Medical C-sections increasing, risks involved

[mktsgm]

There is a slow but steady progress in creating incidences of c-section deliveries globally across the world.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743929/

What is the cause of it? Is this alarming and should it be earnestly reversed? Why childbirth is considered to be terribly complicated now, when humanity had had vaginal childbirths for thousands of years?

Is there a systemic reason apart from saving mothers and children?

 

[Greg Bernhardt]

humanity had had vaginal childbirths for thousands of years?

But there was high childbirth mortality rates back then. 600 deaths in 100k back in 16-17th century compared to 15 out of 100k now.
https://slate.com/technology/2013/0...-in-the-20th-century-are-midwives-better.html

 

[mktsgm]

But there was high childbirth mortality rates back then. 600 deaths in 100k back in 16-17th century compared to 15 out of 100k now.
https://slate.com/technology/2013/0...-in-the-20th-century-are-midwives-better.html

This line of thinking avers that vaginal childbirths which are natural, are considered dangerous now. And there is a distinct March away from such deliveries.

In order to prevent mortalities is there no other way other than c-sections?

With the advancement of science we should be able to make the natural childbirth safe. Why this is not happening?

 

[Ryan_m_b]

This line of thinking avers that vaginal childbirths which are natural, are considered dangerous now

"Avers" is not a word. Did you mean "implies"? In any case vaginal birth is not suddenly being considered dangerous, it was always considered dangerous.

And there is a distinct March away from such deliveries.

In order to prevent mortalities is there no other way other than c-sections?

With the advancement of science we should be able to make the natural childbirth safe. Why this is not happening?

Why should we? What is it about vaginal delivery that makes you think it automatically should be possible to be completely safe?

Medical advances have made birth a much safer process. In addition caesareans have made complications in birth much safer to deal with. As your linked paper suggests the exact reasoning why caesareans are more common than they used to be are complicated and go beyond the strictly medical into social practices.

 

[pinball1970]

This line of thinking avers that vaginal childbirths which are natural, are considered dangerous now. And there is a distinct March away from such deliveries.

In order to prevent mortalities is there no other way other than c-sections?

With the advancement of science we should be able to make the natural childbirth safe. Why this is not happening?

Following on from Ryan MB
We have not evolved to be perfect biological machines, we have evolved from what material we had to begin with genetically from our ape like ancestors and natural selection did the rest.Refrigeration, warm clothing, central heating, dentistry, sanitization, pasteurization, vaccination, antibiotics, condoms and life-saving surgery are not in any way natural but they save lives.That’s why we live till about 80 in the west today compared to about 40 yrs 200 years ago.

 

[Ygggdrasil]

While c-sections are essential in some deliveries, caesarian sections carry many short-term and long-term risks to the mother and child. For these reasons, the World Health Organization has published recommendations that ~10-15% of births be done via c-sections. Obviously, in many countries, access to health care has many countries below this rate. However, in many developed countries, the rate of c-sections has increased dramatically, overshooting the recommended rate. There is considerable evidence that many c-sections in developed countries like the US are not medically necessary and provide no benefits to the mother and child. The medical journal The Lancet has referred to this increase as a "global caesarian section epidemic" and published a series of articles examining this issue:

Caesarean section—the most common surgery in many countries around the world—is a procedure that can save women’s and babies’ lives when complications occur during pregnancy or birth. However, caesarean section use for non-medically indicated reasons is a cause for concern because the procedure is associated with considerable short-term and long-term effects and health-care costs. Caesarean section use has increased over the past 30 years in excess of the 10–15% of births considered optimal, and without significant maternal or perinatal benefits. A three-part Lancet Series on Optimising Caesarean Section Use reviews the global epidemiology and disparities in caesarean section use, as well as the health effects for women and children, and lays out evidence-based interventions and actions to reduce unnecessary caesarean sections.

https://www.thelancet.com/series/caesarean-section

Popular press coverage of The Lancet's reports:
https://www.npr.org/sections/goatsa...e-of-c-sections-is-rising-at-an-alarming-rate
https://www.sciencefriday.com/segments/why-are-more-expecting-mothers-having-c-sections-deliveries/

 

[OCR]

"Avers" is not a word.

You're sure ?

You're really sure ??

.

 

[DaveC426913]

There is a slow but steady progress in creating incidences of c-section deliveries globally across the world.

What is the cause of it?

Access to medical interventions is certainly one reason. If you can go through childbirth without the pain, why wouldn't you? At least, that's the way many people think.

