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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.
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.
"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.
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.
PS: I agree with "My wife and I." At least, when I'm smart that's how I say it :)
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.
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.
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.
"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?
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?
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.
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