need info

[Inanna]

I also want to add that many women spend more money on their maternity wardrobe than on their support people. That always always worries me. It's like spending money on your wedding dress & reception but not engaging in pre marital counselling etc.

We need support. We need support from women who share our ethos. We need support from our "sisters" in our community.

We need to set ourselves up for the best possible situation...

[skeetaboat]

I think it's important to seperate out rates of PND, uninitiated or early termination of breastfeeding, and bonding issues experienced by mothers on whom an unwanted cesarean was performed, mothers on whom an emergency cesarean was performed, and in cases where the mother requests the cesarean. I would imagine the rates would be highest in the first two groups, and lowest in the third. Do the increased rates we're talking about lump all c-sections together? What are the rates?

I think it's important to point out in Meringue's case, she is probably MOST likely to have post birth issues like PND etc, if she ends up with a vaginal birth which she has already stated that she absolutely DOES NOT want, and suffers trauma to her perineum as a result. And the chances of that happening are much higher than any of the risks involved in having a c-section (epesiotomy rate of 20.6% in Victoria in 2006 (Australia mother and babies report 2006) & 3rd or 4th degree tear rates of 4-5% (Maternity Services Performance Indicators 2006). So all up a 26% risk and that's not even including 2nd degree tears.

I think it's also important to point out that yes, the relative risks of maternal & infant morbidity and mortality are higher in c-section versus vaginal birth. However, the absolute risk of major morbidity or mortality is still quite low (eg. VB MMR is 2.1/100,000 vs ECS MMR 5.9/100,000 - CMAJ • March 2, 2004; 170 (5), and neonatal respiratory distress in VB = 8/1000 vs CS = 16/1000 - American Journal of Obstetrics and Gynecology (2006) 195, 1538–43).

And in Meringue's case, physical trauma by way of natural birth (quite common) is something she especially wants to avoid. Obviously this risk is weighing heavier in her assessment of risk. And fair enough! It's her perineum! No amount of dealing with fear of birthing will guarantee her an in-tact perineum. She's looked at the stats and weighed it all up and has made an informed decision.

For some women, simply facing their fears isn't always the answer. We do not and cannot presume to know the reasons behind the fear. Sometimes the birthing mother isn't in a position to persue counselling. Sometimes there isn't enough time. Sometimes people aren't ready. Sometimes the issues are too deep and it will take a lot longer than 6 months. Sometimes people just don't want to or can't. Sometimes, even after the fear is faced, the mother is left still wanting a c/section. And at the end of the day, it is up to the mother. It is her body and her choice. For healthy outcomes, mothers need support to have the birth they need.

[Inanna]

Mmmmm some argue that requesting a medically unwaranted major surgery isn't the choice of the patient but rather of the practitioner... So that's another interesting point to ponder. Some also say that getting pregnant but not wanting to birth might be a bit like not wanting to drive but to seek a job as a taxi driver...

Skeetabout absolutely 6 months often isn't enough. Absolutely some people still will be too fearful of the prospect of vaginally birthing their child that they will still want a c/section. That is absolutely undoubted. However, this is part of my plea. That as Women (& Men who will father) we need to prepare ourselves for birth. We need to examine the issues. Women who are fearful of birth are often (and not always & I am not referring to any particular person) fearful of other things. They are often fearful of losing control. Birth, mothering is about letting go of control.

No I don't believe the stats are sectioned out Skeetabout. But someone feel free to prove me wrong if you can. This isn't about birth disappointment the PND & the breastfeeding issues. This is about the mechanics, about the hormonal response that labour & birth gives...

[Fleur]

Inanna I love your passion for all things birthing & mothering

Is that hormonal response initiated if the mother has a CS but has been labouring? Just wondering.

[Inanna]

I believe Jasp that labouring actually does help to trigger this. As our bodies go into labour - the trigger for that is hormonal - releasing that hormone prepares for the moment of birth. Without labour we don't have that. So, the birth process is interrupted when a surgical birth occurs. Do you get me?

I will try and dig out something for you to read... But I may not have time tonight... (ironing basket is screaming at me!)

