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Interesting title for this piece - sums it up well.

Pushing is damn hard work and not at all dignified. If I think back to my two deliveries, I can hardly imagine anyone choosing to go through that pushing when they have an alternative option. I would never have dreamt of having a c-section before the time (and have no regrets about that) but I can totally imagine that "posh women" would balk at the process.

Wow! I have had two c-sections - the first was because my baby had too many birth defects to name, and the second was because I was terrified of a natural labor after a c-section. If we have another, though, I "plan" on trying a vaginal birth after c-section. It is so interesting to me to look at how c-section rates are just skyrocketing. I didn't feel pressured at all to have a c-section though, either time. I do think the pendulum is coming back the other way - or hopefully, at least.

I'm taking a biology class on The Modern Epidemic of AIDS and we were recently talking about the need for HIV + mothers to have a c/s before her water breaks to reduce transmission to the baby. Does your medical aid have a policy that disallows vbac under any circumstance? Is that what that last bullet point meant?

Carrie Jo - no, it means that there isn't a policy / program encouraging people to try VBAC. Doctors here are quite anti VBAC

Holy shit those rates are high!

i have never given birth before and would never ever dream of doing it the natural way!
heard and seen too many horror stories and even though i've heard of those about slower healings from c-section, i would still gladly run for it when my time comes!
the ideal way to give birth, for me, is to be knocked out, baby taken out, for me to still be knocked out for another 2 days until when the wound heals that teeny bit before i finally wake up and see my bundle of joy.
alot of people tells me that to go through labour makes a woman a real woman.
i guess i am too ball-less to be a real woman.
pain scares me.

I may be risking annoying some here, but I had an elective c-section and I have no shame admitting it.

It was an informed choice and one I'd be happy to make again. Very informed. I'm a medical practitioner and have assisted in a few c-section deliveries myself. I know the risk very well. I also know the risks of vaginal birth. I have delivered babies that way too.

Nothing is risk free when it comes to giving birth, we simply all need to decide which risks are right for US.

Interesting tidbit though- the c-section rate for female doctors? Very high. Mostly elective. Draw your own conclusions :)

J

Interesting post. I have had an elective C section and plan on doing that again. My Gynae asked me what kind of birth I wanted - vaginal or c-section, I get to choose (I am on medical aid in SA) I may be wrong but it seems like in some countries, even in private health care, you do not always get to choose and have to go along with your doctors wants or is medically warranted?
I have asked my gynae/friends who are gynaes in SA what kind of birth did you / your wife have and no-one has yet said anything other than C-section.

I had an elective c-section for 2 reasons, one my back would not be able to handle the normal delivery & 2nd, we lost a previous baby, so we just wanted it all to be over as quickly as possible.

Everybody said that the recovery time is so long & that I will have a lot of pain.... bull!!! My son was born 09H15 & by 17H00 I was walking around. Yes, there was pain, but it can be managed. And I certainly do not feel less of a woman because I did not push! I'm happy with the choice we made, even if some people feel the doctors recommend it to fit in with their golf schedules. ;-)

Hi Tertia

Had natural with my daughter and as you know had a c section three weeks ago with the twins that I surrogated for and I wouldpt for natural any day!

i had amelia by cs, after 3 vaginal births 22 - 25 years ago. maybe because i had already had the natural non-pain assisted labour experience, i found the c section affected me profoundly. i walked to the shower after all but one of my births, had my milk come in very rapidly, and my body (admittedly in its 20's!) bounced back amazingly quickly.

after the c section i had difficulty bonding with the baby, as i felt very detached and disoriented during and after the birth. i felt a huge sense of disbelief that she was actually mine, whereas the hours of labor and pushing etc with the others left me in no doubt whatsoever. i asked for, and got, psych help with the bonding for 8 months after her birth being visited by a psychologist in my own home. and i needed it - finding it too easy to float into detachment land. my physical recovery took ages as well, and i was more emotionally fragile than i had ever been before - again age and circumstances took their toll, but i felt so physiologically weak - and not being able to exercise as i would normally do made me feel distanced from my own body.

if you can get hold of a chart entitled 'the cascade of interventions' as used here in aussie, it is really interesting; it shows the way in which one medical intervention during labor almost always leads to greater pain relief and/or a caesar because of the women's physiological response to the intervention process. it generally prevents the release of necessary pain relieving and strengthening hormones such as oxytocin, and instead often leads to an oversupply of adrenalin, which hampers those natural opiated from doing their job - and thus ups the pain, increases anxiety, prolongs the labor, exhausts the mother - all of which point to the c/s as the only feasible alternative in the circumstances. from my research, and experience, a relatively uncomplicated pregnancy PLUS a woman who feels supported and empowered - PLUS an environment the woman is able to control and manage without intervention PLUS a very well informed birth support team leads really well into a vaginal birth. plus, the recovery of the baby from this type of birth is usually more rapid . . . but i know you can't guarantee anything!

i am not against c/s's - they are life savers - as in amelia's case, but the ob specialist also gave me every chance to deliver naturally, saying she preferred that option when possible, and only going for the knife when the other option proved dangerous. but i also loved my three vaginal deliveries - especially the visceral and highly physical pushing which made those babies mine in a very specific manner.

i am concerned that pregnancy and labour is being pathologised, as in seen as a medical condition and almost automatically problematic, and not always promoted as the gentle (but farking tough) process it can be.

but yep, again, its a personal decision - go with your heart and soul when you do decide. anything that gets the baby out safe has to be good! aint it grand to be a woman with choices?

I have "pushed out" three daughters. I second what Ruth said regarding how higher maternal age can affect the recovery - I had my first two in my late teens, and my body bounced back extremely quickly. The third one now, in my mid-thirties - things kinda moved South and stayed there!!

My first two were in Govenment hospitals in SA. With #1 all I had was gas and air (and the obligatory shave and episiotomy). With #2 I took Lamaze classes and managed to breathe through the pain (clearly I was young and stupid then).

I always said if I had another baby I would, at the very least, have an epidural, however along comes number 3 - a week late, induced, and I managed another natural birth (altho I did ask for some gas near the end - I was NOT prepared for te ferocity with which the contractiosn hit after an induction - it was like slamming into a brick wall).

