Elective c-sections

Jay Allen talks on Blogging Baby about the recent increase in elective c-sections and I read the post and comments with interest. I disagree with Jay's conclusions in the post, which I summarize as: "because cesareans are major medical surgery, they should be avoided unless medically necessary."

I think that statement, and several of the comments, are missing a more important point. The root problem isn't an increase in elective c's, the problem is lack of choice or uninformed choice.

When women are given the freedom to choose the birth experience they want without unnecessary pressure from their doctors, peers or others, when they're aware of the risks of that choice and understand what the likely recovery will be like, what's the problem?

Of course, part of informed choice means knowing that even though you choose something, you may not get it - plenty of women who 'choose' vaginal births don't end up getting them. Going into a c-section without being aware of the risks and effects is a bad thing; the same can be said about vaginal births.

As always happens with these kinds of issues, you hear anecdote after anecdote, on both sides of the fence - this one had a horrible experience with her C and so can't imagine why anyone would ever choose one, that one had a much easier time recovering from her C than her vaginal birth and so plans on choosing a C for her next. Personally, I think that an important part of informed choice is being aware of the anecdotes, knowing what the actual statistics are when possible as well as reading a decent sampling of stories on all sides of an issue to understand what others' experiences have been. In any medical situation (or really any situation at all), someone who relies 100% on information supplied by a single source (whether that be doctor or web page or friend or parent or blog) could be missing part of the story or falling prey to an individual's biases or agenda.

When this issue comes up (and a quick search for "c-sections are unnatural" on google shows me that this is nothing new), the word "unnatural" is often bandied about. But what does "unnatural" really mean in this context, and why is it inherently bad? I certainly won't disagree with "it's the way nature intended" for babies to exit via the vagina - my point is that there's nothing inherently wrong with doing things "unnaturally". It's also natural for animals to be eaten by other animals - and when we're the target animal, we aren't such fans of nature.

So why is nature good and proper sometimes and not other times, and how are we supposed to figure out when we should let nature take its course and when it's OK to prevent that course or intervene in the middle? I always get a wee bit cynical when "it's unnatural" is used in an argument against something, whether that be elective C's, pain medication during labor, formula feeding or hey, how about gay marriage? Pffft.

Another point that is often raised in the "elective c-sections are inherently bad" camp is that c-sections are major abdominal surgery and thus should never be elective. Yet we humans choose to have major surgery performed on us for a lot of reasons, many of them elective, and yet I've never seen the kind of passions flare around those surgeries (say for example a knee replacement) that I do around elective c-sections.

I am not trying to diminish the risks or effects of c-sections, but rather to reframe the issue: the important problem here is lack of choice, or lack of informed choice. Even this article, from the International Cesarean Awareness Network, Inc (that sounds like a group without an agenda, fer shore!) starts out talking about the problem of women choosing elective c-sections despite risks... and yet ends up delving into how women aren't necessarily informed of what those risks are.

And for what it's worth, I'm very much hoping I don't end up having a c-section for my upcoming birth. But I'm walking into it with my eyes wide open, knowing it's a possibility, and having a decent understanding of what it could be like during and afterwards.

Comments

[Kendra]

I agree with you. Keep your eyes open. I had an emergency c-section with my second baby. I knew the it was a possibility and we both alive because of it. The recovery was "different" than the first but I think after you've had one child EVERY recovery (like every birth) is different. I did snarl when I heard Brittany Spears had an elective C-section to "avoid the pain of childbirth." Huh??? If I remember, I wasn't on morphine after my first delivery. And I could get in and out of bed without feeling or fearing something (ie-my incision) was going to explode.

[dbt]

We were close to considering an "elective" C-section to avoid possible vaginal complications, but ended up going au natural.

Me, I'm all for informed decisions made by patients.

[Karen]

Are you ready to take on the circumcision subject then? There's a good article in this month's Mothering Magazine about it... I think the part of the "informed" consent that I had w/DS was about 30 seconds long and included the doctor saying that there was no need for pain relief because he had done thousands, and that he'd be done in less time than the time we'd spent talking about the procedure (again, about 30 seconds...)

GRR.

Meanwhile, Britt had an elective C????????? With her belly-baring tops and pants I would have figured there was no way. Think she's got stretch marks?

K

[Cynical Mom]

Not planning on going near that one =)

My only strong opinion there is that I don't get people who are firmly against circumcisions EXCEPT they're OK with it if it's religious.

If you think it's a horrible mutilation of a body, why would you be OK with it just because it's done for religious reasons?