Aa
Aa
A
A
A
Close
Avatar universal

Maternal Request Cesarean - A Reasonable Option?

So my wife just had a positive pregnancy test, and I've started to do a lot of research particularly on a maternal request cesarean versus a planned vaginal delivery.

Isolating maternal request cesareans in studies from elective and emergency cesareans has apparently just not been done that much yet.  So weaving through the few studies out there yields somewhat contradictory information a lot of the time.

What is perhaps most fascinating to me, is that obstetrician's prefer a maternal request for themselves at an astronomically higher rate than the general public, almost entirely citing prevention of pelvic floor trauma as their reason for the preference.

I have found conflicting information on the effects of mode of delivery on pelvic floor trauma.  Many studies suggest that pregnancy itself is what contributes most to long term pelvic floor trauma.  But I have found other studies that refute this, stating that anywhere from uncomplicated vaginal delivery to assisted vaginal delivery does inherently damage the pelvic floor, from permanently increasing hiatal dimensions to levator ani avulsion etc., some of which never occur in a cesarean without labor.

So what is the truth here?  Do obstetricians have a better understanding of a truth that vaginal delivery is just plain anywhere from worse to severely worse for your pelvic floor than a cesarean?  If this is the biggest concern they have, then does that indicate that many obstetricians think all the other considerations like mortality are a wash either way?  Or even further, are the other morbidities and the mortalities better off with the maternal request cesarean, leaving pelvic floor trauma to be significantly more important?

The biggest reasons why I think my wife, and I have talked to her about this in general, should consider a maternal request cesarean is that a) this is our only planned pregnancy, with a plan to get a vasectomy and foster and adopt any further children, and b) this will be her first birth.

From what I have seen where maternal request cesareans are separated from planned vaginal deliveries, the overall morbidity and mortality is basically the same between the two.  However, there is an unquestionable higher rate of mortality and morbidity with assisted vaginal deliveries and emergency cesareans.  And in your first birth, where labor is toughest and longest, these latter scenarios are much more likely than in subsequent births.

If severe mortality and morbidity are basically equal between the two modes of delivery, I can't help but reduce the choice to something like the following:

Maternal Request Cesarean
1. A scar. (permanent)
2. A slower recovery time. (temporary)
3. A small difference in time until breastfeeding can be started. (temporary)

Planned Vaginal Birth
1. Anywhere from a minorly to heavily damaged / reconfigured pelvic floor. (permanent or requiring surgeries, although avulsion appears to have no actual solution)
2. Greater chance of organ prolapse. (permanent or requiring surgeries)
3. Greater chance of urinary, or even nightmarishly anal, incontinence. (possibly permanent)
4. An anywhere from slightly to largely more lax vagina and less sensitivity in sex due to pelvic floor trauma. (possibly permanent on some level?)

In the end, the thing that it comes down to for me is that a planned vaginal delivery is exactly that.  You are only going for an attempt at an uncomplicated vaginal delivery, and in your first delivery especially, your chances of having an assisted delivery or an emergency cesarean are significantly higher, and these latter scenarios are much more dangerous to mother and baby.  And even if you have an uncomplicated vaginal birth, you are still possibly damaging your pelvic floor, especially with the longer labors associated with a first birth.

So where am I going wrong with my thought process?  Or am I just on to the secret of why so many obstetrician's silently do a request cesarean themselves?  I’d appreciate any extra opinions I can get, as this is no doubt a highly controversial opinion with far reaching and important implications.
131 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Update: at 8 weeks the heart rate was only about 80.  She wanted to check progesterone levels, and they were only slightly low, so the wife is going on some meds to do something about it (apparently if they were too low it would have been game over, give up).  But in all reality, there is little likelihood this little one will survive; the encompassing word the OB used was "pessimistic."  Not a good day.....  but I will let you know what happens in a week.
Helpful - 0
Avatar universal
Let us know I am curious to know how that talk goes.
Helpful - 0
Avatar universal
Had our appointment!  My wife and baby are 6 weeks in :)

A little early to have the first appointment.....  my wife tried telling them that she had a 6 week cycle time and when she had a positive ovulation test (she came off the pill, after nearly 9 years of taking it, about 4 months ago).  I suppose the good thing was that they were able to very accurately ping the gestational age.

