Why do LTTTCers seem to prefer a c/s?

[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.

[Nixon]

Hey girls,

I haven't read all the comments, but I've read most.

We went thru ICSI due to male infertility factors. We were successful and I am now almost 12 weeks. I want to attempt a natural drug free birth, but I am not stupid nor am I uneducated. I will plan with contingencies - the levels of pain relief and when I will want them administered, vac V's forceps - C-section will be my last resort unless something is discovered pre-labour that changes the birth plan completely.

I will not put my baby's life at risk because I want to prove something. I trust my doctors and I will listen to what they are telling me. I also believe that having a plan for all eventualities will help me deal with things better post-baby in terms of the psychological effects. If I say now "No I will not have a C/s" and then for what ever reason end up having one - then I would feel like I had lost all control. If I plan for it in an emergency situation then I have control.

I don't think it's a matter of forcing women to see that VB is safer - I think it is a matter of SUPPORTING women in their choice and not making them feel like they are doing something wrong that could possibly hurt their baby by choosing to have a C/s.

Same goes for the BF-ing. I'm going to try , but I'm not going to kill myself over it. A lot of women do feel like failure because they can't do it. Sod that - I will do my best for my baby every day of my life and me beating myself up over whether I have a c/s or can't BF is NOT going to give my baby a healthy view of the world

[paradise lost]

I'm a lurker too, as i'm not a LTTTCer or an ACer, but man can i TALK!

I think a lot of the GENERAL (i.e. not just IVFers) trend towards cs as "the safest thing" is to do with familiarity. Watching any of the many "baby" shows - here to maternity, birth day, etc. the frequently show c-sections in graphic details. They FEATURE vaginal births, but they never SHOW them. As Bath says, you're left looking at pictures and thinking "Um, WHAT? How is THAT coming out of THERE!?" I was very lucky to have seen several animal births, and one human birth, before i became pregnant with DD and i had SEEN with my own eyes how beautifully the vagina can and does stretch, so i didn't suffer from that, but in a society where just to see another non-birthing, completely normal vagina one has to look at pornography, how is a woman really supposed to become familiar enough with the process that she will believe her body can and will perfectly well push her baby out into the world?

In other societies girls see birth as normal because it IS normal - there is no dash to hospital, no exclusion of sterility in a special room, no mysterious machines. There is only the woman, the labour, the baby. I have read several studies on groups of women in Africa and rural India and women who HAD needed treatment during labour, when asked "How did you know you needed to get to the hospital?" tended to reply something along the lines of "The labour lasted long enough for me to get there" - usually hospital was 80-100km away and the women walked or were carried by others who walked. For all the babies born within a day or two of the onset of labour there will have been maybe a dozen young related or close village girls and women who SAW the labour and the baby. I know among the !Kung San peoples of North Africa in the 70's (when the research i read at uni was done) the average girl having her first baby was something like 16.8 years old and had seen SEVEN babies born already - where is the mystery for those girls? Likewise, every single one of those babies was successfully breastfed or had died. There was no other option, and although babies who did not thrive weren't unknown, mothers who consistently failed to BF well enough to raise babies to childhood were incredibly rare. As a group though they often nursed one anothers' babies and pubescent but childless girls often offered a breast to comfort children they were caring for, so while it was "dry" nursing, most had nursed before they gave birth too.

It comes down to perception of life too - i recently read something about how Indonesian women seem to regard "normal" life starting when you have your first baby, in our society we talk about how life gets "turned upside-down" when we have our children. We seek a mythical reality which was irrelevant when we were in it, and will be impossible to regain once we're parents. Concepts of control speak of this to me. Whether one considers cs or vb to be the "in control" way of doing it, it seems to wipe out the gritty fact - with pregnancy, babies, children, parenting there IS no control for us to "get" or "keep". Birth, whether cs or vb, unfolds as it does. No-one, not the baby or the mum or the surgeon if there is one, has much control. Even the surgeon, who is "out of the loop" of labour and able to think clearly - he cannot know how the body of either mum or baby will react to the drugs, the procedure, the aftermath. But those Indonesian women regard that control as laughable - they know it doesn't exist except as a temporary illusion, they don't seek it, and when they have it they enjoy it but don't rely upon it. To them having a baby is how you get to normal, rather than being an interruption in your normal.

