Reply With QuoteThats what I think!!!
I dont think birthing in these situations "to be a problem", or 'too risky", which I what I assumed the original poster meant???
Am I getting it out right?? I know what I mean!!!
BellyBelly Life Subscriber
Yeah, look at all our vbac'ers here on BB. Fighting tooth and nail against the drs that are telling them it's too risky. There are situations where people are put in a high risk category automatically, so there are people going 'against dr's advice' by attempting VB as opposed to going straight for c/s. I wouldn't say these women are stupid and putting their babies at unnecessary risk though. They are usually very researched and informed when making that decision, and usually make that decision because the real risk is actually still less than a c/s.
OK.. that made sense in my head.. not sure it came out clearly.. sorry.
BellyBelly Member
Thats what I think!!!
I dont think birthing in these situations "to be a problem", or 'too risky", which I what I assumed the original poster meant???
Am I getting it out right?? I know what I mean!!!
BellyBelly Life Subscriber
Yeah. I haven't heard of anyone attempting VB if the risk is higher than that of a c/s (not on purpose anyway!). But a lot of women are being told they are high risk, but really it's still less than c/s. Perhaps it's these women being mistakenly counted in that category of 'high risk' vaginal births.
♥ BellyBelly's Creator ♥
I think the amazing Marsden Wagner (of the Business of Being Born, he's a reknown doctor and worked for the WHO) says it all here:
Being Seduced to Induce: What Women Should Know About Their OBs
Women will only agree to caesarean section if they are convinced it is safe for them and their baby. One of the first efforts of obstetricians promoting caesarean section has been to take the scientific evidence on risks of caesarean section and torture the data until it confesses to what they want it to say.
One example: Obstetric hype in popular and professional magazines says research shows 60% of women who have vaginal birth have urinary and faecal incontinence. But a careful reading of the research papers they refer to reveals something very different. The hype lumps all women with vaginal birth together instead of doing what the researchers did – dividing them into risk groups. When analysis of risk was done, they found that women at high risk for urinary and faecal incontinence have had large numbers of births; have had babies weighing over ten pounds at birth; and most importantly, have been the victims of unnecessary, aggressive obstetric interventions during their labour and birth.
What are these aggressive, invasive obstetric interventions that have been proven scientifically to cause permanent damage to the pelvic floor and urinary tract and also lead to more otherwise unnecessary caesarean section? One example is the use of powerful and dangerous drugs to start or accelerate labour, a practice that has doubled during the past 10 years. These drugs make labour abnormal with violent contractions that can damage the uterus and pelvic floor. The only reason women agree to such induction is because they are not told the truth about the drugs, for example that Pitocin (oxytocin), a drug used for decades to induce labour, doubles the chance the woman will have urinary incontinence in the future. By withholding such facts doctors seduce to induce.
Induction with drugs is not the only aggressive, invasive intervention that is frequently used in vaginal birth and is associated with damage to the urinary system, pelvic floor and rectal areas. Episiotomy has been scientifically shown to result in more pelvic floor damage than a natural tear. When an effort was made in the 1980s to reduce caesarean section in the United States, the rate of using forceps or vacuum extractor to pull the baby out went up—some doctors just can’t stop doing invasive interventions. And there is good data that using forceps or vacuum to pull the baby out has more risk of pelvic floor damage than any other form of birth.
Obstetricians have turned birth into a surgical procedure and done damage to women’s bodies and now suggest the solution is to promote yet even more radical and aggressive surgery; caesarean section. The solution is less unnecessary invasive surgical procedures during birth, not more.
