Voluntary C-sections

My sister-in-law is pregnant, due in November, and she just scheduled a C-section. She has no medical issues; she just wants to be in control of the whole process, including the timing.

As someone whose wife had to have a C-section (our first son went into distress in the delivery room), I just don’t get this–I got to see first-hand how long the recovery period is, how unpleasant the first few weeks are, and so on. Is this sort of thing (having a C-section for convenience) as wacky as I think it is, or is it pretty common, and I’m just hopelessly out of touch?

That’s pretty nuts. I’ve heard of people inducing on their first pregnancy to fit some weird scheduling shit, but skipping straight to the c-section is bonkers.

My wife grudgingly accepted an induction because we were a week or so late, and it wound up as a c-section. Apparently inductions quite often turn into c-sections since there’s a 24 hour window or something after the amniotic sac is ruptured (a common part of the induction toolkit) before you need to get the baby out.

Both inductions and c-sections are ridiculously stupid things to do unless necessary to protect the health of the mother or child. Have your sister-in-law do some reading while she still has time to change her mind.

That reminds me of this article. The short version is “c-sections scale”; they don’t require years and years of expertise with forceps on the part of the doctor.

The story of the forceps is both extraordinary and disturbing, because it is the story of a life-saving idea that was kept secret for more than a century. The instrument was developed in the seventeenth century by Peter Chamberlen (1560-1631), the first of a long line of French Huguenots who delivered babies in London. It looked like a pair of big metal salad tongs, with two blades shaped to fit snugly around a baby’s head and handles that locked together with a single screw in the middle. It let doctors more or less yank stuck babies out and, carefully applied, was the first technique that could save both the baby and the mother. The Chamberlens knew that they were onto something, and they resolved to keep the device a family secret. Whenever they were called in to help a mother in obstructed labor, they ushered everyone else out of the room and covered the mother’s lower half with a sheet or a blanket so that even she couldn’t see what was going on. They kept the secret of the forceps for three generations. In 1670, Hugh Chamberlen, in the third generation, tried and failed to sell it to the French government. Late in his life, he divulged it to an Amsterdam-based surgeon, Roger van Roonhuysen, who kept the technique within his own family for sixty more years. The secret did not get out until the mid-eighteenth century. Once it did, it gained wide acceptance. At the time of Princess Charlotte’s failed delivery, in 1817, her obstetrician, Sir Richard Croft, was widely reviled for failing to use forceps. He shot himself to death not long afterward.

By the early twentieth century, the problems of human birth seemed to have been largely solved. Doctors could avail themselves of a range of measures to insure a safe delivery: antiseptics, the forceps, blood transfusions, a drug (ergot) that could induce labor and contract the uterus after delivery to stop bleeding, and even, in desperate situations, Cesarean section. By the nineteen-thirties, most urban mothers had switched from midwife deliveries at home to physician deliveries in the hospital.

But in 1933 the New York Academy of Medicine published a shocking study of 2,041 maternal deaths in childbirth. At least two-thirds, the investigators found, were preventable. There had been no improvement in death rates for mothers in the preceding two decades; newborn deaths from birth injuries had actually increased. Hospital care brought no advantages; mothers were better off delivering at home. The investigators were appalled to find that many physicians simply didn’t know what they were doing: they missed clear signs of hemorrhagic shock and other treatable conditions, violated basic antiseptic standards, tore and infected women with misapplied forceps. The White House followed with a similar national report. Doctors may have had the right tools, but midwives without them did better.
The two reports brought modern obstetrics to a turning point. Specialists in the field had shown extraordinary ingenuity. They had developed the knowledge and instrumentation to solve many problems of child delivery. Yet knowledge and instrumentation had proved grossly insufficient. If obstetrics wasn’t to go the way of phrenology or trepanning, it had to come up with a different kind of ingenuity. It had to figure out how to standardize childbirth. And it did.

Three-quarters of a century later, the degree to which birth has been transformed by medicine is astounding and, for some, alarming. Today, electronic fetal-heart-rate monitoring is used in more than ninety per cent of deliveries; intravenous fluids in more than eighty per cent; epidural or spinal anesthesia in three-quarters; medicines to speed up labor (the drug of choice is no longer ergot but Pitocin, a synthetic form of the natural hormone that drives contractions) in half. Thirty per cent of American deliveries are now by Cesarean section, and that proportion continues to rise. Something has happened to the field of obstetrics—and, perhaps irreversibly, to childbirth itself.