Is there a systemic reason apart from saving mothers and children?

Interesting that you use that term.
When presented with interventions, some patients ask if they are necessary, and are often told " Well, we're trying to save your baby."
Nothing works better on someone in distress than scare tactics.

In order to prevent mortalities is there no other way other than c-sections?

Yes. Education. Advocation. Informed consent. Birth plan.

With the advancement of science we should be able to make the natural childbirth safe.

Natural childbirth is safe.

Fun fact: pregnancy is one of the precious few conditions you go to a hospital for when you aren't sick.

Why this is not happening?

It is. But it's a grass roots movement.
Who will fund it?

 

[DaveC426913]

Posted this here for no other reason than because it just popped up on my wife's news feed, like 12 seconds ago. (She's a childbirth educator, and a strong advocate of natural childbirth. Don't get her started on the rate of C-sections in hospitals!)

She has witnessed doctors call for a C-section because they're about to go off-shift. (True story!)

 

[DaveC426913]

But there was high childbirth mortality rates back then. 600 deaths in 100k back in 16-17th century compared to 15 out of 100k now.

Yes. And that has changed now.

What has not kept up with the times is hospital protocols.

 

[Ryan_m_b]

You're sure ?

You're really sure ??.

Words die out all the time. I am reasonably sure that it I spoke this word to 100 English speakers more than 90 wouldn’t recognise it.

 

[pinball1970]

Is there a systemic reason apart from saving mothers and children?

I think this is the key part, when required to save lives.
Having a C Section as some sort of life choice is obviously wrong.

 

[DaveC426913]

I think this is the key part, when required to save lives.
Having a C Section as some sort of life choice is obviously wrong.

Only wrong if the decision is made in the shadow of ignorance of the benefits, risks and consequences.

 

[Laroxe]

Its always popular to think people make decisions based on ignorance, I don't believe a word of it. In fact most women know less about vaginal birth than caesarean and don't understand the risks of natural births. Like all surgery caesarean's carry some risks but they are in fact less likely to cause as much pain, injury to the vagina, heavy bleeding soon after birth, or shock caused by loss of blood. Vaginal births are more associated with longer term sexual problems and continence issues, these risks increase with age and people are having babies later.
In the UK NICE which produces the evidence based guidelines has changed its position and no longer thinks a vaginal birth should be the default or even preferred option, they think it should be a matter of choice.

This is an interesting court decision which will also effect the issue.

https://www.newscientist.com/articl...y-starting-warning-women-of-childbirth-risks/

 

[Ygggdrasil]

Its always popular to think people make decisions based on ignorance, I don't believe a word of it. In fact most women know less about vaginal birth than caesarean and don't understand the risks of natural births. Like all surgery caesarean's carry some risks but they are in fact less likely to cause as much pain, injury to the vagina, heavy bleeding soon after birth, or shock caused by loss of blood. Vaginal births are more associated with longer term sexual problems and continence issues, these risks increase with age and people are having babies later.
In the UK NICE which produces the evidence based guidelines has changed its position and no longer thinks a vaginal birth should be the default or even preferred option, they think it should be a matter of choice.

This is an interesting court decision which will also effect the issue.

https://www.newscientist.com/articl...y-starting-warning-women-of-childbirth-risks/

There are also a number of risks associated with birth by Caesarian section. For example, see this article in the journal The Lancet:

A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose–response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.

(emphasis mine)

Sandall et al. 2018 Short-term and long-term effects of caesarean section on the health of women and children. The Lancet 392: 1349-1357.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31930-5/fulltext

 

[pinball1970]

There are also a number of risks associated with birth by Caesarian section. For example, see this article in the journal The Lancet:Sandall et al. 2018 Short-term and long-term effects of caesarean section on the health of women and children. The Lancet 392: 1349-1357.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31930-5/fulltext

I read that the baby is less stressed from a cs birth although nhs data states mortality and morbidity is increased. Can't post Links right now but will do

 

[Laroxe]

You make the point from the lancet article that "The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth." This is a good example of the problems with this sort of research, remember a lot of Caesarian sections are carried out as emergency procedures when a birth becomes complicated, this often occurs when there are less staff available. It is also the case that most CS are also planned when difficulties are anticipated with the birth. Basically the outcomes are not comparable but the general view is that both types of delivery are very safe and following practice guidelines makes them safer. There seems to be more debate about the long term adverse outcomes which seem to be more noticeable in the vaginal births, in fact its the changing patterns of the age of the mother at the first child and the reduction in the number of children that favours CS. Like it or not, these days there is a cosmetic dimension to some of the decisions.
Its also worth remembering that the idea that a vaginal birth is the same as a natural birth can be misleading a considerable number of births are induced, this may be to facilitate certain types of analgesia, like spinal analgesia where specific expertise is needed, to reduce some risks and almost invariably when a pregnancy goes into the 41st week.