We did not have "the talk" though; the doc got called off to an emergency C.  I would sit here and say "that's a sign," but I believe in the numbers.  Looks like "the talk" will be in two weeks.  After all the nuclear war I caused, I'll be sure to share.
Helpful - 0
Avatar universal
Have you read anything above?  Yes there is a longer recovery period, but that is one con on a big list for either mode of delivery.  Sure its surgery, but that doesn't stop it from being safe and tolerable enough that a ton of doctors pick it for themselves.  And you know what is more "traumatic" than a planned cesarean, to both mother and child?  One done in an emergency, that you have no control over.

Both sides have risks.  The amazing thing at all is that cutting open a woman through the abdomen can actually be as safe as a vaginal delivery overall.  But the truth is what it is, I could give a crap about what's nature if it is more dangerous.  If you choose to believe that's BS, more power to you.  Everyone has to make an informed choice.  But I think its safe to say at this point that if you think a planned cesarean is wildly more dangerous and detrimental to health than a vaginal, you are not well informed.
Helpful - 0
Avatar universal
So you would rather have your wife go through a traumatic surgery than deliver the way it was meant to be?  You honestly don't sound like you have a lot of common sense. And it is far far too early to be even thinking about delivery as you just found out you are both expecting. How about carry to full term first then question everything.
Helpful - 0
9812003 tn?1452545539
Many women are in denial if they believe that their vagina goes back to its original form. I have been in a room full of married men who have admitted that the sex is good but it is not the same. What man is going to tell his wife who he plans on having sex with his wife until hen can't would tell her it's. Not as good as it use to be.
Pregnancy has always had risk as mothers we find the reward greater than the risk. But women die giving birth everyday.  I have never given birth vaginally and I don't want to. My scar blends in with my skin and isn't that visible.
Every couple should have a plan that works for them. There will always be people on either side who feel strongly about their decision, but the best decision is an informed decision.
Helpful - 0
Avatar universal
"For those who believe the Adam and Eve story as an allegory,  at the time when humans evolved into creatures who could tell right from wrong,  our hippocampus became so big that women were in terrible pain in childbirth.  So when Eve developed the ability to know morality,  childbirth would be horribly painful.  We walk upright,  forcing our bodies to develop systems that hold the babies in unlike mammals that walk on all fours and their babies aren't about to drop out due to gravity as ours are."

I have to comment, and involve god, because I've taken flak about it and why not make this conversation even more crazy?  That sounds way too Darwinistic for the fundamentalist.  They have to go with, childbirth would have been fine if Eve didn't have it coming because of her sin.
Helpful - 0
Avatar universal
PS: I agree with "My wife and I."  At least, when I'm smart that's how I say it :)
Helpful - 0
Avatar universal
I'm glad she was one of the lucky ones :)  I don't mean to say that all gloom and doom for everybody, but like I mentioned 2 posts up, you can find a lot of women that lament what has happened to them down there.
Helpful - 0
Avatar universal
Actually, that was a genuine mistake on my part.  I don't know why I read "risks to the vagina" but that's what I thought I was responding to.  

Of course, you can feel free to interpret that as me being obsessed with the sex side of this debate and seeing what you typed as something else, but honestly I had a dyslexic moment there.
Helpful - 0
Avatar universal
"So yes.  Vaginal birth is traumatic in a way that it's not traumatic for other mammals.  Cesarean sections are traumatic also."

Precisely the reason for the controversy, the debate, and in my opinion based on what I've seen, difficult choice to the well-informed.

