Why do LTTTCers seem to prefer a c/s?

Just following from another thread, I was thinking today that in all the years I've been involved with BB, I'm constantly amazed that LTTTCers keep saying that they believe that a c/s is 'safer' for them and their baby than a VB. I've read countless posts about it, and each time I get more and more confused.

Because we all know the stats - a VB is safer than a c/s. No grey area there, it is a fact. So to me, when I finally fell pregnant, I guess the idea was firmly in my mind that for my baby and me to be as safe as I could possibly be, I should have a VB. Conversely, if I had to have a emergency c/s, I similarly understood the increased risk I was exposing my child and myself to - risk that TBH I was not prepared to accept unless it was a true medical emergency. As an IVFer, the thought of putting my child, or me, at an increased risk of complications heightened my anxieties, not lessened it, which is why I was quite scared of having a c/s.

Yet I constantly read about women, esp LTTTCers, saying they want a c/s to be safe and to ensure their baby is safe. That's completely at odds with all the statistics wrt to VB and c/s births. Nothing suggests that a c/s is safer than a VB, in fact all evidence is to the contrary. Yet LTer after LTer seem to believe it's true, that your baby is safer being delivered by c/s.

So I do wonder, is it that we've become so dependant on the medical profession to conceive that once pregnant, we actually ignore all the stats and start to believe that an obstetrician can deliver our babies better than we can birth them? That this too is 'safer' in our Dr's hands?

Have we, as women who needed medicine to help us conceive, then completely lost faith in our bodies and believe them faulty? Or have we begun to believe that the best thing for all involved is to hand everything over to our Drs, the same way we handed over the rest of our reproductive lives? Or is it that, like many women of this generation, we've succumbed to the 'societal' fallacy that a c/s is somehow safer?

I want to make clear that I don't wish this discussion to be about c/s vs VB. I am geniunely interested in this 'phenomenon'. Because to me, it's clear - if VBs are safer for mum and the child, then surely more IVFers would be choosing to have VBs than caesereans, and yet the opposite seems to be true. I would love to discuss it with LTers who have chosen either VBs or caesareans, and how it is that being a LTer influenced that decision.

It's something I have noticed in other places as well, Sushee. And I also wonder...

Is it about control? Perhaps a c-section appears to be a more controlled way to give birth.

One thought that crossed my mind before my fear of surgery kicked in was that the doctors got this baby in there, the doctors can get it out!

It is obvious though, that LTers need more support and encouragement to trust their bodies and give it a go. The fear that breast feeding won't work out either is something I have also seen - and am currently grappling with now.

BW

Great point about the fear of BFing, too, BW. I know I have the benefit of hindsight in both birthing and BFing, and I wonder if it meant I trusted my body more than someone having an AC baby as their first baby.

I also saw that BG talked about being in control with a c/s. I guess I feel differently there too - everything up to then was so scientific that I knew the date of conception, the 'stage' my embryo was in before transfer, the exact HCG and P4 levels, that I really wanted my unborn child to decide when it was ready to come. Of course it doesn't always work out that way, in fact Charlie was in distress because the cord was wrapped around his neck and my labour was augmented, so in the end, he didn't really get to choose his birthdate, my Dr and I chose it for him. But I was in labour already at that time, and I birthed him vaginally despite my Dr pressing me to have a c/s.

I guess it's because I also personally feel far less in control having someone cut me, and then direct how my baby will be born, than if I push the baby out on my own. For me, a c/s was a loss of control - a very scary loss of control, in fact. With my VB, I felt like the one in control, and the birth was about me and the baby, and not a room full of people operating on me.

I guess that's why it confuses me. It's so black and white to me - and before anyone says anything, I understand not everyone thinks the same way. But a VB to me was 1) definitely safer, 2) made me feel more in control, 3) allowed my child to choose when it was ready to come and 4) excluded from the process a whole bunch of people who were not connected to the baby the same way I was. So as an anxious IVFer who had tried for so long to have a baby, all those things meant an incredible amount to me, and made my choice a no-brainer.

Just going back to BFing, I actually never noticed a direct positive correlation between IVF mums and FFing, but I believe, like you say, that it must exist, and I just missed it. It's interesting, and does confirm in part my belief that IVFers, in particular, must lose trust in their bodies in general.