 

[DaveC426913]

Some complications from (voluntary) C-section:

Mother:

• any surgery causes an inflammation response
• wound dehiscence (breakdown)
• increased recovery time
• increased risk of endometriosis
• placenta accreta (from scar tissue - increases risk of subsequent fetal demise)
• placental rupture
• post surgical depression
• breastfeeding difficulties

Baby:

• longterm problems with gut development (normally picked up in birth canal and breastfeeding - including autism and bipolar disorder)
• asthma & other respiratory diseases
• longterm neurological complications (from lack of vaginal birth)
• risk for obesity

 

[pinball1970]

You make the point from the lancet article that "The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth." This is a good example of the problems with this sort of research, remember a lot of Caesarian sections are carried out as emergency procedures when a birth becomes complicated, this often occurs when there are less staff available. It is also the case that most CS are also planned when difficulties are anticipated with the birth. Basically the outcomes are not comparable but the general view is that both types of delivery are very safe and following practice guidelines makes them safer. There seems to be more debate about the long term adverse outcomes which seem to be more noticeable in the vaginal births, in fact its the changing patterns of the age of the mother at the first child and the reduction in the number of children that favours CS. Like it or not, these days there is a cosmetic dimension to some of the decisions.
Its also worth remembering that the idea that a vaginal birth is the same as a natural birth can be misleading a considerable number of births are induced, this may be to facilitate certain types of analgesia, like spinal analgesia where specific expertise is needed, to reduce some risks and almost invariably when a pregnancy goes into the 41st week.

Pretty glad I am reading links now rather than when my son was born (emergency c section)

Negative links with CS birth in this study also, stress/lack of and gut bacteria mentioned by DaveC426913

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597642/

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(99)02549-0.pdf

 

[Ygggdrasil]

You make the point from the lancet article that "The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth." This is a good example of the problems with this sort of research, remember a lot of Caesarian sections are carried out as emergency procedures when a birth becomes complicated, this often occurs when there are less staff available. It is also the case that most CS are also planned when difficulties are anticipated with the birth. Basically the outcomes are not comparable but the general view is that both types of delivery are very safe and following practice guidelines makes them safer. There seems to be more debate about the long term adverse outcomes which seem to be more noticeable in the vaginal births, in fact its the changing patterns of the age of the mother at the first child and the reduction in the number of children that favours CS. Like it or not, these days there is a cosmetic dimension to some of the decisions.
Its also worth remembering that the idea that a vaginal birth is the same as a natural birth can be misleading a considerable number of births are induced, this may be to facilitate certain types of analgesia, like spinal analgesia where specific expertise is needed, to reduce some risks and almost invariably when a pregnancy goes into the 41st week.

That's a fair criticism. Studies that attempt to control for these factors, such as the UK NICE study you cited earlier are more mixed on the relative costs/benefits of each delivery method:

A 2017 evidence update for the UK's National Institute for Health and Care Excellence (NICE) includes nine prospective studies that compared the outcomes of planned CS with those of planned vaginal birth (for women with an uncomplicated pregnancy and no previous CS).28 Planned vaginal birth was associated with reductions in length of hospital stay, the risk of hysterectomy for postpartum haemorrhage, and the risk of cardiac arrest compared with planned CS. However, planned CS was associated with a reduced risk of vaginal injury, abdominal and perineal pain during birth and 3 days postpartum, early postpartum haemorrhage, and obstetric shock compared with planned vaginal birth. Other intraoperative, perioperative, and postoperative risks showed no difference between the modes of birth, or conflicting findings regarding any differences.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31930-5/fulltext

CS does appear to have adverse effects on subsequent pregnancies, and while some of these could be due to selection bias for women who would need an initial CS delivery, it does seem likely that some of these effects are due to the lasting effects of the surgery:

After a CS, subsequent pregnancies show increased risks of hysterectomy, abnormal placentation, uterine rupture, stillbirth, and preterm birth.33,41 A higher frequency of bleeding, need for blood transfusion, adhesions, intraoperative surgical injury, and hysterectomy occurred with increasing number of CSs.16,44,45

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31930-5/fulltext

In general, I agree that doctors should discuss more the risks and benefits associated with each mode of delivery and that ultimately the choice should be up to the mother.

