C-sections increasing, risks involved

[pinball1970]

[Qwas "DaveC426913, post: 6086269, member: 15808"]Vulnerable to what, exactly?


Someone with an existing disorder - one that impacted the pregnancy - would be considered high-risk.


None of those. We're talking about interventions.

You are casting a wide net for "natural".
.

Which can be said about doctors too. Why do you assume midwives don't advance with the times?


Straw man. We're talking about interventions.[/QUOTE]
I was discussing the concept of natural

 

[Laroxe]

The idea that medic have created the belief that childbirth is a sickness doesn't really make much sense, we have medical interventions for lots of things that are not a diagnosed sickness. The great majority accept vaccination when they are not ill, primarily because the natural way turns out to be a messy version of hell.
Childbirth is indeed natural and pregnant women are not sick, but it is a non-sickness with a particularly high mortality rate. Remember when the recording of deaths started in the early 1800's around 25% of children would die at birth or in the perinatal period. The reason for the greatly reduced risk is largely because of medical intervention, and a great deal of midwifery is informed by medicine. Remember there has been a similar debate about breast feeding and while its true that there are advantages to breast feeding, it evangelical promotion in a culture where both parents often need to work and the fact that some women did have real difficulty has been identified as causing significant distress to some women at a time of increased vulnerability. This harm is in no way justified by the evidence, the alternatives are perfectly adequate. In fact the idea that the main concerns of the Dr are to protect the hospital isn't strictly speaking true, of course people are influenced by the needs to protect themselves, but so is the hospital, they all ultimately answer to the law and the law is a much more effective advocate than support workers.

Really this isn't an issue of natural childbirth or artificial c-section, all births are medicalised to some extent the debate is simply about the degree of intervention. The current evidence suggests that in uncomplicated pregnancies vaginal and elective C-sections have similar outcomes though there may be some differences in costs. Assuming that neither Drs or hospitals want to promote interventions that increase these costs I think its unfair to suggest self interest is the reason for the increased risk. However I think its reasonable to assume that if there is a possibility of a problem and a c-section is considered to be a possibility then issues like when the most staff are available do become part of the decision making process, why take the risk of waiting and allowing a problem to develop.? I agree the risk of malpractice litigation is real, but it requires a bad outcome and evidence of malpractice, if a Dr deals with the situation appropriately there isn't a case a Dr who fails to act on an identified and manageable risk is guilty of malpractice, and rightly so.
In the UK virtually all births are attended by a midwife and many take place at home, it is women in high risk groups who are advised to have hospital births, again with midwives in attendance, in most cases it would be the midwife that would draw attention to problems and make sure there were medics in attendance, they are a very significant part of the decision making process. The time in labour and the gestation period are also significant,as they increase so does the risk of more serious problems.

 

[DaveC426913]

I was discussing the concept of natural

That word has no unambiguous meaning in the context of childbirth.
Ask six people what "natural" childbirth is - and is not - and you will get six different answers.

 

[DaveC426913]

The idea that medic have created the belief that childbirth is a sickness doesn't really make much sense, we have medical interventions for lots of things that are not a diagnosed sickness. The great majority accept vaccination when they are not ill, primarily because the natural way turns out to be a messy version of hell.

While that may be true, it's a red herring. The logic does not mean that women in childbirth are sick - more specifically, it does not mean that women in childbirth need intervention.

Remember when the recording of deaths started in the early 1800's around 25% of children would die at birth or in the perinatal period. The reason for the greatly reduced risk is largely because of medical intervention,

Early 1800's?

No. The reason for the greatly reduced risk is much more due to the subsequent establishment of the Germ Theory of Disease. In the early 1800's, most practices knew little of sterilization and contamination.

And you're kind of making my point here. This is the 21st century. Why are you basing your arguments on medicinal practices that are older than the discovery of germs?

...a similar debate about breast feeding ... the alternatives are perfectly adequate.

What alternatives? Do you mean bottle-feeding? Or do you mean formula?
Because formula is definitely not adequate.

In fact the idea that the main concerns of the Dr are to protect the hospital isn't strictly speaking true, of course people are influenced by the needs to protect themselves, but so is the hospital, they all ultimately answer to the law and the law is a much more effective advocate than support workers.

Rather than refuting that hospital staff answer to the hospital, you just concurred with it.

Really this isn't an issue of natural childbirth or artificial c-section, all births are medicalised to some extent the debate is simply about the degree of intervention.