It makes one wonder what can be done to help LTers learn to let go of this distorted view of themselves. Any suggestions?

Unfortunately, no suggestions having not been there yet.

But I guess people perceive control differently...

For some, going through IVF and knowing everything about their embryo and the exact time and date of conception is having control over things. While for others, having all of that go on would be seen as control being taken completely out of their hands.

I guess it would be a similar argument between VB and CS - some would view VB as being out of control, while others would see it as you did, Sushee.

Does it all come down to difference in perception?

I will agree, though - I have observed many women on other forums more devoted to IVF and assisted conception who view their bodies as failures - for not being able to conceive, for not being able to birth vaginally, for not being able to breast feed successfully. I have no idea how to build up trust in one's own body - apart from attempting VB and BF, and making sure there is appropriate support around me to give me the best shot at making it happen.

BW

Sushee - when i mentioned "control" in the other thread, it wasn't about controlling the birth by having a c/s at all. this is something BW and i have discussed at length. perhaps i didn't word it correctly. this is the only part of this journey that i have any say in at all - and at this point i want a VB. but, like anyone, if there is a medical need, i will submit to a c/s - and to me, a psychological need is a medical need as well.

you DO have the benefit of having been through three VB's before Charlie, so you know your body works - a lot of us don't have that. we're having to believe our bodies will do something "normal" when they haven't so far! i don't think it's up to any one else to judge our beliefs (or lack of belief) in our own body. there are also other risk factors that might not apply to everyone - due to family history, and the severity of my insulin resistance, i'm at high risk of GD. i also have two parents that are on meds for BP, and have, when ill, had BP that is borderline high. so in MY circumstances, a c/s might very well be the better option. it may not be the "safest" physical option, but there is a lot more to it than just the physical - there is a huge psychological impact of this journey that has to be taken into account. and if that leads to someone deciding to have a c/s for their own peace of mind, so be it.

as i said - i want a VB. but i'm not going to close down the thought process that surrounds a c/s just because it's not what i "want" - that just messes with your head if and when it does happen - you have to be open to every eventuality (look at the VBAC girls that ended in c/s and how much they're struggling). even if it's not what YOU would choose, you have to accept others having made that choice.

For me it was quite the opposite, I wanted to stay as far away from medical intervention as possible. I wanted to prove, mostly to myself, that my body was capable of doing something it was designed to do. Eeven after having had a c/s with Alexzander I was so sure of myself & so sure I could do it this time round. When my VBAC didn't work I was absolutely determined to breastfeed Juliette because of IVF & the c/s. It was a selfish reason to begin with & I struggled with a lot of pain in the first three months & Aaron just didn't understand why. I am a woman, I am supposed to be able make babies, birth them vaginally & feed them.... I missed the boat on two of those so no matter what hell I went through I was going to feed my baby.

It's funny because I thought about posting this thread for ages before actually posting it. In part because I wanted to make sure I phrased it correctly. I was concerned that women would feel 'judged' but it wasn't about that. It was more about the equation - VB's equal a safer birth, therefore it didn't make sense that IVFers consistently chose c/s. Not for always medical reasons, but in fact for the psychological reasons you mentioned BG. I guess I wanted to know - why is it that psychologically, women think a c/s is a safer option?

I guess I see myself working with IVF women for the rest of my life, and I wonder how we start to heal them so that they in fact stop ignoring the evidence that says they're better off having a VB, or better off BFing, and start believing in themselves and their bodies. That's got to be something we can do to help other IVFers, we're all women, it's in our best interests to ensure that we support each other and educate each other and help each other heal.

In fact, let's open this topic up a little - if you're pg and a LTTTCer, then I guess I'm interested in knowing, how has being LTTTC affected you and the choices you make? How has it influenced your decision wrt to birth and BFing and parenting? How has it influenced these decisions to one method, despite evidence suggesting that it's not the safest/most beneficial/least risky option?

This is an interesting discussion.

For me, it's really, really important to have a low or no-intervention VB, or at least to have the best opportunity to try for one.