 

[Laroxe]

I've no idea why I've ended up sort of defending c-section but there always seems to be this natural = nice bias to discussions like this when there is nothing particularly nice about a natural birth in humans. We have to recognise that human childbirth is a very risky business and its only in recent times that the major risks have been managed successfully. The large human brain and therefore the head cause considerable problems during childbirth, even though the babies skull isn't fused, in fact the child is delivered in a much less mature form than most animals and is highly vulnerable.

In terms of natural births without modern medicine, in 1850 after they started recording deaths, in every 1000 women 55 would die at delivery or in the post-partum period (1 month up until 1900), this risk was for each child. For children in 1850 its estimated that globally around 50% of live births would have died before their 5th birthday and half of these deaths would occur at birth or in the post partum period. The current figures in the west are less than 0.5% (https://ourworldindata.org/child-mortality) with the major reductions only starting in the 1930's.
Generally a lot of opinions are influenced by peoples biases, much like the issue of breast feeding, so to respond to some of the issues I would suggest some qualifiers.

Any trauma initiates and inflammatory response including vaginal births, we need to know if this is significant.
C-sections are associated with an increased hospital stay of on average 1 day, wound problems in young healthy women are very uncommon.
Placental problems are far more likely in vaginal births and are one of the principle reasons for C-sections, longer term risks increase with the number of births.
The evidence doesn't support the idea of increased problems in breast feeding or mood disorders.
For the baby these risks occur in all deliveries and some are more likely to be due to the complications that lead to the c-section, this is particularly true of cognitive effects. Currently around 1 in 4 births are by c-section but only 1 in 20 are actually pre planned.

I think we need to be very wary of the claims around the microbiome which may be more a fashion than anything else. Currently most authorities seem to advise against things like vaginal seeding because of a theoretical risk of increasing infections. The vagina is not normally the stomping ground for the early gut colonisers and this colonisation is a closely controlled process, the breast is probably a better source. Most of the claims about the positive effects of our microbiome are based on a very limited understanding and there are increasing reports of harms. The bacteria are a different species, they are not around for our benefit, we have evolved together and learned to tolerate each other but only in certain circumstances. Many of our colonists become serious pathogens in our body.

There is a nice table of the evidence around various risks in this link its worth noting the the quality is generally considered poor, though the level of risk is considered very low. Nice have also produced a specific care pathway this year, (2018) but this doesn't provide the detail.

https://www.nice.org.uk/guidance/cg...lanned-CS-compared-with-planned-vaginal-birth

 

[mktsgm]

Its always popular to think people make decisions based on ignorance, I don't believe a word of it. In fact most women know less about vaginal birth than caesarean and don't understand the risks of natural births. Like all surgery caesarean's carry some risks but they are in fact less likely to cause as much pain, injury to the vagina, heavy bleeding soon after birth, or shock caused by loss of blood. Vaginal births are more associated with longer term sexual problems and continence issues, these risks increase with age and people are having babies later.
In the UK NICE which produces the evidence based guidelines has changed its position and no longer thinks a vaginal birth should be the default or even preferred option, they think it should be a matter of choice.

This is an interesting court decision which will also effect the issue.

https://www.newscientist.com/articl...y-starting-warning-women-of-childbirth-risks/

Reasoning like this (dangers associated with vaginal delivery) reinforces c-section.

In my view not all c-sections are performed under real emergencies, currently. Most of them are done for convenience and perceived emergency.

In such cases, the baby is forced out of the womb when it is not ready to be born! We never take the baby into account in all these things.

Besides vaginal delivery is natural. It should be the right way of being born.

Of course, complications can occur. Under such circumstances, assisted vaginal birth should be preferred Norm. C-section should be the unavoidable last resort.

Talk of vaginal birth being dangerous, is by itself dangerous, as it precludes and preempts nature.

 

[Ygggdrasil]

It is worth noting that the problem of the "CS epidemic" referred to in the medical literature is not primarily a problem of the US and Europe from which many of the data we are citing come from. Rather, the largest rates of use are in China and Brazil:

The Series shows that the global rate of caesarean birth has doubled in the past 15 years to 21%, and is increasing annually by 4%. While in southern Africa use of caesarean section is less than 5%, the rate is almost 60% in some parts of Latin America, including in Brazil where we will launch the Lancet Series at the World Congress of Gynecology and Obstetrics (FIGO) on Oct 18. Of the 6·2 million unnecessary caesareans done each year, half are in Brazil and China. The wide variations reported between regions, within countries, and between groups of women confirm that caesarean section use is not evidence-based.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32394-8/fulltext

In these cases, it seems that the populations of these countries may be overestimating the benefits of caesarian delivery vs vaginal delivery. The editorial and accompanying studies suggest that greater education to address misconceptions is an effective tool to decrease CS use and improve outcomes.

