Friday, January 13, 2017

A Somewhat Educated but Even More Opinionated Post Regarding Caesarean Deliveries

  It's just after 4:00 a.m. PST, and I've been out of the house on my fourth call since I left work at 8:15. I left work later than usual because a baby announced its intent to its entrance into the world just as I was headed out the door for home at 6:05.  If anyone missed the news in an earlier reference, I'm nearly through the first week of my OBGYN rotation.

     OBGYN is not a branch of medicine that is well-suited to those who like and/or insist upon regular working hours. Babies choose to make their appearances into the world at whatever hours are convenient to them through some process that is still a mystery to all of us.  Doctors use  measures to reduce the inconvenience. They trade on-call nights so that any given doctor's sleep isn't disrupted every night. Some doctors attempt  lot of labor inductions during normal working hours. Some obstetricians perform a disproportionate number of caesarean section deliveries, the majority of which happen during normal business hours, in order to reduce the number of times they'll be called in at odd hours to deliver the babies.  

     This, in my opinion, isn't as terrible as it sounds to some. Any given baby in the United States has almost one chance in three of being born via c-section regardless of the best-laid plans of mothers and doctors. Some mothers are predisposed to a greater likelihood than others of delivering via the surgical route. Some caesareans happen through the luck of the draw. Some doctors resort to surgical deliveries at the first sign of difficulty. Whether the baby in question is dealing with his own odds or those of his or her obstetrician, there is an element of wisdom in determining what would have been the forty-week point of gestation for the baby (which is actually thirty-eight weeks, but that can be discussed at another time), shaving a day or two off the time so that labor doesn't start, and scheduling a c-section delivery.  I AM NOT SAYING OR EVEN HINTING THAT EVERY BABY SHOULD BE BORN BY C-SECTION. I am saying, however, that if a surgical delivery is safer for mother or baby, it should happen.

     Gone, in most parts of the U.S., anyway, and even in most parts of the world, is the idea of a woman delivering her baby in a potato field, then carrying him in her apron to the farm house, where eventually someone might come to her aid. (That actually happened to my great-grandmother in giving birth to her third child.) That happened because it was the best people could do with the circumstances they faced. It in no way meant such was the ideal way in which to bring a child into the world.

     Pregnancy and childbirth are now very much dealt with in medical capacities. From the diagnosis to early care to late care to delivery itself, the medical profession is involved.

   There are those who would have it otherwise. Some of them are actively fighting medical intervention -- even actively fighting others' right to medical intervention. Others are quietly going about their own lives, hoping their own rights to use widwifery and to bear their children at home will not be taken from them. I feel they are endangering their own well-being nd the lives of their own unborn children, I'm still willing to champion these women's rights as long as they do nothing to undermine my right to treat pregnancy and childbirth as a medical procedure.

     Where I feel that these women and their families have gone wrong [in my opinion]  is that they seem to value to the process of unassisted labor itself over the end product of producing a healthy newborn. To my way of thinking, it's all about producing the healthiest baby one can have. The simplest and most logical way of doing that is not to stay home for the birth and to give birth on one' toilet [although I do suppose that's one way of exposing the neonate to bacteria right away] or to kick all the doctors out of the birthing setting.

     While there's no reason for a child to be born in a more harsh environment than is necessary, when my day comes, I'll keep the lights dim util the OBGYN says he needs brighter lights in order to see what it is he's (or she's) doing. I'll have soft music played in the background, but if the doctor gets a bit loud and causes me not to be able to hear the Mozart or Bach that's playing softly in the background, I'll consider it a natural casualty in the name of modern medicine. If my OBGYN suggests that things are not moving along a quickly as they should be, and insists a caesarean is the safest way to move things along, he or she will not get any argument for me.

     The reasons for this are that most medical personnel do their bast work following a decent night's sleep and knowing in advance what is scheduled for the day and time. Healthy babies are born all the time, whether vaginally or abdominally, at odd hours.  A tremendous advantage to the baby in this process is that most labor ad delivery personnel, from the doctors to the nurses to the technicians of various sorts, genuinely thrive upon bringing new babies in the world at whatever hours the babies manage to be born.  I can understand the mentality that goes into this. There is a rush present at the birth of a healthy baby that I've never seen  and probably never will ever see elsewhere. 