I also thought of another point we could perhaps ponder... What do you think it would feel like for a woman very very fearful of birthing vaginally (many women who have been sexually abused have this fear also - so it's not just from witnessing births ).... How would it feel for a woman who has planned all along to have a c/section... But she's at home & her membranes rupture. She gets to hospy but she's 8 cms and there's no time to call in the anesthetist. She has to birth vaginally...

That can feel incredibly incredibly violating. I have seen this myself. It is terrifying. It's a bit like a young young woman who has denied her pregnancy birthing. It can be very traumatic.

This is the angle I take. That we as Women have vaginas to enjoy sexual pleasure & to push our babies out. That's the way it's meant to happen. (yes I know it can't always be that way... I've established that & fully 200% agree) If we are finding it a struggle to do that psychologically again the sacred act of pregnancy & birth has touched our shoulder and nudged us to work on ourselves. Why? Because the issues that cause you to be afraid of birthing outta ya hoo haa... They are going to be the issues that cause challenges in your parenting. I guarantee it...

[fionas]

Mmmmm some argue that requesting a medically unwaranted major surgery isn't the choice of the patient but rather of the practitioner... So that's another interesting point to ponder. Some also say that getting pregnant but not wanting to birth might be a bit like not wanting to drive but to seek a job as a taxi driver...

Inanna, I think you've written some brilliant things in this thread but clearly in Meringue's case it is the choice of the patient, not the practitioner.

I also absolutely disagree with the taxi driver metaphor. We will have to agree to disagree on this one. I know you see birthing as a rite of passage towards motherhood. I, and I'm sure many women like me, just don't. I wanted a VB because it appeared to be better for me and my baby AND because I didn't want a 6-week recovery from a caesar (which actually turned out to be 18 months from the VB and almost destroyed my relationship as a result) but NOT because I thought that it was essential for me to experience as a woman and as a mother. And having had one, pffffft, y'know, I still don't think it's that important to me. Like I said, we will have to agree to disagree but I think you should respect that not everyone comes from the same starting position as yourself. Don't get me wrong, if I have a VB, I would like it to be beautiful and empowered and all that good stuff, but I don't see a VB as my primary aim.

Skeetaboat thank you for raising the statistics argument. As you've pointed out, it's all very well saying that caesareans are riskier but if the risk is quite small then they are riskIER not riskY. We always go off at obs who say that the risk of a uterine rupture from a VBAC is risky and point out that it's not THAT risky in the whole scheme of things so why do we make comparisons that imply that caesareans are much riskier than VBs? We can't have it both ways.

[skeetaboat]

Some also say that getting pregnant but not wanting to birth might be a bit like not wanting to drive but to seek a job as a taxi driver...

See I would see it as the other way around. Becoming a parent is about so much more than the birth. We go through birth in order to get a baby. So a more fitting example is wanting to be a taxi driver but being afraid of getting your licence. Getting your licence is the hurdle to overcome in order to do what you dream of. For some getting pregnant is about having a baby. Maternally requested cesareans enable some people who would otherwise miss out on becoming a parent to to become one. I think we're lucky to live in a day and age where that can happen. ETA - and fionas situation where she would just like to avoid a painful and long lasting repeat of the issues caused by her previous birth

I agree sometimes issues causing fear of birth may also be issues that challenge your parenting - but there's no reason that we can't deal with them then. Also, sometimes it's as simple as not wanting your perieum to be cut or torn, and taking steps to ensure that doesn't happen.

Yes, the example of SROM with a planned c-section (unlikely I might add) would not be good. Perhaps its a case of preparing for both, as is advised in VBACs.

I agree Fionas.. we minimise the stats when it comes to risk of rupture for VBACs, but maximise them when it comes to the differences between CS & VB.

Inanna, I have great respect for your passion about birth. And I would fight for your right to access homebirth and have the birth practitioner of your choice in your birthing space. It's just that not everyone is as passionate, or cares, or wants to care about having a VB. We can't and shouldn't force them to see birth the way we do or have the birth that we think is right (for us). We can help people see alternative views and models of care, but at the end of the day I personally am happy to see a woman get whatever care it is that she feels she needs (informed of course).

[skeetaboat]

We as women need to own the process & experience. That isn't to read some literature of either support or denigration of natural birth and make a decision. It's about really going inside. Thinking about what birth is and means. What you need to feel safe & supported & seeking that out. Demanding that. Interview your care providers. You are paying them. If they fall short - you need another. You are employing them. If their practice doesn't suit you - seek one that has ethos you agree with.

