Choosing cesarean limits future choices

I was irritated to discover that Time magazine published an article entitled “Choosy Mothers Choose Cesareans” in their special Environmental Issue. Since cesarean surgery is an over-used procedure[1], it is quite inappropriate for this type of article to appear along-side articles dealing with the Presidential candidates’ climate change positions and how the US can be more green.  Needlessly consuming medical services is anything but green, and Time magazine should take responsibility for its poor choice in content.

According to the article, more women are choosing cesareans, a trend doctors expect will continue.  I do not know nor have heard of anyone actually choosing a cesarean, save the stories I read or hear about through the media.  I believe that the media is creating this belief that women choose cesareans, and that this is a trend we should expect to see continue.  But perhaps it is true that women are choosing major surgery for reasons cited, such as (1) fear of ripping/tearing the perineum, (2) fear of incontinence, (3) fear of pain, (4) fear of birth, (5) or fear of having a stretched-out vagina.  Time‘s article feeds into the misperceptions of birth generated by Hollywood blogs and reality shows like A Baby Story.

Fear of ripping/tearing:  from what I have learned over the years, women rarely rip or tear during childbirth if they push following their body’s signs, are given appropriate time to labor and birth their babies, and/or have the perineum massaged or supported during pushing.  Episiotomies can cause more damage to the perineum, vagina, and anus than a natural tear anyway.  I wonder if this fear stems from botched episiotomies?

Fear of incontinence: cesarean delivery does not prevent incontinence.  Sorry!

Fear of pain: I wonder why so many women are taught to fear the pain of childbirth.  Granted labor was one of the most challenging things I have ever done, but I think my exercise habits and outdoor enthusiasm (road biking, hiking, backpacking, running) had prepared me for childbirth.  I don’t look back on my labor and regret the pain – I regret the fact that a cesarean became necessary.  Anyone who has done a little bit of study on the purpose of pain in childbirth can tell you that it is actually beneficial – it can indicate problems that need attention as well as provide important feedback to the mother and her careproviders regarding her progress.

Fear of birth: there actually is a term for women who have a fear (phobia) of childbirth – lockiophobia.  If a woman is not phobic, then she should work with a psychologist or psychotherapist to determine the root causes of her fear and overcome those.  Pregnancy can bring up psychological pains of the past, but they are not avoided through cesarean surgery.

Fear of a stretched-out vagina: do I really need to address this?

The title of my post suggests that cesareans will limit future choices.  This is true – women who have had a cesarean are at risk of being pressured into repeating surgery for future births, have a slightly more elevated risk of uterine rupture and other poor birth outcomes, are unable to have normal birth at most birth centers [2], may not be able to have a normal birth at their local hospitals [3], will be pressured to comply with hospital protocols that may lead to interventive birth outcomes for future births, may have difficulty finding providers who will support their choices in future births to name a few limitations.

Other things you may not know about cesarean aftermath [4]

  1. Risk of post-partum depression and post-traumatic stress disorder
  2. Negative impact on breastfeeding, bonding, and other key mammalian birth-related processes
  3. Stillbirth, miscarriage, infertility
  4. Pain, adhesions, slow recover, unsightly scaring
  5. Negative impact on relationships with other family members, particularly partners/spouses
  6. Rejection of birth – some women choose to never have another baby because they don’t want to go through surgery again; some women don’t feel like they gave birth; some women equate cesarean birth with “birth rape

Thankfully I have come to learn about the viability and appropriateness of vaginal birth after cesarean.  I was encouraged to subscribe to the ICAN Yahoo list where I learned much of what I know now about birth that I didn’t know before my daughter was born.  I know the dangers of choosing cesarean for the first, second, or fifth time.  I have experienced stress, depression, and other tangible and intangible outcomes related to cesarean surgery.  I worry that my current trouble with recurrent pregnancy loss is related to the cesarean.  I resent that I have to consume more medical services to rule out uterine defects caused by the cesarean.  Tomorrow I will have a hysterosalpinogram performed.

It is regrettable that women such as Ms. Chung are led to believe and accept that cesarean birth is risk free, complication free, and consequence free.  It is simply not the case, and it does not take more than 30 seconds with an internet search engine to learn that much care should be taken when deciding if cesarean surgery is right for a woman and her baby.  The March of Dimes states that cesarean surgery should only be performed when the mother’s life or baby’s life is at risk.  Cesarean surgery is a blessing when used appropriately, but its safety is not justification for indiscriminate use.

[I sent a slightly abridged version of this post to Time magazine's Editor.]

[1] The World Health Organization maintains that an acceptable rate of birth via cesarean surgery is 10-15%.  When the cesarean rate exceeds this range, the risks outweigh the benefits.
[2] To read the AABC’s recent statement on VBACs at birth centers, click here.
[3] Go to http://www.ican-online.org to see if your hospital allows VBACs.
[4] See also http://www.childbirthconnection.org/article.asp?ck=10166; read ICAN’s book, Cesarean Voices to learn how cesareans have impacted real women and real babies.

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14 responses to “Choosing cesarean limits future choices

  1. Fear of a stretched-out vagina: do I really need to address this?

    Actually…please??? I know this is ridiculous, but I’m 20 weeks pregnant w/ my 1st, planning a NCB, and I don’t know ANYONE who has had a vaginal birth (well, I do, but they aren’t close enough to me for me to ask about the state of their privates;). My mom had C-Sections (smooshed her pelvis in an accident years before, truly necessary), most others were kind of “cascade of interventions” Cesareans.

    So, I kind of want to know. I don’t have a fear so much as a – well, how is it? How bad is it?

    Thanks!

