Doctors warn of alarming C-section 'epidemic'

https://www.dw.com/en/doctors-warn-of-alarming-c-section-epidemic/a-45856378?maca=en-RSS_en_Flipboard-9487-xml-media

by walterbell • 8 years ago

131 180 8 years ago

jsoc8153• 8 years ago

Find it interesting that the article seems to place the blame on the women, when it's long been said that the docs and hospitals, ever in search of time compression and profits, were encouraging c-sections versus vaginal birth. That, to my knowledge, is the likely cause of the procedure appearing "fashionable" and "modern."

siculars• 8 years ago

Blame definitely on the docs (liability). That being said, most new obgyns are women. So ¯\_(ツ)_/¯.

DoreenMichele6• 8 years ago

I actually think it is probably more insidious than that. We have a lot fewer full-time homemakers. Women are much more likely to have paid jobs.

The only way to schedule the birth is by scheduling a C-section. Waiting for the baby to show up when it decides to do so is a very organic, let nature take its course, humble thing to do and it is pretty alien to how most people live these days in developed countries.

Historically, we farmed. We had to figure out how to respect nature and work with it. Most jobs today don't really do that. We think we are in control.

cellis• 8 years ago

Actually historically, we foraged and hunted. After reading Sapiens I’m convinced that farming actually set humans on the path towards this very suffering. Large scale war, famine and pretty much every post agrarian revolution ill, is a direct consequence of having food surpluses.

ant6n• 8 years ago

Civilized countries have parental leave, where this is not an issue.

jsoc8153• 8 years ago

The only way to schedule the birth...

Wow! Hadn't considered that at all. But, yeah, I guess, that would align w/ some other things I've heard(, but never actually experienced). Yikes!

We think we are in control.

Yeah. (Thriller laughs)

(edit) Btw, one of my college profs used to send a lot of time in rural India. He said women there would go into labor while in the field, leave and give birth, and then pretty much return to work immediately.

sambe7• 8 years ago

Are you talking about the US? Many countries with state/cheap healthcare also have high rates (Europe).

In the UK, I’d say there’s a bias towards “the natural way” (not offered epidural, counselling for elective CS, NCT antenatal courses tend to focus on natural methods etc). Eg https://www.rcm.org.uk/news-views-and-analysis/analysis/mate...

ertand4• 8 years ago

I wonder what its correlation with induction is. Artificially inducing labor does not tend to give the body enough time to adjust and progress.

sambe7• 8 years ago

I don’t think c-section after successful induction is common. There are some number of failed inductions (i.e. nothing happens) which result in c-section. Bear in mind that this is generally done - like the original induction - because “giving enough time” after 42 weeks costs lives.

This review finds the rate is actually lower after induction, contrary to popular claims:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049989/

KaiserPro5• 8 years ago

[citation needed]

induced labour happens in so many different ways, that broad statement is not going to fly.

Also there are many way to induce labour, none of them are quick. Some take a few hours, others days.

For example a "sweep" is where someone goes in and stretches the cervix, with their hands. There are pessaries too. None of it is quick.

ertand4• 8 years ago

Sorry for not being clear, I was specifically talking about pitocin level induction.

dabbledash4• 8 years ago

Elective induction of labor at 39 weeks results in a lower c-section rate than expectant management (waiting to see if labor will start naturally).

https://www.nih.gov/news-events/news-releases/induced-labor-...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049989/

Normally though, induction happens because there is some problem or because the pregnancy has gone past the due date, and in these cases your risk of a c-section is already elevated.

ertand4• 8 years ago

Makes sense. As mentioned in the comments, there are different ways of inducing labor. I was referring to usage of pitocin or similar too early in the process, instead of gradually inducing the labor with other medications. We had success with just misoprostol during our labor, but the process was quite long.

grecy2• 8 years ago

My sister-in-law just had her first baby, and got very into all of these statistics and the "medical industrial complex take on childbirth"

I believe the WHO recommends around 10-15% of births should be C-Section in a healthy population, but the figures in first world countries are at least 3-5 times that.

There are about 3 million stories of ladies "booking in" their birth a month or three in advance. I.e. I want my baby on the 3rd of May, lets schedule a C-Section now. It's more convenient that way. Also tons of stories of doctors wanting to go home for the weekend or to play golf, so they do a C-Section after only an hour of labor so they can hurry it up.

It's horrifying that hospitals will market a "natural birth" as anything that is vaginal. i.e. it doesn't matter how many drugs they give you, it doesn't matter what drugs they give you to speed up the afterbirth, etc. etc. It's still "natural".

harry84• 8 years ago

"natural" like half of women dead in childbirth natural?

Synaesthesia3• 8 years ago

When there are problems, you operate. Otherwise it’s preferable for natural birth for mother and baby, for reasons mentioned above.

grecy2• 8 years ago

Such a great myth that our culture perpetuates.

You genuinely think half of women are dying in Childbirth in undeveloped countries right now?

I'm in Africa typing this, and I can honestly say you have no idea.