There is a difference between medicalizing, and intervention.

The current evidence suggests that in uncomplicated pregnancies vaginal and elective C-sections have similar outcomes

Yes. And there is a perfectly good reason for that. Because "outcomes" end with a successful birth. They exclude long-term effects, such as previously mentioned.

...why take the risk of waiting and allowing a problem to develop.?

Because problems definitely do develop from intervention. But those problems are not tracked by vaginal/C-section birth studies that end at the birth.

In the UK virtually all births are attended by a midwife and many take place at home, it is women in high risk groups who are advised to have hospital births, again with midwives in attendance, in most cases it would be the midwife that would draw attention to problems and make sure there were medics in attendance, they are a very significant part of the decision making process. The time in labour and the gestation period are also significant,as they increase so does the risk of more serious problems.

Yes. This. Good.

 

[Laroxe]

While that may be true, it's a red herring. The logic does not mean that women in childbirth are sick - more specifically, it does not mean that women in childbirth need intervention.
I think regardless of how we label things childbirth is a risky business and many of the risks can be reduced, even the UN has recognised that as countries caesarian rates increase up to around 10% there are significant reductions in mortality, after that point the advantages in terms of mortality are less obvious. Its really a risk management decision informed by the woman's personal choice.
No. The reason for the greatly reduced risk is much more due to the subsequent establishment of the Germ Theory of Disease. In the early 1800's, most practices knew little of sterilization and contamination.
Actually Pasteur cultured the streptococcus early in the 1800's and Lister was introducing the principles of asepsis a little later, this was largely ignored in the world of obstetrics, it wasn't until 1929 that the Royal College of Obstetricians recommended surgical gloves and masks during deliveries. While this did have an impact, it was less than what many people believe, it wasn't until the introduction of drugs that puerperal fever, the major killer was conquered.

Annual death rates per 1000 total births from puerperal fever in England and Wales (1911-1945) (Registrar General Reports)
Because formula is definitely not adequate.
The response to the breast feeding point is interesting, its certainly true that there are advantages but the reality is is that these advantages are only really seen in the developing world, at a population level in the west it is very difficult to demonstrate significant health advantages.
It is not however difficult to identify the harm being done by the uncritical promotion of breast feeding and the negative moral judgements that accompany it with the guilt and disapproval of formula feeding leading to double the rate of depression.
The National Childbirth trust has been critical of this saying that women can experience unacceptable levels of pressure and the Royal College of Midwives this year issued a position statement reaffirming a woman's right to choose and stating explicitly that women should be supported if,... they opt to bottle feed using formula milk.
This article is fairly typical of what is increasingly seen in the media and links to supporting evidence.
https://www.telegraph.co.uk/women/mother-tongue/10911177/Breastfeeding-wars-is-breast-really-best.html

I would also say that you misrepresent much of the research. When comparing the outcomes stopping at the point of delivery would be daft, and in fact most of the comparisons are clearly in relation to longer term interventions, I don't remember if I posted this link to the latest care pathway which links to all the underpinning work but it is informative, you just click on the various sections. Somewhere in there was the point that 4 c-sections are not associated with increased risk.

https://pathways.nice.org.uk/pathways/caesarean-section#path=view%3A/pathways/caesarean-section/deciding-whether-to-offer-caesarean-section.xml&content=view-index

You might be interested in reading some stuff about the inquiry into midwifery services the Morecambe Bay Trust which identified the midwives role in pursuing normal childbirth at any cost and the consequences of this, though there were lots of other issues involved. It provides a useful overview of the relative roles and power of different organisations in relation to the law and its findings were damning leading to some very serious consequences.

 

[Capecutterman]

One point that I don't think anyone has touched on is the management of vaginal births.

Yes, it is possible for someone with no knowledge of vaginal birth to give birth to a bonny baby on her own.
Bit scary and somewhat painful, but nature is not stoopid and in an uncomplicated birth (the majority),will take care
of things quite effectively, just as she had been doing for tens of thousands of years.

As humans evolved, the phenomenon of the "wise woman" or midwife emerged, who would assist and support
the mother during the birth process. This ranged from reassurance and breathing guidance to more complex
procedures such as internal podalic version, breech delivery techniques and care of the perineum during delivery
of the head. These all made childbirth less traumatic and much less likely to result in damage to the mother or child.

With the ready availability of C-section and the rise in litigation, obstetricians (and midwives) are far more likely
to opt for the "easy" way out of a C-section and have slowly become deskilled at managing anything more than
the most routine of vaginal deliveries.