Recovery times - after #1 and #2 the episiotomies made me feel really uncomfortable for a while - like sitting on a pineapple. With #3 I was out of hospital after 1 night, and walking on a golf course two days later.

I have always said that if I am lucky enough to carry another baby to full term (I had a MC in July), I won't be able to face another natural delivery, but I am also pretty sure that when the time comes I'll be sweating and swearing and pushing again.

My ONLY regret is that my Mum was not with me for any of the births - I am adopted, and I would have loved for her to experience the miracle - albeit through someone else.

This explains some comments to me from South Africans when they came to the UK. Having my children with the NHS, they only want to do c-secions if absolutely necessary because of the expense. Thus, you've got midwives promoting and supporting as natural a birth as possible. This must be a bit of a shock after the medical-aid system.

I'll be very honest, labor while labor was intense, I found it both quick and not what I'd call painful. I didn't tear. Life rebounded back to as much "normality" as you can have with an infant. Figured my "easy" labors was to make up for the fact that during the nine months of pregnancy I feel like utter crap.

I was very relieved that both times, labor went well. The idea of having a c-section terrified me, not so much the surgery, but the recovery afterwards.

That said, I'm glad we have the technology to preform c-sections. There are people I love and care about on this earth who might not be here with out the surgery.

Sorry for all the typos.

This topic is very interesting. I find that doctors are too quick to tell you that a c-section is needed. Hell, I was barely 16 weeks pregnant and my doctor was pushing the whole concept. Yes, I am a small women, yes, the baby I am carrying is large, and yes it will be tough... hence they call it labour and not pleasure, but surely it is my body, my baby and my choice to at least give natural a try.

I feel that because a lot of doctors require a pay in because they charge more than the medical aid rates, their first choice is c-section. The pay in is larger, they can schedule you into their lives, their is no waiting around and they make quite a nice profit from lining pregnant women up for their procedures. Personally, my Doctor will have to earn my money and stick around for the big PUSH!

I'm a crunchy hippy who uses cloth nappies, so of course I had my son at home (with a midwife, I may be crunchy but I'm not stupid), in a pool. It was the most amazing experience of my life, and next time I would want to do the same again. We were on such a high after the birth - it was fantastic. My husband caught the baby as he popped out - he really felt included and part of it all. I started off thinking maybe a hospital birth with epidural, cause what kind of dirty hippy gives birth at home :) after a lot of reading I got very convinced in the other direction, especially as here in Jerusalem the hospitals are not fantastic (socialised medicine like the UK), and the one hospital which had rooming in also had a reputation for plonking you in the corridor after you gave birth until a room was free.

I'm not against c sections but I am against women being uninformed about their options regarding birth - I think a good birth is a great start to being a parent - it gives you a lot of confidence (where I define a good birth as one in which you have your choices respected all the way through, even if you end up with a lot of interventions). I also think its a disgrace that most women plan their weddings to the nth degree, spend a lot of money and time, and don't bother even thinking about their options for a birth - something you would think would be at least as important!

My sister is a paediatrician in Joburg - she says one of the reasons for the fairly high c section rate in government hospitals in SA is that black women have a documented problem with their pelvises, possibly due to nutritional problems - I think she said.

I had two easy and wonderful natural births, an emergency c-section (eclampsy in week 32) and another very long and difficult natural birth. C-section is easy, no doubt. But I would always choose natural birth... I don't even know why. Irrational love of pain, I guess :-)

The hormonal rush of euphoria after after every natural birth was really nice. I didn't have that after the c/s. It made the transition easier for me.

But I don't judge other women. I've seen enough women traumatized after birth or in terrible fear before. Birth is just one day in a long relationship. My third child and I had a really rough start with weeks of NICU and none of the cozy stuff you find recommended, and yet we had and have a wonderful relationship.

Your stats for private c-sections are pretty close, but I think that the c-section rate in government hospitals may be as high as 60% in some provinces for all of the above-mentioned reasons, and then for the fact that most government hospitals are used as training facilities for tomorrow's private OBGYNs, so where else do you get to practise your knife skills than in an academic hospital?

While C-sections seem to be the most acceptable form of birth for the twenty first century, (in fact, some philosophers have suggested that normal birth will become an impossibility as the human body evolves, allowing previously unbirthable pelvises to regenerate through the medium of Ceasarean birth), one must remember that a Caesar is still full-blown abdominal surgery, and as such, carries high risks. Women who recover quickly from a Caesar are very fortunate, and their recovery is not necessarily due to the fact that they had a Caesar in the first place.

Most women who have experienced both normal and caesarean births will chose a normal delivery over the surgical alternative.

And by the way, the World Health Organisation suggests that 15% of all live births should be ceasars as a safe recommended guideline - shows just how off-base us South Africans are!

I would of loved to have natural with my daughter - but things dont always go as planned. Gyne gave me the heads up a week before (during my internal) that my pelvis was extremely 'tight' and i might want to start opening up to the idea of a C-Section, just in case. Well a week later my waters broke at home, went of to the hospital (I am on private medical aid) was sitting at 2cm (This was at 10pm) and with induction jel was only at 3cm the following morning, with alot of pain. My daughters heart rate was all over the place and my B/P was no better. Medical decission made for ceasar as she was 'stuck' (incompatible pelvis) - she was out ten minutes later and i was up and about the following morning and breast feeding 1 hour after birth! My mom had the same problem having me - labour for 24 hours, forceps and big tears, and both of us almost dieing - so i am all for natural - but will not take the chance when we decide to add to the family!

oh I also wanted to say I used hypnobirthing to prepare for the birth - either I didn't do it right, or it was lies, damn lies :) no I kid, it did really help - my midwife was very impressed at how I handled things - she said first timers usually start screaming for mommy at about 2 cms, and I only really let rip in the last hour (of a 20 hour labour). next time I plan on actually doing the hypnosis part - cos this time around I wanted to phone our teacher half way through and tell her - you lied, it does hurt! :)

Wow those stats are high. I am absolutely shit scared of a c-section although I had a horrifying 44 hour labour with my daughter. Is the attitude in SA that most women should give birth via the sun roof?! I think it is very different here in the UK - two of my friends had to have sections and both of them are now pregnant again and desperate for a VBAC. Maybe it's the tight NHS but they seem to do everything to prevent a caeserian here!