[Re: the Midwifery Today E-News article, Issue 3:23]: The two obstetricians tried to say that vaginal birth can damage a woman, but they never pointed out the ways in which caesarean section can do harm not only to the woman but to the baby as well. The following excerpt from my article “Choosing Caesarean Section” in The Lancet of November 11, 2000, reviews some of the dangers associated with caesarean section, the alternative to vaginal birth that some doctors are trying to promote:
‘In addition to the increased risk the woman will die with an elective caesarean section, there are other risks for the woman including the usual morbidity associated with any major abdominal surgical procedure—anaesthesia accidents, damage to blood vessels, accidental extension of the uterine incision, damage to the urinary bladder and other abdominal organs.1 Some of these risks are common: 20% of women develop fever after caesarean section, most due to iatrogenic infections requiring diagnostic fever evaluation for both woman and baby.1
There are also risks women carry to subsequent pregnancies due to scarring of the uterus including decreased fertility, increased miscarriage, increased ectopic pregnancy, increased placenta abruptio, increased placenta previa.1,2, 3 Recently in the United States the widespread use of the unapproved drug misoprostol (Cytotec) for labour induction has created a new risk of caesarean section in subsequent pregnancies. Women attempting VBAC (Vaginal Birth After Ceasarean) who are given misoprostol have a rate of uterine rupture of 5.6% compared with a rupture rate of 0.2% for women attempting VBAC not given misoprostol, a 28-fold increase in risk of uterine rupture.4 For women choosing caesarean section, all of these risks exist in all of their subsequent pregnancies even if the original caesarean section was not an emergency. The increased risks of ectopic pregnancy, abruptio placenta, placenta previa and ruptured uterus are all life threatening to both woman and baby.
For whatever reasons women choose caesarean section, very few are clearly informed about foetal risks. In an emergency caesarean section where the baby has developed a problem during the labour, the risks to the baby of doing the caesarean section will likely be outweighed by the risks to the baby of not doing it. In an elective caesarean section where the baby is not in trouble, the risks to the baby from doing a caesarean section still exist, meaning the woman who chooses caesarean section puts her baby in unnecessary danger. That some women are choosing caesarean section strongly suggests women are not told these scientific facts.
The first danger to the baby during caesarean section is the 1.9% chance the surgeon’s knife will accidentally lacerate the foetus (6.0% when there is a non-vertex foetal position). (5) Obstetricians may be less aware of this risk — in one study only one of the 17 documented foetal lacerations was recorded by the obstetrician doing the surgery.5 A much more serious risk to babies born by caesarean section is respiratory distress. Many reports in the scientific literature document the caesarean section procedure per se is a potent risk factor for respiratory distress syndrome (RDS) in preterm infants and for other forms of respiratory distress in mature infants.1 RDS is a major cause of neonatal mortality. The risk of newborn RDS is greatly reduced if the woman is allowed to go into labour prior to the caesarean section.
Another serious risk to the baby born by caesarean section is iatrogenic prematurity (the baby is premature because the caesarean section was performed too early).
Even with repeated ultrasound scans, the standard deviation for estimating gestational age is large, creating errors in judging when to do an elective caesarean section. Doing the elective caesarean section after the woman goes into spontaneous labour would markedly reduce this risk as well. A vast literature documents the increased mortality and morbidity, including neurological disability, associated with premature birth.’
So beware. Surgeons try to sell surgery. Never forget that obstetricians are, after all, surgeons. Women must be extremely cautious in the face of this hard sell and get the facts from those who do not have a vested interest in surgery.
About Dr Marsden Wagner
Marsden Wagner, born in San Francisco, his education at UCLA included an M.D., clinical specialty training in pediatrics, then in perinatology (neonatology and obstetrics) followed by two years post-graduate study with an advanced scientific degree in perinatal science. Following several years of full time clinical practice and some years as a full time faculty member at UCLA, he was a Director of Maternal and Child Health for the California State Health Department. After six years as Director of the University of Copenhagen-UCLA Health Research Center, he was for 15 years Director of Womens and Childrens Health for the World Health Organization. He is now an independent consultant.
With extensive experience in maternity care in industrialized countries, including midwifery and the appropriate use of technology during pregnancy and birth, he has consulted and lectured in over 50 countries and given testimony before the US Congress, British Parliament, French National Assembly, Italian Parliament, Russian Parliament and others. His publications, in 11 different languages, include 131 scientific papers, 20 book chapters and 14 books.
For more about Dr. Wagner:
1. Wagner M, 1994. Pursuing the Birth Machine: The Search for Appropriate Birth Technology, Sydney, Australia: ACE Graphics.
2. Enkin M, Keirse M, Renfrew M, Neilson J, 1995. A Guide to Effective Care in Pregnancy and Childbirth, 2nd ed, Oxford University Press.
3. Goer, H, 1999. The Thinking Woman’s Guide to a Better Birth. Putnam, New York: Penguin.
4. Plaut M, Schwartz M, Lubarsky S, 1999. “Uterine rupture associated with the use of misoprostol in the gravid patient with a previous caesarean section,” Am J Obstet Gyn 180:1535-42.
