I am reading Expecting Better, a book about evidence based pregnancy and in it, there are passages about the high rates of C-sections and why it might be. The conclusion was that one medical intervention, whether by drugs or over-monitoring, usually leads to another and another and you end up with a C-section. Non C-section births have better outcomes. So you want to avoid it if you can. The book also mentions that the use of a doula can reduce rates of C-sections to less than 10% from modern U.S. rates of 30%. That is very impressive. Why and how?
I interviewed a professional doula and just asked quite plainly how does her service provide such a dramatic decrease in C-sections. Her personal experience if she is to be believed, is in line with the 10% figure. Her answer is that by being an advocate for the mother and delaying any unnecessary medical intervention in the delivery room, and by providing a calm and coping environment for the mother, she is able to have better outcomes. This means not bringing the mother to the hospital too early.
The way she described it was that the delivery room is a high stress situation where there are doctors and nurses who are supposed to be doing something, and when nothing is happening, they tend to make things happen, when the right thing to do is just wait. Doulas often go to your home before you are in active labor and bring you to the hospital no earlier than you have too. This is the key, by going to the hospital too early you are increasing your chances of having some medical intervention.
So the take away is that there is good evidence that doulas are effective and do so by:
timing the right time to go to the hospital
preparing a mother to be calm and mentally strong
advocating for a mother in the delivery room for more time, before intervention
The devil is in the details: what you control for and what you don’t. Compare: “Not being in a hospital bed has better outcomes than being in a hospital bed”.
So the take away is that there is good evidence that doulas are effective
Maybe the book cited some, but you didn’t show any.
Ideally 100% of those that medically need C-sections will get it, and those that don’t wont.
I think there was a study that was cited in the book about the reduced C-sections rates, but of course the devil is in the details like you say, best to do your own research. I have personally updated my beliefs in favor being more resilient to time pressures of labor and that use of a doula isn’t just a waste of money as I previously had thought.
I think there was a distinction made between planned C-sections and unplanned C-sections (medical emergencies), so that they were able differentiate outcomes following emergencies like a breech baby vs a completely planned C-section. And I think it showed that show C-sections overall were more risky than vaginal birth and long term health was better for vaginal births.
I haven’t done any google fu on this topic, other than reading a few passages in a book.
Scar tissue is less flexible than the original one, and flexibility in the areas that need to be stretched during childbirth is important. Having a C-section when you don’t need one increases the chance that the next time you will need one.
...which probably doesn’t seem like a problem if you have already decided to have C-sections only.
Arguably, doing childbirth the “unnatural” way can mess up with your or your baby’s instincts, because they were evolved expecting certain circumstances. Some instincts depend on timing. I am not sure if this is the situation here, but some people prefer to play it safe.
Seems to me that frequently used arguments for (medically unnecessary) C-section is that it is supposed to be less painful and heal better. As far as I know, the better healing was never proved empirically; and with pain it seems like you are kinda trading more intense pain in short time for less intense pain in long time; but I am not certain about these two things.
Arguably, doing childbirth the “unnatural” way can mess up with your or your baby’s instincts, because they were evolved expecting certain circumstances. Some instincts depend on timing. I am not sure if this is the situation here, but some people prefer to play it safe.
That seems totally crazy to me. Claims about transfer of bacteria (both good and bad) are much more plausible differences with a C-section.
Lorenz demonstrated how incubator-hatched geese would imprint on the first suitable moving stimulus they saw within what he called a “critical period” between 13–16 hours shortly after hatching.
In my country the C-sections rate is very high (not sure I can trust my memory on the exact number). We pretty much decided to have our child born in a neighbor country, just to reduce the related risks, even if that included a risk that any medical complication would make the costs skyrocket (because our health insurance system does not like this kind of healthcare shopping).
From what I was told, seems like the most important factor is that C-section is more convenient for the doctor. For example, doctors can choose exact timing, to avoid a situation when two babies decide to get naturally born at exactly the same moment. Or they can make more babies get born during the day, when there is more staff at the hospital, and less during the night. (There are also other ways to artificially influence the timing, and yes, those are used too.) Another factor is that in my country it is more-or-less mandatory for mother during the childbirth to lie on her back… which again is most convenient for the doctor, but also happens to increase some risks associated with childbirth (which can be then conveniently solved by the C-section). If I understand it correctly, the position on the back is more dangerous because the child needs to be pushed uphill (over the tail bone).