I would take any anecdotal evidence re female OBs and their prefs for c-sections with a large spoon of salt. The only studies I know of in the UK are old (1996 and 1997), small (only asked London OBs) and showed 31% in favour of elective c-section from the women. The London studies prompted a rash of other ones in other countries. A study of German OBs showed 90% would choose vaginal for a low risk pregnancy for themselves, a Danish one showed only 1% would choose a c-section, an Irish one only 7% would choose a c-section. All the studies were looking at low risk first pregnancies with no indications for a c-section. I couldn't find a US one but I would think they would be more in favour of c-sections. (An Ob friend (whose 3 kids were all vaginal deliveries) pointed me in the direction of these.)

If there is a high risk of natural delivery then sure choose c-section but I can't see the point of abdominal surgery when the risks are minimal.

I had no choice in the matter as my triplets would have not survived a normal birth - but if I think back, even if I was having a single child I would choose a C-Section. I once read an ariticle written by a gynae about why she as a doctor chose a C-section, it was entitled "the safest option for my child" - after that there was no going back for me 1 or 3 a C-section it was going to be.

Doctor here too and crunchy granola births with no drugs. Rates like that scare the shit out of me, almost as much as the comments that follow.

Holy cow when I got pregnant with my first I was over the moon, yet from moment one had ZERO DESIRE to push him out. none. Zip. I mean, over here in the US it seems that when a group of women sit around and talk birth story, there is always something about what 'grade' tear there was, how many stitches, etc. and I wanted NONE OF IT. But my doc is not really an elective C section kind of guy (but he did work with me on my fears, I will say, and by the time the little bugger was ready to come out I would have pushed if necessary). But somehow I lucked out, and my labor kind of stalled halfway through. I was getting a little feverish and his heart was getting a little tacky, so my doc said "Wanna go with a C?" and I almost leapt out of the bed to kiss him.

I still have an amazing birth story, was still on a great high, and with 2 kids and 2 cs I still have a pretty functional girly part! No peeing a little when I sneeze! (though I am told that can still come with age).

I guess I'm just saying, no matter how it happens, we end up parents at the end of it.

2 vbs and fully functional bits and excellent pelvic floor entirely unaffected by the births - keep doing the exercises whatever birth you have!

My friend had a VBAX and her doctor had to in front of the hospital board and tell them why, she was also told by her doula not to get admitted to soon cause the hospitals puses for csections because it is more revenue. So they are the ones pushing our doctors and here I was thinking that our doctors just find it more convenient. Luckily for me my doctor waited 3 days so that I could have my natural birth, but on the 3 day my baby's heart rate dropped to almost nothing and I had an emergency csec

My friend had a VBAC and her doctor had to appear in front of the hospital board and tell them why, she was also told by her doula not to get admitted to soon cause the hospitals pushes for csections because it is more revenue. So they are the ones pushing our doctors and here I was thinking that our doctors just find it more convenient. Luckily for me my doctor waited 3 days so that I could have my natural birth, but on the 3 day my baby's heart rate dropped to almost nothing and I had an emergency csec

2 vbs and fully functional bits and excellent pelvic floor entirely unaffected by the births - keep doing the exercises whatever birth you have!

Mom of 4 here. I labored naturally for 5 hours with my first because I wanted the "True experience". Idiot! I wasn't aware that every woman's labor was different(I was young and stupid) and that my labor coach was a fucking moron. After I got an epidural my life was much more at ease until they turned the damn thing off so I could feel the contractions so I could push. Still pissed about that 11 years later!

My 2nd child ended up being an emergency CS and I admit, it took a long time to heal from. I think mainly because I labored forever before the dr's figured out there were severe complications and she wasn't coming out the natural way. My staples also became impacted afterwards which didn't help recovery.

My 3rd and 4th were scheduled CS. My hospital doesn't allow vbac's. You can go into labor and travel an hour and a half to the nearest hospital that does if you would like, but I didn't like. Surgery was fine. I healed very quickly, I think faster than with a regular birth. I was up and walking within a few hours of surgery each time.

I for one, if given the choice, would always take the CS. One regular birth was way more than enough for me!

Having always lived in Cape Town - and with a luxurious medical aid, I only ever once encountered the government care at Tygerberg Hospital: when my grandmother had a colostomy. The nurses generally had an aggressively negative and negligent attitude - and swept up dust and detritus piled up in the corners over a period of days... However, I myself am now on the receiving end of government care living in the UK, almost 6 months pregnant with my first baby and not that pleased with the service you get. Granted, the hospitals are clean and the nursing staff are generally quite kind and aggreable: but it sure the hell ain't what my sister's getting back in Cape Town under the care of her medical aid. By 13 weeks she'd had 4 scans already in comparison to my current status of only two! It's not what the poor (in both senses of the word) have to deal with in Cape Town, but I kinda miss the customer service a medical aid lavishes upon you. Great article, by the way!

PS. Have a look and please leave your comments or stories at http://thesoutpielphenomenon.blogspot.com/2008/10/health-safety.html

I have one child, delivered vaginally through induction (darn girl had to be evicted!). She was a big baby (9lbs3oz), I was warned (had an u/s day before with approx. weight). The thought of surgery scared me more than a vaginal birth. A tear or episiotomy also scared the crap out of me. However, the thought of them slicing me open to take out my little girl? Trumped whatever tearing worries I had. In the end with the help of glycerin oil, perineial massage, and a dr who knew what she was doing: I gave birth with no tearing just minor lacerations and no hemmorhoids.

However, having said that, that is MY view. MY choice. I was given all the facts on c/s and vaginal birth. I chose vaginal, c/s if necessary. I would never tell a woman that her choice is the wrong one. Because, for her, it isn't. There are risks no matter what choice and you will find horror stories on both sides. Now if a doctor PUSHES a woman towards c/s... well I have a problem with that.

In the end we all want the same thing, a healthy baby and mom.

I would do natural again any day! I did it natural with my son, no meds at all, and within an hour after giving birth to him I was in the shower walking around and stuff. I like many before am scared of the recovery of a section. I just can't imagine having a new born and having a 6 week recovery time.