If you super-impose that model on top of the experience of the LTTTC IVF-assisted mother, well, it's not hard to see why such a woman might choose cs. Conception is a sexual function and birth is a psychosexual event. For such a woman the sexual function has been removed from the equation. Sex does not make her pregnant. In addition LTTTC and IVF are BOTH associated with sexual problems, so perhaps even her once-happy sex-life has been damaged too. Why would she NOT fear she was as incapable of the task of birth as she was with conception? Perhaps if the sexual element/nature of birth was more commonly discussed, women would feel less like just because conception didn't work out, birth won't either. Ability to orgasm would be a FAR better indication of ability to birth than ability to concieve is.

In addition i do wonder about the effect Obs have on this decision. I had a "pro-VB" ob. This meant he talked about the benefits of VB and didn't offer elective cs without medical reason. How then, did his cs rate get to be 53%?! INTERVENTION! He believed in a VB. But he believed it should be within very rigid parameters, with strict limitations on what he considered "safe". Most medical staff, when they encounter death or serious injury, will act to avoid that outcome in the future. Imagine you have 100 women who will naturally labour for longer than 24 hours (this is a rising trend due to higher numbers of obese mama's in our society - high BMI and bodyfat have been shown to interfere with calcium levels in muscle cells which in turn make contractions less organised and less strong, and thus labours can be far longer - has ANYONE had their Ob tell them their BMI is high and they should take calcium in high doses at the end of pregnancy and throughout labour? I will bet not!). Of those 100 women one will lose her baby during the labour/birth. The Ob who sees that woman, who catches that baby, will NEVER forget it. And for that reason he will push to section any woman who has been labouring for 23 hours regardless of the condition of her or the baby, to avoid the situation again. Which is good for the 1 woman who might avoid losing her baby with this limitation, but for the other 99 it's likely to mean unnecessary augmentation, foetal distress and a cs. In trusting our medical professionals we must also look at the how and why of their parameters. If my Ob had seen 30% of babies in mama's who were 11 days overdue die, i'd be more sympathetic in listening to his reasons to induce me than if he'd seen one baby EVER die, and never forgotten it.

Perhaps that's another element? In LTTTC/IVF hope can be in such low supply, and for hope we ignore statistics and look for anecdotes, stories, HUMAN experience that we can relate too. When facing low beta results, a behind-dates embryo, or a lack of a heartbeat when one should be there how much comfort is a table of stats? I know when i was losing my babies i didn't WANT to know "One in 3 women experience spotting or bleeding in early pregnancy, around half of these pregnancies end in miscarriage" i wanted a WOMAN to tell me it was going to be ok, or that it wasn't but that i would survive. So when an Ob tells a woman "i've seen babies die that way" we LISTEN! In REALITY the stats speak the more important truth, but a chart, graph, study doesn't really speak to you like a friend, midwife, ob can. I think the value of films like BOBB is that they present the stats, but in a far more accessible, human way.

Like it or not, LTTTC/IVF mums are exposed to the medical system more than those who conceive naturally, and the current model of care is often very fear-based rather than evidence based (because doctors are humans too!). How many of you have been told something by an FS, only for it to be countered by another FS or doctor? Drug regimes, diet regimes, AC regimes, all of those are dependant on not only the individual couple, but the individual FS too. After months or sometimes YEARS of putting your faith in your care-provider's knowledge, experience, and instinct, how are you supposed to suddenly hop to trusting yourself and your body once you've got a sticky baby growing in there? It reminds me of nic's birth up above - a whole PREGNANCY of "You'd better cs, it's safer, your body won't do it, you should really book it now" etc. etc. and then suddenly on the day "oh, it turns out you're labouring fine, want to VB?". How could ANYONE make that transition, from being the patient who needs special treatment to get a normal thing, to being a bog-standard nobody who can just hop through the hoops like everyone else? It's as you've said before Sushee - having a baby doesn't "cure" you of infertility. The trauma of infertility, treatment, loss, treatment, disappointment, treatment... doesn't go away when the 2 lines appear.

