Do You Think Most C-Sections Are Necessary?

[Polly]

These days, doctors seem to do them at the drop of hat. "Failure to progress" is sometimes a code for "Because You're Really Not Progressing On My Timetable."

I would have been not happy with my doctor if they had mucked it up and Elizabeth wasn't 12lbs, 11oz. aka, Giant Baby.

Polly

[Maggie]

I'm pretty certain my c-section was necessary. Eleanor's hr dropped quickly and wasn't recovering. My dr. did all she could (vacuum) to help me have a vaginal birth. However, her hr continued to drop with each contraction and wasn't coming back up like it should have. I suppose I could have pushed for a bit longer with the vacuum, but the hr drops were quite scary. It was a very fast delivery, Andy wasn't even allowed in the room. They wanted her out stat, so they didn't have time for him to dress in scrubs.

She ended up having her cord tangled around her arm. Each time I had a contraction it was squeezing the cord, cutting off the blood supply.

I had a vaginal birth with Emily, but my dr told me that I should prepare myself for a c-section because the she was so big. Emily was a whopping 6lbs 15 oz LOL

[Mary]

I had a vaginal birth with Emily, but my dr told me that I should prepare myself for a c-section because the she was so big. Emily was a whopping 6lbs 15 oz LOL

I have no problem with c-sections for emergencies but stuff like that is what ticks me off. C-sections are pushed based on info like that. If it's a woman's first baby how the hell did they know what she would and wouldn't be able to push out? Just because you have been to medical school doesn't make you an all-seeing oracle who can predict exactly how someone's labor will go -- and that just proves it. My best friend was told, after her first labor ended in a c-section, that she would never be able to have over a 7-lb. baby vaginally. Two years later she had a VBAC and delivered her 9-lb. daughter. :rolleyes

Anyway...that's a bit off the topic, sorry. It's just that I DON'T think most c-sections are necessary and part of the problem has to do with fear mongering like that.

BTW....I am not challenging anyone here who had a c-section, or questioning your situation, personally, so please don't anyone get defensive over this particular post. You don't need to justify your situation to me or anyone else. I'm simply speaking in general terms about the entire populace.

[YourMom]

No, I don't. I think many are caused by a cascade of interventions that make them seem necssay (or create problems.)

I'm not certain Adia's birth wasn't an "unneCesarean."

[Maggie]

Mary, my doctor was convinced she was huge (like 10lbs +) because of an ultrasound done at 38 weeks.

She actually wanted to induce me early, but I refused.

[Amy J]

Mine was necessary as Rosie was breech and I had already pushed her foot out. IMO, you need to have a pretty big complication in order to get a c-section. I don't think that asking for one because you're scared of pushing is legit. Sorry to those of you who did that but that is just how I feel.

[Lisa]

well I had a c for Robert because i had been in labor for 36 hrs and got 3cm. My water had been broken for 24 hrs and they were concerned about an infection because i hadn't gotten very far. I think he was just stuck and since I was small, he wasn't able to adjust himself. Rhayan was a C because my hospital didn't do vbac's but also she was breach. They never would have let me deliver breech with Robert being a c.

[Lori]

I do think that most are probably necessary, but I suppose that depends on how you define "necessary." If you define necessary as meaning that the mother or baby will die without the c-section, the most probably aren't. I'd say, though, that "necessary" for me means that the risks of a vaginal delivery genuinely seemed to be greater than the risks of a c-section. I think there are a lot of unnecessary c-sections, but I think that in most cases c-sections are performed because at the time they truly seemed to be the safest option.

However, even though I think most c-sections probably are performed because they were genuinely thought to be the safest option, that still leaves a lot of c-sections taht I think are performed for unnecessary reasons.

[Beka]

With my first I asked for one and luckily my dr laughed at my then teenage self and told me "you were designed for this" - 4 drug free, uncomplicated births later I now agree with him :giggle (although at the time i despised him thinking how easy it was for a man to say that!)