That's interesting. My mother who gave birth in South Africa in the 1970s says that they were very pro-unmedicated childbirth at that time. She took a weekly stretching yoga-type class for most of her pregnancy and her labor went very smoothly. I think very few of her friends from the stretching class had a c-section and I don't even think epiderals were available?!

I wonder why the younger generation has not embraced natural childbirth in the same ways their mothers did?

I had a c-section because my little angel was breech but I was thrilled the decision was made for me! I just wish random people who chat to you when you pregnant didn't give their 5 cents worth. What's it got to do with anyone else anyway. I had a woman lecture me in the lift at Woolies and proceeded to tell me she had 3 natural births- I felt like asking if her bladder was falling out of her and what happened to her sex life. Don't feel like that about all woman who have natural births only those that lecture random people about a c-section!
P.S the hospital I had my daughter at is also known as Caesar's Palace!

I had an unplanned c-section with my first baby (failure to progress) and elective c-sections with my second and third.

The second was in California, and my doctor tried to pressure me into a VBAC. I resisted -- I didn't go into labor by my due date and didn't want to be induced again and risk having my uterus rupture. Part of my did want to try for the "normal" birth experience (and potentially easier recovery), but overall, it seemed to me that the harder recovery seemed like a small price to pay for the peace of mind that a c-section would be easier on my baby.

I gave birth to two 9+ pound babies vaginally, one with drugs (which didn't work) and one without. I LOVED my natural birth--the recovery was a dream and emotionally I felt fabulous afterward. I was terrified of a C-section and so thrilled I avoided having one.

Wow. That IS alarming. And simply not right.

Tertia, I can understand why you might be terrified of natural birth. You've had some bad sh*t dealt to you reproductively speaking. And a nearly-ruptured uterus would certainly give me pause. You are a good example of someone who probably should have a CS.

What bothers/alarms me is that C-sections are FAR more risky than natural birth. Any reputable and unbiased source of medical research info will say so (e.g., the Cochrane Group). The maternal and infant death/infection/complication rates go WAY up with c-sections. And doctors generally don't tell women that.

I say if you are fully informed of the risks/benefits/appropriate use of CS, and choose it as the best option for yourself, right on! I am all for self-determination in healthcare. But if a doc is pressuring you to have a CS, or you just think it'll be easier, you might want to do some more research and/or think some more about it.

Hmm, well, I have had one terrible vaginal delivery with an epidural and forceps and tears and episiotomy etc., due to a car accident. And one easy vaginal delivery with an epidural, pushed the kid out easy as pie, no tears no episiotomy.

And both times, my vagina went right back to normal, no prolapse, no scars, as long as my estrogen stayed normal.

I was going to have another vaginal delivery this time, but ended up with a crash c-section instead due to placental abruption. Terrible recovery, simply awful. I'm only feeling normal now, and my scar still hurts and my abdomen is numb and looks awful. This is with physio, lots of rest, lots of good food, etc. I figured it was because of the emergency cs instead of the planned c, but my neighbours both had planned c-sections and they have taken just as long to recover and feel just as awful.

So personally, I only think c-sections should be offered for medical necessity, like yours Tertia, or like mine, just because why buy trouble?

So funny question everyone, in the infertility blogosphere we are allowed to complain about having to do IVF and the pain and the inconvenience and the shots and still be glad it exists so that we can have our kids and no one says anything bad to each other.

So why is that we aren't allowed to complain about c-sections even if they turn out bad? Everyone calls us complainers and moaners if we are sad we didn't get to have a vaginal birth, or if it's a hellacious recovery. We're still glad our kids exist, but why the double standard? Isn't a bad recovery a bad recovery?

I keep meaning to blog about this, but never do. Seems odd to me.

Oh, funny coincidence in Canada. As soon as we set the doctor and hospital pay rates for c-sections and vaginal births to be exactly the same, c-section rates went down. It was almost immediate. Makes you wonder, huh?

I'm in the US - Wisconsin to be exact and I had a C section with my first (and only) baby in March of this year.

We have a genetic condition in our family (XLI or X linked Ichthyosis) which is indicative of long labors with no progression, even with the use of drugs like pitocin. There is a high percentage of emergency C sections with this condition, woman who labor for hours or days and then end up having a C section because things aren't moving along and the baby is in trouble.

I talked to my doctor about this around month 6 and had hoped that he would say, 'no problem, we'll do an elective C section' but he didn't. He wanted to wait until closer to the end, possibly induce me and then make a decision. This made me nervous!!! He explained to me that here in the US OB/GYN docs need to keep their C section rates at a low percentage of their practice, as it effects their malpractice insurance. Interesting perspective!

Teagan ended up in a transverse lie, so we did a planned C section at 39 weeks anyway. I didn't have any trouble bonding with him afterward, course I don't know any different! My husband, who went thru two natural deliveries with his first two children, was disappointed with the experience. He didn't like the fact that I wasn't there (was sedated, being stitched up, still in the OR) while the baby was weighed and measured, etc.

If I have another, I'd plan to do another C section. VBAC scares me more than the idea of natural childbirth did to begin with.

I'm a doula and, if it was my choice (which it's not), I'd choose vaginal birth for 80% of my clients. Some people - like you! - should probably go with cesarean births because of the already-established risk of uterine rupture. I think someone already stated the World Health Organization figure of 15%...

Gah, I could go on and on. What I really wanted to say was this:

For anyone who went through a cesarean or had an episiotomy and your scars are still painful, try tincture of green soap. A couple capfulls in a warm bath does WONDERS. I used it on my surgery scars and felt the difference after a couple days of using it!

xoxo
katrina

I had natural child birth 3 times and loved it. Seriously - I loved giving birth. I also popped the babies out really fast so I don't think I'm a typical case. No hours of pushing for me. Just POP! water breaks, 2 or 3 pushes and voila! a baby.

I just wanted to say that. I'm all for freedom of choice for everything including how you give birth.

Very interesting that doctors have a high rate of elective c-sections. Very interesting.

I had an induction at 37 weeks because my doctors were terrified I would go pre-eclamptic or develop HELLP (because of my pre-existing high blood pressure). They did an amnio to check my son's lung function and then, after determining his lungs were ready, said "more bad than good can happen from here on in."