FWIW, my sister-in-law had her baby at home, zero medical anything, just a widwife keeping an eye on things.

dang• 8 years ago

"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize." Doing otherwise leads to tedious flamewars.

https://news.ycombinator.com/newsguidelines.html

harry84• 8 years ago

This was me pointing out the word "natural" is loaded BS. Whatever one's view is on whether a baby should be delivered by C-Section or vaginally (which should depend on the circumstances, obvbiously) "natural" as a description is really silly. We aren't cave-people. We are incredibly thankful for it. We don't consider it a good thing to watch our children die and will intervene in all kinds of ways animals can't to avoid it. Anyone touting "natural" for anything, especially childbirth, should be treated with extreme caution.

Look how it's done:

If you're a fit, 19 year old mother with a healthy, correctly oriented fetus vaginal birth may be preferable to c-section.

Take "natural" the hell away from all of it. It's a sign of thinking being replaced by emotion which probably isn't a good idea if you think evidence based medicine is a good idea.

jakelazaroff• 8 years ago

Also tons of stories of doctors wanting to go home for the weekend or to play golf, so they do a C-Section after only an hour of labor so they can hurry it up.

There is a world of difference between a doctor pressuring a woman to have a C-section because it's more convenient for them, and a woman freely choosing to have one for her own reasons.

marmaduke2• 8 years ago

The lack of mention of epidural or not is a big thing I think. Among the mothers I know, epidural makes everything but the pain worse.

DanBC3• 8 years ago

It's horrifying that hospitals will market a "natural birth" as anything that is vaginal. i.e. it doesn't matter how many drugs they give you, it doesn't matter what drugs they give you to speed up the afterbirth, etc. etc. It's still "natural

That's definitely not the definition used in the UK. Normal birth in the UK doesn't include epidural but does include some other pain relief. This is controversial because epidural is probably safer.

dabbledash4• 8 years ago

We don’t have a great way of knowing the optimal c-section rate. But plotting national c-section rates against perinatal outcomes (an obviously imperfect approach) shows that increasing c-section rates are associated with significantly better outcomes until about 20% after which there is no real effect one way or another.

http://www.skepticalob.com/2015/12/world-health-organization...

I’m not sure why it would be “horrifying” what kind of birth a hospital labels natural. It’s all bullshit anyway. No births in a hospital are like births in nature, which is why so many more babies survive the experience these days.

empath75• 8 years ago

My wife had a natural child birth with just a shot of pitossin at the end for the afterbirth. At a hospital. No medication at all other than that, not so much as a Tylenol.

v_lisivka3• 8 years ago

Instead of death of baby and mother, babies growth into mothers, with genetic incline toward same problem, so you need to add another 10-15% to account for that.

Sharlin• 8 years ago

I believe the WHO recommends around 10-15% of births should be C-Section in a healthy population, but the figures in first world countries are at least 3-5 times that.

Apparently 45% in China, 25-35% in many Western countries. I had no idea that the numbers in many countries are that high; Northern Europe (where I'm from) is evidently something of an outlier at 15% or so.

burfog2• 8 years ago

"wanting to go home for the weekend or to play golf"

That is 100% real. A friend got hurt for that purpose. In her case, it was a huge and brutal episiotomy. The moment the kid was out, he ran out to play golf. Another friend got just about exactly the same, but because the doctor's house was flooding.

Doctors are human. Humans are often uncaring or even evil. Customers get dehumanized, like mechanical widgets on an assembly line in a factory.

lostlogin6• 8 years ago

Where has ‘at least’ a 75% C-section rate (5x 15%)? That is alarming.

harry84• 8 years ago

Ok so no mention of the health implications of so called "natural" childbirth, which aren't trivial and have an increasing risk as your age. No mention of the rising age of mothers in wealthy countries. No mention of different trade offs for fit 19 year olds and less active 35 year olds. A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives. Word gets around and it undermines trust in doctors advice when they don't even mention the issues. A higher proportion of doctors make the c-section choice. They're kind of educated, doctors, less likely to be bullshitted into higher, unnecessary fees too.

But you're not an idiot so you want the actual numbers. So did I. Not available, no research done and/or no doctors know of it and can hand you print outs of the papers.

So much for evidence based medicine... There's an epidemic of women not just doing what they're told! FFS Lancet. How's their credibility nowadays? Taking hits?

sergers• 8 years ago

"A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives."

Not specifically only for those reasons, my wife always wanted a c-section birth due to the risks with vaginal birth and recovery times.

vladgur• 8 years ago

I would imagine the recovery times for c-section are longer

wsc981• 8 years ago

In Thailand a lot of woman prefer C-section in order to choose a lucky day for the birth of the child [0].

---

[0] http://www.nationmultimedia.com/detail/national/30355415

paavoova• 8 years ago

Women have been giving birth since creation with minimal enough problems for humans to survive and succeed as a species - it absolutely is natural, no idea why you put that in quotations. Why stop at C-sections? Raise them in test tubes a la Brave New World, skip the biological process entirely. After all, it's much safer, quite possibly even zero risks on the woman's part.