I'm going to say no, most aren't, many are the result of people being pressured into believing they are though and frankly who risks their babies well being with no medical knowledge and a dr telling you it's safest option? When i went against their desires to schedule a section for my "huge" breech baby he was my 2nd, i'd read up alot, got the advice of several midwives and i knew what we were headed into- if he were my first i'm not sure i'd have known or been willing to fight my own corner... incidentally he arrived in my easiest, shortest labour, right way up, perfect apgar and weighing a whopping 7lb 3oz- more than 1/2lb lighter than his lightest sibling and a whole 1.5lbs lighter than his heaviest! (he was however very long... mr chicken legs :giggle)

I'm also saying no based on statistics... in 2004 the UK was running at 22% for C-section, USA at 29.1 yet - according top unicef- maternal & neonatal death rates are higher in the USA, surely if c-sections were necessary for maternal and infant health then the country with the higher section rate would have a lower death rate for mother and child?

However I also wanted to add even if they are not medically necessary I think we're not at an age where we're able to look further than physical well being of a woman- we are a society that looks at the emotional and practical well being also, we're a society that looks at physical damage vaginal birth may cause after previous tears etc.

[Desirae]

I agree with Lori here.
It's easy to look back and say that I probably could have vaginally delivered Aidan had we not induced as my body was not labor ready however the induction was needed for my well being.

[gr8mommy]

I don't think c-sections are the business of anyone but the woman and her doctor.

[freebiemom]

I have had two vaginal (one being a VBAC) and two c-sections. I think it depends on the circumstances and what you and your doctor decide is the best course to take.

I do believe that the birthing process is good for babies and if I could have, I would have had all mine vaginally.

[Amber]

I don't know about most, but I do think that many are medically unnecessary.

[Kristi]

I don't really know. But I think that there are more done now days for unnecessary reasons. I have had two one was an emergency Csection because labor wasn't progressing his heartrate kept dropping and the second was a repeat C section (mainly because the OB pretty much refused to do a VBAC and was the only OB On the base at the time)

[Maleah]

I've had three and was pretty upset about all of them. The first one I let my doctor upsell me because Jeremiah was breech and as far along as I was it would have been painful to turn him and my water could have broke while doing it, yadda yadda. With Gabriel the same doctor was the only OB in town and we had some very long conversations about what I was going to make him do for me. We ended up with a C because the hospital wouldn't induce me for a VBAC. I always have to be induced. It probably turned out for the best since from the time they grabbed Gabriel's foot to the time he was actually out took 25 minutes.
The 3rd wasn't even a discussion. The hospital wouldn't do a VBA2C, period. And that probably turned out to be a good thing too since my bladder had fused to my uterus and needed some repair and my uteran wall was starting to thin, and we figured might as well get a tubal while the doctor was in there anyways.

I think doctors like c-sections because there's more they can control.

The only c-sections that I would be against really is the ones that are given at 36 weeks because of superfical reasons like not wanting stretch marks and etc.

[Lisa]

for the most part I feel mine were nessesary. I do believe that Robert was stuck and if he or we could have moved him out of that position, I could have done a vaginal. Hind sight is 20/20 though and after 36 hrs of labor and only getting 3 cm, I was ready to be done. Also,the risk of infection had gone up with my water being broken for 24 hrs and I also had elevated blood pressure. With Rhayan, I had to do a c. The hospital didn't do vbacs of any kind and she was breech as well

[Jeri]

I think most are not necessary. I also think that some save lives. It's hard to know when you're in a situation which type your OB is recommending, and I would never tell a motnher that hers was unnecessary.

[Kate]

The fact that matenal and infant death rates are rising along with the c-section rates strongly highlights the fact that a c-section isn't the safe easy option many people believe it to be.

Realistically, I know that there are many women and children alive now that are alive thanks to the c-section...but I also know of women and children that have died as a direct result of elective c-sections.

