Strollerderby : elective c-sections

Babble Talk: Do We Still Judge Women for Having C-Sections?

Jen Chaney — Sat, 04 Apr 2009 16:02:00 GMT

I have had a C-section. So has Tova Mirvis. So have many women. So why do so many of us still feel like we're being judged for it?

That's one of the questions Mirvis tackles in her Babble essay, "In Praise of the C-Section," a thoughtful piece in which she acknowledges the sense of inferiority that can result from having a Caesarean, as well as the need -- however irrational -- to justify one's reasons for doing so.

"When I was pregnant with my third child, I accidentally wandered into a conversation in which two mothers I'd recently met were extolling the virtues of homebirths and water births, midwives and doulas," she writes. "When the well-meaning moms asked about my birth plan, I told them I was having a scheduled C-section. Their faces conveyed self-righteous disapproval and my mind was immediately awhirl in disclaimers: I was having the scheduled C not because I wanted the convenience, not because I was afraid of labor, not because I didn't want to miss my manicure appointment. 'My oldest son would have died if I didn't have a C-section!' I said instead."

Every woman who has a C-section has a different reason for doing so. In Mirvis's case, as she describes in more detail in the essay, she went that route with all three of her children because of complications, including last-minute ones during her first delivery that threatened her son's health. Other moms may elect a C because they've lost, or nearly lost, a child in the past and want to take whatever steps they can to control the process. And still others, like me, have C-sections because there is no other option. My son was breech and few OBs are willing to risk a vaginal delivery under those circumstances.

Are any of these mothers less motherly because of the types of deliveries they had? I may be biased since one of them is me, but I think most would say, no, of course not. But what about a woman confronted by no extenuating circumstances or complications who chooses to have a C because she doesn't want to have a vaginal birth?

Aha, this is where the judgment comes in. Having a C-section when you don't necessarily need one is indicative, to some women anyway, of a lazy, shallow and self-absorbed mother, someone who doesn't have the cajones to do a little pushing, grunting and lamaze breathing. I don't necessarily agree with that, but I can understand where the perception comes from. Elective C-section moms have the same reputation as the boss who takes credit for all of her employees' great ideas: they want to revel in the glory without having to do any of the hard work.

But here's the truth of the matter, something Mirvis wisely points out at the end of her essay: How we deliver our children ultimately has nothing to do with what kind of mothers we are. So maybe we should stop judging the elective (or non-elective) C-section mothers, or feeling guilty for not having vaginal births, or developing inferiority complexes because we broke down and got an epidural. Maybe we should realize that the test of our motherhood really begins once that healthy child arrives on this Earth and in our arms.

As Morvis writes, "If the experience of childbirth is in fact a crucial process, then let it be the process of teaching us that our children will emerge in ways varied and complicated, not necessarily in times or manners of our choosing, neither made in our image nor as proof of our prowess. Let birth remind us that, with children, so little goes according to even the most well-drawn plan."

Well said.

An Early C-Section Could Harm Your Baby

Jen Chaney — Fri, 09 Jan 2009 14:28:00 GMT

Deciding to have a Caesarean section at 37 weeks, when an infant is technically full-term, should be harmless, right? Wrong, according to a new study by the National Institute of Child Health and Human Development.

The information in the study, published in the New England Journal of Medicine and reported by many media outlets, including the New York Times, says that babies born via C-section at 37 weeks are twice as likely to develop complications as children delivered via C-section at 39 weeks. At 38 weeks, the increase in medical risk is also higher, but only by 50 percent. In other words, it's safest to have that Caesarean at 39 or 40 weeks. Or, to put another spin on this data, women who elect to have C-sections a little ahead of the curve, primarily for reasons of convenience, are putting their kids at risk.

Of course, as we all have heard and read, more women have been doing just that in recent years. As the Times reports, 30 percent of deliveries in 2006 were "Cs," an increase of more than 20 percent over 10 years prior.

Now, a lot of the blame for that gets placed on the moms, those "horrible control-freak women who just have to organize and schedule everything." But I suspect that, at least in some cases, OBs also bear some of the responsibility for encouraging women to go ahead and schedule the 'ol C because it's just as convenient for them as it is for the mom. At the least, doctors may not be discouraging women from taking that course of action.

