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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.
"This is something you just cannot and should not plan for by just getting a positive pregnancy test. So many things can happen during a 9-10 month pregnancy."
Of course. We might end up with a planned cesarean no matter what. This discussion is only applied to whether or not a maternal request cesarean is a reasonable option for an uncomplicated pregnancy.
While I may be a bit ahead of myself, I prefer to be well informed, and if this pregnancy goes to fruition (80-85% of pregnancies will), 8 months is going to fly by.
I'll have to share what happens with the doc on Wednesday. Should be interesting. Maybe my entire argument will be effectively shot down. In that case, I'll let you know what I had wrong.
No matter what though, I'm excited for the apt., and excited at the thought of being a dad :)
Of course. We might end up with a planned cesarean no matter what. This discussion is only applied to whether or not a maternal request cesarean is a reasonable option for an uncomplicated pregnancy.
While I may be a bit ahead of myself, I prefer to be well informed, and if this pregnancy goes to fruition (80-85% of pregnancies will), 8 months is going to fly by.
I'll have to share what happens with the doc on Wednesday. Should be interesting. Maybe my entire argument will be effectively shot down. In that case, I'll let you know what I had wrong.
No matter what though, I'm excited for the apt., and excited at the thought of being a dad :)
I was hoping to see some medical personnel weigh in on their opinion. I didn't know that I would end up talking with a bunch of pregnant women.
"You are totally ignoring ACTUAL womens experiences, and sticking by your statistics which is just not making any sense to me."
No, I am ignoring the majority opinions here because they are a small data sample, whose biases have not been determined. My information is based on randomized and controlled studies of thousands of women, on everything from satisfaction with birth experience to types and frequency of mortality and morbidity.
You're trying to tell me the opinions of a few women in this discussion is the better set of data to go off of? Whose to say the women posting aren't tilted towards the die hard natural birth crowd?
No, I am ignoring the majority opinions here because they are a small data sample, whose biases have not been determined. My information is based on randomized and controlled studies of thousands of women, on everything from satisfaction with birth experience to types and frequency of mortality and morbidity.
You're trying to tell me the opinions of a few women in this discussion is the better set of data to go off of? Whose to say the women posting aren't tilted towards the die hard natural birth crowd?
Yes, but there are no evolutionary selective pressures against moderate or severe incontinence and organ prolapse in later life. As long as you cranked out and raised all the babies you could, nature has no reason to make these problems go away from an evolutionary standpoint. And as far as the vagina being able to handle it, I turn again to the obstetrical dilemma. If there were a benevolent god, childbirth wouldn't be such a potentially dramatic and traumatizing experience. (notice I did say potentially). Our difficult childbirth is a product being smart. Unless you want to tell me that god actually decided to punish women this much for eating an apple.....
And maybe its because I'm a guy, but I will never understand why the birth experience / a few hours of missed bonding should be high on the list of concerns. Its a very temporary thing. Me and my sister are both cesarean babies. Is somebody going to try to say that we, and all cesarean babies, are fundamentally missing something by losing a few hours of bonding? Or that my mom somehow missed out on something fundamentally important even though she has been our mom for 30 years now?
And this is all ignoring the fact that, once again, a nulliparous woman at 42 weeks has around a 1/3 chance of having an emergency cesarean anyway. And as far as satisfaction with birth experience goes, it goes uncomplicated vaginal, elective cesarean, assisted vaginal, and emergency cesarean.
- Mr. Statistics
And maybe its because I'm a guy, but I will never understand why the birth experience / a few hours of missed bonding should be high on the list of concerns. Its a very temporary thing. Me and my sister are both cesarean babies. Is somebody going to try to say that we, and all cesarean babies, are fundamentally missing something by losing a few hours of bonding? Or that my mom somehow missed out on something fundamentally important even though she has been our mom for 30 years now?
And this is all ignoring the fact that, once again, a nulliparous woman at 42 weeks has around a 1/3 chance of having an emergency cesarean anyway. And as far as satisfaction with birth experience goes, it goes uncomplicated vaginal, elective cesarean, assisted vaginal, and emergency cesarean.
- Mr. Statistics
This is something you just cannot and should not plan for by just getting a positive pregnancy test. So many things can happen during a 9-10 month pregnancy. When it comes time all this research and statistic stuff is going to fly out the window. If you were a women, you would understand how each pregnancy is SO different. There are some places for statistics but pregnancy/birth is not one of them. There are too many depending factors.
You are totally ignoring ACTUAL womens experiences, and sticking by your statistics which is just not making any sense to me. There are SO many women (almost all of them who have had C section or both) who will say they would pick vaginal birth over c section any day! Also, mommy and baby are going to be tested and monitored throughout the whole pregnancy. So if something is wrong the DOCTORS will be able to make the right decision regarding the birth plan. Just calm down on the statistics and see how your wife and baby will do during the pregnancy. If all is well then there shouldn't be too much risk for a vaginal birth.
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