I do however have a friend who is a hospital midwife, and in her experience in her hospital, many unneeded c-sections are performed because of fear of possible later litigation...and that that isn't something unique to her hospital.

I think the big reason for many c-sections are somewhat spurious.

The failure to progress? Tends to happen when it's felt that all labours should fit the same pattern.

The you can't push out a big baby? Based on ultrasounds, that are notoriously unreliable for predicting a baby's size.

Plus the interventions that put women in bed and unable to effectively labour, which lead to sections.

So many of those reasons I believe are unnecessary, which I guess means I do believe that many c-sections are unnecessary.

[gr8mommy]

Ultrasounds are as reliable as the tech reading them. With all three of my pregnancies, they were right on within a couple of ounces.

[freebiemom]

Ultrasounds are as reliable as the tech reading them. With all three of my pregnancies, they were right on within a couple of ounces.

I have to agree. The tech for all four of my pregnancies was pretty accurate on size. But I have heard stories where they said the baby was big and turned out small and vice versa. So there are good and not-as-good (don't want to say they're bad just because they were off a little on size) techs, just like in any profession.

[Jejune]

I was induced based on a faulty size calculation in an ultrasound, so I would not use size as a basis for a C section. For the most part, I agree with those who have said that it's not really anyone's business why an individual woman gets a C section. I do think the over arching statistics are everyone's business, though, and what concerns me are the C sections that are pushed on moms when they're not medically necessary. Anecdotally, a friend had one when her doctor announced that he wanted to get out of there and wasn't going to wait around anymore. She was too exhausted to resist. I think that was bad practice, and while I think many C sections are necessary and life saving and many more are at least risk limiting, there is a whole range of those that increase risk. I think moms should be well educated in the risks of C sections as well as vaginal births so that they can make an educated choice with their doctors.

My C section with Eleanor may not have been considered medically necessary by some (I know it wasn't considered necessary by at least one acquaintance) but I wasn't willing to risk delivering a breech baby vaginally. Ultimately, I'm extra glad I had the section, since she turned out to be a footling breech. I would have liked a home birth, but I'm glad that she was born safe, as disappointed as I was to have a C section.

[Lori]

My C section with Eleanor may not have been considered medically necessary by some (I know it wasn't considered necessary by at least one acquaintance) but I wasn't willing to risk delivering a breech baby vaginally. Ultimately, I'm extra glad I had the section, since she turned out to be a footling breech. I would have liked a home birth, but I'm glad that she was born safe, as disappointed as I was to have a C section.

I think that brings up a very good point, which is that "necessary" isn't, IMO, a particularly useful term. I think maybe a better way to look at it is to allow the woman, in conjunction with her doctor, to assess the benefits and risks, and decide what is the best way to proceed. I think the issue is more that many women are basically just told, "You need a c-section," and given one, without really being made aware of their options. I don't think we can really say, in the majority of cases, whether the c-section was strictly necessary or not, because people are going to have different ideas about what constitutes a necessary c-section. But it is a problem when the decision to do a c-section is made--in a non-emergency situation--without the woman being given the information and time needed to make her own informed decision.

I think purely elective c-sections--the ones where somebody opts for a c-section at 36 weeks so they don't have stretch marks, for example--are another issue, but I imagine that very few of those actually happen. In most cases I think "elective" and "necessary" are pretty ambiguous terms. If a woman is having a c-section after 2 previous c-sections, is that "elective"? In some ways, but others would say that the risks of vaginal delivery outweight the risks of a c-section, and so would deem it necessary. I think the problem is when a doctor tells a woman who had a c-section that she MUST have a c-section for her next delivery, rather than giving her the chance to make an informed decisions about the risks and benefits of VBAC and a repeat c-section. I think that is a problem that does concern society, but whether the women ultimately decides for a VBAC or a repeat c-section is her business alone and not something that should be judged.