     Caesarean section deliveries (the name supposedly came about due to Julius Caesar having been delivered in this manner, though much debate surrounds the origin of the name) were major surgeries at one time. They're still considered as such, as any opening of the body to major organs is typically classified as "major surgery."  The procedure, though, is now also considered routine, and, depending upon the nature of the hospital in question, is often the most frequently performed surgery in any given day.  Unexpected complications can arise in a caesarean delivery, and recovery time is definitely longer for a caesarean delivery than for a vaginal delivery, but I personally do not believe that it can be rationally concluded that a vaginal delivery is safer for the baby than is a caesarean delivery, particularly when a surgical delivery of the child has been anticipated in advance. While a baby whose is delivered vaginally works mucus and fluids out of his lungs through the natural process, which is a good thing, modern medicine is equipped to deal with any issues related to the absence of this happening due to the manner of birth. Additionally, a child born vaginally is exposed to bacteria through its mother while traveling down the birth canal. While the idea of bacteria may seem like an automatic negative to some, we all need exposure to bacteria in order to develop our immune systems. This is especially true for newborns, and the initial exposure to the newborn to bacteria through its own mother is probably the least harmful way such can happen. Nonetheless, it is my opinion that the positives of a vaginal delivery for an infant are outweighed by the negatives, with the negatives, in my opinion, is that throughout [in particular, a lengthy] delivery, so many hazards are present that, even disallowing for human error, a baby is usually safer through a surgical delivery.

     Where the mother is concerned, more risks are, at present, associated with Caesarean delivery than with vaginal delivery. The single greatest risk for the mother is the risk of death due to blood clots, which is at present  three times greater for mother who delivered by c-section as opposed to mothers who delivered vaginally. The rate of maternal death in childbirth or following childbirth is still incredibly low in the U.S. Other risks cited include frequent delay in breast-feeding by mothers who have given birth surgically, the greater pain as associated with a surgical delivery, and the economic impact of longer hospital stays. As far as economic impact of extended hospital stays is considered, it should not be a concern, in my opinion, if the surgical delivery is otherwise better either for the mother or for the baby. Where breastfeeding is cited as having been interfered with by surgical delivery, I personally do not believe it. yes, it may be delayed by up to a dy, but my experience is that it happens when it would otherwise have happened irrespective of the manner of delivery.  Where greater maternal death is taking place due to blood clots, this is obviously not something to be taken lightly.  It's a reason not to automatically sign up for caesarean deliveries when no other indications for surgical deliveries are present. Still, women develop blood clots or otherwise bleed out following vaginal deliveries as well.  

     Many studies detracting the practice of caesarean section deliveries are paid for or otherwise promoted by insurance carriers. This is a fact that should not be taken lightly in forming conclusions regarding the safety of one manner of childbirth over another. Insurance carriers have a vested interest in slowing the rate at which caesarean deliveries because the norm as opposed to the exception. Because there is a considerable difference in cost to the insurance carrier for the more invasive surgical delivery, it is entirely reasonable that an insurance carrier should not be forced to bear the full cost of a purely  elective surgical delivery. It seems logical [and is current practice] that the patient should pay the difference between the cost of a caesarean delivery and a vaginal delivery in cases where the choice to opt for a caesarean is entirely elective. That alone will not solve insurance carriers' cost issues, though, as doctors have been known to be creative in advocating for their patients' needs; it's not inconceivable that  the most elective caesarean ever performed was done so at full cost to the insurer through skillful wording on the part of the obstetrician. It would be nice if a happy medium could be found here. I know that there is supposed to be discomfort associated with giving birth to  baby. If I elect to have the pricier option that gives me the least amount of agony through the actual labor/delivery process (the pain may be greater later than if I had opted for the more natural process of delivery itself) I should expect that it will come at greater financial cost to myself. 

I came across this piece of my mom's writing on a related topic. She gave me permission to use it.

     When I was taking civics and economics my tenth-grade year (I would have been thirteen, turning  fourteen, at the time, but most of my classmates would have been seventeen or eighteen), a girl who sat directly in front of me was in early stages of pregnancy at the beginning of the school year  but by June, was great with child. The child was conceived quite legitimately. The mother's own parents, in their infinite wisdom, had allowed their daughter to marry the love of her life  on Valentine's Day of her junior year of high school.  The baby who appeared as a result of his parents' love was due to make his official appearance into the world on the day in June on which graduation was scheduled. 

    Our economics instructor was in his twenties, and his wife, also in her twenties, was expecting her first baby close to the time my classmate's baby was due. (As it turned out, my classmate's baby beat the instructor's baby by six hours give or take a few minutes, but the two babies were roommates in the hospital's neonatal nursery.) Our instructor  was especially interested in his student's and my classmate's pregnancy. Each day as she dragged herself into the 7:55 a.m. class (her attendance was exemplary that year, as she had been told that if she experienced undue absences due to pregnancy-related matters, she would be transferred to an alternative high school program) our instructor would first ask her how she was feeling, but would soon launch into his daily speech, which he supposedly picked up from his wife's OBGYN, that pregnancy was neither an illness nor a medical condition, but  instead, was a perfectly normal part of life. This must have been difficult for my classmate to hear at the various phases of her pregnancy. Early in her pregnancy, there wasn't enough concealer or foundation to cover the shade of green that her face had become. I recall following her out of the classroom on numerous occasions to offer water, damp paper towels, breath mints, or whatever else she might want as she sat in the damp dirt of the flower beds outside our classroom on cool October mornings after having tossed up whatever breakfast she had been able to get down. The two of us had not been especially close prior to being seated one in front of the other in this class. I don't think we'd even before been enrolled in the same class previously. It was simply a mother-of-invention sort of thing. Melinda needed someone to attend to her needs, and I, in addition to being seated nearby, could afford to miss a few notes from the teacher's lectures. He lectured straight from the book and I, unlike most of my older classmates, had actually read the required readings.