 

[Ygggdrasil]

Talk of vaginal birth being dangerous, is by itself dangerous, as it precludes and preempts nature.

I don't agree with this argument. Almost any medical procedure (e.g. antibiotics or antiviral drugs) could be seen as precluding and preempting nature. What is natural is not always what is best. Medical decisions should be based on scientific evidence regarding the costs and benefits of a particular medical intervention (which is what most of the discussion here has so far focused on).

 

[Laroxe]

Mktsgm, you make the following points and I'm sure that some people would agree in principle, but you seem to be ignoring some important parts of the debate, I'll try to expand on them.
Reasoning like this (dangers associated with vaginal delivery) reinforces c-section. In any medical intervention there is a legal requirement for the person to be given sufficient information to make an informed choice (if possible). This must involve an outline of the risks as well as the benefits & this is what the court decision reinforces.
In my view not all c-sections are performed under real emergencies, currently. Most of them are done for convenience and perceived emergency. I doubt very much whether many C-sections are done simply for convenience, like most decisions the medics have to make a decision based on the assessment of risk, because the overall outcomes of both types of (uncomplicated) delivery are similar, it makes sense to err on the side of caution.
In such cases, the baby is forced out of the womb when it is not ready to be born! We never take the baby into account in all these things. This is simply wrong, it is in fact the baby that is most at risk and keeping the baby safe the principle reason for intervention.
Besides vaginal delivery is natural. It should be the right way of being born. The right way to be born is the way that gives the best chance of survival, nature hasn't got a brilliant record in this respect. Nature has no say in the matter, nor does it have opinions or make judgements, or care, because it can't.
Of course, complications can occur. Under such circumstances, assisted vaginal birth should be preferred Norm. C-section should be the unavoidable last resort. The preferred norm is and should be the safest and discouraging the use of the most appropriate intervention would increase the risk to both mother and child, this should all be based on the available evidence about relative risks.
Talk of vaginal birth being dangerous, is by itself dangerous, as it precludes and preempts nature. People don't talk about it being dangerous, they describe possible risks. Not describing these risks is indeed dangerous to the professionals involved as they risk being held legally accountable, nature isn't a "thing" or entity, with rules and procedures that can be pre-empted.
Ygggdrasil makes some very important points that very much reflects the current thinking, we have to prioritize the health of the mother and child, not naturalistic beliefs.

 

[DaveC426913]

...it makes sense to err on the side of caution.

... keeping the baby safe the principle reason for intervention.

The right way to be born is the way that gives the best chance of survival

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"?

There are real long-term consequences - for both mother and baby - that are tossed aside in the stressful moment for the sake of "saving" a baby that doesn't need saving.

 

[Ygggdrasil]

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"?

There are real long-term consequences - for both mother and baby - that are tossed aside in the stressful moment for the sake of "saving" a baby that doesn't need saving.

The Lancet's editorial on the topic notes that doctors' tendency to "err on the side of caution" is, in part, ingrained in the culture of medicine and how doctors are trained (if you have a hammer, every problem looks like a nail; if you're trained in surgery, then you'll recommend surgery). Furthremore, the specter of malpractice litigation often pushes doctors to intervene, lest they be seen as negligent:

The guidance acknowledges barriers to evidence-based practice: cultures of medicine shifting toward surgical intervention, risk of litigation, the financial incentives of performing caesarean sections, and the convenience of scheduled deliveries. As the Series notes, young doctors are regrettably now more equipped and confident with the skills for surgical delivery than they are with managing vaginal births.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32394-8/fulltext

 

[DaveC426913]

The Lancet's editorial on the topic notes that doctors' tendency to "err on the side of caution" is, in part, ingrained in the culture of medicine and how doctors are trained (if you have a hammer, every problem looks like a nail; if you're trained in surgery, then you'll recommend surgery). Furthremore, the specter of malpractice litigation often pushes doctors to intervene, lest they be seen as negligent:

Yup and yup.

The doctor answers to the hospital, not to the p̶a̶t̶i̶e̶n̶t̶ mother*.

This is why my wife is training Perinatal Support Workers. The mother and baby can benefit from someone who is an advocate for them.

