Why do LTTTCers seem to prefer a c/s?

[butterfly_warrior]

So do women undergoing IVF due to male factor infertility tend to have more trust in their bodies than those of us dealing with female factor or combined infertility?

I suspect that much of my view on doctors, etc comes from my own battles with chronic illness - I have doctors that teach me how to adjust my medications in order to manage my condition as best I can... It wasn't until my FS that I encountered a doctor who wanted me to sit back and passively accept the treatment he prescribed without (much!) question.

Does it all come down to choice of OB? I'm with mine because she took good care of me in hospital with OHSS. But part of the decision to go with her was knowing that she'd helped a friend through two pregnancies and did everything she possibly could with the first to get a VB, and was happy to go with a VBAC for the second (until she was away and the person covering her whipped her in for another c-section, so it's not even all doctors in that practice).

Would I still be thinking the same way as I am now if I had an OB who was much more willing to go the scalpel route?

BW

[sushee]

That's a good question, BW. My ob purported to be very pro-VB, and I do think, in comparision to other obs, he is in fact very much prefers less intervention if possible. BUT even he, on two occasions, suggested a c/s. Once when I was 39w2d and saying I was 'so tired' of being pregnant (I politely declined) and the 2nd was when Charlie was in distress.

It actually made it harder believing he was pro-VB yet thought I should have a c/s. I think had I had less fears of c/s, and less confidence that I could birth vaginally, I would have caved, thinking that if my pro-VB ob thinks I should have a c/s, then surely I must need one? Yet I didn't need one after all. My ob, as lovely as he is, was most reluctant to admit that in fact I probably would be able to deliver a baby in distress vaginally without consequence. In fact, I did!

I want to believe that there are obs out who will not offer c/s as an option unless there is a definite medical emergency based on evidence, not just an ultrasound or their 'hunch'. And who will explain to the women clearly that a c/s as an option is less safe and more prone to complications for her and her baby than a VB. I think if there are obs like that are out there, they are in a very small minority indeed.

[briggsy's girl]

damn, i hate it when BB errors out! i had a huge post typed up earlier, and lost the lot

the crux of it though was a response to sushee's ongoing mention of psychological issues. psychological orders can be just a debilitating, sometimes more so, than physical issues. for me, when i'm having a full blown anxiety or panic attack, i shut down completely. i lose the plot and start doing things that make no logical sense. i have gone the path of self harm, but not for quite some time. if, coming to the end of my pregnancy, i can see this sort of thing developing (and it IS becoming a problem at the moment just with the fact that i am not coping with the nausea - upchuck phobias SUCK!), i will make the call safest for myself and my baby. i can't say what will happen in labour, but i can imagine that losing control of your own sense of self, and trying to physically harm yourself to speed things up can't be good...

i am doing what i can in the mean time to try and prevent this sort of outcome - i'm educating myself on birth - what might happen, the good and the bad - as, with everything, knowledge is power. but IF i make the choice before my EDD that i want to have my child delivered by c/s for, what i personally deem to be our safety, i'd be mighty peeved at anyone who thought they had the right to judge that.


Tobiliy - fwiw, i've had the "precious baby" comments - was given the choice of two OB's at one hospital, one at another. i wasn't told about shared care by my GP. i wasn't told about KYM programs. this annoyed me no end. i know i'm at higher risk for GD, family history also puts me at higher risk of PE - but i'm trying to avoid medicalising this birth so that i DO give myself the best chance of a VB, but if i have to have a c/s for whatever reason - it will be MY call.

[sushee]

I think that anyone who says ' I need this c/s for psychological issues' that aren't connected to feeling that a c/s is safer for no other reason than it's what they've been led to believe, then fair enough. Like I said, I am not anti-c/s, and I do appreciate that a whole host of reasons may be involved in the decision to have a c/s that have nothing to do with believing it's a safer option than having a VB.

But when it's when I read LTTTCers say over and over again that they're choosing a c/s because they believe it's safer, that the panic and anxiety they feel is associated with their belief that they are putting their babies are higher risk by attempting a VB, that I get confused.

I'm not making it up - how many times have we read in these very forums posts from women (LTTTC or not) that say that they wouldn't put their baby at risk by having a VB? That to be on the safe side, they should have a c/s? That too many things can go wrong with a VB? That their babies would be better off being born via a c/s (like satya has said she believes in this thread)? I can't even begin to count how many posts of that nature I've read just here in BB, never mind how many women actually believe it that aren't posting here.

So when I was asking about 'psychological' issues, I meant those that drive you to choose a c/s specifically because of issues that relate to those I mentioned above, in that you're anxious because you think having a VB will put your baby at higher risk. And NOT because of other, unrelated anxiety issues that may cause you to struggle with birth in general. Because it's in those circumstances, where a woman is convinced by her Dr or by society that a VB is a 'dangerous' way to birth, that I feel the system is failing us as women by not getting the message across that a VB is a safer option all things being equal.