     Things got better for Melinda for awhile -- I hear that the second trimester of pregnancy is often the easiest -- until they got worse. She wasn't sleeping well; each morning the circles beneath her dark brown eyes seemed to grow a bit darker and more deeply ingrained.  The heartburn probably would have killed her had the pregnancy gone on for twenty-four hours beyond the doctor's initial estimation of the length of the pregnancy. Melinda's walk progressed to the classic pregnancy waddle, which no one dared to make fun of  primarily because of our civic/economics teacher, who, while spouting nonsense about pregnancy being not an illness or infirmity but  a perfectly natural condition, was also hearing another side of things from his wife. The teacher's wife understood that pregnancy was sufficiently uncomfortable as experienced on her living room sofa. She couldn't have imagined what it would have been like as a barely-eighteen-year-old, dragging herself from one high school class to the next while feeling pains in places she didn't even know existed. The thoughtless comments from dweebishly immature high school jocks, not to  mention the snide cat-like commentary from too much of the female enrollment -- not about what landed her in the state she was in, but, rather, pertaining primarily to her resemblance to a whale and her difficulty in making her way for one class to the next, were almost more than Melinda could tolerate, and Mrs. Roche, our instructor's wife, had heard of Melinda's tormentors. She - Mrs. Roche -- made it her mission to insure that her husband took it upon himself as his personal crusade to put a stop to any and all harassment of Melinda.  Sexual harassment laws had been recently enacted, and Mrs. Roche saw to it that those laws were used to for the benefit of Melinda's protection. Eventually other faculty member got on board, and it became difficult for anyone to make the most benign of jokes at Melinda's expense without soon realizing that the few laughs one might get from such a joke were not with the faculty harassment and possibly even office involvement Melissa still had to face the near-terminal heartburn,  the baby's favorite trick of stomping on his mother's bladder at the most inopportune of times, the awkwardness of her body's vastly different dimensions as compared  a year earlier, her related dwindling wardrobe, and other related indignities almost too numerous to count. Still, she was spared harassment from the student body, which was only fair. While I have as much a problem with slut-shaming as does the next person, Melinda wasn't guilty of it. She was, as far as anyone in our high school could prove, as pure as newly fallen snow on the night she married. While her choice or non-choice (I have no idea, nor have I any need to know, how "planned" this pregnancy was) of conceiving her child so that she would be in a state of enceinte throughout that vast majority of her senior year of high school, it was no one's concern other than hers and her husbands. The reason it was treated as such was largely because of the commitment on the part of Melinda's civics/economics teacher's wife  to insist that her husband act as a protector to this seventeen-to-eighteen-year-old girl. No one could spare her the physical discomforts inherent to pregnancy, but she was at least protected from the vast majority of demeaning comments from the student body.

Credit for one aspect of Melinda's comfort belongs chiefly to my own father. He was at this time out of the air force and was flying commercially. I casually mentioned at dinner one night (even though it was just the two of us at home, we usually ate dinner together whenever his schedule permitted it) that Melinda could no longer fit into the desk that had a chair attached to it. Her midsection had grown so large that she didn't fit into the space allotted for a body any longer. He didn't even appear to be paying attention as I told him of this situation. Nevertheless two mornings later, about an hour before class was to start, he appeared on campus with a local furniture owner. They carted in a not-inexpensive plush recliner. After custodians were located, the classroom was unlocked, and the previous desk was moved out, the recliner, complete with matching cushions and a board of sorts which Melinda could hold on her lap in order to write as she needed to , was loaded into Melinda's spot in the front row.  I recall her actually crying when she came into the room and saw it. It hadn't occurred to me jut how self-conscious she must have felt wgiile trying to squeeze her body into the old wood-wire-and -plastic model student desk.

My teacher may have felt that he was doing the right thing in telling Melinda that pregnancy isn't an illness and that it is a very natural biological process, but the truth of the matter was that he was incorrect. There was also a time when -- while I don't think anyone was saying it wasn't an illness, dealing with cancer was a very natural process as well. Since not much could be done for anyone suffering from it, in the end, a whole lot of morphine was injected until the victim finally succumbed. The same probably could have been said of numerous illnesses. 

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