The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Friday, May 05, 2006

A Woman's REAL Right to Choose

Did you think that I was going to talk about abortion? Wrong. I'm talking about a woman's right to choose how she gives birth.

I know I've touched on this topic briefly before, particuarly when I was doing my obstetrics rotation in a tertiary care centre. I saw so many bad outcomes in both high and low risk pregnancies, it seriously biased my view of childbirth. For quite some time, I thought that if I were currently pregnant I would chose an elective c-section over labouring. For me, I prefered the idea of predictible risk against the idea of unpredictible risk. A c-section is a higher risk procedure than uncomplicated vaginal birth overall, to be certain. But an elective c-section is a lower risk procedure than an emergency c-section (meaning any c-section done for medical indications after labour has started) and it's impossible to predict beforehand if your birth will be one of the uncomplicated vaginal ones or if it will get complicated as your labour progresses.

In Chatelaine magazine this month (did I mention I'm a total magazine whore?) columnist (I refuse to call her a journalist) Rebecca Eckler waxes poetic about her elective c-section. People, for the most part, are horrified that she is 'too posh to push'. I have to disagree. Why mock her motivation for chosing a c-section? No where in the article does she say that she doesn't want to mess up her eye makeup by labouring or anything that implies that she made her choice based on aesthetics alone. Granted, some of the 'pros' to elective c-sections that she mentions do seem a little superficial (like knowing exactly when she'd be giving birth, being able to plan her mat leave accurately, knowing when her mother should come and visit) but who are we to judge?

I'm all about giving patients the choice. Like when it comes to Vioxx. Vioxx was a drug that gave many people with osteoarthritis a new lease on life. Finally, their pain was under control and let them be active with far fewer gastrointestinal side effects than many of the earlier drugs for OA. Then it was pulled from the market under fears of cardiovascular disease. I know for a fact that many people would gladly accept a higher risk of cardiovascular events for the improvement in their quality of life that this medication offered. I also know that I'm not alone in wishing that this medication were still available so that patients would have the choice.

But I'm going off on a tangent. I know, so unlike me.

The health care system has evolved far beyond the days when the doctor would decide what's best for the patient and the patient wouldn't have any say. Why shouldn't the patient get to decide if they prefer the predictibility of a c-section over the experience of a vaginal birth?

Sure, a c-section has it's drawbacks. It's major surgery-- the recovery period is longer, there are risks associated with any surgery, and there is the threat of wound healing problems. But there are risks associated with childbirth, period-- and the complication rate of elective c-section in low-risk pregnancies is very comperable to the risks associated with vaginal birth. Vaginal birth carries the risk leaving women with urinary incontinence, fecal incontinence, sexual dysfunction, uterine prolapse-- some studies suggest that these complications are less likely in women who were sectioned. And the tearing... ugh! I've seen tears that have ranged from what we affectionately refer to as 'skid marks', superficial tears that don't require closure, to fourth degree tears that penetrate the anal mucosa. And that's if you're lucky enough to tear downwards. Clitoral tearing is also a possibility. Then there's always the potential for the stellate tear (I'll give you a hint... stellate means "star-shaped") and the ever-horrifying perineal blowout.

Sure, natural childbirth can be a beautiful thing. But that's not a guarantee.

I know I'm singing a different verse of the same old song. But if the pros and cons are laid out for expectant women in a non-biased way, why shouldn't they have the right to chose?

Now if only I could figure out how to reconcile the increased costs to our overburdened health-care system that c-sections would carry...

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Blogger ninepounddictator said...

I think I'm loving your blog.
(not only because you kind of, sort of, stuck up for me...)
I'm not sure of the added costs of elective C-sections, but I do think that's an important argument (And I don't buy the whole c-sections require you to stay in the hospital for three days! That's true, yes, but I think all women are pushed out of the hospital way too quickly after any means of birth..that's another story.)
I don't actually think that planning for mat leave, or planning to have my mother there, is a superficial reason.
As a woman, going on mat leave is hard - the pyscological aspect no one talks about. Yes, women do still worry, and do need to, about a job not being there for them...that' another story too.
But you're right. I was not too "posh" to push. I don't adress that, because, as you know, you cant be posh when giving birth - by any means. It's ridiculous that people say that...
And, it's funny too, that you brought up the arthritis drug. I've had rheumatoid arthritis for years. As you can guess, I'll take the risk, thanks very much, in order to live a productive day to day.
Anyway, I enjoy your blog....great idea.

3:29 AM

Blogger clara said...

I chose an elective section with my 3rd after having a horrific outcome with a low risk vaginal delivery, and losing my baby to hypoxia during the delivery.

I agree with everything you wrote comparing the risks. A c section recovery is much easier than a 4th degree tear recovery (had one of those too). The one risk you didn`t mention though is that in future pregnancies after a section there is a higher risk of placental problems, especially the dreaded placenta accreta which can end a woman`s reproductive life.

4:04 PM

Anonymous Anonymous said...

you need to read more recent studies. There is NO increased risk of urinary incontence with a normal birth plus you are not allowing your infant the myriad of benefits that go along with a normal birth.

appalling a doctor is making these kind of foolish recommendations.

11:05 PM

Anonymous Anonymous said...

Ahh yes, and the years and years of scar irritation, pain, the inevitable hysterectomy, fibroids? how about scar tissue... decreased fertility, won't go into placental problems, that was covered already.
Could you please look at the skyrocketing IOTROGENIC causes of "emergency" c/s? If it is an emergency, lets be clear, no one signed consent forms after having the doctor mention all the above (and more!).
Emergency is when mom is knocked out by general anaesthesia and everyone waits outside the operating theatre. It isn't when well, you aren't progressing and we've upped the pit four times already *thinking... I want to get home!*.
Sad, so sad to see another Canadian doctor with such American ideas...
I've had a c/s. I've had a fourth degree tear. I've had a baby transfer to hospital after birth. The c/s was by far the worst experience of my life! By far. Never again did I let a physician near my body.
Saddened in Manitoba

11:05 AM

Anonymous Anonymous said...

I like your blog!
Why can't a woman have a choice in the way her body is to be mutilated? My first baby was a low risk 'natural' birth which has left me with a legacy of problems that I equate with the darkest time of my life when it was supposed to be the best! My subsequent next 2 C-section deliveries (one emergency, one elective) were 100% better in terms of after delivery survival. No post-natal depression, no 4th degree tears with sutures coming undone, being able to stand up for more than 2 minutes so I could bath my baby, non painful sex after 1 month instead of 4 months and a much happier me!!!!! I still have all the horrible lasting effects of my first birth and no effects from the others. Why are women so critical of the way another women chooses to safely deliver a child into the world? Who says we have to be mutilated by a so called 'natural' child birth and willingly go back for more? If you can deliver a child naturally and walk back to your bed within the hour more power to you! I know that's how it is meant to be, I certainly was aiming for that. Just don't judge those who can't. Admire the healthy happy baby and happy well-adjusted mum instead!

11:20 PM

Anonymous Staci said...

I wished I get the facts you listed here from my doctor before the birth of my child. What made it worst was that my baby was in posterior position. I ended up with a very horrible 18hr delivery experience that left me with a 4th degree tear. I wished I had a C-section instead. Ironically, My friend whom gave birth by section told me she wished she could do it naturally.
I was still having pains even after 6 months postpartum. I was lucky to have a good doctor and that my body healed itself nicely. It was definitely not worth it to go through the labor pain and the possible 4th degree tear. Even my mom who witnessed my delivery discouraged me from having another baby. I too am traumatized myself.
Thank you for your blog. Every woman should get educated on this matter.

8:17 AM

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