The thing with C-sections is that until fairly recently, children weren't inoculated with the mother's vaginal canal microbes. Now they know better and do a smear, but that means many children failed to receive a proper immune boost when they needed it most. There's an growing body of evidence that suggests early microbial exposure is required for proper immune development and function, and that the lack of this exposure is linked to allergies and other self-inflicted immune diseases. I can't speak of any data off the top of my head, but perhaps the doctors recommending against C-sections are aware of decades of data on C-sections and childrens health?

rodgerd• 8 years ago

Women have been giving birth since creation with minimal enough problems

This bears no resemblence to the actual history of childbirth.

isostatic3• 8 years ago

At a species level yes, childbirth works fine.

Before the modern era deaths of both child and mother were very high (10%+) when giving birth.

That said, the U.S. approach to childbirth is clearly not working, with childbirth deaths at 3 times that of Canada, and higher than the rest of the developed world.

KaiserPro5• 8 years ago

There's an growing body of evidence that suggests early microbial exposure is required for proper immune development

Yes. But that's not linked to "seeding" which doesn't have any conclusive evidence to back that up(yet) compared to colostrum/breastfeeding[1] I'm aware of one study that has tried seeding. It's hypothesised, but needs much more research before being counted/discounted

Women have been giving birth since creation with minimal enough problems for humans to survive and succeed as a species

Yes, but up until decent, clean deliveries with the option of c-section, and anti-biotics child birth killed 5% of mothers[2]. Bear in mind that without birthcontrol (pills or condom) most women would have about 6 pregnancies in their life time. [3] my bad maths makes that a ~1/4 chance of dying in childbirth/complications arising from.

The study that link obecity and asthma to c-section is small[4] however it is worth widening and expanding to more than scotland. Brazil would be a good target as 50+% of births are c-section.

[1]https://www.nhs.uk/news/pregnancy-and-child/breast-milk-rais... The only link I could find that wasn't selling something (either hippy nonsense or a drug)

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/

[3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865739/

[4]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055095/

TL;DR: 5% of child births were fatal to the mum, modern medicine has made that drop to <0.1%. There is some evidence that you might be fatter if you were born by optional c-section. However this is a limited study in one country.

dabbledash4• 8 years ago

Real natural childbirth involves “minimal enough problems” if you don’t particularly value the lives of individual babies, a significant minority of whom would die during birth or late pregnancy if we just let nature take its course.

And putting “natural” in quotes is entirely appropriate when discussing most vaginal births, even drug free vaginal births, in the first world. There’s nothing natural about 9 months of prenatal care and monitoring, careful observation of the fetal heartbeat during labor, prophylactic administration of antibiotics to women with group B strep, early delivery of women with gestational diabetes or pre-eclampsia, and the availability of c-section any time labor starts to go south. The women who end up delivering vaginally have very good outcomes, in part because a bunch of “unnatural” interventions before the moment of delivery weeded out all the women and babies who would not have done so well. If you want to see what real natural childbirth looks like, you can look at the maternal and neonatal outcomes in countries without modern health care. It’s not pretty.

We need to stop using the world “natural” as some kind of signifier for goodness. “Nature” doesn’t care that lots of tadpoles or lion cubs, or salmon fry don’t make it, and it doesn’t care that lots of human embryos miscarry or lots of babies die in birth. WE care about human babies, and so intervene.

Also, is there some reason we wouldn’t gestate fetuses in artificial wombs if that was safer for women and babies? Are we just obliged to suffer and risk our lives for no benefit? Because it’s “our place”, I guess?

jobigoud• 8 years ago

If we perfect the art of surgery to a point where it's painless/seamless/benign it won't even be a question, it seems so much more efficient and clean. Open, extract, close.

Synaesthesia3• 8 years ago

There are a number of factors which make natural childbirth better, the mother recovers much quicker, a day or two vs weeks. There are things that happen during vaginal childbirth with hormones released by mother and child which do not happen with c-sections, like the bacteria which transfers from mother to child which is essential for gut function.

The baby is also prepared for birth during the process and is more awake and able to suckle faster with natural birth.

https://www.mamanatural.com/natural-birth/

sambe7• 8 years ago

The second paper of the series does review and compare several aspects in comparison to natural birth:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

iforgotpassword3• 8 years ago

OTOH, you seem to argue that since you couldn't find any papers on that, doctors and media must be lying and c-section is just better. That sounds an awful lot like the typical conspiracy theorist.

A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives.

I heard of that child once that died after it got the flue shot. We all should stop vaccinating now.

jayalpha• 8 years ago

Sorry for being naive but:

"A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives. "

Is this a real risk of vaginal child birth? And how risky is it?

iforgotpassword3• 8 years ago

Yes, vaginal birth increases the risk compared to c-sec. However unlike what GPs wording suggests you don't go full throttle like a toddler learning to sleep without a diaper, it's more like a few droplets. If you had it during pregnancy already, chances are higher it'll continue after birth. In most cases it stops after a few weeks, but it can be permanent, so it will happen every now and then, when you're sneezing hard etc. You can get it under control with exercising.