What is even worse, when there are too many C-sections, a feedback loop appears—suddenly people (both the doctors and the patients) need to protect their egos by rationalizing that, actually, C-section is the best way to go. Which in turn further increases the rate of the C-sections, because if “everyone is doing that” then it is “perfectly normal” and certainly “happens for a good reason”, and people who think otherwise must obviously be wrong. So now you have mothers expecting to be given C-section, because that’s how it is usually done. And you have doctors giving C-sections at a smallest opportunity, because that’s what most mothers want them to do.
And communicating this with doctors is almost impossible. When you mention that, they will start lecturing you that sometimes the C-section is necessary to save the baby’s or mother’s life or health. And when you say “okay, of course in such case I would want you to do it, but if there is no complication, then I don’t want you to do that needlessly… I am even willing to pay to extra to compensate for all related inconvenience”, then the doctor usually gets offended or treats you like an idiot and says that “of course we are doing that only when it is necessary”. Except, comparing statistics across countries shows that somehow, in neighbor countries it is “necessary” in maybe 15% of cases, but in our country it is close to 50%… but of course, for each specific case the doctor can argue that this specific case happened to be an exception where the C-section was necessary. And no, they are not going to allow the mother to give birth in a different position, because that is simply not how things are done, full stop. (Cross the border to the nearest country though, and the local doctors are like “yeah, sure, no problem”.)
Generally, comparing medicine across countries can make you mad. Seems like in each country, doctors have a consensus on how things are supposed to be done, and they always claim that their opinions are backed by science. Yet somehow the “science” says sometimes completely opposite things in different countries. (I suspect “science” is a shorthand here for “what they taught me at university, a few decades ago”.) And if you look into peer-reviewed journals to find what the science actually says, you will usually get yet another opinion. (Though we noticed the trend that the peer-reviewed journals usually agree more with the “science” of our neighbor country than with the “science” of my country.)
Without claiming that it is directly relevant to the question, let me quote Atul Gawande, from “The Score: How childbirth went industrial”
Yes, he said, many studies did show fabulous results for forceps. But they only showed how well forceps deliveries could go in the hands of highly experienced obstetricians at large hospitals....Forceps deliveries are very difficult to teach—much more difficult than a C-section
I am reading Expecting Better, a book about evidence based pregnancy and in it, there are passages about the high rates of C-sections and why it might be. The conclusion was that one medical intervention, whether by drugs or over-monitoring, usually leads to another and another and you end up with a C-section. Non C-section births have better outcomes. So you want to avoid it if you can. The book also mentions that the use of a doula can reduce rates of C-sections to less than 10% from modern U.S. rates of 30%. That is very impressive. Why and how?
I interviewed a professional doula and just asked quite plainly how does her service provide such a dramatic decrease in C-sections. Her personal experience if she is to be believed, is in line with the 10% figure. Her answer is that by being an advocate for the mother and delaying any unnecessary medical intervention in the delivery room, and by providing a calm and coping environment for the mother, she is able to have better outcomes. This means not bringing the mother to the hospital too early.
The way she described it was that the delivery room is a high stress situation where there are doctors and nurses who are supposed to be doing something, and when nothing is happening, they tend to make things happen, when the right thing to do is just wait. Doulas often go to your home before you are in active labor and bring you to the hospital no earlier than you have too. This is the key, by going to the hospital too early you are increasing your chances of having some medical intervention.
So the take away is that there is good evidence that doulas are effective and do so by:
timing the right time to go to the hospital
preparing a mother to be calm and mentally strong
advocating for a mother in the delivery room for more time, before intervention
!!!
The devil is in the details: what you control for and what you don’t. Compare: “Not being in a hospital bed has better outcomes than being in a hospital bed”.
Maybe the book cited some, but you didn’t show any.
Ideally 100% of those that medically need C-sections will get it, and those that don’t wont.
I think there was a study that was cited in the book about the reduced C-sections rates, but of course the devil is in the details like you say, best to do your own research. I have personally updated my beliefs in favor being more resilient to time pressures of labor and that use of a doula isn’t just a waste of money as I previously had thought.
You speak as if women don’t have preferences. Hint: they do.
I am constantly reminded of that fact daily!