My wife had two C-sections due to a car wreck when she was in her early teens. HEr pelvis was fractured and was not going to allow either baby to be delivered vaginally. It is all I know, so does not seem that weird to me other than being different from the way most people do it. We showed up, I went back once she was prepped and within about 15 minutes of them starting, we had a baby each time. It was unbelievably simple. The recovery time is a bit longer, but other than that, there were no problems whatsover.

I understand there is more risk invovlved, but as it was our only choice and we had little difficulty, it was not a big deal.

A friend of mine from college is an ob-gyn. When she has kids, she’s going to insist on C-sections. She just won’t do a vaginal birth. The fact that she’s a doctor, specifically an ob-gyn, made me curious about it, but I never had the chance to ask her.

My wife was induced when our son was born, no medical necessity, was never sure why her doctor wanted to go that route. Her delivery was relatively comfortable and smooth for most of it, but the baby had some weird issues halfway through that made everyone think an emergency C section was coming. Anyway, not sure if those things would have happened anyway, but it always made me wonder.

Keeps the cooter tight.

So the pediatric nurses tell me.

My wife’s expecting our second kid any day now – literally; she’s having contractions every couple of hours, and little Matthew just dropped down into her pelvis. So it’s happening Real Soon.

With our first child Sophie, two and a half years ago, we think she might have had undiagnosed pregnancy diabetes – she had a lot of edema, and the baby was large, 10 lbs 11 oz (which is really big for anyone, but especially for my wife, who’s not the largest-framed woman out there). My wife labored for 22 hours, spending about half of that time at what’s called “transition”, which is the time when the kid is SUPPOSED to move into the birth canal. It’s the most painful and stressful time of labor, and she worked at it and worked at it and WORKED at it – without drugs, yet! – until she was totally exhausted and we were getting heart-rate flutterings on the fetal monitor. Finally she had an epidural and C-section, and it was really pretty traumatic, because she was completely and utterly wiped out before even going into the operating room.

This second time, we had an ultrasound just two weeks ago – if Matthew had been as big as Sophie, we would have scheduled a C-section right away. And if Matthew doesn’t arrive by shortly after his due date, we’ll schedule one for then – it’s not safe to induce labor after having had a prior C-section, apparently.

We’re hoping that he’ll be a reasonable size and that we can have a smooth and straightforward vaginal birth this time… epidural city, no all-natural for us, no sirree. In retrospect if we’d been less gung-ho about the all-natural thing the first time, we might not have had one of the more difficult birth experiences that you can have. So this time, if there’s any fetal trouble or if the doctor thinks it’s a good idea, we’re going straight into the operating room for a C-section, no questions asked.

My personal theory is that medicalized childbirth in affluent nations is eliminating an evolutionary backpressure on increased fetal size. If larger babies no longer kill their mothers in childbirth, due to C-sections and other interventions, then over time babies will tend to get larger and larger in utero, especially in brain size. I think that eventually C-sections will be the only form of childbirth, several centuries from now, when humanity has gotten to the point that babies simply get too big before delivery to make it through the pelvis.

You never know how birth will go. Our kids were all very large babies (8-10 lbs at birth), and only the first was delivered vaginally. It was a very difficult and long labor - about a week of prodromal labor with trips back & forth from the hospital, then 20 hours on pitocin, finally ending with three hours of pushing in the delivery room. We only avoided a c-section by a few minutes after all that, and it was obviously quite traumatic for my wife and daughter. Having a purple baby with a squashed head while your wife cries from exhaustion isn’t the Hallmark Moment one anticipates.

So screw birthing - the next two were scheduled c-sections. Much easier, far fewer complications. Our second daughter was delivered 10 days early & still hit 10 pounds (first was “only” 8 lbs. 2 oz.), and the third was 11 days early and 9 lbs.

At that point where everything has to be done by C-section, though, we’ll all be grown in tubes. And have psychic powers, green eyes, and glow-in-the-dark hair.

10 lbs. 11oz. Yikes. Glad she made it through that. :D

We’ll probably look like Talosians.

At that point, we’ll make excellent batteries for our robotic overlords.

In brain size? Can you explain that a bit further?

BTW, is seven-hundred years (several centuries) enough for that type of change to occur?

My wife narrowly avoided a C-section - our kid was projecting out at 10.5 lbs, we were past the due date, but she wasn’t going into labor, and was additionally fighting some blood pressure issues.