Inanna I think in effect we are saying the same thing, because I could write the same paragraph myself... except you're adding a clause that it should be vaginal (except in emergency).

[fionas]

Brilliant posts in this thread skeetaboat but I can't give you any more points apparently.

Just while we're on the subject of stats, are there any stats on infection rates from caesars from individual (Victorian) hospitals? I want to throw this into my decision mix.

[skeetaboat]

Thanks fionas. You have made some excellent points yourself

One study I just looked at (I don't have the link now sorry) for staples was .7%, so 7 per 1000 births. But that wasn't Australia. Will have a hunt around and see what I can come up with.

[Fleur]

I believe Jasp that labouring actually does help to trigger this. As our bodies go into labour - the trigger for that is hormonal - releasing that hormone prepares for the moment of birth. Without labour we don't have that. So, the birth process is interrupted when a surgical birth occurs. Do you get me?

I think I get you.
Part of the reason I ask is because I had my CS after labouring for hours, and I felt no difference in the bonding process to my other 3 children (I realise though that it would be different for different women etc)
What I am wondering is, can a woman who wants an elective CS get the same hormonal kick if she allows her body to go into labour first? Would this be a viable option for someone who had decided to go this way?

[fionas]

Inanna, I'm going to throw my situation into the ring and ask for your perspective and advice. I'm not coming from a place where I'm trying to deliberately throw you a curly question, I have a lot of respect for your views, don't necessarily ALWAYS agree with them but I think you are very knowledgeable and make a lot of good, valid points.

So this is my situation. I have a condition called SPD, otherwise known as an unstable pelvis. There are different schools of thought on what causes it. Some believe it is caused by the hormone relaxin which is released when pregnant and loosens the joints in the pelvic area, readying them for labour. Unfortunately in some women this causes problems as their joints become too loose making it painful to walk, stand or bend. Others believe that it is caused by an underlying misalignment in the pelvis that is exacerbated by the hormonal changes.

In my last pregnancy, this happened at 28 weeks. I saw a physio throughout. My ob and my physio told me it would go away after the birth. I didn't manage the condition as well as I should have by resting, wearing a support belt, icing. Basically, I was so over the moon to be pregnant that the pain of the condition was secondary to me especially as everyone said it would simply go away. I was in pain 24 hours a day, sometimes excruciating, sometimes more annoying than mind-blowing but constant nonetheless.

As per my previous post, I had a long prelabour with little sleep over 3 nights, DD was posterior, active labour lasted about 14 hours and the end result was an epidural. The pushing stage lasted 3 hours with my knees pushed against my chest during which time DD did not budge and my ob used forceps. I later found out that is actually THE worst set of circumstances for someone with my condition.

Long story short. The pain did not disappear after the birth. It took 18 months. I attribute this to the protracted pushing stage and the position I was in. During that 18 months I was largely housebound for the first six months, still could not walk very far and standing/bending was still very painful. Being in chronic pain for so long put an enormous strain on my relationship to the point where DP and I almost split up.

Fast track to this pregnancy. I have been in pain since Week 7 when my physio told me that if I didn't manage the condition properly I would soon be in a wheelchair.

This time I have done everything I can to manage my condition which means that I have been housebound since Week 11 as the biggest trigger is walking. I gave up working a month ago. This week I have been out of the house once to walk approx 30 metres to my local coffee shop. I have another five months of this to go. I wear my support belt 24/7 (even in bed), ice three times per day and do clinical pilates once or twice a week. I could tell you many more things but basically my life has been dominated by my condition for almost three years. This from someone who was previously as fit as a fiddle.

In the meantime, I have asked many care professionals what they would advise. My ob and most of my physios (I see numerous ones) blithely say that recovery takes longer with a caesarean without really listening to my point that IT TOOK 18 MONTHS TO RECOVER FROM A VAGINAL BIRTH. The midwives that I have spoken to have suggested that a caesar is probably best for me. The Pelvic Instability Association largely advises that a vaginal birth is better in most cases provided that the birth is properly managed, an epidural is avoided and that positions that cause pain are avoided - all things that I did 'wrong' last time. However, it also says that in severe cases a caesarean may be advisable. I believe my case is severe.