"I think if a "hot dog down a hallway" were the typical experience of couples,  though,  word would have gotten out and no one would have kids anymore.  I think it's rare."

Well I've only seen a small data sample of men, but its not encouraging.  And you really don't think something like this would remain hidden to some extent?  That it wouldn't be something kept behind closed doors?  That it might only be talked about women to woman in whispers?  That many decent men wouldn't politely lie to their wives about it?  I've seen personal experiences described from many women who claim they have returned to pre-birrth, or even tighter.  And I've read many women lament the loss of their pre-birth vagina, several wishing they had gotten a cesarean instead of being handed an entirely different pelvic floor by childbirth.

It varies woman to woman so much, is what to take away.  But that's because the lack of, or level of trauma to the pelvic floor varies so much from woman to woman.  Some women will have levator ani avulsion during an uncomplicated vaginal delivery.  And some women will walk away, somehow all of the distention of their muscles etc. being not a problem at all.

One of the interesting things I saw was how doctors are actively pursuing better imaging techniques to identify the women at most risk for the most severe damage.  Perhaps such prediction could lower the elective cesarean rate to only those at high risk.  But it seems that is in its infancy.  Or even more sci-fi, perhaps the day when we can temporarily alter the actual necessary tissues just for childbirth.

Until then though, if you have an avulsed levator ani, there is nothing they can do about it.  If you have permanently highly increased hiatal dimensions, pelvic floor exercises are only going to do so much.  In lieu of not having better prediction technology, its another dice roll in this whole debate.

But its the last time I'll say it, sexual sensitivity is on a whole different plateau much below the importance of severe maternal and neonatal mortality and morbidity.  If anybody actually put it up on the same plane, I would hope they wouldn't have any kids for the kids sake.  Although I do find it interesting, and I haven't mentioned this yet, that the second reason doctors prefer a cesarean for themselves, after general pelvic floor trauma concerns, is sexual dysfunction.  Of course, the two are tied together, but its still the same question of, what do they know that we don't?  Why is this the secondary concern that pushes them towards and elective for themselves?
Helpful - 0
7965686 tn?1396910229
Also if altering the "tight fit" you and your wife currently have, was the least of your concerns, you would not be commenting on it or assume every post talking about vaginal vs surgical was referring to sex after labor.
Helpful - 0
7965686 tn?1396910229
I said nothing in my last post that involved sex. That was not what I ment either. There are complications in vaginal delivery, just as there are in surgical. You assumed I was speaking about sex. If I gave birth and had a problem with my pelvic floor I'd probably have surgery too, heck if I could afford it I have a breast lift too, but that's not the direction you took this discussion.  
Helpful - 0
13167 tn?1327194124
JMV,  I've enjoyed this conversation a lot and it's been informative.   But  "My wife and I" is how you say that, not "me and my wife".  ;D  *snark*

Here's the deal.  Human females are at the absolute edge of what they can push out of their birth canal.  As human heads get bigger and bigger,  birthing becomes harder and harder.

For those who believe the Adam and Eve story as an allegory,  at the time when humans evolved into creatures who could tell right from wrong,  our hippocampus became so big that women were in terrible pain in childbirth.  So when Eve developed the ability to know morality,  childbirth would be horribly painful.  We walk upright,  forcing our bodies to develop systems that hold the babies in unlike mammals that walk on all fours and their babies aren't about to drop out due to gravity as ours are.  

So yes.  Vaginal birth is traumatic in a way that it's not traumatic for other mammals.  Cesarean sections are traumatic also.  

