This is actually the problem with the c-section rate. We should not be able to "schedule" a c-section to avoid the "pain and complications" of child birth. This is a serious medical procedure that should be medically necessary not for the convenience of the patient or doctor.

any MD that did a c-sec just because you wanted one shouldn't have a license to practice...that's pathetic.

I urge everyone to watch The Business of Being Born, What Babies Want, Birth As We Know It and Orgasmic Birth even if they’re done having babies or are men! I own them all and the more I learn about the process of giving birth as our bodies intended, the more I start to believe that perhaps some of our personal problems (that of course bleed into our societal problems) could be linked to the medicalization of birth.

It’s a misconception that it doesn’t matter how the baby gets out of the mother. And although C-Sections should be available to anyone who needs them, if we prevented chemical intervention in labor I know we would “need” a lot less of them. I think it begins with free, proper prenatal care that defies the fear-based sensationalizing of medical dramas and stops hinting at every turn that something could go wrong. Our bodies are FANTASTIC! There is no shame or incompetence in our flesh and helping young girls understand that from sex-education on should be mandatory.

I have to believe that we are on the verge of a de-medicalization of birth and we will look back at this period in our medical history with the same revulsion and shame that we do for the forced lobotomies in the 30’s and 40’s or the “bleeding” of sick patients prior to modern medicine. We have the technology, now we just need to start using wisdom of when NOT to use it.

Choosing a C section as a "birthing plan" (whatever the hell that is) boggles my mind. WTF??? I agree that any doctor that goes along with such nonsense should lose their license.

Not quite. It may be about getting the OB out of the equation faster, but the most insurance companies allow 48 hours for recovery after a vaginal delivery and 96 hours for a C-section, provided there aren't any major complications.

Im not a women, But I do know what pain is. Can't blame anyone for wanting less pain.

Snigs, aactually is not quite like that. I wanted to have a VBAC (vaginal delivery after c-section) my OB/GYN wouldn't even attempt it. So I switched doctors, it was almost impossible to find a doctor that would try to do a VBAC, secondly my insurance won't cover doula services (a doula would assist you through birth & a VBAC). Like everything else in this country, it comes down to money, doctors won't risk being sued if a c-section is not performed on time. I much rather deliver naturally that have to go through surgery, but that's not the doctors agenda, they want you to schedule c-sections so they can perform a number of deliveries a day/week without being bothered with middle of the night calls or lenghty labors. I have several friends who are going back to basics, delivering at home, in a tub, with a midwife or doula, actually one of them just delivered a healthy 8+ lb baby yesterday, at home, no complications for neither the baby or the mother. She had a hospital near by and a plan to get there in case she had complications, but there was no need for it.

This c-section trend is taking away the right to deliver our babies in less intrusive ways, don't get me wrong, if you want a s-section, go ahead an schedule one, but I should not have to go through several doctors and beg for one to allow me to deliver naturally if I please, just because is not convenient for the doctor. There is a huge amount of doctors that would try to scare you away from this option, telling you you could die, or the baby could die if you deliver vaginally, that a c-section is the safest way to deliver a baby. A big fat lie, but sadly the lie that's being told to most of laboring mothers in USA.

This comment is a pretty insulting. I can't speak for others experience, but in our case my wife was induced at 38 weeks because of pre-eclampsia. After an overnight stay for prep and 4-5 hours of trying to induce, they broke her water and realized that our baby was breach and was not going to come naturally.

The delivery from that point on was short, but the recovery was much longer than had it been natural. It was difficult and expensive, but it was absolutely unavoidable in our case. And I can assure that there was absolutely no "instant gratification" for us, that the doctor was not on the way out the door to play golf, and that my wife was in no shape for days to text or do much of anything else for that matter than try to take care of our new baby while trying to recover from major surgery herself. I think your comment is way off the mark.... but that's just my opinion.

Nice post! Glad I'm not having any more children to have to search around for an OB/GYN who would allow a VBAC. My first was a c-section due to pitocin and fetal distress because my water had broke 24 hours prior. My other four children were VBACs. My oldest daughter, now 24, was my first VBAC in 1986 and I had to search and search, and when I did find a doctor who agreed, she stayed with me the entire labor and delivery which took 10 hours. My third VBAC in 1989 was two hours and doctors were accepting of VBACs. My third VBAC in 2004 was not met with enthusiams. Had a planned VBAC, but the doctor on-call was in attendance. At 9 cm he was contemplating taking me to the OR, bitching me out for risking my life and my baby's actually telling me we "could die". Guess he didn't have his morning coffee. Glad I delivered 20 minutes later, and with a check of my uterus he found no "windows" (thinning of the uterine scar).