However, despite what I previously posted about a VB not being THAT important to me (which it isn't), I'm one of those people who likes seeing every angle and likes solving problems.

So I have asked myself whether I think I can still do a VB and the fact is that I don't think there will be one single position that I can birth in that won't cause me pain. I can't even open my legs wide enough to get a pillow inbetween them at night-time without it hurting quite badly.

So, because there is such conflicting information, I can't put my hand on my heart and say that I have a true medical reason. Some would say I do, some would say I don't.

But I do know that I am very scared of a VB because I simply can't find a position that I think I can actually birth in. And if holding a position hurts after a few seconds now, I don't understand how I could be in that position for minutes, possibly hours, without it further damaging me.

So how would I work on that fear given that there is no conclusive evidence that I've found either way? Only my experience from last time that I couldn't walk, stand or bend for a significant length of time afterwards and that I almost lost my relationship? No health professional can give me a reliable timeline for how long it will take to recover from a VB versus a caesar (with this condition). I only know that it took 18 months from the VB and I find it hard to believe that recovering from a ceasar could be any worse and could infact be considerably better.

[AnyDream]

This is the angle I take. That we as Women have vaginas to enjoy sexual pleasure & to push our babies out. That's the way it's meant to happen. (yes I know it can't always be that way... I've established that & fully 200% agree) If we are finding it a struggle to do that psychologically again the sacred act of pregnancy & birth has touched our shoulder and nudged us to work on ourselves. Why? Because the issues that cause you to be afraid of birthing outta ya hoo haa... They are going to be the issues that cause challenges in your parenting. I guarantee it...

I agree in principle, but this doesn't account for those of us who have processed our issues through deep therapies like rebirthing etc, did our research & preparation, and faced our first births fearlessly and in a state of complete self-awareness and clarity, and yet were still traumatised by the circumstances surrounding our births. Not every woman gets a choice over her birthing care providers - think regional areas - and often women are promised a standard of care when they meet with midwives etc but by the vagaries of hospital staffing & the reality of routine practices end up with a completely different experience to the one promised. In my case, I was issue-less when I entered the birthing suite, but horribly impacted for well over a year afterwards - the physical healing alone took 18 months - and no amount of debriefing, counselling, contextualising, healing, etc afterwards could induce me to go there again. Ironically, after my calm and empowered 2nd birth by maternally requested C/S surrounded by people who really cared about my wellbeing - this experience was healed deeply in me. So deeply that I felt from that point onwards that I could indeed contemplate another fearless VB, should the need ever arise.

I guess I'm saying that an empowered birth, in the sacred sense and in the context of the larger arc of life, can occur regardless of VB or CS. It's really important that there exists a space like this on the forum where those of us who find ourselves taking the CS journey - no matter what the reason or whether any one else thinks it's valid - can get information and support.

[sleepyljm]

I agree. I know some VB come be a bit disturbing but a CS is brutal. I had one in May last year under general anesthetic (emergency) and had a big 3L blood loss. My sis who is a Mid Wife was in the theatre and was traumatised by it all. I nearly ended up with a hysterectomy.

My experience did impact on bonding and breastfeeding. I was very unwell for days afterwards and had trouble bf.. my milk didnt come in for 8 days and having a screaming newborn who needs to be fed can be very hard when you dont have milk in and have a drip in your arm and are in alot of pain. People i know who have had a VB and CS say that they cannot understand why people would opt for CS because of the length of healing time.

I do believe that CS does have its place in hospitials and in some circumstances it is nessecary. But would suggest that the trauma that you have witnessed can be addressed before the birth of your child.

[skeetaboat]

I think I get you.
Part of the reason I ask is because I had my CS after labouring for hours, and I felt no difference in the bonding process to my other 3 children (I realise though that it would be different for different women etc)
What I am wondering is, can a woman who wants an elective CS get the same hormonal kick if she allows her body to go into labour first? Would this be a viable option for someone who had decided to go this way?

I'm not sure of the technical answer to your question Jasp, but I can share my two experiences.

First birth I went into labour (SROM) breech presentation so had a c/s. No issues bonding, felt the love, BF straight away, milk came in on day 3, etc.