I agree with the comment BW made about some AC women - for me I felt that my miscarriage, trouble conceiving and fertility treatment were signs that I was a failure as a woman. That was one of the hardest things for me to deal with. So now that I am pregnant, and everything seems to be going perfectly normally (:crossfingers:), I really want a vaginal birth to reclaim that feeling that I am a normal woman. I agree with you Sushee - for me a VB means I am in control, a c/s means I have lost control. And I'm terrified of surgery, the idea of being conscious while I am cut open is the most horrible thought. I don't want to be able to feel people messing around with my insides.

I really want to go through the process of birthing my baby in as natural a way as possible. My main concern is how I will cope if I do end up with a high intervention birth, or god forbid, a caesarean. I need to do some work on accepting that, yet again, I don't have 100% control over the outcome of this.

I'm really excited to have booked our doula, and I'm hoping that she'll give me the best chance of having the natural or low-intervention birth that I so hope for, especially considering that I'm with an obstetrician in a private hospital.

And a small woo hoo - I'm 26 weeks today! I am so excited to meet our baby, I just can't wait!

ETA - please don't anyone who has had a c/s take offence at my comments, obviously any woman is a normal woman, however she gives birth. But at this stage it's just so important for me to have one thing about this pregnancy done the 'old fashioned' way, and to prove to myself that my body can do it.

Devon
xxxx

ihave every intention of BF - always have. in some ways, it's because of the LTTTC and wanting to prove i can for ME - the other is pure stubborness because my mum thinks i won't be able to seeing she wasn't able to due to inverted/flat nipples. i know there are ways around this if it happens to me, and i'll do whatever it takes. i want to give our family the best start to life that i can!

I didn't go down the IVF road but I was a LTTTCer. I started TTC at 28. I gave birth for the first time at 42.

I never once thought about having a planned CS. I just hoped I could have a vaginal birth. I was quite worried actually that I would have to have an emergency CS due to my age causing complications. In the end it was a vaginal birth with the help of a vac.

I must admit after giving birth I thought "I'm not doing that again, and if by some miracle I do give birth again it will be a CS". That was all about pain and trauma though, nothing to do with safety. I think I've got over those thoughts now.

I've never looked at the stats on safety of CS so I don't know the facts but I guess I kind of think it would safer for bubs to be born that way, but not for mum. I base this on all the problems that can occur during labour that bubs would not face if it's just cut out. That's probably how a lot of people see it when they've been trying for so long.

That said I still thought a vaginal birth was best for us as did my OB. CS was never ever discussed.

I never thought I'd have the issues I had with BF. I thought there could be a few hurdles but that I would still manage to do it OK. It didn't turn out that way. Even though I'd picked my hospital partially because they had a large SCN I didn't really expect to have to use it. A bub in there for 5 days made things far more difficult for BF than I ever expected.

Our bub was conceived naturally. Maybe that's why I didn't think about planned CS or BF difficulties. I guess I just figured that I got pregnant without help, I should be able to birth & feed bubs as well. Maybe when you've had so much assistance to get there you lose a little confidence in your ability to do those things.

Oooh Great topic!

I definately think IVF and LTTTC affected how i felt about birthing these babies, i remember when i first fell pregnant i actually said to my Ob "i don't care how you do it i just need these babies in my arms, there is nothing natural about how they were conceived and i dont care how they get here so long as they do" i found as time went on i then wanted to experience labour and birthing my children if possible mainly because i know there is a HUGE chance that i may never get to experience this ever again due to the fear of going back to IVF. I think after everything i went through to fall pregnant i felt i should be thankful that i was, when other women were still struggling so i shouldn't be selfish and expect to get my optimal child birthing scenario.

And to be honest there is no part of me that thinks childbirth, breastfeeding, mothering etc is going to come naturally or i will get what i want because that's just not how history has worked so far.

Sorry to babble but another point i think it affects our DH's BIG TIME! Mine is terrified after watching me go through the IVF crap that something will go wrong and he will lose me and/or the babies and so wanted a c/s as itwas controlled and up to the medical staff and not dependant on me and my body. I think sometimes we forget how out of control they feel during IVF and they then view childbirth as the same but with more to lose.

Shan

Another good point, Shannon, about how it affects our DH's. My DH insisted on an obstetrician, something I was indifferent too until I started 'catching' his fear and believed that an ob would 'monitor' our pregnancy more.

