 weeks, I labored for 20 hours, I pushed for 6 hours, and I will love and care for him for the rest of my life. For me, the countless stories of how horrible it is to deliver by c-section make my healing all the more difficult. But, I am learning to let go of my guilt and disappointment and feel pride for what I did to help my child into the world.

  • invalid-0

    I believe there are a variety of factors that have led to the increasing c-section rate, and maternal request (as the article states) is a very small one. Yes, I have known women who have scheduled their c-sections in their first trimester, and that was that. But I also believe that very busy OBs are more likely to suggest/pressure one because it is more convenient for them. Rather than let labor progress at it’sh own pace, many hospitals will impose stringent timelines on how long a woman is in labor. It allows them to schedule their time better. There’s also the liability issue. OBs have the highest medical malpractice insurance rates of almost any other kind of specialty. While it is natural for the heart rate of the baby to vary during contractions and throughout labor, a doctor might see a decreased heart rate and rather than wait to see if it goes up, will suggest a c-section for the health of the baby because there is a possibility of fetal distress. Because if he didn’t, and the low heart rate wasn’t part of the natural cycle of labor and the baby died (or was born significantly disabled) due to lack of oxygen or its distress, it increases the liklihood of a lawsuit and that the doctor would be held liable. So it is safer to do a c-section that will almost always guarantee a healthy baby. There is also the fact that epidurals (which are increasingly used) can both stall the progression of labor, as well as numb the mothers pushing urge, making pushing less effective, and therefore increase the liklihood of needing a c-section for those reasons. And increased inductions often lead to incrased epidural rates because of the more intense contracts (because unlike contractions triggered by the natural hormone oxytocin, pitocin does not also trigger the endorphin release that can blunt some of the natural pain of labor). What it comes down to, is that one intervention often leads to another, and another, and another, which increasingly results in a c-section.

    There are so many things to consider when deciding how you are going to give birth. My goal (for my baby due any day now) is a natural child birth with no drugs or interventions. But I also know that may not be possible. And it is a decision that I have come to (and fortunately is strongly supported by my OB and the hospital where I will be delivering). But you better believe that I’m not passing any judgement on anyone else’s decision. Some people think I’m nuts for wanting to go natural. I’m certainly not going to judge someone else’s decision on how they will handle a such a joyous (but also painful and difficult) moment in their lives. A healthy baby is what matters, right?

  • http://iamthelizardqueen.wordpress.com invalid-0

    Miriam goes on to say that “just one woman in 1600 actually reported having a first c-section because she chose and planned it ahead of time without any medical reason – a rate far lower than the 2% suggested by Dr. Reichman on the Today Show.”

  • http://www.nakedthoughts.wordpress.com invalid-0

    I was a C-section baby. I never turned around to say hello to the world face first. My mom had a C-section so I would be able to breathe when I first came out. That is not narcissism or greed. She wanted a second baby to love and care for. To have a family. We should all be so greedy to want to have more people to love.

    I think your anger is displaced. Why are you attacking women if they exist in a “capitalist-pig, male-dominated” world. In such a male dominated structure are women really given choices? I think it is too much to ask someone who is concerned for the wellbeing of their child to ignore the advice to of the person that society tells us is “the expert.” People want the best for their children. it’s hard to decide what is best. doctors don’t know everything, but sometimes C-sections are necessary. How do you know when to trust someone, especially when you have fear for the little ball of life you want to bring into the world?

    it’s often luck who we meet at what time in our lives. if the only “experts” we meet tell us C-sections are safer, and dismiss all the other studies as “left wing conspirocy” how are we supposed to know not to believe them?

    When Magazines like TIME are quoting innacurate information about the level of demand of C-sections, who can we believe?

  • http://neptunesmoon.blogspot.com invalid-0

    What hasn’t been mentioned is that the climbing c-section rate fuels the climbing c-section rate. If a woman has a c-section for the first birth, it’s *very* hard to have a vaginal birth for any subsequent births. This is not due to physical concerns but litigious concerns. Many hospitals WILL NOT allow VBACs because of the increased likihood of a c-section (relative to moms who have never had a c-section before), the expense of keeping doctors and an OR available for these women, and the hospital insurance restrictions. Only ~8% of laboring women should require c-section, when women of all ages and risk factors are considered (according to the WHO). If a few extra women elect to have one, the number might bump up to 9%. Why are we not investigating the cause for a rate more than 3 times this high? And how many women “choose” to have a c-section because there is no other choice?

  • invalid-0

    I think “The Internet Mommy Brigade” (BTW, I’d like to sign up, where can I find them?) is trying to be a vocal minority for some things that should not be a minority. I agree, the contempt and judgment need to go. But why are our breastfeeding rates so low? Why are our interventions (and c-section is just the final intervention, so many lead up to it) so high? Because so many women don’t know they have options! Low income, poorly educated women are most likely to use formula and have hospital births with an OB while higher income, more educated women do the opposite. I think the vitriol isn’t for the women who research and make these decisions, it’s for the doctors who mislead women. We need strong opposite poles in hopes that one day we end up somewhere in the reasonable middle.

  • invalid-0

    I had a c-section on July 9th and gave birth to an incredibly healthy 9.2 pound baby boy who can already lift his head and is incredibly alert. He stares directly into people’s eyes, catches and examines bold patterns on walls, and reacts to even the slightest of sounds and stimulus. My c-section was performed for medical reasons (I have a narrow pelvic arch and he was a big baby) and all of this recent judgment toward c-section havin’ women makes me very uncomfortable. I’ve not had any trouble bonding, loving, or interacting with my incredibly alert and engaging child- we’re doing beautifully, thank you.