I did not want a c-section because of the abdominal surgery I had had previously (to remove a bouncing baby dermoid cyst along with a fully-involved and completely useless ovary). Fortunately I was in crunchy-granola Santa Barbara, CA and my doctors did not have a problem with that (though I think they were all certain I would wind up with a cs).

After 2 days hooked up to machines and drugs labor actually started Wednesday and my son was born on Thursday morning (I went to hospital on Monday at noon). Thanks to my blessed blessed epidural I slept through most of my labor Wednesday night and woke up to push my son out on Thursday.

I was up walking within 30 minutes of birth (my nurse went to look for a gurney and did not return for a while and I needed to pee...); have no idea if I tore or had epi or what, but my recovery was a breeze; much easier than the recovery from my ovary removal 3 years previously.

So long as both me and baby were doing well, I would do it again. But I would have a cs in a heartbeat if either baby or mom were going downhill.

Healthy baby. Healthy momma. That is the trick.

good god. color me a crunchy (american) hippie, but i find the attitudes and stats you gave for SA rather horrifying. ack! i thought the US had a bad attitude towards natural (meaning, vaginal) childbirth.

i wonder about the rates of lung problems for babies in SA and for rates of asthma later in life. and i wonder about other things, like food allergies, that are supposed to be worse later in life for c-section babies. i guess SA will be a good long term "experiment" for some of these studies.

given the "fear" of natural childbirth in SA I am very curious how many people breastfeed? if the vagina isn't trusted to birth babies, then are breasts trusted to feed them?

I had a planned c-section. Recovered quite well and was thrilled to stay with my baby in the hospital for 4 nights with nursing help as we had no family around. I don't mourn, but wish I might have felt labor, would have loved to push her out, really wanted her put on me right after she came out, but she was a double footling breach, big baby, first time 40 year old mom after 7 years of infertility. I'm glad she's here safely. Had a bit of a weird experience 3 weeks after she was born, though. I recovered very quickly from the c section and lost all my baby weight and had trouble remembering if I had actually been pregnant with her. It was really disconcerting. I had to look at the pregnancy photos to remember that I had actually carried her. My doc diagnosed me as PTSD after 7 years of infertility and 6 first trimester losses. Weird. The bonding was there though and to juliag...although my vagina didn't work, I'm still breastfeeding and she'll be a year in a few weeks. My milk came in within 48 hours and I fed her colostrum within the hour of having her. This after warnings that an IVF baby, and a csection, meant I probably wouldn't have milk for 4-5 days.

As a nurse in the U.S. who attended many deliveries I found myself terrified at 7 months with my first at the thought of actually having to vaginally deliver - it isn't called "labor" for no reason, you know.
At 8 months my beloved MD informed me that due to the babe being a high breech a c-section was necesary. I grabbed his hands, smothered them in kisses, and merrily waltzed out of his office.
After that I happily had the next 4 by section, also.
In fact, I have a tee shirt that says "Cut me, slice me, anything but labor".
I am always puzzled by women who mourn having a section and "missed out" on a "natural delivery".
Huh? You regret missing out on having your insides ripped with pain?
Yes, I am a chicken. But a happy chicken none the less.

Melissa, your husband was "disappointed" in the experience of your c-section?

AND HE TOLD YOU THIS?

Good Lord.

I'd be interested in hearing more from women who have had both CS & vaginal births. I've "pushed" two out (with an epidural), and I thought the process relatively simple, and the recovery very quick. I was up and about and comfortable within 24 hours. I was on over-the-counter pain killers, but mostly because of my problems with breastfeeding, not for the birth itself.

But, I've never had a CS. I'm amazed at the rates you're reporting for private care, really amazed that so many prefer CS (and I'm using the 80% rate, and assuming that 30-40 might have been medically preferred).

I've seen similar stats in Turkey among those with private medical insurance. I went private here in NZ for the delivery of my twins. Basically I wanted the best for my babies. My Ob.Gyn was a lovely Swiss guy who was the only one in our area who would have considered it okay to deliver the twins via VB. We were scheduled for a C Section as the top baby was transverse and the bottom breach. They turned at 32 weeks, which was agnoy and I decided to go for a VB. This was due to my allergies to anesthetics. I did have an epidural in the end but that was after 12 hours of extreme pain due to the allergic reaction. I'm glad I did deliver the twins via VB - recover was so much quicker. In the hospital that were there were two floors full of new mums and only two of us had a VB - the rest C Sections. Yeah and I'm a crunchy hippy and use MCN's too. I was scared to death of the birth and I never want to be in that lelvel of pain again. You have to do what is best for your and your baby - only you can make that choice.

Having seen this I don't know why they go on about c-section rates being too high in the UK.

I don't have kids but I know quite a few women who've had c-sections. Most of them were because they were quite slim and their babies were big, but my thoughts on the subject are that it's a personal choice. Especially in this country people seem to be pushing for everyone to do it completely natural with no pain relief, and despite not planning to have kids for a few years yet I still say there is no way in hell I would ever do that.

Whatever works for the individual and is safest.

I'm not against a c-section for medical reasons, after all, the most important part about birth is ending up with a healthy baby. However, I am against an elective c-section because people are scare of natural birth and think it will be easier. A c-section is MAJOR surgery! They are cutting your body open. Why would you elect to have that done? Not to mention the time it takes to heal. Plus, there are benefits to the baby by being born naturally. I didn't have an easy labor for my first but I would never ever choose a c-section for no medical reason. Besides, if you are scared about the pain of natural birth, that's what epidurals are for!

My sister had two easy and quick natural births in a state hospital, but when the third one came around she was on medical aid and decided to go for an elective c-section in a private hospital. She said afterwards that it was the worst decision of her life... she cried solidly for three days. The whole experience was very traumatic for her.

I am one of those "natural" freaks, so when my time comes that is what I will be aiming for, unless there are solid medical reasons why I shouldn't.

With your own history, I wouldn't dream of suggesting that you opt for a natural delivery though.