New Risks Associated with Elective Deliveries

They Say: Even Late Preemies at Higher Risk

Image: newyorktimes.com

In light of this new study, I wonder if we'll see a shift in that trend, both in terms of what OBs and their patients will allow. No matter how attached we are to our Blackberries and Google Calendars, we all want to deliver healthy babies. And this knowledge could very well change people's plans.

Given the information in this study, would you elect to have an early C-section or would you wait until that 39th or 40th week?

Pre-Term Elective C-Sections Are Dangerous: So Why Insure Them?

Miriam Axel-Lute — Fri, 19 Dec 2008 15:00:00 GMT

Michael McGuire is CEO of UnitedHealth, a health-insurance provider in New Jersey. In an op-ed in the Trenton Times recently he talked intelligently about the health dangers of elective pre-term c-sections.

The evidence keeps mounting—prematurity, even by a few weeks, means higher rates of breathing problems, cerebral palsy, NICU stays, etc. When the baby's not ready to come out, it's not ready, folks.

McGuire makes the impressive assertion that when he explained this carefully to a "pilot group" of physicians and hospitals and they stopped scheduling c-sections before 39 weeks, there was a 46 percent drop in NICU stays. Those are results to write home about. As he writes, "That's almost half the number of newborns with potential health problems, almost half the number of distraught parents, al most half the number of potential tragedies. The cost savings to these hospitals, the parents and the health-care system is enormous."

He notes carefully, as do I, that sometimes a pre-term c-section is medically necessary for health of mother and/or baby. Obviously, that is not what I'm talking about. But I would include c-sections that are planned for medical reasons,* but where there is no medical reason not to carry the baby to term. I think those are far, far more common than the over-hyped "too posh to push" phenomenon.

So here's what I want to know: If it's documented to be such a health risk, why don't McGuire and his colleagues just stop paying for c-sections that are unnecessarily scheduled at an unsafe time?

Insurers already go out of their way to not cover things they claim are optional (including some that are emphatically not), not to mention dangerous. Usually I question their judgment, but the evidence is pretty compelling on this one.

I'm all for educating docs, but it seems to me the insurers could stop this practice cold with their purse strings.

Photo by César Rincón.

*(Of course, many of those "medical reasons," like a previous c-sections or breech presentations, don't actually require a c-section, but that's a separate post.)

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Elective C-Sections and Midwives: Saving Lives in Iraq

Rachael Brownell (Redsy) — Fri, 05 Jan 2007 14:00:00 GMT

In today's Washington Post, the story of mounting infant mortality rate in Iraq as the medical system -- at one time the pride of the Middle East -- unravels under the weight of the 1990s embargo and now the war. The Post's story focuses on the tragic death of a baby who became lodged in his mother's birth canal and died when unskilled nurses (no doctor could be found) used forceps to extract him and crushed his skull.

The combination of road closures, physician kidnapping, and the stress of war and poverty are taking a signifant toll on maternal-child health in Iraq and the problem is exacerbated by the mass exodus of Iraqi physicians (some estimates say up to 50% have fled since the U.S. invasion).

Understandably, women are frequently less willing to take the risk of traveling during curfew hours to hospitals that may or may not have doctors avalable to help them deliver their babies. More women are turning to midwives to avoid hospitals altogether. Still others are scheduling elective c-sections around curfew hours.

The infant mortality rate in Iraq now stands at 48.6 per 1,000 live births -- in other words, 5% of all babies delivered die or are dead on delivery. As a point of comparison, the U.S. rate is 6.9 per 1,000 live births -- one of the industrialized world's worst rates.

For those of us totally overwhelmed by the tragedy in Iraq, learning that women and children are suffering there isn't surprising or particularly new information. But stories such as these have a way of cutting to the chase. I simply cannot imagine the sorrow of delivering a baby who should have been healthy and living, but who died almost directly because of the war. And I can't help but think I'd be ready to take up arms against my oppressor -- whether American, Sunni, or Shi'ite.