5. Smith J, Hernandez C, Wax J, 1997. “Fetal laceration injury at cesarean delivery,” Obstet & Gynecol 90:344-6.
First published in byronchild/Kindred, issue 1, March 02
By Marsden Wagner M.D.
Kelly xx
Creator of BellyBelly.com.au, doula, writer and mother of three amazing children
BellyBelly Member
This is the thing - the large, public tertiary hospitals that get all the high risk and tough cases aren't the ones with the caesareans rates through the roof.
The hospitals with 50-80% c/s rates (and there are many) are private hospitals. They are hospitals where every birth is overseen by an obstetrician.
All public hospitals are required to disclose their c/s rate.
About 10 years ago (coincidentally when the c/s rate started to rise) private hospitals in QLD began burring up about this being on the public record and they no longer have to disclose. The only indication a woman can get up here is to look at the rate of ALL private hospitals lumped in together, which can be found in the state perinatal data, or rely on the honesty of the hospital/obstetrician. I can tell you right now that the hospitals and OB's that are sporting those rates are NOT telling them to anyone who asks. Why should they? There's no one telling them they have to.
For everyone who doesn't understand why this matters, let's put it another way.
If you were wanting an elective caesarean, and the hospital you were planning to birth at wouldn't tell you how many caesareans they do, or wouldn't tell you whether you could have one until you were due, or already in labour would you not feel that critical information that you need to make an informed decision about where to birth was being with held from you?
For a woman who wants a natural birth, this information is absolutely imperative. In the work I do, I often see women who have obliviously booked into a hospital or taken on an OB with a caesarean rate that I know is going to make their natural birth an uphill battle all the way. There is little point planning for a natural birth, engaging a doula and then walking through the doors of a hospital with an 80% caesarean rate.
I'm sorry I really can't understand how anyone could object to women being able to access this information. It just baffles me.
Last edited by Tobily; November 20th, 2008 at 02:04 PM.
Registered User
I didnt see anywhere the OP said they were stupid?
Good for the women who want a VBAC..
nothing wrong with it, and def not against it.
back on topic...
But again there are many many different reasons behind a c sect and we do not know these.. each and every labour has different circumstances so naming and shaming hosptials with high c sect percentages does no good without the info behind it to back them up.
what some women think is a legitimate reason to have a c sect other could be dead set against..
BellyBelly Life Subscriber
I see absolutely no reason why statistics shouldn't be freely available.
The name & shame label is perhaps counterproductive, since it sets people's backs up, but really, what have these hospitals got to hide that they don't want to release stats? If they've done nothing wrong and are acting correctly in their patients' best interests then what's the problem?
BellyBelly Life Subscriber
hmm.. I never quoted the OP? Just saying that these women aren't stupid.. they're probably the most informed of the lot of us for these 'riskier' births.
Thanks Tobily for answering my question.. thought it might have got lost back thereAll public hospitals are required to disclose their c/s rate.
Well, if the information is already available, then I guess I'm not really for the whole naming and shaming if the shaming is it's sole purpose. I kinda jumped in thinking it was just about making the information available.
Registered User
Well said hun. I think most women weigh up the risks and the information they are given, and try to make the best decision for them and their baby. In some cases, yes they are misinformed and choose to have c/s for reasons that are not valid (like the too posh to push brigade on 60 mins saying they didn't want their veejays stretched) but even then, they believe they are making their decision based on what they think is fact. They obviously havent researched extensively enough but that is the choice they have made for reasons they believe are valid.what some women think is a legitimate reason to have a c sect other could be dead set against..
As far as "risk"goes.... I was booked in for a c/s at 9 days because of "risk"I was able to push it out to 14 days because I was determined, had done my research etc.... Other women would have taken the 10 days at face value and agreed, just as I did with the magical 10 days over and getting induced with Isabelle. I still believe the info should be there for those who want to make an educated choice about what they think is best for them and their baby. I also think that what I see is "risk"is different to the next person- I know many people at my mothers group can't believe I went to 14 days considering I was "high risk"and I know others who probably though I should have gone longer, but my "risk"assessment ended at 14 days. Ugh not sure what I am getting at but hopefully you all get the point.
Registered User
As I believe in Freedom of Information and Transparency in public services I will be voting Yes.
Some people have posted opinions based soley on their experience without seeing the big picture... I see this as a bit futile, no one is suggesting womens' choice will be compromised... only the ease at which women can inform themselves. This is a discussion about a policy that will affect everyone, not just an individual.