So her OB/GYN “stripped the membranes” (you can google it - I’ll skip the description, other than to say that it’s supposed to be a natural way to generate a burst of prostaglandin that can start labor) - we wanted to get the kid out before he got any larger.

It did indeed start labor, but it didn’t really proceed (must likely because we were trying to push a labor before it was ready to go), and after about 30 hours we went the full-blown induction route (epidural, pitocin, etc) and were able to have a vaginal birth - she was exhausted and actually fell asleep for a few hours after the epidural was administered.

So in the end we missed the C-section, which is great because the recovery time for the C-section sucks, apparently. Ironically, the kid was only 9lb 8oz, so we really didn’t need to induce after all.

As for doing a voluntary C-section - I don’t see why that’s a bad thing, although if you go hit up the various doula websites they’ll tell you all kinds of reasons why you should do vaginal birth (my favorite is that the extreme pain of natural child birth causes a flood of oxytocin in the mother’s body, which helps her “bond” with her new baby - yeesh).

Edit: And no, 700 years (which is about 20 generations) is not likely to be enough for that type of change to occur. And that assumes that the only thing keeping us from having larger brains already is pelvic width - while that’s certainly one limiting factor, it’s just as likely that from an evolutionary standpoint our brains are “big enough” already - making them bigger doesn’t make us more likely to pass on offspring. In fact, in a modern society, it can be argued that the more educated you are (and you need education to take advantage of your bigger brain), the fewer children you’re likely to have, so I’m not sure that there’s a strong selection pressure on larger brain size anyway.

Most of the scheduled C-section anecdotes here fall into medical necessity, it seems. Which I totally get–if you can be pretty sure you’re going to have complications through a regular delivery, it makes total sense to avoid them.

It still seems weird to me to schedule a C-section for the convenience of scheduling your life, so you’ll know when the baby is being delivered (this decision isn’t being driven by medical issues at all). It seems to me that it’s a huge trade-off to decide that you’re going to put yourself through an additional few weeks of recovery from surgery so that you can put your calendar in order.

I’m not approaching this from a standpoint of “natural is always better”–after all, medicine is all about interfering in the natural course of events. It just seems odd to me to decide so far in advance, without some sort of medical issue (not even just a very large baby), to put yourself through major surgery. My girlfriend says I’m just out of touch, and that this is on the rise among professional women, so maybe I’m just a Luddite…

Good point. But there may be other trends at work – it’s well documented that average height (and, Lord knows, average weight) have significantly increased in the last century, largely due to better nutrition or at least a lot more calories. So it’s quite plausible that babies are growing larger in utero due only to environmental, rather than genetic, factors.

In fact, in a modern society, it can be argued that the more educated you are (and you need education to take advantage of your bigger brain), the fewer children you’re likely to have, so I’m not sure that there’s a strong selection pressure on larger brain size anyway.

That’s an interesting thought, though I would tend to think that highly educated / intelligent people tend to want to breed with other highly educated / intelligent people, which would tend to foster big-brain genes in that sub-population. Talosians, absolutely. (That Talosian dude’s expression actually totally reminds me of a new baby. “HOLY FUCK WHERE AM I AND WHAT ARE ALL THESE WEIRD LIGHTS???”)

Also, as intelligence and education become steadily more highly correlated with affluence and wealth (definitely happening – look at the decline of blue-collar jobs relative to knowledge work), that definitely produces a strong selective pressure towards high intelligence, and perhaps towards larger brain size. (I recognize there’s room for debate about whether bigger brains actually imply higher intelligence.)

[i]Mother was an incubator
Father was the contents
Of a test tube in the ice box
In the factory of birth

My name is 905
And I’ve just become alive
Im the newest populator
Of the planet we call Earth

In suspended animation
My childhood passed me by
If I speak without emotion
Then you know the reason why[/i]

A couple of stiches post-partum help with vaginal births to help with that, or so I’ve heard.

Even with medical necessity, other non-medical issues influence scheduling. With ours, the doctor had to wait long enough for the baby to be over normal size, which backed up his diagnosis and need for the c-section, otherwise the insurance company would dispute it and not pay beyond the cost of a non-complication vaginal birth.

So, we could have scheduled the births 2-3 weeks earlier, the babies would have been in the 7-8 pound range, and the prescribed procedure would have successfully avoided the complication of high birth weight. Despite the medical need being correctly diagnosed and treated, purely for insurance purposes we had to wait longer.