You can look up further information from your country's health institutions, usually including numbers on how prevalent it is where you're from. Being older when giving birth, being obese and some other factors do increase the risk.

SolaceQuantum• 8 years ago

This is a real risk of vaginal birth. Long term complications of vaginal birth are not usually studied (this may be related to an ongoing issue in the medical community in failing to address women’s health). For example, painful sex has been reported in a quarter of women 18 months after birth. Painful sex is common in 90% of women in the shorter term after giving birth. Women overwhelmingly experience at least one complication within 6 weeks after birth and are recommended to wear adult diapers as the uterus continues to expel. Women also report at least one long term health complication about a third of the time. (https://en.m.wikipedia.org/wiki/Postpartum_period)

(Edit: this doesn’t differentiate between vagina and c-section, but for example I’ve seen in passing that vaginal birth causes more issues with incontinence and painful sex)

kdowining3• 8 years ago

The majority of incidence of female incontinence is attributed to child birth. It's a very high risk that no one like to talk about...mostly because who cares about women? And who cares if they pee themselves for the rest of their lives? They're alive aren't they?

I'm not joking, when I talked to my doctor about this they totally dismissed this concern in a manner that suggested that women should just be fine with a diminished quality of life after child birth. That that's just the way it is and should be and if you don't like it, then don't have kids.

snapit• 8 years ago

My opinion based on living with a midwife for most of my life. Not fair to blame the women for this The reason is more to do with the doctors or medical staff being cautious about complications from a normal birth than caused by the preference of a women for chosing a c section.

basicplus2• 8 years ago

Thats nothing.. perth western australia has been the csection capital of the planet

Heres 2012 figures

https://www.birthsavvy.com.au/caesarean-section-rates-perth-...

lathiat• 8 years ago

Hello from Perth. Just recently had our daughter at SJOG Murdoch but was not a Caesar. However we went with our obstetrician partially because he was less likely to push towards Caesar and that ended up being our experience. He was happy to wait and deliver late.

We had some non trivial complications though from going natural.

There was however clearly a high rate of those around us but I think basically it’s one of the more well known private hospitals for people to visit where you get the choice so plenty of people are just choosing to go that way for various reasons. also we are 30 but most of the people in our prenatal class were older except one.

sambe7• 8 years ago

Several papers were released as part of a series, and are available currently in full text form:

https://www.thelancet.com/series/caesarean-section

The more sensational language being reported appears to come from the FIGO position paper rather than the research. I’m not sure about the relationship between the two but they look to have been published together.

danw1979• 8 years ago

Women feel enormous pressure (at least here in the UK) to give birth naturally, from both their peers and health professionals.

How a baby is delivered is none of anyone's business but the mother herself.

My wife (an epidemiologist) deliberated for months over having our second by VBAC (vaginal birth after csection) and opted to go for it, due to the overwhelming expectation from everyone around her that she should do it naturally, and despite having read an Australian study indicating higher rates of stillbirth during VBAC [citation needed]. Sadly, our daughter didn't make it through the labor.

Needless to say, the csections that safely delivered my first, and recently (yay) third children seem like a miracle of modern medicine to us both.

Even before this personal tragedy, I was astounded by the sheer force of opinion surrounding the cesarean section and childbirth in general. This is creating an environment where women are not able to make their own choices and I fear that the doctors in this article, however well meaning, by warning of an "epidemic" are only adding fuel to this fire.

DanBC3• 8 years ago

James Titcombe and others are campaigning pretty hard on this. Women need to be given correct information, but their wishes also need to be respected.

These campaigners have persuaded the CQC to stop pressuring trusts over rates of C-section or normal birth, and to get the NMC to stop paying normal birth so hard.

qrbLPHiKpiux• 8 years ago

How a baby is delivered is none of anyone's business but the mother herself.

Try telling that to some of those here, in the US. The mantra is "do what I say, not what I do."

Angostura• 8 years ago

How a baby is delivered is none of anyone's business but the mother herself. I'm sorry for your loss.

Caesarian's costs the NHS around £1,700 a time compared with £750, for a normal childbirth and women also stay in hospital for twice as long on average. There is a general presumption in the UK that avoiding what is an invasive operation is preferable for both baby and mother alike, in the absence of other factors.

I would argue that clearly How a baby is delivered is other people's business since other people are involved. However the ultimate choice should be the mother's.

pbhjpbhj2• 8 years ago

Vaginal delivery is associated with better outcomes for the child too. IMO that makes it not strictly the mother's choice. Indeed surgical procedures should never be entirely elective.

isostatic3• 8 years ago

Nobody gives a stuff about the cost, you'll get the same pressure if you plan to deliver privately.

There's fewer than 700,000 births a year. If every one was a c-section it would cost an extra £700m a year, less than 1% of the NHS budget.

NICE guidelines state that the woman should discuss the pros and cons and then it's her choice.

TheCoelacanth• 8 years ago

£950 for something that occurs once per lifetime seems extremely negligible.

monocularvision2• 8 years ago

I would argue that clearly How a baby is delivered is other people's business since other people are involved.