Perhaps there should actually be a dedicated service for LTTTC women who are newly PG to help them make the informed decisions they need to, but to be honest i see that as a hole in the WHOLE system - EVERY MOTHER should be given that support and help, and let's face it, they're not. Women come to places like BB to find out the reality and, heartbreakingly, it's often with one traumatic or horrific birth experience already under their belt. To me only the normalising of birth AS A WHOLE can hope to allow ALL women to make fully informed decisions which aren't being coloured by the medical climate surrounding pregnancy and birth. Perhaps in addition there should be a transitionary period of care for ACers, or maybe even a process within the ttc process, or familiarisation with services and models of care available. It's hard - how to say "think about birth" to a couple who are having to endure invasive, painful treatment to get PG?

Ina May Gaskin says there is only ONE hereditary and contagious factor that can affect a woman's ability to birth and that is fear.

Bx

[Hollybolly]

I can most definately see the trend, but can only speak from my point of view as to how I feel - but I can imagine there are a few women in my position also.

I'm sure everyone knows my dramas by now - but we've been doing IVF & have been LTTTC now for over 70 months - due to secondary infertility.

After having huge issues with my reproductive system since I first got AF at 9yrs (lovely), I was told that my chances of conceiving naturally, if at all, were slim.

After numerous surgeries, I was lucky to fall pg with Luke when I was 20 - had him when I was 21yrs old.

Although I'd spent my teenage years believing I wouldn't have children without a massive struggle, when I did fall pg I don't think I considered myself to be a LTTTC (well, I wasn't really, I was 21!) and so the VB/CS thoughts were not due to this.

I have to admit I KNEW I would need the C/S (All of the women on both sides of my family have smaller than average cervixes, they all have had c/s births... Luke was a big baby, and at that point in my life, I was a tiny person) - the midwives at the hospital I gave birth told me I talked myself into it - mainly because when we did the classes, they were only showing videos/strategies to get through a vaginal birth.
I asked constantly about strategies if faced with having to have a c/s - they told me not to worry, I wouldn't need one, it was rare, etc (maybe it was then, that was 11yrs ago now?) - and were really hesitant to lend me the video of a c/s birth. I had to sign and take the video home - also had to sign that I was aware that the footage could cause me fear & distress due to its graphic nature (WTF???!!!) - and they WOULDN"T play it at the classes (despite playing numerous videos of different VB).

I took the video home, watched it and felt I was better in control if I were to be faced with a c/s delivery.
NONE of the other girls in my class would take the video home - out of 13 of us, 8 of us ended up having c/s... all emergency c/s

My birth was horrendous - I was in labour from 9am Monday morning until 2.38pm Wednesday afternoon (56 and a half hrs) - when they took me to theatre, I was still only 2.5cm dilated & Luke was stuck sideways across my body - his head had been engaged, but when he couldn't make it through, had tried to move & gotten stuck.

Once he was born, and they measured the size of his head circumference, with my small cervix, the doctor said he WOULD NEVER have fit through, and my scan 4 weeks before showing his head measurements would have shown this.

ANYWAY!

Due to an infection I contracted during the c/s, we now have to have IVF to conceive, as my tubes have been damaged and cannot be fixed to conceive naturally.
The infection went unnoticed for years, as I left Lukes dad soon after he was born, and was not sexually active for a while in between ExDH and DH now.

Although the c/s should have freaked me out, it didn't (even with the infection and the fate its caused me) - i went through 3 days of hell in really painful labour (my labour started when my water broke, so it was pain from the beginning) - and honestly, I was so delerious by the time they wheeled me up to theatre that I honestly believed I was going to die.

I have never known fear like that in my life - I can't describe how bad it was, and the c/s for me was like an angel saving my life.
Sounds extreme, but I was beyond scared. And I was 21 years old.

This time around, I will do whatever is advised by my OB - knowing that I have a small cervix and knowing that I just didn't dilate last time, I'll just trust with whatever they suggest.
I also have other issues in the fact that when I was sewn up after my c/s, it was done wrongly and poorly, so my current doctor has concerns that my body may need an elective c/s next time round at about 36 weeks so he has the opportunity to fix the current scar for if /when there is a third pregnancy.