I've had many surgeries, including joint replacement surgeries. If you can go through a knee replacement and its associated pain and therapy, you can go through labor and delivery....no problem.

Albeit some c-sections are necessary, the scheduled cesareans for conveinice or those scheduled because of fear of labor....crazy! There was one comment above that a patient was doing stairs the evening following her surgery. Well, if you're not numb from an epidural, you can do stairs as soon as you can stand up following a vaginal birth. Regular deliveries have no major pain or recovery afterwards. I guess it comes down to no pain before....or less pain after.

You might want to research a bit more before making this conclusion. Csection poses more risk to mother AND baby. It is a major abdominal surgery.

Normal pregnancy and birth are usually semi predicatible in that a normal healthy baby will be born w/o complication. Most complications arise from the cascade of intervential that one encounters in the hospital setting.

As a midwife...we take only normal low risk clients aand currently have less than a 2% c-section rate.....so tell me....how is that more unpredicatble than the 32% rate one faces by simply walking in the door of a hopsital.

Now Im not saying csections dont have a place because they do, but in normal healthy low risk pregnancies that are followed by an observant care provider with an eye on nutrition, the majority of births go as planned with little or no intervention.

I to work in the industry and anyway you slice it, C-sections cost more then vaginal deliveries. Convenience, regulation, litigation, and preparation do play a role. And finally lets not forget about genetics. Do we have any studies that discuss the continued fertility of people who do not have the body to deliver babies. Many are passing on those genes to offspring.

This trend started in the 70's so no need to blame Obama for it, actually I think there is a light at the end of the tunnel and women are trying to get back to a less invasive labor experience, we are becoming better informed and we are starting to question our caretakers, and seeking counseling and different options like home births, doulas & midwives services (services that are NOT covered by insurance). Secondly like Lovemy5 stated a c-section is surgery, having delivered my first by C-section I would never, never, never opt for it again. Recovery is longer and has more risks for infections/complications. Delivering a baby vaginally (unless it's breech) carries little recovery time.

My wife delivered vaginally with the risk of the cord wrapped around the neck. With an episiotomy(Sorry if it's spelled wrong) and a quick flick of the wrist by Doc, it wasn't a problem. C section never crossed our mind. There is a time for C section but not all the time. Not just because it's easier or more predictable. I'm with Post 1.1 and 1.2 . It's called "labor", not a "minor inconvenience". Kids are work in all aspects and if someone isn't willing to do a little to bring one into this world then maybe they should rethink the situation. I've never been through labor(I'm a man), but I wouldn't doubt that's the easiest part of raising a child.

Thank you for a male point of veiw. l had 2 children, both vaginal births...labor is intense...it's long, hard work, but the MOST rewarding labor a woman will ever do! Men will never get the sheer joy of experiencing the wonderful feeling of ELATION that a woman gets after the delivery of her baby!! The moment the child slides out of the vagina the pain is gone, and most women don't remember the acual pain...she remembers having pain and the duration of that pain, but the actual feel and intensity vanishes. The proof...moms with more than 1 child. Face it, if childbirth was such horrific pain...why would a woman do it again? As a nurse l can tell you C-section should ONLY be done if the life of the baby or mom is in danger. The post-op concerns and possible complications over rule any reason for doing a 'schedualed C-section'......C-sections should ALWAYS & ONLY be done as a life saving operation...not as a convience.

Only if they don't do a proper sponge/needle count. Never say never.

They should be. Dr's should be sued for doing unnecessary surgery. It's unethical on so many levels.

Childbirth is a natural part of reproduction. The problem is that we are getting soft. I had both of my babies with absolutely no pain medication, epidural, or even Tylenol afterward. It hurt - a LOT! But my baby was healthy, I was alert, and I suffered no bad effects whatsoever. My doctors in NC had the lowest C-section rate in the state, because they firmly believed that they were there simply to help nature do its job. Everyone wants everything NOW, with NO pain. Well, some things are worth a little pain, especially if it means being healthier.

All those drugs they use go straight to the baby - how is that better? C-sections also take longer to heal. How is that better? It alarms me how quickly people jump to induction and c-sections. My first baby was induced, but only because I was three weeks overdue, and my doctors knew that it was time to induce. They are inducing now within two days!