This is one major reason to oppose publicly funded health care. _Every_ decision becomes a public one.

oculusthrift• 8 years ago

and that’s why we don’t want socialized healthcare in the US. because it shouldn’t be other people’s business

gdubs3• 8 years ago

Sorry for your loss. And I agree on the pressure around birthing choice. My wife just delivered our 3rd child, and at this point we felt confident in our choices. But the birthing class we attended before our first child was born was full of fear, pressure, and pseudoscience.

thrower123• 8 years ago

There is an unbelievable amount of woo marketed at first-time parents. I suspect its a bit of an artifact of smaller family sizes, so that there is less practical experience in general circulation. I wish my grandmother who had nine children and a dozen or so pregnancies was still alive be a source of advice.

b_tterc_p• 8 years ago

I feel doctors should be allowed to refuse alternate procedures that heighten risk for the patient.

lostlogin6• 8 years ago

That is an incredibly slippery slope. Apply it to other healthcare scenarios, particularly pregnancy, and it’s got a poor track record. Take this thalidomide, keep this pregnancy etc etc.

gcb0• 8 years ago

contributing to your social critic on everyone having an opinion; why not see the first c-section as the root of the problem?

Herodotus38• 8 years ago

They may not have had the option to avoid the first c-section, depending on the circumstances of the first pregnancy.

Spooky23• 8 years ago

I’m very sorry for your loss - my wife and I went through this and it was very difficult and awful, especially when you rationalize or question choices presented to you.

In the US, there are a couple of tiers of pressures and thought process. People make these choices from reasons varying from the medically advised, to cosmetic, to schedule based, to something else. Some people make choices for trivial reasons that are disturbing to the doctors who are placing people at risk, at their direction.

I think the medical concern is that there are more complications, the less informed people tend to correlate to folks who are less able to care for themselves afterwards in recovery and overall risk of anesthesia and other things.

jessaustin5• 8 years ago

Very sorry for your loss. After her first C-section, a relative of mine was told by her physicians that all subsequent births should be the same because that was safer. It's interesting how the standard of care varies between nations.

lostlogin6• 8 years ago

Standard of care may not be relevant. Stats are great for making policies to improve population health and wellbeing, but when you are the one in a million to whom a rare and catastrophic event occurs despite best practice, where does that leave one?

paulddraper• 8 years ago

How a baby is delivered is none of anyone's business but the mother herself.

* It's the doctor's concern because of the Hippocratic Oath

* It's the baby's and therefore father's concern (but not choice), since vaginal birth is correlated with better outcomes.

* If insured, it's the insurer's concern, as it's over twice the cost of vaginal delivery. (In the case of the UK, this is the government, so literally everyone.)

throwaway1391• 8 years ago

I see a lot of people in this thread idly sniping talking points on the benefits of vaginal delivery, insurance/costs, etc. - illustrating the point in your last paragraph.

My son and wife's lives were saved by a C-section three weeks ago. Watching that fetal heart rate monitor dip to zero and then slowly, unsteadily rise back up over and over again was the hardest thing I've ever done. The hospital staff pushed us to do a vaginal birth the whole time. I understand and appreciate what they did, but at the same time I hope there is a better way, because in hindsight I would have never put my wife and son through this again.

This isn't a programming language preference. If you don't know the details of clinical practices around C-section, if you're not an expert or a patient, then you really shouldn't be pushing your opinion on others. Refrain.

kleopullin• 8 years ago

I'm very sorry for your and your family's loss.

In the information age, there are so many irresponsible and incomplete bits supporting this, that or the other in as many superlatives as possible. What can a person do? I thought that VBAC was more dangerous for the mother than the newborn, for a healthy young woman, coupled with even a tiny amount of pressure this could easily lead people to make a decision they were not really comfortable with. The "sheer force of opinion surrounding ... childbirth in general" is astonishing; I agree with you here. The information age is badly curated and gives far too much weight to the inexpert opinion, imh (and non-expert) o. Mothers must give birth naturally, mothers must nurse their infants for x months, fathers must cut the umbilical cord.

All the modern medicine in the world coupled with the power of the information age can't make these decisions for us. Maybe, in the future, machine learning methods can pull relevant information out for people to counter some of the cultural pressures.

SigmundA• 8 years ago

This really seems like one obvious way in which we are effecting our own evolution and would not be surprised if in a short time (on an evolutionary scale) that humans will require c-sections for successful birth.

This may not be a bad thing, the reason child birth is so difficult for humans vs most other animals is our head size vs the female pelvis. C-sections bypass the evolutionary constraint allowing more large headed babies to smaller pelvis women which could allow greater head size and perhaps even more intelligence.

https://en.wikipedia.org/wiki/Obstetrical_dilemma

aklemm• 8 years ago

Do babies with too-big heads regularly die at birth if C-section isn't available?

evgen• 8 years ago

In the world of modern medicine where complications like this would lead to an immediate c-section? No.

Roll the clock back a couple of centuries or so and both mother and child would die.

analognoise• 8 years ago

Yes, and it can kill the mother as well.