[freebiemom]

Let me clarify that I don't think being told you're having a big baby based on ultrasound is a reason to have a c-section - normally (see below). Especially if it's your first, you have no clue what you can deliver until you try. I was just saying that my tech was really great and was very accurate on the size she said my babies would be.

That being said, my decision for a 2nd c-section was based on the fact that it appeared my child was going to be very big. I had a history of having big babies and two previously had gotten stuck and had to be helped out so I didn't want to risk having an even bigger baby and having problems resulting in an emergency c-section. Glad too because she was my biggest at almost 10 pounds - maybe I would have had no problems or maybe I would have. We'll never know but I still feel we made the best decision for our situation.

[Jejune]

Let me clarify that I don't think being told you're having a big baby based on ultrasound is a reason to have a c-section - normally (see below). Especially if it's your first, you have no clue what you can deliver until you try. I was just saying that my tech was really great and was very accurate on the size she said my babies would be.

That being said, my decision for a 2nd c-section was based on the fact that it appeared my child was going to be very big. I had a history of having big babies and two previously had gotten stuck and had to be helped out so I didn't want to risk having an even bigger baby and having problems resulting in an emergency c-section. Glad too because she was my biggest at almost 10 pounds - maybe I would have had no problems or maybe I would have. We'll never know but I still feel we made the best decision for our situation.

Oh, I wasn't disagreeing with you - sorry, if it seemed that way. I was just saying that I personally wouldn't use the ultrasound calculations because of my experience with being told I needed to induce early when I really didn't. It complicated my first birth a lot.

I think your reasoning is exactly the sort of educated choice I'd advocate for. Having a baby get stuck is nightmarish.

[freebiemom]

Having a baby get stuck is nightmarish.

And I had it happen twice! At least the 2nd time we were prepared for it considering it had happened before. And luckily my doctor didn't jump to the "gotta do a c-section now!" and both ended up being born vaginally.

I didn't think you were disagreeing, I just wanted to clarify what I meant. :) I'm personally all for vaginal births and think that too many women don't give themselves the credit they deserve when it comes to being able to deliver their babies and opt for elective c-sections just because they're afraid of the pain. I also think too many of us are so quick to throw out the horror stories of labor instead of telling all the wonderful (don't laugh!) parts of it to women that haven't experienced it before, making them terrified of the process and thus wanting c-sections. :)

[Erika]

I do think that most aren't fully necessary but due to the increase of managed, medicalised labour, C Section can end up being an inevitability.

[YourMom]

I think purely elective c-sections--the ones where somebody opts for a c-section at 36 weeks so they don't have stretch marks, for example--are another issue, but I imagine that very few of those actually happen. In most cases I think "elective" and "necessary" are pretty ambiguous terms.

The problem with that is that many "necessary" C-sections are classed as electives. Failure to progress? elective Breech? elective My birth with Adia was "elective" even though the doctor was pulling the dead baby and mother cards on me. Many hospitals/doctors are refusing VBAC's for purely financial reasons, so there are more "elective" C-sections, despite the women having no other choice.

The C-section rate was around 5% in the 1960's in the US. It was over 30% last year. The UN (I believe) says the rate should be between 10-15%.

[Jejune]

The problem with that is that many "necessary" C-sections are classed as electives. Failure to progress? elective Breech? elective My birth with Adia was "elective" even though the doctor was pulling the dead baby and mother cards on me. Many hospitals/doctors are refusing VBAC's for purely financial reasons, so there are more "elective" C-sections, despite the women having no other choice.


That clouds the waters, doesn't it? The "elective" rates are often used as support for the "too posh to push" phenomenon. I'm sure it happens, but I doubt it's as much as trend as it is represented.

Edited to add: The danger, I feel, of the "too posh to push" stereotype is that it puts all the responsibility and negative onus on the mothers, and leaves doctors who push C sections out of the picture entirely.