[Bathsheba]

Sush: I'm just lurking... kinda on behalf of my SIL who i think has thoughts like you describe (IVF with preference for c/s purely for the "safety" notion). I just want to congratulate you on expressing your thoughts so tactfully given the high degree of sensitivity of this subject and hope you don't mind me continuing to lurk!

The only thing I could suggest is that IVF women at least watch The Business of Being Born. I learnt soooo much about exactly why VB is technically the safer option for both mum and baby. I just needed to add that i think that most women (IVF or not) briefly entertain the idea that having a c/s might be the best way of getting baby out! I guess it just seems the smoothest option. You only have to look at diagrams of a VB to kinda "freak" and wonder how on earth THAT is meant to happen... it's a lot to wrap your brain around... it just looks so damn scary! Whereas the same set of diagrams illustrating a C/S seem so much more straightforward. BUT so much is left out of those schematic portrayals! They don't describe how beneficial it is, for example, how the contractions naturally squeeze out all the fluid from baby's lungs... how actually being pushed through the birth canal stimulates optimal breathing.... and being alert enough to BF when they are arrive into their mother's arms. I won't go on about it... but I think if these things were more known to pregnant women then they might be in a better position to make the best decision for themselves and their babies.

Anyhow.... sorry for interjecting... I do hope that my SIL somehow manages to labour and birth naturally and smoothly... but if she doesn't I won't be judging her... I just hope she is committing to being fully informed.

[nic]

Ok, I typed something up beforehand, and one handed too lol, then it got eaten!
But I managed to save it first.

I think there are a lot of women who believe a c/s is safer than a VB, that is until a lot of them end up here on BB reading.

And, it may very well be that LTTTCers have lost faith in their bodies, and so, place their faith in the medical profession that helped them conceive?

Maybe what BW said about control is right? (Right is the wrong word, but lack of sleep ATM, prevents me from thinking of the right word to use) Being able to 'choose' the birth day and how it will happen may be what some people need after having no choice or control over drug amounts, follicles numbers and growth, fertilisations -etc.. YKWIM.

Shannon also makes a great point about our DH's. After my DD was born (public system) I was told it would be a c/s from now on. It was always a great way to have an arguement with my husband, talking about a VBAC. He thought I had died after our DD was born, so it was quite emotional for him to even entertain the idea of a VBAC.
When pregnant with DS, my choices were to travel to the next town over (45minutes away with no family) to the public hospital who is extremely pro c/s, or 2 hours to my family, back to the same public hospital where DD was born. We chose a private OB after being LTTTCers, I wanted continuity of care more than anything, and we only had 2 OB's to choose from. One who I kind of knew was pro c/s, and the other who we went with, who is pro VBAC and breech birth. For us, the choices where we live played a big part in it too I suppose.
My OB, said no to vbac, but when I fronted up for my c/s and was already 8cms, he said he thought I would be able to birth DS, or I should at least try. I was terrified of ending up in the same situation as with DD, even though he explained why he thought I wouldn't, I didn't trust my body or have that belief in myself to do it.

BG, makes a great point about psychologicl issues too. I chose a GA with DS, simply because it was doing my head in thinking about that needle going in my back for a spinal c/s. I was forever crying at the thought of it, and after chatting to our OB, he said he was fine with the GA, because if I was already emotional , once I got into theatre, I could quite possibly become even worse when they started tugging and pulling.

Wouldn't it be great if there was so sort of inbetween services to AC/ LTTTCers to show them there are a huge variety of choices in their ante natal care and birthing experience.

[sushee]

Wouldn't it be great if there was so sort of inbetween services to AC/ LTTTCers to show them there are a huge variety of choices in their ante natal care and birthing experience.

That too is a great point (all the contributions to this thread have been fantastic! So many ideas and thoughts!). I have come to believe that the greatest disservice to IVFers is how they're left to flounder once they fall pregnant.

There are threads about how IVFers feel guilt about complaining about the more uncomfortable aspects of pregnancy.

There are threads about IVFers not 'connecting' with their unborn baby for fear that if they start to believe that something good has finally happened to them, something will go wrong.

There are threads about IVF mums putting incredible amounts of pressure on themselves to be 'perfect' mums that they drive themselves into the ground trying to live to a standard that is impossible to achieve.

So, as IVFers, we have to ask ourselves, why is that that once you fall pregnant, support and understanding seems to 'fall away' and suddenly you're expected to cope with this new and scary phase without anyone but the medical profession - and its 'medicalised' view of things - to help you with your decisions? Or feeling like you not only have to cope with all the anxiety that pregnancy brings, but also have to cope with your DH's anxieties as well? And cope without help or support?