I don't have statistics, but my wife and/or son wouldn't have made it without a csection.

stordoff• 8 years ago

As far as I know, no, because emergency Caesareans are available (I was an emergency Caesarean - my mother was told I was 'small', and I ended up being close to 13lbs[1]), but it can cause other complications - my sister still has a small scar from a forceps birth, and the recovery time was longer for my mother.

[1] The entire pre-birth care was flawed - at one point they couldn't find a pulse for over 24 hours and they were telling my mother to induce labour (because I was dead...).

Edit: spelling fix

JauntTrooper• 8 years ago

French bulldogs mostly can't have natural births. 80%+ of the births are c-sections.

tinbucket• 8 years ago

They've been specifically bred to exaggerate characteristics that are not healthy. The predominant result is brachycephalism which causes breathing and heat regulation issues amongst other things. This is also why they can't give birth naturally.

JoshMnem2• 8 years ago

I think it's more likely that it's a bad thing. Babies are supposed to get seeded with microbes, which probably affects the immune system.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

civility• 8 years ago

There's probably some truth to this, but it doesn't take much imagination to imagine how the babies could be "seeded" after a C-section birth.

jarvist• 8 years ago

It is believed that this is already happening: "The regular use of Caesarean sections is having an impact on human evolution" https://www.bbc.co.uk/news/science-environment-38210837

notimetorelax• 8 years ago

If there is indeed a causal relationship, then the only alternative was not to let those parents be born through c-section. We anyway already heavily depend on medicine for our survival.

rayiner• 8 years ago

Relevant counterpoint: http://www.skepticalob.com/2018/03/what-if-c-sections-are-be....

The article doesn’t actually say why C sections are bad, it presupposes that fact, and assumes that rising C section rates must indicate some sort of “epidemic.”

gdubs3• 8 years ago

This page from the university of Utah suggests that C sections have a higher mortality rate, and are more expensive — while necessary in roughly 15% of deliveries:

https://healthcare.utah.edu/the-scope/shows.php?shows=0_w7uq...

Edit: This Time article points out that while maternal mortality rates have dropped significantly worldwide, they have actually risen in the US by 27%. They list numerous possible factors, a rise in unnecessary C Sections being one of them:

http://time.com/4508369/why-u-s-women-still-die-during-child...

amykyta• 8 years ago

I would describe that post as propagating junk science. It’s cherry picking stats and skewing them. Odds ratio difference for pelvic organ issues for women who have a C section vs natural delivery. That’s just establishing strength of association. It’s surprising that there is any association for women who have a c section. The ‘safer for babies’ paragraph makes the claim that 692 babies would be saved if 1 million women chose c-section over natural delivery. So 0.069%? I hear you about wanting to be skeptical but there is conclusive research on negative effects to children who are delivered via c section. https://www.economist.com/science-and-technology/2017/10/14/... Not to mention that it’s a massive surgery for the mother with all the inherent risks of one.

tptacek4• 8 years ago

Caesarians are way more dangerous than vaginal births. A C-section patient can die of pulmonary embolism from the blood clots from the procedure, directly from bleeding (the surgeon can nick an artery or the incision can lacerate during the actual birth), the wound can get infected (it's quite a large wound), and, of course, it's major surgery, so the anaesthesia can kill you (even if you're not all the way under; my wife had a near miss when our first was born). The risks get worse in subsequent Caesarians.

ineedasername• 8 years ago

You would think this is true, but the mortality rate for c-sections tends to be higher because they are often performed in the presence of other extreme complications that contribute to the higher mortality rate. The mortality rate for non-complication (elective) ceasarian is actually lower.

The Birth Trauma Association found that mortality rates are lowest for women who have elective caesareans. [0]

https://amp.theguardian.com/lifeandstyle/2017/jan/21/how-ris...

bluejekyll• 8 years ago

This depends entirely on why you’re getting c-section in the first place. When my son was born, we luckily detected that the umbilical cord had velamentous cord insertion, which basically means it’s not completely connected to the placenta. This can often lead to detached cord during vaginal birth, and cause still-birth and worst case also kill the mother. We also discovered after the fact that the pregnancy was also suffering vasa previa. Luckily the first was discovered before birth with modern ultrasound equipment that also tracks blood flow (not all hospitals have this apparently). And we were extremely luckily that we didn’t risk vaginal birth even though with just the first condition the risk was still within decent margins.

You can read some horror stories about these conditions when they go undetected. Luckily for us they were detected, and so we scheduled a c-section and everything was smooth. If we had listened to the peer pressure, which there was a lot, it’s possible that neither would be around today.

