Pregnancy: Ages 25-34 Community
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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
Avatar universal
A vaginal delivery is almost always less complicated and less traumatic for mother and baby. I would never choose a cesarean. There's nothing wrong with my pelvic floor because I've had a vaginal birth already, in fact my husband says if feels even better now. Having a major abdominal surgery sounds horrendous on top of recovery from pregnancy and having to take care of a newborn. I would suggest, sir, that you sit back and let your wife decide for herself how she wants to take her journey into motherhood.
Avatar universal
Wow, looks like you've given this a lot of thought. Where I am they encourage all women to do kegel exercises no matter how you deliver so maybe that might be something your wife can look into if thats a concern to her. Otherwise I wish her luck on whatever way she chooses to give birth.
13167 tn?1327197724
I think you've got some misinformation in there.

There are three c -section possibilities:  planned,  unplanned and emergency.

In an unplanned, the woman has labored and somewhere in the labor it's decided that a c section will be needed.  An epidural or spinal is done,  and she is wheeled into the delivery room accompanied by her partner.  

In an emergency c-section,  it's bedlam.  Suddenly the baby has got to get OUT NOW the way you'd yank a baby out who had fallen into a swimming pool.  They're extremely rough and do have more risks and complications due to the race against the clock - about 3 minutes.

I would be curious where the stat comes from that obstetricians would choose c sections for themselves.  I haven't seen that,  and in fact I do know a number of female OBs who have delivered their babies vaginally or been induced.
9445847 tn?1408063355
Obs opt for c sections because they cost more, so they get paid more. I'm sure they dont care that much about a woman's vagina. Women have been giving birth vaginally for hundreds and thousands of years. You also have to get an epidural during a c section which can cause back problems but I've had a vaginal birth with my first and my vagina is the same as its ever been.  My hubby h a s no complaints about it being too "relaxed" which is one of your concerns. I am terrified of having to have a c section because of the scar, I want to breastfeed asap and I can't imagine being cut open. Morbidity and mortality shouldn't be something to focus on if you live in the U.S. because there are thousands of Dr's that deliver hundreds of babies a year and I doubt they would let anything serious happen to your wife. So the question is are you worried more about what happens to her vagina or worried about what happens to her during birth? The internet is a horrible place for information. I wish you the best of luck!
13167 tn?1327197724
I found a fairly comprehensive article,  written in the UK.

Apparently about 33% of OBs in the UK would prefer a c section for themselves,  and about 50 % of OBs in the US would prefer that for themselves.

Additionally,  about 50% of women who go into labor planning to have a completely natural birth without forceps,  induction or c-section achieve it.

Avatar universal
I think he's just worried about the condition of her vagina (sexually) after a vaginal birth. Women have been giving birth vaginally since forever...and are fine!! Let her decide.
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