  • invalid-0

    Jeez! I had one ventouse birth (anaesthetist was busy otherwise would have been a c section) and one c section. I am 5 ft tall and have tiny feet and a correspondingly little pelvis. I was always aware of the possibility of c section but with my second child, having had polyhydramnios and then being in labour for 36 hours, I was scanned and my daughter had turned so she was oblique,her dead was not engaged and my body was trying its hardest to push her out diagonally. Without a caesarean we would both be dead. I was staunchly opposed to the increase in caesareans but, having had one, I’ve come to suspect that the vast majority are not planned and are carried out for medical reasons alone. Politicking about caesareans is a waste of time and ultimately makes some women feel bad that they needed one and gives other women permission to be smug that they didn’t.

  • invalid-0

    I think it is women who are simply terrified of giving birth. We have been cowed into believing that our uteruses are ticking time bombs that will ultimately kill our unborn child unless the superhero doctor does something to get the child out. Read the latest entries on alittlepregnant.com. I had the audacity to suggest that giving birth naturally could be a positive experience and should not be given up so lightly and the piling on has not yet ceased (280+ comments and counting.)

  • invalid-0

    Empowering to have watermelon charge through my vagina? I don’t think so. Give me drugs and zip me open.

  • invalid-0

    Just as an aside, there are several posts here with women who say they chose a c-section, on full information, because a baby was breech or oblique or otherwise not in the right position. My husband is an accupuncturist and has sucessfully turned babies that were not in the right position. Generally he does this around the due date, but before labor has begun, but I know he’s once made a housecall for a patient who began her labor a few days early. The baby was fine. This is a very small part of his practice, but he has peers that specialize in fertility, pre-natal, and post-natal care for whom this is fairly regular (many of whom are closely affiliated with midwives).

    So how many people who scheduled a c-section because a baby was out of place were counseled by their doctors that it was possible to attempt to right the baby through acupuncture, accupressure, and massage? Perhaps anyone of the posters to this blog would have been the person that it didn’t work for, but how many even got to try?

    My own expereince giving birth is that the doctor’s lie to you. Even the good doctors, even the ones I really liked, lied to me. They couldn’t seem to help it. It created the disconcerting feeling of being twelve in a room full of adults who all absolutely insisted the Santa Clause and the Easter Bunny were real, even though I’d known differently for years. Even when you speak up, you get dismissed. Affably, lovingly dismissed, but dismissed none the less. I never felt like this with my midwife.

    • invalid-0

      My second baby successfully flipped (from breech to the correct position) after an accupuncture treatment in late pregnancy. But a couple weeks later immediately after my water broke, the baby turned sideways and wedged herself into an even worse position.

      Many hours later, during my c-section, it was discovered that if I had gone into strong labor there was a good chance my uterus would have ruptured and both of us may have died (particularly because I was planning on a home Vbac quite far from a hospital). It amazes me that my baby knew that and did everything in her power to protect us by flatly refusing to come out the way I thought she should.

      Even though c-sections are abused, it is an amazing, life giving surgery.

  • invalid-0

    This is certainly a been a lively discussion.

    I have been a nurse for 32 years, 20 in Women’s Health. I’ve had the great satisfaction of working in labor and delivery pre-epidural. We labored everyone. It’s all in the breath. And then something happened. We began intervening. The monitor and the epidural arrived and instead of dropping down into the experience, women watched television. One day out of their lives, 14 hours (on average), to be fully engaged in one the most incredible experiences a women can ever have and they were either watching the monitor or the television. Talk about giving your power away!

    Next the “spin” doctors invented “High Risk Obstetrics”. Jeez Louise, what a scam. The consensus reality is “Everyone is high risk.” Yes, babies occasionally have problems, and mothers do too, but the current state of affairs is absurd.

    I currently work in managed care. The company I work for flat out denies payment when guidelines for inductions or a c-sections are not followed. But I can tell you, honestly, it’s horrific out there. Here are some examples. Several of these every day. Pt admitted at 0730 in labor. Baby delivered at 1100…by cesarean section, Why?! Failure to progress. Three hours? Or C-section for cephalo pelvic disproportion (CPD), baby’s weight…6 lbs 5 oz. And this happens over and over again, day in and day out. And did I mention pre term deliveries?
    Hospitals all across the country are adding more beds in their neonatal intensive care units trying to keep up with all the intervening. If you build it they will come. Not to mention how lucrative it is.

    Things have progressed or should I say failed to progress in the direction I thought we were headed 30 years ago.

    May I suggest a book. “Lying In the History of Childbirth in America”. Excellent account of what happened, and why. Birth is the hero’s journey Joseph Campbell speaks of. A true initiation.

  • invalid-0

    OK, before any of you decide to blast me for my choice, hear me out. I had always planned to have a vaginal birth, but I have chronic pain from an unstable coccyx. After doing hours of research, reading the experiences of other women in my same situation who’ve given birth both vaginally and via C-section, and talking it over with my OB and husband, we’ve decided to go with an elective C-section. I know all of the reasons why a vaginal birth is better for my baby, however, we feel that him having a mommy who is able to sit reasonably comfortably on her butt to breastfeed, can get up to walk him around and comfort him, and not spend the first year of his life on her stomach recovering from tailbone removal surgery is much more important.

    My OB didn’t push for this, it was a subject I broached with him. We even discussed possibly giving birth vaginally in different positions, but when it comes right down to it, it’s the baby coming through the birth canal which pushes the coccyx – regardless of the position the mother is in. If you’ve never had coccyx pain, bless you. I hope you never have to live with it. If you have, then you know what I’m talking about.