Being an ol' fart trained many years ago in a country where multiparity was the norm, we students were taught all
of these things. I never became nearly as skilled as a good midwife/obgyn, but at least the knowledge was there
and when I was unexpectedly faced with a footling breech (I hadn't done a delivery for 35 years) out in the sticks
with no help, the old lessons came back and all was well for mother and child (a dose of luck too..)

I was able to had the wonderful experience of delivering my own son (with an obgyn looking over my shoulder).

Short answer: Many of the skills of managing a vaginal delivery are being lost, and so C-sections have by default
become more common.

Mac

 

[pinball1970]

One point that I don't think anyone has touched on is the management of vaginal births.

Yes, it is possible for someone with no knowledge of vaginal birth to give birth to a bonny baby on her own.
Bit scary and somewhat painful, but nature is not stoopid and in an uncomplicated birth (the majority),will take care
of things quite effectively, just as she had been doing for tens of thousands of years.


Mac

There's that word again. Nature/natural. A birth today compared with 10,000 years ago would have beared no resemblance. There is nothing natural in that sense about the way we live today. There are some communities in remote areas that have virtually no technology, that would be a comparison.

 

[DaveC426913]

With the ready availability of C-section and the rise in litigation, obstetricians (and midwives) are far more likely to opt for the "easy" way out of a C-section and have slowly become deskilled at managing anything more than the most routine of vaginal deliveries.

I'm sure you didn't mean to imply that midwives can perform C-sections.

I was able to had the wonderful experience of delivering my own son (with an obgyn looking over my shoulder).

That's fantastic. You are very lucky. (Not that luck had anything to do with it.)

Closest I ever got to be birth was as a security guard at the front door of the hospital while a woman gave birth as she was getting out of the car.

Short answer: Many of the skills of managing a vaginal delivery are being lost, and so C-sections have by default become more common.

Not so much being lost as being downloaded to the expectant parents and their team.
And wouldn't say so much it's the skills as the decisions.
Having a birth plan is an excellent way of setting the expectations of the hospital staff.

 

[DrDu]

Remember when the recording of deaths started in the early 1800's around 25% of children would die at birth or in the perinatal period. The reason for the greatly reduced risk is largely because of medical intervention, and a great deal of midwifery is informed by medicine.

Actually Dr. Ignaz Semmelweis found in the 19th century that much more mothers died of post partum infections who gave birth in hospitals than those who gave birth at home. He found the reason for this to young physicists in the hospitals to work with cadavers and not washing hands before looking after the birth giving mothers. During his lifetime his colleagues never accepted his theory.

Beside this story, I am not a big fan of midwifes, especially German ones. There is hardly any medical related profession which is more into esoterics like homeopathy than midwifery.

Although a pregnant women is certainly not ill per se, pregnancy is statistically certainly one of the riskiest states of health a young woman will face. Think of (pre-)eclampsia, diabetes or intrauterine pregnancy.

Due to the big head of human babies in comparison to other primates, birth is especially risky and probably limited evolution of intelligence.
I never understood people who wanted to get their children at home. In case of a real emergency, do you really want to waste time in transport to the hospital?

At least here, people are quite critical about cesareans and ask about the rate of cesareans in the institutions where they want to give birth.
So you can be pretty sure that you don't get a cesarean because the doctor's shift is about to end.

 

[russ_watters]

Unfortunately, it is common practice in medical facilities play up the very points you make.
caution! ... keep the baby safe! ... survival!
It's fear-mongering.

The thing that we have done in the last century of medicine is convince people that pregnant mothers are at risk, and we need to "save the baby!".

We don't. With rare exception, childbirth is the most natural thing in the world. Pregnant women aren't sick. Why do we treat them like they are, and "err on the side of caution"?

I have a hard time accepting this logic is real in 2018. You aren't suggesting that women should never see a doctor while pregnant, are you? Or that people should never get physicals? Or see a dentist until they feel pain? You're not anti-vax, are you?

Preventative medicine is a thing. I'm sure you must know what it is and what it is for.

 

[DaveC426913]

I have a hard time accepting this logic is real in 2018. You aren't suggesting that women should never see a doctor while pregnant, are you? Or that people should never get physicals? Or see a dentist until they feel pain? You're not anti-vax, are you?

No, of course not.