Second birth planned elective c/s at 39 weeks. No labour contractions or rupture of membranes. I felt the love and was gushing about how wonderful it is having babies. More so than with my second actually. I kept ringing up DH and telling him how wonderful it all went, what a great support person he was, and telling him that I wanted to have a third (when all through the pregnancy I was adamant that two children was more than ENOUGH!).. after about the third phone call he was like, "yes you told me the first three times you called. I'm glad you're happy but I want to go to sleep now!" lol.

So in my experience, not having labour didn't seem to affect getting the hormonal kick at all.

But I have heard that actually going into labour before your c/s is beneficial for baby. I'm not sure exactly how it benefits, something hormonal I believe, but sure that Inanna or someone else can shed some light. In fact, that's why I did wait until spontaneous labour with my first (that, and because 50% of breech presentations actually turn during labour), but alas it wasn't to be.

[AnyDream]

ETA - And FionaS - I want to add this...my experience of pain during my 20 hour labour far exceeds anything that women routinely describe. I have had plenty of excruciating gallstone attacks and I can tell you they weren't a jot on what I experienced during labour. Ironically I turned down the offer of an epidural because I didn't want the cascade of interventions that could follow. I don't buy the line about pain in labour being caused by fear - in my case there existed a physiological difference which affected my ability to birth & recover from birth compared to the next woman.

Which put me in an interesting position during the 9 or so years when I contemplated whether I would try to have another child or not. Should I trust those people that say that if i had the loving support of a IM (which might not be possible in the current insurance climate) then my pain levels might be more manageable? Or should I trust my prior experience? I know I *did* all the preparation that could possibly be done, and yet it didn't work for me. Well, the baby got born, but the cost to me was enormous. I can only conclude that perhaps I'm wired a little differently to the next person, in terms of my pain receptors. So at what point do I trust the external voice that told me my first birth would turn out in a way it did not - without knowing the specifics of my experience? In the end I listened to the small clear voice of my own intuition, and asked for what I needed.

(Edited) Some might think that I copped out, didn't face or process my fear, but they know nothing about me or the deep processing I did to get to the decision that I made. Which was *not* a fear-based decision. Fiona, the trick is not necessarily working through your fear (unless you feel its warranted) but rather identifying where you fear is and observing to what extent it colours your decision. If it sways your decision completely, then maybe that's not the best option. If on the other hand there is a balance of factors and fear is one of them, then you are in a better position to take a decision regardless of that fear.

ETA - Jas P I asked your question when I was preparing for my C/S. The answer was that once a woman is in labour it can take some time for a team to be assembled (esp in the middle of the night), a theatre to be found etc. Given that no one ever knows how long the labour will take, this can be risky, depending on the reason the C/S is being done. In my experience, the bonding period immediately after my CS was much better than after my VB when I was still dissociated from the trauma I had experienced. Breastfeeding wise, I was given extra support by LCs and established a good supply using a breast pump, whereas after my VB I was pretty much left to my own devices despite huge difficulties. So from that viewpoint, I think support is more important than birth modality in terms of good outcomes.

[fionas]

Good for you for listening to your intuition Marydean! I think it's wonderful that your choices turned out to be the best for you.

I only wish my intuition was as strong, then this would not have me going around in circles Though I guess it is a fairly big indication of where my intuition is at if I can imagine screaming at anyone who tells me to open my legs (because it will hurt not just at the time but I will all the time be worried that it will actually lead to me being disabled after the birth) whereas I can imagine being put onto a trolley with my legs together being very peaceful.

I'm not sure how you feel about this next point but I also need to safeguard my mental health. I've had severe depression (before babies) in the past which has been triggered by me thinking I'm stupid or that I've done something wrong. I know that if I have a VB and it leads to another long recovery, then I will think I'm stupid for repeating the same 'mistake' and will then be at high risk of becoming depressed. If, on the other hand, I have a caesar and it still leads to a long recovery, I won't feel so stupid as at least I tried something different.

Bloody confusing this whole thing.

[skeetaboat]

I know which choice I'd make if I were in your position, but it's something only you can decide. It certainly sounds like you're feeling like it will be difficult for you to relax and concentrate on the task of birthing. Is there anything that might help you relax if you chose another VB?

What is it that's making the decision difficult? Maybe we can help you nut it out a bit..