JustSomeNobody• 8 years ago

Years ago c-section rise was due to medical malpractice lawsuits from people like John Edwards, now it’s a fashion trend by the well to dos. Wow.

lanius• 8 years ago

I'm surprised C-section rates are higher among wealthier, education women. I would assume educated women are more likely to understand the risks associated with C-sections.

noisy_boy• 8 years ago

Just because they are wealthier or educated, doesn't mean they will make the most scientific decision; otherwise no doctor would ever smoke. Background/nurturing/societal norms also play a role. I have heard multiple well-off/educated women say, "no way I would put myself through so much pain when I can have quick c-section". Note that I'm not passing any judgement as it is their body and they are the one who will experience the pain so it is their decision.

v_lisivka3• 8 years ago

Heads of their babies are larger, while vagina is same, so higher risk to rip vagina and die, so higher C-section rate.

chongli• 8 years ago

It's not the size of the vagina that's the issue, it's the size of the pelvis. The vagina is extremely flexible. Bones much less so.

watwut2• 8 years ago

Highrr age of mother during first childbirth and money probably make difference.

epmaybe2• 8 years ago

Interesting article. I also thought that encouraging cesarean sections was something obstetricians did often to avoid the time spent waiting for delivery. However, in my training I witnessed quite the opposite. My resident and attending physicians were very cautious with going forward with cesarean sections, and would do whatever they could to continue with vaginal delivery when the mother wanted that, and also encouraged patients that wanted cesarean to consider vaginal delivery.

Obviously this is one hospital, but it did help me not be as cynical of the profession, and will probably help serve as a reminder to do what's best for my future patients.

e402• 8 years ago

With the birth of my son, we switched obgyn's because she basically told us it was pretty certain we'd have a c section, because she didn't have time to wait. We switched doctors and it was the first question we asked when interviewing prospective doctors. This was in 2000.

lostlogin6• 8 years ago

I had no idea that interviewing doctors for delivering your child was a thing. Do they charge for it? Is it common?

wild_preference• 8 years ago

Your initial suspicion is alive here in Mexico where you need to rent your own obstetrician and install them at a private clinic facility while you wait for baby.

learc83• 8 years ago

Did you find that obstetricians encouraged inducing labor as a way to avoid spending time waiting for deliver?

epmaybe2• 8 years ago

Yes and no. I can only speak for this one hospital, but most of the time we would only induce if there was indication for doing so (twins is one example that comes to mind) or if the mother truly wanted induction. I don't recall specifically encouraging for reducing time, though the residents would joke about wanting to do so instead of waiting.

I wonder if this is more common at teaching hospitals, so that attendings can hand off the waiting to the residents in training.

lellotope• 8 years ago

With the birth of our daughter, we had a different, and more complicated experience.

Pre-delivery there was no pressure to do a c-section. None at all. My wife definitely did not want one.

At the time of delivery, though, there was very much pressure to do a c-section. Although the admitting resident didn't seem to pressure my wife, care was quickly transferred (because of shift reasons) to other physicians (resident and attending) who did.

The way this manifested, though, was sort of subtle. For example, my wife had a procedure done to speed up the delivery; however, as we found out later, we were definitely not sufficiently informed of the consequences of the procedure, one of which was increased likelihood of a c-section. They tried to talk my wife into a c-section, and then when she declined, they tried to talk her into other procedures that would speed up the delivery, and would omit mention of the fact that they were associated with increased likelihood of c-section. Overall, even if c-sections weren't being explicitly mentioned, they were kind of relied on or assumed, for time and convenience reasons. The discussion was sort of like "Oh you don't want a c-section? Ok, then how about X to speed things up? Oh--I forgot to mention that now we probably have to do a c-section? Oops!" It came across as manipulative to me.

My wife did not have a c-section, but this was probably only because the nurses there (who were phenomenal) were actively arguing with the physicians to not do one, and to wait. We weren't really in the hospital that long either.

wizzard• 8 years ago

This is a well-known phenomenon called the cascade of intervention: http://www.childbirthconnection.org/maternity-care/cascade-o...

StreamBright2• 8 years ago

C section saved the life of my child. I do not care if there is an "epidemic" (what a heck does it mean in a context of a surgical procedure at all???).

gdubs3• 8 years ago

It means that in some cases the procedure is life saving, and in other cases unnecessary and potentially riskier than vaginal delivery. (Happy for you and your family that your child made it out OK — don’t know if it was recent, but congrats nonetheless!)

StreamBright2• 8 years ago

Well I was kind of interested how can somebody use epidemic as a noun for a surgical procedure. There are many factors to this but c-section is often safer for the child than normal birth. I am not sure if there is any problem with c-sections, in my country it is widely used even as an elective option without issues. It is hard to see the downside.

amalag• 8 years ago

My mother was in labor for over 36 hours (maybe more, she told me but I forgot) in 1976. You know that would be a C-section nowadays. She had two more children after that. I don't know how long her labor was for those but I assume it wasn't as bad.

zrail• 8 years ago

My wife was in labor for 40ish hours in 2016. There was never any pressure for a c-section.

hypertexthero• 8 years ago

Interesting perspectives from cesarean born people:

https://cesareanvoices.com/

See in particular this presentation by Jane English:

https://cesareanvoices.com/SHOW-small.pdf

kuwze• 8 years ago

I know most people on HN are guys, but I've heard a lot of women talk about the peer pressure. In fact some women look down on those that have children via a C-section. It's despicable.

watwut2• 8 years ago

C-section all in all hurts more and you heal longer after that and you need more help afterwards. Plus it limits how many kids you can have safely.