I am simply pointing out that labour is not an emergent situation - or even a situation that requires intervention. There is nothing to cure or treat. A labouring mom going into a hospital is - unless there are indicators otherwise - in optimal health and condition.


And they really do say things like "the baby's safety is paramount" - an implication that the baby's safety is in-jeopardy.

 

[russ_watters]

No, of course not.

Unfortunately, it is quite real. They really do say things like "the baby's safety is paramount" - an implication that the baby's safety is in-question. How does a woman say "Thanks but I don't think the risk is great enough"?

Can you say then in your own words why a woman should go to a prenatal checkup? What other reason is there besides the health/safety of the mother/baby?

 

[DaveC426913]

Can you say then in your own words why a woman should go to a prenatal checkup?

[ EDITED, BTW ]

It is perfectly normal for perfectly healthy people to go for checkups. What does this have to do with labour? This is a red herring, as far as I can see.

 

[russ_watters]

[ EDITED, BTW ]

It is perfectly normal for perfectly healthy people to go for checkups. What does this have to do with labour? This is a red herring, as far as I can see.

Dave, near as I can tell, you are saying perfectly normal things and implying they are abnormal. *I* am trying to get *you* to show me why what *you* are saying isn't a red herring (or similar fallacy). Since you won't, I'll put a finer point on it:

The thing that we have done in the last century of medicine is convince people that pregnant mothers are at risk, and we need to "save the baby!".

Evidently you recognize that prenatal checkups are necessary because mother and baby *are* at risk, right? So what you are saying is "fearmongering" is in fact a true statement promoting a logical course of action you support, right?

 

[russ_watters]

This has been bothering me for a week, so I'll just vent it all out:

I guess the main fallacies I'm seeing here are the false dichotomy and perhaps exaggeration. You declare childbirth "safe" and have criticized other uses of the word, as if it is binary choice: safe/unsafe. Given only a binary choice, it is much worse to declare childbirth "safe" than "unsafe", because that implies there is no need for preventative medicine: preventative medicine is for mitigating or preventing unsafe conditions.

The reality is this: a person's lifetime odds of death are 100%. Everything a person does contributes a fraction of that 100%. Giving birth is more dangerous than spending that afternoon on your couch watching TV+. It's dangerous enough that parents spend a lot of time, money and effort mitigating that risk by changing their diet and behaviors, getting prenatal checkups and making choices about how to give birth.

You apparently know and agree with this and yet you said "[Natural] childbirth is safe" and suggested there was something wrong with going to see a doctor to deal with this "safe" condition: "pregnancy is one of the precious few conditions you go to a hospital for when you aren't sick" [your bold]. Pregnancy and childbirth is "safe" - women aren't sick - so they shouldn't be going to the doctor is what that implies.

There is certainly case to be made that doctors and society are being overly aggressive in promoting c-sections, but you aren't doing the conversation any favors by doing exactly what you are criticizing them for: exaggeration.

+In fact, giving birth is about 37x more dangerous than skydiving, at least in the United States (where it is around 8-10x more than most of the rest of the developed world).

 

[DaveC426913]

Evidently you recognize that prenatal checkups are necessary because mother and baby *are* at risk, right?

What? No. Why would a routine checkup lead you to risk?

There are lots of things that are done in routine checkups that have nothing to do with safety of the baby:
Is the baby nearing full development? is the baby turning the right way?
There are things that will aid in planning when and how the pregnancy will likely proceed.
There is no implication of safety there.
Sure, there's lot of things we want to watch for - but a routine checkup has no risk in-and-of-itself - there's no downside to it. So it's not like the doctor is going to "push" a routine checkup on mother, and she has to weigh the consequences of it.

So I still see this as a false equivalent.

 

[DaveC426913]

You declare childbirth "safe" and have criticized other uses of the word, as if it is binary choice: safe/unsafe.

I'm going to assume you're addressing me.


It was not my intention to present a binary choice.It was my intention to refute the idea that childbirth is not safe -which was what I was reading.
Riding the streetcar downtown is safe. That does not mean there are no risks. It is obviously a relative thing.

Given only a binary choice, it is much worse to declare childbirth "safe" than "unsafe", because that implies there is no need for preventative medicine: preventative medicine is for mitigating or preventing unsafe conditions.

Again was not my intention to suggest a binary choice.

Let me rephrase: Safe is the default. It is only unsafe when there is reason to think there is a problem.
The general tenor I've been reading is the opposite: that it is generally considered unsafe, and therefore any intervention are warranted.