I mean, you have gone through a traumatic and life changing event - dealing with you or your husband's infertility/subfertility, yet once you're pg, you're expected to just 'accept' that you're just another pregnant woman, when you feel so much more fragile, so much more anxious than anyone could possibly believe. Why isn't there anyone for you at that point in your life focussed on assisting you through your difficulties, to help you cope with the new phase of this never-ending journey.

What do we need to ensure that IVFers have as much support during pregnancy, birth, BFing, and parenting as they need, so that they can learn to trust in themselves, their bodies and their instincts again?

[Devon]

I also feel that I would prefer to have a GA if I had to have a caesar, the thought of being conscious while I feel myself being cut open and people moving my innards around is much, much more scary than the idea of labour for me (although I have experienced neither of these situations).

I do feel that my experience of medicalised conception (and pregnancy loss) has caused me to be more anxious about all aspects of pregnancy and birth. The whole thing perhaps seems more risky than if I had fallen pg easily and not lost a baby. I think that's why I never even questioned whether I would have ob care in my pregnancy. It's only since I started to feel 'safer' with this pregnancy that I gave labour and birth a second thought. I'm really grateful to BB for providing the information that started me thinking about the kind of labour that I would prefer, and I have discovered that I really do want to give birth with as little intervention as possible. That's just my decision, I don't think it should necessarily be anyone else's. I guess there are so many factors that influence the choice of how you would prefer to give birth, lots of them aren't related to LTTTC, some of them are, and all LTTTCers will arrive at their decision via lots of different ways.

ETA - really good points, Sushee. I found that the only way I could stay relatively sane during the early stages of my pregnancy was to keep seeing my fertility counsellor regularly to work through all the issues that I still had, even though I was now pregnant. Those issues certainly don't just disappear when you get pg. Infertility has such a massive impact across so many areas of one's life, DH and I are still dealing with the consequences, and I really feel that my experiences over the last two years have changed me for ever, and lots of those changes are quite negative.

[Ellie]

So glad you've continued this discussion Sushee...

I've posted in the other thread but in brief...for me even thinking about CS has little to do with the actual 'birthing' process and more to do with 'post traumatic stress'. I had an ectopic that ruptured and I was literally moments from death...people running around everywhere ...DH saying 'goodbye' as they couldn't get the plasma into me fast enough...thank God I was in the right place at the right time and knew my blood type so it all went done in minutes...I will always be so thankful that I was sitting in my Fert Clinic when it happened and my FS just happened to be across the hall...he never left my side...and with all that falling into place getting me to theatre still took time...it made me realise how fragile life is and how quickly it can be taken away...that probably doesn't make alot of sense but I guess it is about 'my body letting me down' and nearly killing me...so maybe I don't trust that it will do 'the right thing'...I need to think some more...

[onthefly]

Wow, this is a really interesting thread. Thanks Sushee and everyone else for your contributions.
I guess, perhaps, that there's a general belief that surgery brings certainty and control, though I would agree with you Sushee that the evidence does not necessarily support this.
Personally, the thought of yet more medical intervention during labour/birth, as well as the prospect of recovery after major abdominal surgery completely put me off c/s. And that was before I read about the risks to my baby.
Having come through the other side now, and still not getting the natural birth that I so wanted, I only feel more strongly that that is what I want. I had a forceps delivery and episiotomy - not nice! But I still want a vaginal birth next time (fingers crossed, knock on wood) and hope for a home birth.
I think also during my pg that I forgot (or maybe just didn't realise) the continuity between conception, pregnancy, birth and parenting. What I mean is, I compartmentalised each, rather than seeing how they linked together and influenced each other. But, how we conceive affects our pregnancy, which in turn affects our birth, which in turn affects our parenting. How we labour and birth can also have a big influence on whether or not we successfully breastfeed, which is often overlooked, i think. Many ACers need help to make the jump from conception to 'mainstream' pregnancy and beyond, i believe...
Oh, not sure if this makes sense...

[Willow]

This is an interesting thread. I must say I'd never actually noticed the tendancy for LTTTCers/IVFers to opt for a c/s.

There really was absolutely no doubt in my mind that our baby would be born via VB and to be honest, my ob never mentioned any other option. But one of the reasons I chose him was because I knew he had a low intervention policy, which proved to be gold once we passed our EDD. One of my biggest fears at the end of my prg (there were many during, prg following a loss is HARD, let alone an IVF prg) was that we'd make it all the way and then something would go 'wrong' during labour and we'd end up with a c/s. I was terrified of the idea of a c/s.

BUT - like Sushee our IVF prg was a result of secondary infertility. I had birthed a baby vaginally before. Although I must admit that after losing our second baby, having to conceive via IVF and a few surgeries in between I had (and have) lost all faith in my body to do what it should do.

The other benefit I had was that I'd had pretty major surgery to remove a large cyst from my ovary. The recovery was long and extremely painful. There was no way I could grasp the concept of being in that much pain AND trying to care for a newborn baby. There is no way I'd sign up for that.