The dominance of guys shows up mostly by completely ignoring practical considerations.

jaclaz2• 8 years ago

In 2015 the WHO has issued this [0] [1]:

Conclusions

Based on the available data, and using internationally accepted methods to assess the evidence with the most appropriate analytical techniques, WHO concludes:

1. Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons.

2. At population level, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.

3. Caesarean sections can cause significant and sometimes permanent complications, disability or death particularly in settings that lack the facilities and/or capacity to properly conduct safe surgery and treat surgical complications. Caesarean sections should ideally only be undertaken when medically necessary.

4. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate.

5. The effects of caesarean section rates on other outcomes, such as maternal and perinatal morbidity, paediatric outcomes, and psychological or social well-being are still unclear. More research is needed to understand the health effects of caesarean section on immediate and future outcomes.

[0] https://www.who.int/reproductivehealth/publications/maternal...

[1] (PDF) http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15...

nickwalton00• 8 years ago

Well said, I think where all things indicate it will be healthy normal births should be the default, but when medical risks indicate otherwise than c sections can provide life saving help.

jaclaz2• 8 years ago

Yep, if you think about it, the above advice is nothing but "common sense" and good medicine practice.

The point is that the decision between a normal birth and a C-section is to be taken on a case by case basis by a (hopefully) competent doctor and not "planned" (one way or the other) in advance or decided because of other reasons.

Anecdata, my uncle was a surgeon and he always repeated us that "if it is really-really, and I mean really needed, than go for it, but otherwise never let anyone cut through your body".

giardini• 8 years ago

C-section babies are prone to certain ailments later in life:

"Giant study links C-sections with chronic disorders" -

http://sciencenordic.com/giant-study-links-c-sections-chroni...

My guess is that this is tied to the reduced exposure to the mothers' vaginal and anal microbiome that occurs during vaginal delivery but which is absent in C-section.

Much as childhood exposure to animals reduces autoimmune disorders in later life, natural birth also likely does the same.

"Study: Children who grow up on family farms and drink raw milk have fewer allergies, autoimmune disorders"

https://www.naturalnews.com/035802_raw_milk_farms_allergies....

nemonemo• 8 years ago

As the article says, the cause is not certain. From some study, higher c-section rate correlates with higher income, so my guess is that it could just be an outcome of better hygiene according to the hygiene theory.

acd• 8 years ago

Babies ingest vital microbes during natural birth helping kick start their immune system when exciting from the mothers vagina. It also helps to get the babys breathing started. The microbes that babies get in contact with during natural birth help form their gut microbes. Gut microbes are essential to human health. If we eat food from animals that have been given antibiotics or we take antibiotics, we mess with the gut microbe system that prevents us from getting sick.

To clean environment is not good for humans. Ie with a little dirt our immune system is better. That is why for example people growing up on the country side has less allergy.

https://www.wired.com/2014/04/missing-microbes-antibiotic-re...

The Normal Gut Microbiota: An Essential Factor in Health. Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983973/

kdowining3• 8 years ago

Every article I read on c-sections misses some really important facts:

1. c-section mortality and complication rates are often not separated between the women who get c-sections pre-scheduled and women who get them after hours of damaging labor and something already going horribly wrong. In fact, when I looked at the data for my own c-section, it seemed to indicate that scheduled c-sections were as safe if not safer than vaginal birth.

2. Vaginal birth leads to lifelong incontinence and sexual dysfunction in many women. Would I take a miniscule chance of death in exchange for not peeing my pants for the next 50 years? Yes. In exchange for having a way higher chance of a pain-free sex life again? Yes. Quality of life matters. Your relationship with your partner and with your own body matters. So many of these studies basically end in the hospital - i.e. did mom and baby survive, but then do not look at long-term outcomes of the MOM at all. I know many women with these issues. Women with horrific tearing and scarring, too. They're still dealing with it years later. It's not trivial even though these studies make it sound like the only thing is whether you live, not how you live.

3. c-sections do not carry the risk of baby being deprived of oxygen during birth. No risk of cord getting stuck around the head, etc. The people trying to convince me that I shouldn't have a c-section because of very ambiguous studies dealing with asthma or allergies are totally missing the forest for the trees on this one.

Lastly, and this is an experiential point from someone who has actually had a c-section: the whole thing was completely painless. I was on my feet the same day. I only had a bit of trouble going from laying to standing in the first couple of days, but I otherwise was in pain and could walk, sit, take care of the baby, everything else. By the time I was out of the hospital on day 5 I felt completely back to normal and could do anything and everything. Is it major surgery? Sure. But I can tell you that women who had vaginal deliveries were still in pain weeks after the delivery and for months if they had extensive tearing or episiotomies. Most of my friends on the "natural" train, now having done that and seen my experience in comparison, wish they hadn't gone that route because they're still dealing with the damage it caused them.

kdowining3• 8 years ago

Otherwise not in pain.

Doctors warn of alarming C-section 'epidemic'

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