I think if a "hot dog down a hallway" were the typical experience of couples,  though,  word would have gotten out and no one would have kids anymore.  I think it's rare.  
Helpful - 0
9832901 tn?1406249569
My mom had 11 children all natural. Her body is perfectly still normal even at 46!!! I hope all goes well in the process..
Helpful - 0
Avatar universal
You just sound like a person who doesn't show much emotion and such and that's fine. But you will not be able to escape emotion when you have kids. But to be honest there is nothing better in this world to deliver my baby and put it right on my chest and watch my boyfriend cut the cord. Maybe that's not important to you but to most of us woman on here its priceless. We were just telling you our experiences, real life experiences take it or leave but don't sit there and tell us we are wrong when we went through it first hand.  
As far as your major scare the health of the pelvic floor muscles I am on baby 3 my muscles are great its like I have never had kids. But I work it that helps too. I don't pee myself ever and I don't poop myself either. I know no one who has these issues after having a baby. They a rare.  
Good luck on your quest to find your answer
Helpful - 0
Avatar universal
"It seems to me your focus is on the risks of vaginal, and making light of the risks of surgery."

I wish I hadn't ever mentioned the vagina thing.  It is very low on the list of priorities, and nothing compared to mortality and severe morbidity.  That being said, it is a minor concern for both of us.  Its a very small data sample, but every guy I have ever talked to about it says "it's a hot dog down a hallway."  Did any of these women try to do pelvic floor exercises at all?  I don't know.  But increased vaginal laxity, per the studies, not the guys I've talked to, is basically inevitable to some degree. And depending on what has happened down there, pelvic floor exercises are not going to bring things back to before.  Me and my wife have even talked about that aspect though (we are about as open as they get), and she would be open to tightening surgery if ever necessary.  Wow did I probably just **** some people off.  But that's out of her mouth, without, I swear, any pressure in the conversation from me.

Men get blasted for this one (my favorite comment from women is "he just has a tiny *#*$@" which ignores the reality of an increase in laxity.  Or maybe "my husband says its fine," as if any guy who wasn't a complete $*^& would say "actually its a lot looser now."), but its a two way street.  Me and my wife have a very nice tight fit, and it would be a tragedy if that was blown away forever.  I'm not the only one of us that feels that way.

Once again though, that is the least of my concerns.  An elective cesarean has almost a twofold protective effect against organ prolapse.  And it skips the possibility of an assisted delivery, and the incontinence risks associated with that, or even worse an emergency cesarean delivery.  THESE are the reasons I find it more attractive; it has nothing to do with increased vaginal laxity.
Helpful - 0
7965686 tn?1396910229
Having had conversations with my Dr about vaginal vs c-section, you will most likely be getting the response that you're trading one set of risks for another. There are riskes in both forms of delivery. It seems to me your focus is on the risks of vaginal, and making light of the risks of surgery.  Where as you really should concider the risks of both with equal measure. You have gotten first hand accounts of what we, as mothers and women, have personally experienced during child birth. Both good and bad experiences I might add, and then tell us that our accounts are not good enough because we have not taken the time to produce a large clinical study. Well my question to you is, where do you think the information for theses studies comes from? It's comes from women recounting their labor experience to said researchers. You have a bias towards c-section, that is very evident in your arguments, however you can't just claim that the women on here do not understand or know nothing about the riskes of childbirth when we have all experienced it, many of us on more than one occasion. We have all talked to other mothers and gotten their experiences; some good some bad. We don't need clinical studies, ment for medical students to do extensive research papers to tell us what could go wrong. Yes, numbers have their use, but are they so important that it negates first hand accounts given from those who have gone through it? You may think they do, but I personally see fault in numbers. I think most women on here would agree with me.
Helpful - 0
Avatar universal
"What does your wife think of all of this?"

She actually always used to think that an elective would be what she wanted to do.  She's open to the debate, but obviously she isn't really interested in researching it herself.

Like I said above, my plan is to bring it up with the doctor, have a conversation about it, and then walk away.  I suppose there are three scenarios; the doc says its actually safer for somebody only having one pregnancy, the doc says its a wash with some risks traded for others, or the doc says its more dangerous for both mother and child.

