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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.
"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.
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.
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?!
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.
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.
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.
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.
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.
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.
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 :)
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