And to say no woman should get pregnant would mean the end of human beings. Maybe not such a bad thing! lol

A c-section should be the last alternative, not the first. I don't think many women realize how dangerous they are. I had my first child natural, no pain medicine, nothing and she was 91/2 pounds. Her shoulder got stuck during the delivery but the nurses managed to get her out. Unfortunately her collar bone was broken in the process. She did fine and healed up fast. My second child was a scheduled c-section because of the size (another over nine pounds) and because of the complications with the first. The doctor thought it too risky to try a natural delivery again. If I had it to do over, I would have done natural, it couldn't be riskier than the c-section was. I almost died during my c-section. I hemoraged and lost over 1/2 the blood in my body. The baby ended up in ICU and I spent three days in the recovery room. My incision had to be re-opened after five days and left open. I spent eight days in the hospital, three weeks of home nurse visits, and then had to have surgery again three months after delivery to fix an incisional hernia from the c-section. After another four days in the hospital I was allowed to go home. Luckily I'm fine now, but I was advised not to have more children after that. The doctor told my husband to get a vasectomy.

I was only trying to bury your pain... in an unnatural world (what with people wearing clothes, cosmetics, cosmetic surgeries, using electricity, computers, and everything else we can’t live without) why is a "natural birth" important? Like I said, let the deliverer choose the method of delivery...

"And to say no woman should get pregnant would mean the end of human beings. Maybe not such a bad thing! lol"

I agree LizzyMae, the world is fit to burst with human beings. If people are desperate for babies/children then there are millions out there who are orphans / have no one to love them / abused by people who don’t want them.

Save the pain (of sex/pregnancy/delivery) and the world will gain (by saving abused children), what sayest thou???

Actually the hospital makes less and the doctor does as well.

Reimbursement to the doc from many insurance companies (esp. managed care) is the same whether the birth was vaginal or operative, as are post-delivery hospital rounds (we call this bundled payments). And some docs are penalized for spending more money per patient in aggregate, so those with high C-section rates may be penalized. Even if done before the weekend for convenience, a doc or the doc on-call still has to do rounds daily, and C-sections keep the mom in the hospital longer.

Hospital reimbursement may be more for C-section, but so are expenses, so C-sections are not a way to make money. Again, contracts with insurance companies might be bundled, and the hospital might end up making less.

Please, PLEASE watch The Business of Being Born, What Babies Want, Birth As We Know It and Orgasmic Birth. They may not change your mind, but I have to hope they will.

I'm a family practice physician who used to practice some OB. I liked the article, but agree no mention of medical malpractice was made. A doc doesn't get sued for doing a C-section too early, but a lawsuit is virtually guaranteed if the C-section is done too late and brain damage to the baby ensues. Sure, some C-sections are done for convenience of the doc or the patient, and this is bad. C-sections themselves are major surgeries and can have long-term complications. Yes, it is nice nurse midwives can cherry-pick all those low-risk OB patients, and dump high-risk patients on the OB docs (thus also skewing the stats on C-section percentage), especially if a last-minute problem occurs during labor and delivery. Ultimately, the buck stops with the doc. Midwives are valued members of the health care community, but do not bear final responsibility, and do not pay the malpractice insurance rates required for the OB docs.

As a Home Birth Midwife I take offence at your depiction of midwives "dumping" a high-risk patient in your lap. In countries with the lowest maternal and perinatal mortality rates, midwives are the primary caregivers for low-risk women and doctors care for only high-risk women. To use limited resources to have a trained surgeon (OB) care for low-risk women is like using a cardiologist to do all well-child exams in the rare event of a heart problem. These countries also have a well-coordinated system of transferring care if a low-risk woman becomes high-risk. I doubt these doctors feel they are being "dumped" on. They just know this is a system that works and each person in the system has their work to do. In my neck of the woods Family Practice Docs need to have an OB intervene if their low-risk patient all the sudden needs a c-section. I wonder if these OB's think the Family Practice Doc is dumping? Oh, and in my busy midwifery practice I deliver 80-90 babies a year and my c-section rate is 2-3 %. I also take care of medium-risk Amish women.

Also: For those talking about money, I was a insurance pay on the first birth, and a cash pay on the second. So, I was fully responsible... and the cesarean tab is a lot higher... Trust me. (My infant is 6 months old.)

So, I suppose these women should sign a waiver saying they do not want a C-section and will not sue the OB doc for a bad outcome related to not doing a C-section. This won't work as long as it is the lawyers who determine the "standard of care" rather than doctors. I'm all for doing fewer C-sections, and maternal bonding with baby after vaginal delivery. Patients do need to understand the medicolegal aspects of their care - lots of people besides the doc and pt are involved: lawyers, Fed and State govt, insurance company, etc.