DH also initially wanted me to have a c/s but I was never going to agree to that, and in time, he understood that I was choosing a method that was in fact safer for us (and it's actually safer for baby too, not just mum, btw, and there is quite a lot of evidence behind that).

It was the same with BFing - he couldn't understand why I was insisting on continuing to BF when my nipples were cracked and I was in so much pain. But to me, I wanted Charlie to have the best of me (and TBH I probably put way too much pressure on myself to be this 'perfect' mum) but the upside is I ended up having a great BFing relationship with my son despite the rocky start, and my DH, as a result, is madly pro-BFing now. Lol!

ETA also to clarify my own position: I am not particularly pro-VB, in that I don't believe a VB is the 'only' way. When I had my 3 older kids, I had a VB because I thought only if it was a medical emergency, would a woman have a c/s. And tbh, back then it was probably pretty true (esp in the public system). My first child, my DD, was incredibly precious to me, yet I never had (or was given) any doubts over about a VB being the best way to deliver my baby safely. Not like it is these days, when women (not just LTers) routinely are either led to believe, or have formed a personal opinion, that a VB will somehow put their baby are more risk than a c/s. But, like I've said before, is simply not true or supported by evidence.

When I fell pregnant to Charlie, I had actually read tonnes and tonnes of stuff here on BB. I now knew you could 'request' a c/s for no medical reason, I even got the impression that a c/s was considered safer by many who were posting (including my ob). But the more I read, the more I realised it wasn't true, VBs were safer. The evidence is undisputed. It made me feel better for not wanting a c/s and wanting a VB - I was doing what was safer for my baby after all.

So now when I read that women wish to have a c/s because it's a 'safer' option, I get confused. Where does that idea come from? The obs? Or does it come from the woman's lack of belief in herself?

If a VB is safer, how do we get the message through to women? How do we ensure that they know that their safest option is not to have a c/s?

Because it's all topsy turvy now. Women, esp LTTTCers are having c/s in order to 'ensure' their precious babies are safe, but the reality is their babies are statistically LESS safe with a c/s. So I guess what I'm saying is I'm not pro-VB, I'm pro-IVFers, and trying to get discussion going as to what it is that makes us choose c/s over and over again, citing that it's safer for us and our babies, when it's not true?

It doesn't help when women hear from their FS or their OB things like "this baby is very precious, let's not take any chances (on a vag birth)...etc

I've heard a few women tell me this has been said to them. When the "medical professional" is saying either outright or by implication that a caesarean is safer, and women who are long term TTC have such trust in their word because they helped them get pregnant....very hard to argue against that.

This is a great topic!

We don't really count as LTTTC, though we needed to use IVF to get pregnant. My partner has cystic fibrosis, which means I've known since before we were married we would need to try IVF if we had any hope of having our own children.

I was surprised to read that there seems to be a preference to CS for women who've used IVF, or couples that have had trouble conceiving. Like Sarah H, I eventually decided that I'd had enough medical intervention getting pregnant at all, and want the birth to be as natural as possible. We did start out on a midwife/ob stream, but changed to a birth centre model after my first appt with an obs (long story!!).

I can't comment on whether or not this is an issue to do with confidence in my body - there have been a few speed humps along the way, but our IVF journey was pretty short and uncomplicated compared to what some of you endure.

Perhaps my partner's medical history has had some bearing on the issue too? Over the years I've learned that doctors aren't the best people to be in charge of your body and health, YOU are. After many incidences where an intervention that a doctor wanted to perform on my partner turned out to be unwarranted (and in some cases would have harmed his health substantially), I don't just automatically trust doctors the way I used to! Also, I feel strongly that, in simple terms, doctors fix sick people and pregnancy isn't an illness.

Perhaps having had so many years to adjust to knowing we'd need IVF to get pregnant (if we could at all) had some bearing on the issue? But CS outside of a medical emergency is something that's never crossed my mind.

As an aside, did anyone feel like they'd been dropped like a hot potato at the end of their IVF treatment? I certainly felt like I could have done with a little more guidance from the clinic about the types of care available. I didn't have a clue where to start.

Again, great topic!

Tish
(40 wks 3 days)

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

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.

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.

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.