ETA:
Yes
38% (475 votes)
No
46% (571 votes)
Only in extreme cases
14% (184 votes)
Total votes
Total of 1230 votes
Last edited by Bathsheba; November 20th, 2008 at 02:34 PM.
its only the public hospitals that Have to share their statistics... private hospitals dont and this is ultimatley what sandra knack is trying to change.
so that eveory one can see which hospital has the higher rates of c/s and intervention.
then from that point look at why these hospitals are having such high rates.
i dont think they would ever name and "shame" an ob......
also most of the stats dont go in to to much detail either a vag birth is still a vag birth doesnt matter that you had an every thing from gels to synto with gas to epidural or episiotomy to suction.
the only time its not a vag birth is when bubs comes out the sunroof!
which isnt a good way to do the statistics as we all know because there are so many variables.
Registered User
Um.. im an unsure how my post offended you?? Saying that as long as mum and baby are ok at the end of the day is offending? i dont get it. I have reread my post and i dont think i needed to reword it, because its how i feel. If i did offended you, i would think you would do the right thing and pm me regarding this.
And yes i know it is major surgery, but the thing is vaginal birth is pushed to be this most beautiful pleasant easy experience when it always isnt the case. c/s are put to shame because they are major surgery, you may have a longer recovery period and the baby may need assistance once born.. but what i was trying to put across in my post is, what is most important is that mother and baby are ok and are both alive to see the next day. As i also said, in my case, my first vaginal birth was a nightmare. It put my son's life at risk. Thankful he was born before quite fast otherwise i would have had a c/s and would have totally agreed to it. As for recover, i could not walk for 3 months afterwards, nor stand for longer than 10 minutes at a time. I could not DTD without being in pain to the point my eyes watered until my DD was born. So not every vaginal birth is wonderful. I just dont see the whole negative aspect of c/s that the article is trying to portray, when the majority of the time they are there for a reason.. to save lives.
A good friend of mine lost their child because they refused to have a c/s when they were advised it was the best option for mother and baby.. but she had her mind set on a vaginal birth. I also know of another 2 people who i dont know personally, but have lost their babies due to the same reason. It does happen, and i think these OBs give advice that a c/s is neccesary because they are trained in that area and know what they are talking about.
Registered User
QUOTE: Saying that as long as mum and baby are ok at the end of the day is offending?
I would say it could be quite upsetting... birth trauma is a very real situation and by telling a mother that she shouldn't be traumatised (by either a c/section or vaginal birth) because her baby is safe is very dismissive and will make the trauma worse. But that is off topic. If women feel fully informed then trauma is less likely to occur. A policy allowing women to be informed could reduce birth trauma.
ETA: and I would suspect that if there were less women with birth trauma there would be less women with PND. This is why being dismissive of "how a woman gives birth" can be upsetting.
Last edited by Bathsheba; November 20th, 2008 at 03:03 PM.
BellyBelly Member
I find it extremely sad that anyone would put a vaginal birth over the true safety of their baby.....
Actually, I find it a little disturbing.....
ETA... By true safety I mean, REAL stats, not just a Ob saying so... My ob said a c/section would be safer if Little Girl stayed breach, and that is JUST NOT TRUE....
Registered User
ok so you would prefer me saying the opposite?
ETA.. im sorry, but i dont see where i said a mother shouldnt be traumatised, nor that giving birth is easy.. If you would read what i said about my birth with my son, youll see it wasnt easy sailing for me either.
Last edited by ShootingStar; November 20th, 2008 at 03:00 PM.
Registered User
As do i.. that is what i was trying to say.
Registered User
I believe it would be best if all women had realistic expectations of the kind of birth that is right for them. A women who enters a hospital who has an expectation far removed from reality is going to be at risk of birth trauma.
I fail to see how fully informing women will be against their best interests. There is nothing wrong with having an emergency c/section, that goes without saying.... but there is something very wrong with allowing women to attempt to give birth in an environment that is going to statistically lead to a very different outcome to what the women believes will be true... and that applies equally to natural or c/section births.
Last edited by Bathsheba; November 20th, 2008 at 03:01 PM.
♥ BellyBelly's Creator ♥
This is not about who should have what and what is the best way to give birth... can we please stay on topic? This is about if the rates should be published for consumers to see... some may not want to but many also make their healthcare choices based on things like this.
Kelly xx
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