[Lori]

The problem with that is that many "necessary" C-sections are classed as electives. Failure to progress? elective Breech? elective My birth with Adia was "elective" even though the doctor was pulling the dead baby and mother cards on me. Many hospitals/doctors are refusing VBAC's for purely financial reasons, so there are more "elective" C-sections, despite the women having no other choice.

I completely agree. I think that's what I was trying to say, but not clearly. ;) I think it's difficult to make judgements about how many c-sections aren't necessary when it's not all that clear from the terminology what the circumstances the c-section happened under were.

[bloombaby]

I think that the c-section is used to cover their tail...had my midwife done her job better, we would have known that Madison was breech and I may not have needed an emergency c-section for a breech baby...I feel jipped and robbed of my ideal birth situation and plan. I love her as a person and didn't have a problem getting along with her, compared to 1 of the other 2 to which I couldn't do ANYTHING RIGHT... but I got what I got. Perhaps if we had found her breechness(if that's a word) earlier, we could have worked to flip her or tried some of the exercises that I know work for this.......

[hillsturner]

My first child was an emergency c-section. Stephs heart stopped and I was worn out. The next two were my choice. It was very nice to be able to choose the day and make sure my mother could be there. She missed Steph because we waited around for mother nature. If I'd have had more babies they would have been c-sections too.

[gr8mommy]

I think that the c-section is used to cover their tail...had my midwife done her job better, we would have known that Madison was breech and I may not have needed an emergency c-section for a breech baby...I feel jipped and robbed of my ideal birth situation and plan. I love her as a person and didn't have a problem getting along with her, compared to 1 of the other 2 to which I couldn't do ANYTHING RIGHT... but I got what I got. Perhaps if we had found her breechness(if that's a word) earlier, we could have worked to flip her or tried some of the exercises that I know work for this.......


I don't really think 'cover their tail' is fair. Perhaps if people weren't so litigious in the first place---and didn't sue for an imperfect outcome, regardless of the reason---doctors wouldn't be required to perform less-than-necessary procedures by their hospitals and insurance carriers.

[Brooke]

I think you hear a lot about what c-sections that the majority of women would consider not medically necessary.

Women, for hundreds of years have been birthing babies. That's what we were designed to do. What is the difference now that women "can't" birth their baby? Did our bodies change? Did our cervixes finally say, Ugh, it's the 2000s, let's only get to 8 cm so I don't have to squeeze this grapefruit head through.

And what are the doctors basing this off of? An ultrasound calculation of weight? A doctor's fear of a birth that goes wrong and a malpractice suit? A doctor's sense of time and convenience for being at the hospital? A mother's input that she can't do this?

It screams to me of the statistics of women that think or are told they'll never be able to breastfeed vs the amount in the world that really can't. How many women give up or don't even try because someone just tells them they can't breastfeed. How did babies throughout time, before formula, live if their mothers couldn't feed them naturally? How many women in the world REALLY cannot breastfeed? It has to be a minimal number or the population would not have survived.

I've been all over the WHO website looking for the exact statistics on this. It alludes to 1%-5% of women in the whole world that cannot naturally breastfeed their baby efficiently. This does not cover women who have HIV or other diseases that hamper breastfeeding, this alludes to mammary glands, insufficient milk, etc.

Well, then what about birthing babies? How many women TRULY cannot birth the child they are carrying? It doesn't seem like it can be as much as the statistics are showing - 25% of births in the US alone.

Also, don't people realize that a C-Section is a major abdominal surgery? It takes SO MUCH longer to heal from a C-Section than it does a vaginal birth. Your body is not doing something naturally, you're cutting through layers of skin, fat and muscle. That takes a lot of recovery. Then you get into the possible repurcussions of taking pain meds, not bonding well in the hospital due to still having your epidural in for 24 hours and you're drowsy, not able to move, etc. Not being able to lift your baby, carry him or her, etc.

