Maternal Request Cesarean - A Reasonable Option?

[jmv147]

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.

[River_Melody]

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.  

[RockRose]

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.  

[Nique5683]

My mom had 11 children all natural. Her body is perfectly still normal even at 46!!! I hope all goes well in the process..

[mw89]

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

[jmv147]

"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.

[River_Melody]

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.