If after an in depth conversation, the doc actually says its safer, I doubt my wife will think twice.  If the doc says they are a wash, well that will definitely lead to more discussions with my wife I'm sure (with, as I've said, her being the ultimate one in charge of the decision).  If it turns out everything I've seen is somehow just flat out wrong, and it is more dangerous, I'll be shutting up on the spot for good.

The thing is, from what I have seen, it is more debatable than what most people assume.  For people wanting a large family?  Absolutely not: many of the serious risks of a cesarean nearly double for each one you have.  But for people wanting one or two kids, its more of a debate.

After all, so many obstetricians do it for themselves quietly.

Excited for the appointment.  Interested to see what the childbirth conversation is like, if we even get into that at all.  And I will share whatever happens.

Regarding the early, very temporary, bonding time.  Are you actually trying to say that all of us cesarean children actually lack something fundamentally important that we were deprived of after birth?  I am just tempted to reply to that with, give me a break.
Helpful - 0
Avatar universal
after reading through all of this..i cannot believe that you have just had a positive test n think that you can do a little research and know more than "a bunch of pregnant women" You talk like you are the most intellectual being on the planet..yet you post on a pregnancy forum fir 25-34 year olds and dont expect to hear responses from pregnant women?!There is nothing anyone will say to you, you clearly have your mind made up..I just think that right now you would be better off looking into morning sickness/constipation/heartburn cures..your wife will probably not be in the slightest interested in you spouting statistics with her head down the toilet for the next 3-4 months..but then again im just a pregnant woman..and mother for 8 years..what would I know?!
Helpful - 0
1905116 tn?1444425264
As a small "disclaimer" for my previous comment...I have no idea of the stats on post op infections!! The risks could be tiny. I'm simply more aware of them because of my job. However, if you like to be well informed, it might be something for you to consider looking into. I would imagine your hospital should publish these stats on a yearly basis.
Above all, be a supportive partner, that's all your other half needs right now, remember to listen to her hopes for childbirth too and don't railroad her into your way of thinking, have grown up discussions and come to an agreement together.
Helpful - 0
Avatar universal
And also I mentioned evolution to the fact that female species do not have c sections and have offspring just fine.
And yes you should had known we are all pregnant women you are on a pregnant woman forum. I work in health care I am not totally incompetent. But real life is usually better than research.
You sound like a cut and dry type of person but there is a flaw in your research/argument you didn'tdo the proper reresearch for both sides.
Helpful - 0
Avatar universal
Maybe it is because you are a man but there are statistics out there stating that a lot of times c section babies do not breast feed as quick or as well as a vaginal birth baby. And yes bonding is important for baby and will be important to your wife. All of us go through a sort of shock after having a baby that is a shock of seperation.
What does your wife think of all of this? It seems like you may be potentially taking important bonding time away from her. Newborns take comfort in their moms as soon as they come out because they know our smell and voice. Do you want your babies first smell to be of someone else? Do you want uour baby to potentially stressed because its not around its mother?  Babies aren't stupid.  
Helpful - 0
1905116 tn?1444425264
Aside from all other issues raised in this thread, I work in a hospital laboratory and hear of many post section infections in wounds including staphylococcus aureus. This is a very serious problem if it arises and unfortunately probably more common than people would think. I would very much avoid a section unless medically necessary. But that's my personal choice (and I live in the UK where cesarean sections are discouraged, so I suppose that may also have affected my decision). I have had 3 children by the way and am looking forward to hopefully having another uncomplicated delivery with my 4th. My pelvic floor and other bits and bobs are all perfectly fine too :)
Helpful - 0

You are reading content posted in the Pregnancy: Ages 25-34 Community

Popular Resources
Get information and tips on how to help you choose the right place to deliver your baby.
Get the facts on how twins and multiples are formed and your chance of carrying more than one baby at a time.
Learn about the risks and benefits of circumcision.
What to expect during the first hours after delivery.
Learn about early screening and test options for your pregnancy.
Learn about testing and treatment for GBS bacterium.