:-)
This is highly suspicious to me. Do C-sections follow or cause worse outcomes?
I think there was a distinction made between planned C-sections and unplanned C-sections (medical emergencies), so that they were able differentiate outcomes following emergencies like a breech baby vs a completely planned C-section. And I think it showed that show C-sections overall were more risky than vaginal birth and long term health was better for vaginal births.
I haven’t done any google fu on this topic, other than reading a few passages in a book.
It would make more sense if C-sections were better. After all, nature is notoriously irrational and inefficient.
Scar tissue is less flexible than the original one, and flexibility in the areas that need to be stretched during childbirth is important. Having a C-section when you don’t need one increases the chance that the next time you will need one.
...which probably doesn’t seem like a problem if you have already decided to have C-sections only.
Arguably, doing childbirth the “unnatural” way can mess up with your or your baby’s instincts, because they were evolved expecting certain circumstances. Some instincts depend on timing. I am not sure if this is the situation here, but some people prefer to play it safe.
Seems to me that frequently used arguments for (medically unnecessary) C-section is that it is supposed to be less painful and heal better. As far as I know, the better healing was never proved empirically; and with pain it seems like you are kinda trading more intense pain in short time for less intense pain in long time; but I am not certain about these two things.
That seems totally crazy to me. Claims about transfer of bacteria (both good and bad) are much more plausible differences with a C-section.
More crazy than this)?
In my country the C-sections rate is very high (not sure I can trust my memory on the exact number). We pretty much decided to have our child born in a neighbor country, just to reduce the related risks, even if that included a risk that any medical complication would make the costs skyrocket (because our health insurance system does not like this kind of healthcare shopping).
From what I was told, seems like the most important factor is that C-section is more convenient for the doctor. For example, doctors can choose exact timing, to avoid a situation when two babies decide to get naturally born at exactly the same moment. Or they can make more babies get born during the day, when there is more staff at the hospital, and less during the night. (There are also other ways to artificially influence the timing, and yes, those are used too.) Another factor is that in my country it is more-or-less mandatory for mother during the childbirth to lie on her back… which again is most convenient for the doctor, but also happens to increase some risks associated with childbirth (which can be then conveniently solved by the C-section). If I understand it correctly, the position on the back is more dangerous because the child needs to be pushed uphill (over the tail bone).
What is even worse, when there are too many C-sections, a feedback loop appears—suddenly people (both the doctors and the patients) need to protect their egos by rationalizing that, actually, C-section is the best way to go. Which in turn further increases the rate of the C-sections, because if “everyone is doing that” then it is “perfectly normal” and certainly “happens for a good reason”, and people who think otherwise must obviously be wrong. So now you have mothers expecting to be given C-section, because that’s how it is usually done. And you have doctors giving C-sections at a smallest opportunity, because that’s what most mothers want them to do.
And communicating this with doctors is almost impossible. When you mention that, they will start lecturing you that sometimes the C-section is necessary to save the baby’s or mother’s life or health. And when you say “okay, of course in such case I would want you to do it, but if there is no complication, then I don’t want you to do that needlessly… I am even willing to pay to extra to compensate for all related inconvenience”, then the doctor usually gets offended or treats you like an idiot and says that “of course we are doing that only when it is necessary”. Except, comparing statistics across countries shows that somehow, in neighbor countries it is “necessary” in maybe 15% of cases, but in our country it is close to 50%… but of course, for each specific case the doctor can argue that this specific case happened to be an exception where the C-section was necessary. And no, they are not going to allow the mother to give birth in a different position, because that is simply not how things are done, full stop. (Cross the border to the nearest country though, and the local doctors are like “yeah, sure, no problem”.)
Generally, comparing medicine across countries can make you mad. Seems like in each country, doctors have a consensus on how things are supposed to be done, and they always claim that their opinions are backed by science. Yet somehow the “science” says sometimes completely opposite things in different countries. (I suspect “science” is a shorthand here for “what they taught me at university, a few decades ago”.) And if you look into peer-reviewed journals to find what the science actually says, you will usually get yet another opinion. (Though we noticed the trend that the peer-reviewed journals usually agree more with the “science” of our neighbor country than with the “science” of my country.)
Without claiming that it is directly relevant to the question, let me quote Atul Gawande, from “The Score: How childbirth went industrial”
Gawande is great. Collect them all. Also, Lewis Thomas.