Tuesday, April 11, 2006

CDMR

In comments to a recent post of mine Dream Mom opined that every pregnant woman wants two things: one, to have natural (vaginal) delivery, and two, to have her baby go home with her from the hospital. There was a time when I would have readily agreed with that, but lately I have to question how true the first wish is because there is a small, but perhaps growing, number of women choosing to deliver by caesarean section on maternal request (CDMR). This refers to caesarean delivery for a singleton pregnancy upon maternal request at term in the absence of any medical or obstetrical indications. In other words, a mother says, I don't want to go through labor, just give me a caesarean section.

When I first heard about CDMR, I thought this is crazy, do obstetricians really agree to this? Apparently some of them do, and they do it often enough that the National Institutes of Health saw fit to recently convene a group of experts to assess the state of current knowledge about CDMR. The result of that conference is a "State-of-the-science conference statement". In short, the experts said that there is really not enough evidence to recommend for or against CDMR.

Post partum hemorrhage, subsequent urinary incontinence, and surgical and traumatic complications might be less in women with CDMR versus women who have vaginal deliveries or unplanned caesarean sections. On the other hand, women with CDMR have longer stays in the hospital and might have more infections and more anesthetic complications, and breastfeed less. Babies born by CDMR have a higher chance of respiratory problems after birth, but might have less of a chance of birth injury and infection. Again, there is not enough data to adequately evaluate the good versus bad of CDMR.

My gut reaction to CDMR is that it can't be good to subvert Mother Nature's wishes regarding childbirth. As a person who believes in the value of scientific inquiry, though, I'm willing to wait for more information on the subject. I fear, though, that if CDMR becomes more accepted then some women will choose it based on fear of delivery, a fear that might be informed by less than reliable sources, such as baby showers and "horror" tales from "friends" about vaginal delivery. The amount of medical misinformation out there is amazing. I don't mean to trivialize the fear, though. Let's face it, the thought that a human being, even a small one, can emerge from an opening the size of the vagina is a bit daunting. But the pain of vaginal delivery can be dealt with, and all mothers should make their decisions based on real information, not scary stories.

I'm curious to see how this works out.

18 Comments:

Blogger Flea said...

Let's be adults for a moment, ND.

In my experience, the moms I've encountered who've gone for CDMR have done so for two reasons:

1) They wanted to have the baby at a time that was convenient for her and/or her family.

2) She wanted to preserve the integrity of her birth canal.

Fear of delivery and so-called horror stories, if they rank at all, are well down the list.

best,

Flea

8:50 PM  
Blogger Amie said...

I have four children. The first two were vaginal deliveries, the third was a c-section due to face first presentation. With my fourth, I was praying hard for a VBAC, I was not interested in another section and I cannot relate to women who opt for elective ones. Not saying that i'm right and they're wrong, just that after experiencing both I can't imagine choosing the surgery.

9:22 PM  
Blogger That Girl said...

Once, again, Flea hit it - Ive never known a woman who did a CDMR out of fear.

People deride moms who choose CDMR because they choose to do it for "convienance" or to preserve their sexual, ahem "desirability". I say, as a society, stop valuing "woman as sexbot" and form over function and you'll see the requests for CDMR go down.

When you make having a baby as difficult as possible (unpaid maternity just the tip of the iceburg) then of *course* you're going to have women who choose convienance.

This whole bewilderment about why someone would choose this is echoed in La Leche circles (re: why choose formula?) and always makes me laugh.

I cant compare the two - Ive never been in labor - but I can say with absolute certainty that emergency C-sections suck. Big-time suck.

9:41 AM  
Blogger Tara's World said...

Dont some women just want their child to have a perfectly rounded head as well? I had mine vaginaly but I have hear that women are making the choice for a C-section for that reason

10:48 AM  
Anonymous Anonymous said...

I saw the same report. As all three of my children were large and born by c-section - initially due to failure to progress and later due to risk of abruption because of previous c-sections, so I guess I should say I start with a bias.

I know c-section is unnatural, expensive and that it alters evolution, but it also saves lives. When I look at Da Vinci's babe in the womb (see http://cherubsinthelandoflucifer.com/toc.html for a full explanation), I am reminded how many lives have been lost throughout history because of the lack of this relatively safe intervention. I don't think we should be doing c-sections on everyone or that they should be a choice of convenience, but I worry that this consensus statement (which is receiving a lot of publicity) is going to polarize the public and make c-sections an "us" versus "them" thing (as in the privledged elite get c-sections while other mothers doggedly insist on natural birth (even if it might be the wrong thing medically in some cases).