Hi Tertia.
I had my first baby by C-section, for compelling medical reasons (breech+placenta-previa+low fluids), and my second baby by VBAC (with an epidural). I had both babies in the United States and with the SAME female doctor, who is very much pro-vaginal birth.
I noticed that the doctor makes a huge difference, because I have seen friends scared into doing a C-section for no reason. If a doctor starts saying that a baby might be 'too big' for example. How many babies are really too big? Very few. First, the error in evaluating how big a baby is by ultrasound is very high. We are talking 20% here! Secondly, the size of the mother's birth canal is what matters, and the baby's position. A small baby can get stuck, or a big baby can go out in a couple of pushes depending on these factors. A doctor who suggests a C-section based on this is bull-shitting you for his own convenience! But, of course, what can you do? No one wants to risk it, and doctors know it. They should be more responsible when they make comments that influence their patients so much. No one ever does it, but I think a second opinion in these cases would be good.
Like at least another one of your readers I feel that vaginal birth is so much better for the mom. It makes a huge difference to let your body decide when it's 'ready' to do something. The recovery is faster, less painful, and breast feeding without a healing scar on your belly is much easier, not to mention the fact that milk comes in faster than if you give birth much in advance of the due date. My feeling after trying both is that a woman's body is designed to do things in a certain way, and that way works better, if it's possible to do it.
If a C-section is medically necessary, like in your case Tertia, it's a fantastic thing. But for those considering an elective C-section, my experience is that the pain of childbirth is really much better (and of shorter duration) than the pain of an incision healing over the course of weeks. Plus, there's no need to go 'all-natural'. There's this wonderful thing called epidural. So, for those who are afraid of the pain, just remember the magic words: epidural, epidural, epidural...
sorry for the long post...I guess these numbers made me angry!

I had a natural birth with my 8 year old daughter and it was great. Although I don't question a woman or doctor's right to choose which is the best way to deliver. I just had an embryo transfer with three embryos. I know it's possible I may end up with multiples here, which is usually a reason for a C-section here in the US. If I end up with multiples, I'll prepare myself for a C-section.

I gave birth in SA two years ago (in a private hospital) and I was the ONLY woman out of about 14 who had a vaginal delivery. I actually had what could only be considered an easy labor and delivery and I still hated it and the after effects and plan to elect a C-section with #2.

I can offer my 2 cents as to why the rate is really high in SA: 1) The doctors really push it. And "big baby" there seemed to be anything over 4 kilos (about 8 lbs). I don't think many doctors would be up for you trying to push out a 9 pounder. 2) The doctor-patient relationship is different in SA and perhaps in much of the rest of the world. I loved my OB (who totally supported me in wanting a vaginal delivery), but she found me kind of amusing/odd with my lists of questions, my desire to discuss this or that, etc. I think I was a typical American patient -- I had books, the internet, wanted to trust my doctor, but believed my opinion counted too. I think the relationship in SA is more traditional -- the doctor knows what's best for you.

I had an elective C-section as well (I joke about inquiring about it before I was even pregnant, but that's not true). I decided to do it after talking with my OB about the comparable risks and made my choice from there. No regrets.

I'll also add that I have two acquaintances that have recently given birth vaginally after easy pregnancies, went into labor on their own, babies were a normal size and both had MASSIVE tearing (one tore her cervix?!), infection, complications. One ended up needing emergency blood transfusions and is barely up and about after 4 weeks. I know that's not the norm, but there is no way I'm risking that. None of my friends that ended up with C-sections (none elective the first time) have ever had anything bad to say about it and one friend that's done both told me she preferred her C-section recovery.

I have had two uncomplicated births without any surgery. My second child had a complex congenital heart defect diagnosed after birth. The doctor said vaginal delivery was fine and sometimes better for the baby because there are fewer respiratory issues in babies delivered vaginally.

With heart defects you don't want any added resistance in the lungs and the process of normal birth helps in some way.

I can speak up as a had-it-both-ways girl. My first was estimated at "way over 10#" and my OB said to let him know what I wanted to do - he thought I could handle a vaginal delivery but if I wanted to go for c/s, he'd be fine with that too. I pushed out my 10#13oz son. Three years later, when I went to have my daughter, they did an u/s to check position (she'd done some flipping around and I had severe polyhydramnios) and we all sat and stared at the loop of umbilical cord floating in teh pocket of fluid between her head and my cervix. The OB sat back and talked about having me walk around for a while or some other ideas to see if the loop would move. I finally interrupted to ask when we'd get to discussing the c/s. I thought his poor nurse was going to pass out listening to him discuss other options. So I went for a c/s and had my 9#11oz girl that way. (and then heard the next day that another woman had come in the morning after me who's water broke and the cord prolapsed and the baby didn't do so well).

With no medical issues involved, I'd go for the vaginal birth. I was feeling great right after the section - I'd been resting all day and done nothing strenuous. And the amount of post-partum bleeding was infinitely less with the c/s. But I had a much harder time getting up and moving around after the c/s and the time to just generally feeling like I was back to "myself" was a lot longer. Although, I do have to wonder how much of that was due to the three-year-old holy terror running around as well as the absolutely brutal pregnancy (first was a breeze, last was so bad I can barely describe it) which left me in terrible shape for a recovery of any sort.

Read a few comments about female medical types choosing C-sections, and wanted to mention.... I am very amused (and slightly annoyed, to be honest) that my female OB has had 3 natural deliveries. While I think it is GREAT for her, I get a little tired of hearing about it at every discussion of my possible VBAC.

I'm in California, with Kaiser, which most of you probably know nothing about, but it's a BIG HMO type organization, with it's own hospitals, everything. They apparently have some of the highest VBAC rates in the country, and actively encourage it (cheaper, I'm sure).

First time around I was hoping for natural all the way (hypno-birthing classes - you get the picture), but my daughter was breech and wasn't budging, so scheduled C-section for me. Hoping for a (unmedicated) VBAC next month, but not holding my breath. Will take what I get, but feel weird being defensive with my doctor about maybe needing an epidural! :) Yes, the pendulum does swing....

I had two C-sections due to both babies being breech, I would love to have a third child but am too afraid that I will have to have another C-section. It was the worst, most painful experience ever. It HURT like a bastard. Not sure if delivering the babies in Taiwan had anything to do with it. I am amazed that so many woman experience such a little pain. P.S. having sex afterwards was really really sore, it took months to come right. Whats that all about??!!! and yes we did use loads of lube.