I think it's such a sad state when there are so many doctors afraid of being sued and women afraid of birthing babies.

*and btw, my youngest was a c-section, will explain more when I'm off the phone*

[YourMom]

25% of births in the US alone.

31.1%, actually :( record high, even
http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf

[nancenet70]

Mine was an emergency c-section. Erratic heartrate/loss of O2 in blood. Very difficult in healing, infection etc. But in the end, I was more scared of pushing baby out of my vag that i think i was ultimately a perfect candidate for c-section.
My pregnancy sucked beginning, middle and end. As blessed as I felt to be pregnant and blessed as I am with my amazing gal, i sure as hell AIN'T DOING THAT AGAIN!

[Jo]

The C-section rate was around 5% in the 1960's in the US. It was over 30% last year. The UN (I believe) says the rate should be between 10-15%.

That mirrors what my FIL said when he was still in the OB game back in the 60's/early 70's. He said that they had a lot to answer for if their C-section rate went above 4%. He was also glad he got out of it when Dave was born because of how litigious OB has become. I think he liked the GYN/Infertility hours better too.:giggle

[YourMom]

I got that figure out of a great book called "The Silent Knife" when I was researching VBAC. It honestly was a really large part of my confidence in homebirthing. (Because it's not like unhindered vaginal birth has gotten more dangerous in the last 40 years!)

[gr8mommy]

Brooke, I think a lot of the rise has to do with pregnancies that 40 years ago wouldn't have occured---those nearing/past menopause that use hormonal therapies; those who need fertility meds to conceive, others who need more invasive techniques, and so on.

It also would encompass women like my dentist's wife---she is seriously diabetic, and years ago would have been told not to have kids at all. Because of her own risks, she has had two children, both c-sections.

Look at the rate of multiples. How many naturally occuring sets of triplets are there, vs. those conceived with treatment? Not many multiple births (beyond twins) are vaginal, I'd guess.

[Jo]

I feel the bigger issue is how litigious our society has become. The doctors are making decisions based on statistics and not the individual. Basically because if something does go wrong, they would have followed the protocol that is now expected, especially by juries. If the doctors don't follow it, they get screwed as well. It shows in the way they even write up their reports. I have poured over Rai's medical records in the past and I can tell the difference in the reports where they realized they had misdiagnosed her. There were several sentences written in such a way to place more blame on us and absolve themselves. It is subtle but I can tell the difference.

All of this sets up a very adversarial relationship between doctors and patients. I don't think the medical profession can be fully blamed for all the changes until we, as a society stop attempting to sue for every little outcome we aren't pleased with. From experience, we had a valid lawsuit against Rai's original peds but have decided not to sue because it simply would not bring us what we most need which is emotional closure.

Anyhow...going off on a tangent. What I am trying to say is that I don't full blame doctors for the c-section rate when some of their actions are in reaction to the possibility of malpractice lawsuits that probably are not merited.

I am all for women who want VBACs or less monitoring or anything else that is safer than we are led to believe but I also want to see patients take responsibility for those choices when something does not go according to plan.

[Lori]

I am all for women who want VBACs or less monitoring or anything else that is safer than we are led to believe but I also want to see patients take responsibility for those choices when something does not go according to plan.

ITA. I also think it's a matter of parents not only taking responsibility for choices, but also for realizing that birth is, unfortunately, not a perfect process. Sometimes problems arise, and there isn't anybody to blame, and sometimes problems result from human error that was innocent or unavoidable or well-intentioned, and it probably isn't going to do any good to look to assign blame.

I'm not sure that I think fear of litigation is the main reason the c-section rate is so high, though. I think there are a number of reasons, and litigiousness is a part of it, but I think there are other factors more confined to the state of the medical community.

[gr8mommy]

I am all for women who want VBACs or less monitoring or anything else that is safer than we are led to believe but I also want to see patients take responsibility for those choices when something does not go according to plan.


Truly, that is the real issue.