I think that there should be a relatively low threshold and a long list of indications for c-section, such that many women could essentially be given the choice of c-section for what may seem to be minor risk factors (e.g. an infant predicted to be born over ten pounds).

I have seen what happens when a woman insists upon vaginal birth despite the obstetrician's recommendation for a c-section (as I'm sure neodoc has). Its not pretty.

Cherubsinthelandoflucifer.com

12:03 PM  
Anonymous Anonymous said...

In about 9 weeks, I'm going to be induced for Baby #4. That's as close to birth at a convenient time for me as I'm willing to get, and it was my OB's idea, not mine. My last two labor experiences lasted about 3 hours each and I had 9+ lb kids both times. Both times my labor started in the middle of the night. My OB wants to be there when it starts this time and I don't have any complaints about that. I wouldn't ever ask for a c-section though. I'd consent to one if it were necessary, but I'll do this nature's way if at all possible. I don't like needles, let alone scalpels. :-)

12:05 PM  
Blogger Dream Mom said...

I'll be interesting to see how this turns out too:)I was just making a general comment.

I would have loved to have had a vaginal birth however my OB insisted on a C-Section due to Dear Son's size (I still say it was due in part to his vacation schedule.); Dear Son ended up coming out on the low end of the estimate at 8 lbs, 12 oz. I wanted a vaginal birth so bad; I felt cheated when I had the C-section. I must admit I find it ironic that women might choose a C-section; I still remember the pain and that tape being ripped off my stomach before I went home. OUCH!! On the other hand, if I had a vaginal birth, I would have wondered for some time if some of his issues might have been caused by that. I learned three years ago what caused my son's disabilities when the gene responsible for it was discovered and he was the first person in the world to test positive for one of the three gene patterns.

3:53 PM  
Blogger neonataldoc said...

Thanks, everyone. Very interesting stuff. Flea, I think you're being a little hard on me! I'm sure some CDMR's are done for convenience, but until we see data to the contrary, I don't think we should rule out fear as a motivator.

Tara, your friends shouldn't have C-sections just to give their kid a round head. The conehead from a vaginal delivery goes away very quickly. By the age of a couple weeks, a baby's head will be the same shape regardless of the mode of delivery.

P.S. Sorry about the bad link to NIH. I'll fix it tomorrow when I have the correct address.

9:36 PM  
Blogger Catherine said...

Does CDMR include caesars after a previous caesarian section? If so, that'd affect the stats.
We forget that becoming a mother does not instantly confer maturity or ability. There are all sorts of people out there, and compared with other parenting issues, the choice of a major abdominal op over vaginal delivery is a relatively harmless one for the bub (or am I wrong?).
But I do agree that not taking your baby home with you would be extremely traumatic, even if the bub is predicted to do v. well. I've heard of blankets for home-administered phototheraphy. What do you think of those?
Izabela

12:34 AM  
Anonymous Anonymous said...

I had a primary c/s for single footling breech (discovered 15 hours into an unmedicated labour. IT SUCKED!
I've since had two homebirths attended by midwives. I never wanted to ever enter the world of that surgery again! I still don't have an abdominal feeling. I will happily share that my pelvic floor was in much better shape AFTER sqeezing babies out of it. Maybe I'm the exception, not the norm?!
As far as I'm concerned, if you want "convenience" don't have children... they will make your life terribly difficult. Don't kid yourself that picking their birth date is helpful! =( It is already Us vrs. Them... look at how many hospitals on this continent don't allow vbacs! Happy Cesarean Awareness Month...

1:15 PM  
Anonymous Momof3 said...

I am shocked at the rate of c-sections climbing and the rate of VBAC's declining. I had a c-section for my first (breech) and a VBAC for my second pregnancy. This was in 1997 and I had little difficuly in discussing this option with my doctor.

I am now pregnant almost a decade later and getting my doctor to consider a 2nd VBAC is like pulling teeth! I am feeling quite coerced into having a c-section.

And I must agree with many out there...having had both types of delivery I would much more prefer the healing birth of a natural delivery to the weeks of searing pain from sown up abdominal muscles. A woman opting for a first time c-section must have surely lost her mind.

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