  2. Kimberly,
    I am glad you left a comment, and I’m sorry if my comment about the fear of a stretched-out vagina was off-putting. Actually, I wish I could answer you. I had a cesarean with my DD in 2004 and have suffered three miscarriages in 2007-2008 since trying to conceive again. I don’t know that this is much of a problem. Our partners/husbands are usually just thankful when we’re interested in hanky panky. I don’t think most guys are analyzing it too much. ;) Perhaps I should let someone who has experienced normal birth respond.

    Best wishes to you for the rest of your pregnancy and for the birth experience you desire!
    ~ Kimberly (labortrials)

  3. I never considered anything but vaginal birth, but I do remember being terrified of tearing my perineum. I couldn’t imagine pain any more excruciating than that had to be. I had my husband do perineal massage for weeks ahead of time (which neither of us enjoyed) just in case it helped. It turned out that I DID tear very slightly (probably because things went so fast) but I didn’t even notice it happening. One or two stitches fixed it up and I never even noticed it as part of the healing. Which just goes to show that sometimes the things we fear the most aren’t the things we should be worrying about.

    Great post.

  4. Kimberley, just to answer from my own experience – I haven’t talked to other women so can really just speak for myself. After a mid cavity forceps delivery, including episiotomy and internal tear, my vagina is as before. My belly is floppy and didn’t recover ;) but everything else did, in spite of the trauma caused by a forceps delivery which in some country wouldn’t have been undertaken at all.

    And for anyone with birth phobia (I suffered from it) I can only recommend to really deal with it. I did with hypnobirthing and it helped retain a really positive attitude throughout a very long labour.

    Thanks for the post and taking the trouble to respond so poignantly to such ill informed articles, I hope your efforts will contribute to changes in birth culture.

  5. Well, my husband said I was a little bigger after giving birth, but he’s not complainin’! :-)

    My first baby was 7lb 5oz, and I pushed 40 minutes and tore 2nd degree, needed stitches; my second baby was 9lb. 2oz, and I pushed just 2-3 times and didn’t tear at all.

  6. Okay as a gal who had a primary c/s and two hbacs… I have to say… *and yes. I am the freak of the group!
    I have to say… My pelvic floor was better after each home birth. I kid you not. I still have some ‘issues’ but NOTHING like after the cesarean. Yes, I tore in two directions requiring lots of stitches and the midwives discussing transferring me to have a doc suture me. So… yeah.. ouch. Third degree ouch. Not to mention the broken tailbone that my four years old (TODAY!) first hbac child gave me.
    Would I trade any of that pain for a cesarean?
    NEVER.
    EVER.
    EVER!
    Husband actually commented that things are much better than after the c/s. How is that for sharing too much information?
    blushes and goes back to thinking about more cake!

  7. Vaginas are DESIGNED to stretch, and then return to normal.
    Giving birth is not an abnormal event for the body – it’s what females bodies are SUPPOSED to do.
    Vaginas often work better after they’ve been stretched to capacity;)

  8. I definitely agree about the inappropriateness of placing the article in a “green” issue. I’ve been thinking that framing vaginal birth as “eco-friendly” might actually make it more popular!

  9. It wasn’t offputting. I think I’m probably weird for wondering so much, I just…wanted to know! Thanks for the info, y’all! I really appreciate it. It’s such a private thing, it’s hard to find people to ask, ya know? :)

  10. I had a completely natural childbirth, with slight tearing. I have no idea if my vagina *looks* different, but I know it *feels* a little different. This difference has mostly resulted in sex now being much more pleasurable than it used to be, for myself and my husband. (And it was good before, don’t get me wrong.) I don’t know why, exactly, but if the concern is for a “stretched out vagina”–which seems to me like a worry not for oneself so much as for one’s partner–my experience would say: not an issue. Or at the very least, not a negative issue!

  11. I’d just like to share my story with all of you as a response to the first paragraph about tearing. I had a seven pound baby naturally. I needed 22 stitches and only 2 of them were in my perineum (I did perineal massages). I ended up with stitches inside my vagina, I required stitches to sew both of my labia back on (one of them ended up only partially reattached, and the other is missing a large piece), I also needed two stitches in my urethra, had the tears gone a few millimeters further my clitoris would have been torn. When I can feel sex it’s pain that I feel, and my child is two years old. So I would just like to say that there are drawbacks to both cesarean and natural and what happened to me is a lot more common than you think. By the way I was obviously not given an episiotomy as that is an apparent no no these days.

    Lets try and remember that a womans body is her own, and if she does choose cesarean that’s her business. All women should be provided with a worst case scenario for both.

    It upsets me when I read pages like this because they gloss over the nasty parts of natural childbirth as being something we women shouldn’t worry our pretty little heads about. I was never even told that what happened to me was a possibility.

    I would also like to add that the list of side effects of a cesarean birth can also be applied to my natural birth.

    1. Risk of post-partum depression and post-traumatic stress disorder
    -Yes I had both. My nightmares about childbirth just ended about six months ago.

    2. Negative impact on breastfeeding, bonding, and other key mammalian birth-related processes
    -I had trouble breastfeeding because I had a catheter in and was too swollen to sit up.

    3. Stillbirth, miscarriage, infertility
    -This one doesn’t apply

    4. Pain, adhesions, slow recover, unsightly scaring
    -You bet.

    5. Negative impact on relationships with other family members, particularly partners/spouses
    -I love him and I wish sex didn’t hurt. He wants another baby and I can’t go through that again.

    6. Rejection of birth – some women choose to never have another baby because they don’t want to go through surgery again; some women don’t feel like they gave birth; some women equate cesarean birth with “birth rape“
    -See above

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