But, what if a woman doesn't want a lawyer dictating her or her baby's care, or a malpractice insurance person, or the state or federal government? What choice does she have? If a woman really believes the doctor can no longer, with years and years of schooliing and experience, suggest a plan of care which he/she truly believes is in the best interest of the patient because of "medicolegal aspects" of our health care system; what choice does she have? For many women, the choice is to go out of the system. After being an L&D nurse for 10 years, I'm now a Home Birth midwife and I wouldn't go back to the hospital system for all the money in the world. It's wrong. And what's worse, most of the people in the system (OB's, nurses, hospital CEO's) all know it's wrong and the patients deserve better. But the fear of lawsuits keeps this system going. Who's going to stand up for the patients against these bully lawyers? If the lawyers were stopped from taking frivolous lawsuits, the greedy patients expecting perfect babies would have no recourse.

OB docs do C/S after VBAC to prevent against lawsuits. Thankfully, the pendulum is swinging back from that extreme, but the risk of uterine rupture (causing anoxic fetal damage and mom to hemorrhage) still exists. Many measures I learned in my training such as breaking bags, Pit, IFM, IUPC have shown little if any benefit. Hopefully, courts and lawyers will eventually learn this, and take it into account when deciding malpractice issues. Unfortunately, you can always find an "expert" to support your view, even if wrong.

NU Wildcat, you have proved my point from above, that doctors can no longer do what is in the best interest of their patient--they must defer to someone without training in medicine--the lawyer. You say many measures you learned in your training show little benefit, but you didn't finish that sentence which begs the question--why are these measures still used if they are of little benefit? Because that legal "expert" tells you to. The truly sad part about these measures having little benefit is that is only half the story. These measures have known risks--the major risk is that of increasing the c-section rate without improving outcomes. The false belief that there is fetal distress that leads to unnecessary c-sections can be traced to all the measures you list.

cnm - Please continue to use your expertise and skills to educate your pt population and the system. The B.S. above was part of the reason I got out of the OB portion of my FP practice.

FYI - latest ACOG guidelines - http://womens-health.jwatch.org/cgi/content/full/2010/805/1?q=etoc_jwgenmed

By the way, my county is Cook County, IL. Annual malpractice premium for FP is about $32K. For OB, it is near $200K per year. This county is one of the most litiginous counties in the country.

Agree.

But in your case, the c-section was necessary. What's wrong is when women aren't really given a choice - or they foolishly just want what they think is less work. I'm very glad your little one was ok. :) That had to have been very scary!

Thank GOD you had a C-section!!! Your life and your baby were in jeapordy of death. The placenta that tears away from the uteran wall is comparable to a severed artey!!! An emergency C-section was your only hope for life, for both of you. You needed blood transfusion and both you and your baby were hospitalized. You validate the reason for C-sections....only when life is threatened...l hope you and your baby have a wonderful life.

Thank you for your support. I just might be naive to what goes on in larger cities but I can't imagine a doctor forcing a woman to have a C-section without her consent or the next in line to sign for her. What happened to personal choice and the right to not be bullied. I just wish the article had stated more facts about why the procedure was chosen.

Why not simply follow ACOG guidelines? Patient/doctor convenience is not an indication for C-section, but I have witnessed such many times. One correction to your post - reimbursement from many insurance companies (esp. managed care) is the same whether the birth was vaginal or operative, as are post-delivery hospital rounds (we call this bundled payments).

"Why not simply follow ACOG guidelines?" Because the guidelines change like the wind. In the 80's ACOG changed from once a c/s always a c/s to VBAC's for everyone; then in the 90's VBAC's kill babies and that has now remained into the new millenium. Oh, and then there's the cytotec debacle, and how about the pitocin induction with a scarred uterus, and the other one I like, 20 Units of pit IM for induction of labor in the 70's! I ask, "Why not let nature dictate the guidelines until intervention is truly necessary?"

latest ACOG guidelines, just received via email today - http://womens-health.jwatch.org/cgi/content/full/2010/805/1?q=etoc_jwgenmed

cmn - As you know, deviation from guidelines exposes the doc to additional malpractice risk, and all the emotional and financial consequences thereof.

My sister in-law had a water birth for all three of her girls. She said it was the way to go. She had an enjoyable exprience all three times.