I'm not sure that my choices to leave it in their hands have much to do with the LTTTC part, but rather the fear from last time.

My c/s most definately saved Lukes life (and the doctor said mine as well) - thats a scary thing, and I'm scared as hell to be anywhere near that position again.
Add the fact that currently this next baby is still trying to be conceived after 6 and a half years... if the miracle of it DOES come, there is no way in hell I will do anything to risk it not becoming a live baby for me to hold in my arms.

Reading back that last statement, maybe the LTTTC does have a little to do with how I feel - but its only because it follows my experience of last time, if that makes sense?

If I got to the time, and my OB said it was safe, everything looked positive for a VBAC, I would choose that hands down - but if he said no way, then I wouldn't even second guess him.

I HAVE to put my safety (and my babys safety) in his hands.. and I have no issues doing that - I think that somes from the IVF and having no other choice but to put things in his hands.


In regards to breasfeeding, though, I can't say it has any effect at all.
I'm very pro breast feeding - I fed Luke until he weaned himself at almost 12months, and will do so (if I can ) for any further babies.

Because of his high risk birth, he had trouble feeding for the first few days, and for the first 2 days I breastfed via a tube.
I persisted, though - I was so determined that my body could do this after the birth.. and it was something I was sure I wanted to do from before I even fell pregnant.

I have lost a LOT of faith in my body since Lukes birth (and especially now after the too many years of TTC #2) - but I know my body did the breastfeeding last time, so I know I can do it again.

Maybe when the labour part comes around again, it might be different, but I have to go into it with my mind and my eyes open.

I DO look at the c/s as MY safer option - but thats ONLY because of my experience with my body & my circumstances.

(Good on you if you got this far!!!)

ETA - Bec, my whole post just makes the last statement of your post 100% correct!!!

[onthefly]

Hoobly - you make a really great point about control. In labour, I found I coped best and things progressed well when I let go and surrendered to it.
If I'm honest, I have to say that I do remember thinking during pg, when facing the uncertainty of labour and birth and worrying about what might go wrong, that perhaps a c/s would be better, for that sense (though perhaps illusionary) of control and certainty about what would happen. On reflection I decided the cons definitely outweighed the pros for me.

[happymel]

This is a great thread!! Its very interesting to hear everyone's thoughts. Initially, during the pregnancy, i was very pro VB. It was something that i wanted to go through, feel and have that special connection i thought that would come with a vaginal birth. But after long discussions with my OB, both my husband and I realised that by having a VB, we were putting our second baby at risk.
I know some people may not agree with this, but there is a greater risk to the second twin, and we wanted to eliminate that all together. My OB gave us statistics and research and gave us the decision, which didnt take long for us to make. It had taken us so long to get to this stage, we didnt want anything to go wrong. Our OB also told us that a number of second twins had died in the past year due to complications during a VB.
We would have had a c/s anyway in the end, with the babies being born early. If (big if right now!!), we have another baby, id love to deliver naturally. I dont even know if that will be a possibility for me, but i would love to have that experience. Not that our birth experience wasnt special, but it just wasnt the "natural" way. I dont mean to contradict myself in saying that, but we had a choice, and it was the right one, but if i had of been pg with just one baby, i would have wanted a VB.
As for BF, i was always determined to succeed no matter what. And i did, and have. It took 6 days before my milk really started to come in, and then the babies were in special care for 2 and a half weeks, but i got there!
I sometimes feel like IVF took something away from us. I wish that i could have the excitement of doing things "naturally", and finding out with a big surprise, wow im pg!! But it didnt happen, but BF was one thing that i could give my babies.
Sorry if i have gone off track! GL to everyone who is pg now, i hope that everything goes great for you all!!

[scooby]

Nixon I TOTALLY agree with you i think to much issue is put on either stradegy, we need to support one another not ridicule, this is were the mental issues of birth experiences step in and at the end of the day we are not going to comprise the health of ourselves or our babies for a "cause" only to feel guilty for the choices we make.