The reality is this: a person's lifetime odds of death are 100%. Everything a person does contributes a fraction of that 100%. Giving birth is more dangerous than spending that afternoon on your couch watching TV+.

OK now who's making it a binary choice? :)
You're essentially saying that life itself is not safe. We all die.

It's dangerous enough that parents spend a lot of time, money and effort mitigating that risk by changing their diet and behaviors, getting prenatal checkups and making choices about how to give birth.
[/QUOTE]
How parents act is not a litmus test of the reality of danger.

You apparently know and agree with this and yet you said "[Natural] childbirth is safe"

Mia Culpa. It wasn't until several posts alter that I realized "natural" childbirth to others was not what it means to me.
What I should have said is "vaginal birth is (relatively) safe".

and suggested there was something wrong with going to see a doctor to deal with this "safe" condition: "pregnancy is one of the precious few conditions you go to a hospital for when you aren't sick" [your bold].

No. "Going to a doctor" and "going to a hospital" are two very different things.
One is a checkup; the other is prep for intervention.

Pregnancy and childbirth is "safe" - women aren't sick - so they shouldn't be going to the doctor is what that implies.

No. The implication is not that they shouldn't be going - the implication is that - just because they're going to a hospital (because, in many places it's the law) doesn't mean they are going there to have something fixed that's broken.

There is certainly case to be made that doctors and society are being overly aggressive in promoting c-sections, but you aren't doing the conversation any favors by doing exactly what you are criticizing them for: exaggeration.

It would only be exaggeration if it weren't true - something that has not been established.

+In fact, giving birth is about 37x more dangerous than skydiving, at least in the United States (where it is around 8-10x more than most of the rest of the developed world).

Not even close to equivalent analogy.

1] Did someone say skydiving is not safe?
2] 0.0007% chance of death.
3] Is your 37 times figure counting deaths? Or all complications?
4] 37 times 0.0007% is still a very small number: 0.0259%

And again, remember, those 0.0259% of complications in childbirth are generally identified as in the high-risk category. You don't treat the other 99.974% of cases as if they're the 1-in-5000 case - unless there is cause to. Let me repeat that: unless there is cause. At which point, they get increased attention and monitoring.

 

[DrDu]

I now remembered that when we got our children, there was one book which every mom to be considered a must have: The "mid wife consultory: empathetic and naturalistic accompaniment to pregnancy, childbirth, puerperium and lactation with medicinal herbs, homeopathic remedies and essential oils,

Die Hebammensprechstunde : einfühlsame und naturkundliche Begleitung zu Schwangerschaft, Geburt, Wochenbett und Stillzeit mit Heilkräutern, homöopathischen Arzneien und ätherischen Ölen Taschenbuch – 2005
von Ingeborg Stadelmann (Autor), Torill Glimsdal-Eberspacher (Illustrator)

which shaped forever my impression of midwives...

 

[Laroxe]

I wonder if we have drifted a bit to far from the original issue, this was really about how choices were made about the method of delivery. The starting point is that really childbirth in the west is very safe and this is largely because most risks that can be foreseen are managed effectively. However there are risks and potential problems and these are not uncommon, the discussion really is about the way in which some of these risks are managed. I think everyone would probably agree that c-sections can be a life saving procedure and they have become an increasingly common way of giving birth. While comparisons can be difficult, in itself it seems to add few extra risks and these can be set against the reductions in risks associated with vaginal births. We know that serious adverse outcomes are significantly reduced as the rate of c-sections increase to around 10% of all births after that its difficult, its difficult to know the effects on less serious problems.
I think we are in an area in which the evidence we have provides little clear guidance, the general feeling is that as rates are approaching 25-30% (higher in some areas) this is in some way unjustified and this feeling is based really, in cultural values and we do live in times in which the idea of nature and natural is given a high value. Unfortunately these very common views are based on an experience of nature that has been beaten into submission by humans, again to remove all the dangers and risks and by various vested interests promoting very positive and benign beliefs. My own view is that whether something is natural or not is irrelevant and adds nothing of value to these discussions, if mother nature actually was a mother she would be serving a very long prison sentence for the abuse and neglect of her children. Nature in the raw is horrible and when it informs medical decision making it visits that horror on people, the introduction of asepsis was resisted based on naturalist beliefs, anaesthesia was not introduced and diseases were blamed on the persons own behaviour, a view that's becoming fashionable once again.