I recently (3 weeks ago) gave birth to my first child, a baby girl. I opted for natural delivery primarily because that is how our body's are made to function (although I am all for people making their own choices - I completely respect them). I won't lie - it was bloody hard work.

In the nursery I had the biggest child by far (4.3kg) - every single other baby (11 of) was born by c-section. A nurse actually joked and said how not only was my baby the biggest they had seen in a while but that I gave birth naturally too. I think, based on that, it is pretty safe to say that the c-section rate is quite high!

Again, each to their own. Child birth is a personal choice. BUT, truth be told, I chose my way because a) my baby and my body will tell me when its time (and not some randomly chosen date by a Dr) and b) I wanted it how nature intended. Besides, 4 days later and I had fully recovered!

I must say...what was that about welcoming the US "back to the village"? SA with their stark haves-vs-have nots contrasts - not much of a village there, eh?

I'm originally from the netherlands where only 15% of all births ends in a C/S. About one third of all children are born at home with a midwife. It's a real cultural thing. Most Dutch women also do it without pain relief. I was very disappointed when I had to have an elective C/S with my footling breech twins, but I got over it allright... It would be a shame if the art of natural delivery would be forgotten.

We are assuming there's a difference between natural and vaginal, right? I had a vaginal delivery with my son, but opted for an epidural. My labor pains were brief, two hours maybe of actual contractions with no pain medication. I think you people are crazy to WANT a c-section. It's major abdominal surgery with a lengthy recovery time!

I was out of bed within an hour of delivering my son. Was walking without pain (thanks to a little ibuprofen and lortab) a day later. My milk came in quickly. I was driving a week after he was born, doing the grocery shopping with my son in a sling. I would opt for a vaginal birth any day of the week!!

@Brenda: "I must say...what was that about welcoming the US "back to the village"? SA with their stark haves-vs-have nots contrasts - not much of a village there, eh?"

As you might have heard, South Africa had a brutal policy of separation of the races and exclusion of the non-white population from educational and employment opportunities called apartheid. As a result, the global community pressed sanctions on South Africa. The rest of the world tried to talk sense into the South African leaders during that time, warning them that they were heading for civil disturbances, but they wouldn't listen to the outside world. Therefore, for most of the 1960-1980s, South Africa was excluded from international sports competition (including the Olympics), the Commonwealth of former British colonies and the United Nations. In addition, many of the industries countries divested their money from South African-based companies. Finally after a long struggle, South Africa was gradually welcomed back into the global community when Nelson Mandela was released from jail and democratic elections were held in 1994.

George W. Bush has systematically ignored the advice of the rest of the world and has acted unilaterally for the past 7 years. The world is basically saying "thank god you have elected someone who will pay attention to our opinions and not exclude us from important decisions like going to war in Iraq". That was Tertia's point.

Interesting post and comments....I have had 2 vastly different experiences for my 2 boys. I was induced for post dates with my oldest at 42.5 weeks, then proceeded to have a very long and painful birth, full of interventions, failed forceps resulting in emergency c/s. My boy came out flat and was wisked away to NICU, where I saw him 4 hours later. I was shocked by the outcome and it took me a really long time to get a grip on my experience and feel bonded with my baby (who is now almost 4). My second boy, born 6 months ago, was born at home with a midwife, on a birthing stool. It was a relatively quick labour and by far the greatest thing I've ever accomplished. I may be granola for saying this, but I loved the experience and would do it again without any hesitation...

Both boys were 9lbs at birth, and I'm a petite woman - 110lbs and 5'4...

re bladder control? after 4 live births (3 vag, 1 c/s) three miscarriages and 2 D and C's over a 26 year period, I have almost perfect control. Pilates, and yoga based programmes are fantastic for this - sneezing, coughing, jumping, biking? piece of cake. i am 48 next year, so am pretty pleased with that situation. the surgeon who delivered amelia commented on my very strong abs when using the spreaders to crank them apart - heh - not that i was in any way using them at that moment. but, that immediate area healed very quickly.

ditto with sex, better than ever - and no worries re oversized girly bits!

my ob/gyn specialist said she preferred vag deliveries where possible because c/s are major surgery, with a hell of a lot of potential complications - including the baby being cut. my first view of amelia was of a skinned wailing rabbit with serious surgical tape on her head from where she was cut twice, and blood streaming down her face - not careless surgery, but one of the risks we were warned of because you can't piss around in a c/s situation, once the cut goes in it has to move damned fast! it could have been worse - she has permanent but cute scars which will be covered by hair if she ever gets any!

i was numb around the scar area for eight months, and sex was painful for a very long time after the birth, whereas it was fine only 6 weeks or so after the vag del's. i ripped my internal scar a few times when getting out of bed too quickly, bloody agonising. no driving for 6 weeks, no pushing the stroller. no exercise beyond a gentle walk for 3 months (with all others i was back to vigorous exercise within a few weeks). the scar wept for weeks, and was itchy, painful, and became slightly infected at one stage - not fun. bowel movements were painful, as was urinating, for a number of weeks, due to bruising internally and externally. because of amelia's position in the womb, there was a hell of a lot if pushing and pulling to get her out, so the bruising was very deep. i will never have the same muscle tone on my lower belly again - unless i have a tummy tuck, and i had a relatively flat and smooth tummy before. i felt as tho i had very litle control over my own recovery, and that sucked. this is not a horror story, and i don't intend it to be, but for me a c/s was not a better, easier, breezier option. it was however, the safer option, and i am eternally grateful to the skilled team who monitored me so carefully before suggesting the caesar as our only option.

after reading the latest comments, i have to say that this blog is so civil and decent!

having had both experiences, and lots of variations in the vag deliveries with a posterior labor, a pre-eclamptic induction, and a 16 day overdue freight-train-speed delivery, i do prefer the vag method. i am not a hippy, but am also not in favor of major surgery if it is not necessary. Vag del is natural, and can be done relatively painlessly WHEN CIRCUMSTANCE ARE RIGHT.

rather than push pushing as the only ideal though, i do urge women to become as informed as possible before deciding either way. there are horror stories on both sides, and these seem to inflame the debate and scare people unnecessarily.

the peaceful well managed vag dels are not solely the property of dippy greenie types, but can be attained if desired, often with some compromise on the part of the woman her partner and the birth team, and the same with c/s's.