What doctor is going to recommend a woman stay in several hours more labour, if he can relieve that pain right now? The consequences of the doctor's interventions will manifest long after mom and baby are gone from the ward.

*Oops. Almost hoisted myself on my own pitard. "Patients" are sick people. Pregnant women aren't sick.

 

[256bits]

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"?

In a way yes, and no.
Perhaps the legal system should be totally eliminated from having any say whatsoever on how the medical system operates, and the second guessing of decisions taken by doctors and parents on the welfare of infants and upbringing of children, from day one at birth, or even as far back as at the moment of conception.
That would eliminate any chance of malpractice suits of not providing proper care to the mother and the fetus - which by the way has limited recourse in the event of failure, so someone should assume the role as spokesman on its behalf - for doctors and anyone involved such as midwives.

Intervention in the pregnancy comes in many forms, not least of which is the birth.
One well known intervention is the ultrasound, which is also given to the mother far too often than necessary, if one is to consider that "natural" is the best for mother and fetus ( an argument could be made that the procedure is given far to often in any case ), and one can take your chances that there is no complications that could arise within the womb.
I f you can follow that logic, then one can understand why a lot of people detest the word natural. ( See natural ingredients in food )

Pregnant women aren't sick. Why do we treat them like they are

I think perhaps you are questioning for whose benefit are these interventions, and the actual consumer - the medical profession, the legal system, or the client which should really be the mother and fetus ( but maybe isn't ).

EDIT: I see that this is already being discussed ,

 

[OCR]

Almost hoisted myself on my own pitard.

petard... ? ? . .

.

 

[DaveC426913]

One well known intervention is the ultrasound, which is also given to the mother far too often than necessary, if one is to consider that "natural" is the best for mother and fetus ( an argument could be made that the procedure is given far to often in any case ), and one can take your chances that there is no complications that could arise within the womb.
I f you can follow that logic, then one can understand why a lot of people detest the word natural. ( See natural ingredients in food )

Ultrasound isn't, itself, an intervention, but it does encourage interventions.

I think perhaps you are questioning for whose benefit are these interventions, and the actual consumer - the medical profession, the legal system, or the client which should really be the mother and fetus ( but maybe isn't ).

I wouldn't go so far as to say they're not benefiting mother and fetus - the intentions are good. It's just that there are some very real considerations that must be made over and above the immediate convenience at the time of delivery.

Some are just silly. "You've been in the hospital for 24 hours now, with little progress. We need the bed. We think it's time to break the bag of waters."
1] Gestation and labour takes as long as it takes. There is no reason to break the bag of waters unless the baby is approaching a week late.
2] Breaking the bag of waters introduces a lot of complications.
2a] For starters, it starts the clock ticking. That makes the likelihood of more - and more intrusive - interventions skyrocket.
2b] But more importantly, it makes delivery much more difficult. The fluid is both a lubricant and a cushion. It takes the brunt of the pressure from the opening cervix. Remove that cushion and the full pressure of the cervix is put on the baby's skull. That's how you get cone heads.

 

[DaveC426913]

petard... ? ? . .
.

Doh! I wondered why it had a squiggly red line under it!

 

[OCR]

I wondered why it had a squiggly red line under it!

Lol... ✔

.

 

[pinball1970]

It has been stated that Pregnancy is not "an illness" it is "natural," ok. However Pregnant women are vulnerable during pregnancy and existing disorders can come to the fore and pose a real risk.

https://www.msdmanuals.com/home/wom...-disease/overview-of-disease-during-pregnancy.

If everything was just left to be natural which parts do we discard? Blood tests? Incubators? Scans? Midwifery? (you can argue ancient cultures had creche and female assistance but they did not have scientific institutions teaching science)

Sterilizing equipment/hands? Pretty sure alcohol based hand washes were not available in the Savannah.

Natural and "organic" to me are pretty meaningless concepts.

 

[DaveC426913]

It has been stated that Pregnancy is not "an illness" it is "natural," ok. However Pregnant women are vulnerable during pregnancy

Vulnerable to what, exactly?

and existing disorders can come to the fore and pose a real risk.

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

If everything was just left to be natural which parts do we discard? Blood tests? Incubators? Scans? Midwifery?

None of those. We're talking about interventions.

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

(you can argue ancient cultures had creche and female assistance but they did not have scientific institutions teaching science)

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

Sterilizing equipment/hands? Pretty sure alcohol based hand washes were not available in the Savannah.

Straw man. We're talking about interventions.

 

[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).