I've had 2 emergency sections - one after a failed induction and a traumatised baby and my VBAC which went wrong and very nearly ended up with a dead baby.

If/when I have numbers 3 or 4 I'm going straight for the section option now. I've done enough to realise I cant birth a baby naturally. I've heard enough stories in the last 6 months from friends and friends of friends about their vba2cs and natural deliveries that I am almost glad my natural birth plans went wrong.

Your most important thoughts I know will be of a live baby. And if you have a c-section - who cares? (in fact I'm sure you emailed me the same words back in 06 after I wasnt so sure about my first sons birth!) After the trauma of the emcs with Ben and the (almost ruptured uterus) with the twins, there should really be any questions about your c-section.

Not an urban legend, posting anon b/c I'm a coward in more ways than one. The idea of enduring hours of pain makes me want to faint and I swear this is really, really, really, really true. I knew this woman in my small town that had so much scar tissue after giving birth that she could never have vaginal sex again. I swear. On my children's life I swear that is what she was told. Now that was 20 years ago, perhaps they've found something to help the poor woman since then.

They tried giving her dilators but the pain was too much for her. Maybe they have figured out a way to cut some nerves or something. But in 1985, that is what she was told.

In France, the risk of postpartum death is about 4X higher after a c-section than a vaginal birth. In all these anecdotal stories about complications after vaginal births, I think it's important to bring in the stats when people make their decision.

I also believe that the current statistical consensus on VBAC is that it's problematic, so I'm not being a granola vaginal birth advocate here. I just think the data should be taken into account.

I also haven't tracked down the stats on fetal death rates with the two birthing methods.

What pains me about some of the comments on this thread is us-and-them attitude, as if we are observing the Birthing Cup Final. In the blue, we have the Caesars, and the fans are out in force. In the red, we have the Vaginals, a minor but vociferous side. Several players have been forced out of the team in today's match, due to prolapsed undercarriages and abdominal scar tissue.

Grrrr. The first prize, for Pete's sake, is a live baby, so what does it matter whether you peel the orange, or squeeze it and suck out the juice? [And I'm talking about personal choice and luck here, leaving aside the alarmingly high rate of CSs in South Africa]

I'm lucky enough to have had three quickish vaginal births without any meds except nitrous oxide. I say 'lucky' because this outcome was, I sincerely believe, 80 per cent sheer luck [no complications, a family history of easy births, babies of a manageable size, and so on] and perhaps 20 percent miscellaneous other factors [good mental preparation and research, an active labour involving a lot of walking around and swearing like a sailor, and a mulish determination to resist pain relief for as long as I could].

Personally, I found the entire experience of giving birth the most thrilling thing I have ever done in my life [to hell with heroin; I had a natural high all three times that was close to a celestial experience], and it wasn't anywhere near as traumatic or dreadful as I had been lead to believe, even though it was brutally painful in parts. But my brilliant experience doesn't give me the right to judge or dictate anyone else's choice.

Here is one thing I feel strongly about: scare stories that are spread, at parties, on the Net and on the grapevine, among women. Vaginal deliveries [and, to a somewhat lesser extent, Caesarian sections] seem to be the butt [if you'll excuse the pun] of all manner of lore, legend and gory tale: rippings from hole to hole, three-week-long labours, bleeding eyeballs, total collapse and prolapse and of the undercarriage, and so on. These stories are, of course, the exception to the rule. Gazillions of women give birth normally and without excessive drama every day.

A woman who strikes fear into the hearts of other women by relishing, and repeating, other dodgy birth stories needs a kick up the backside, if she still has one. The truth is that no one can predict what's going to happen in those magical hours as labour begins. You might be lucky and all will go swimmingly, with snowy doves and shiny bubbles; you might be about to endure the most traumatic and painful experience of your life. Most likely, the experience will be somewhere in the middle, slanting towards the doves and bubbles.

What is important is an open mind regarding your own birth plans, and a tightly buttoned lip when it comes to other women's choices.

Wow, this is nuts! I had a vaginal birth with my twin girls and it really, really wasn't bad at all. It was only a little painful for the first couple of days and then I was back to myself (albeit without sleep and struggling to breastfeed twins, but still). I'd be more scared of repairing my cut-open midsection, I'm sure that's not a piece of cake either. Thanks for sharing how things are in South Africa, this is really interesting to compare with American health care (this is with good IBM insurance, too). I hope your upcoming delivery is safe and healthy :-)

i met a wedding planner the other day (at a friend's kitchen tea) who is pregnant and planning a c/s. her obgyn apparently told her that natural birth can be bad for the baby... i was stunned, but said nothing, i'm no professional medical person. but how could a "pro" say something like that? unless this women misundestood her doc...?

I had an emergency ectopic on my ovary-was bleeding internally and had to have surgery. I was devastated at the loss of my baby, but worse that I had invasive c-section scars without a baby. For the birth of my son, I wanted to give birth in goats milk, hugging a tree and having Gregorian chants whilst blissfully hypno-water birthing my son into the world. I wanted that. But reality hit me when my son had inter uterine growth restriction, was stuck in my birth canal and even had to be forceps delivered during the c-section. I was also bleeding profusely. I refused to be take the pethidine pump given to me after the c-section, survived on mild painkillers and was walking to the bathroom the next morning. I breastfeed fairly quickly, bonded with my baby, just loved him.

My 2 sides of the coin.

Genetically, woman are programmed to give birth. So, if you can and want to without risk, go ahead and have your baby with the choice that suits you.

My husband is a specialist who has seen natural birth and c-sections go wrong. The outcome should be a healthy mum and baby/babies. My cousin has a an atypical baby because during a natural birth things went wrong.


Listen to your instinct-it will guide you with choices you make. Its when mothers give others power to think and make decisions whether its pushy doctors, adamant midwives or ill informed care givers. Read up alot, then let nature take its course-your body and mind will gide you instinctively as to what is best for you and your baby.

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