Friday, November 7, 2008

"The baby was too big" cesareans and such

This doctor's blogpost and an email conversation with Fig got me on the subject, and I figured I might as well post my thoughts (cut and pasted from my email to Fig) here...

I really believe that most cases of "the baby wouldn't fit" c-sections are preventable. Women who are mobile, supported, and given whatever time they need don't typically end up with c-sections. My husband's sister delivered a 12 lb+ baby vaginally (at a birth center with a midwife). My mom's OB told her she wouldn't be able to deliver her children vaginally and wouldn't be able to breastfeed them either. She delivered all of us vaginally and breastfeed all of us too. Another woman I know got stuck at 5 centimeters or so, consulted with her doctor, and chose a c-section (it wasn't an emergency, there was no fetal distress, and the doctor gave her the choice to continue laboring if she wanted to). Each person will do what they do.

I do think that on very rare occasions a baby might be too big to come out. Here's one example. But I think doctors use the "too big" diagnosis far more frequently than is warranted... often because it's an easy out and women don't typically question it. Here's a good overview of some of the facts and misconceptions that I just found on a quick google search. A study I referenced in a previous Birth Faith post indicates that prenatal tests and diagnoses indicating that the baby is "too large" frequently lead to unnecessary c-sections and inductions without improving outcomes. Here's the original study's link.

But I'm convinced that most c-sections happen because something else (epidural, pitocin, lying down for extended periods of time, etc.) led to the distress or stalling of labor. There are certainly cases of genuine crisis when c-sections are warranted, and I wouldn't hesitate to let a doctor cut me open in those circumstances, but those crises are rare.

As far as the meconium in the doctor's example... meconium isn't generally a valid reason for c-section either. The medical establishment's own research indicates that: "Caesarean delivery does not improve the neonatal outcome when the amniotic fluid is meconium stained" (Journal of Obstetrics and Gynaecology 28(1): 56–59).

Doctors like to rattle off their expertise and claim they have science on their side (and sometimes it is), but it's hard to take them seriously when the research (published in their own medical journals) clearly contradicts them.

Have you delivered a large baby vaginally? Or have you given birth successfully through VBAC after a previous CPD (cephalo-pelvic disproportion) diagnosis and c-section? Were you one of those rare true cases of CPD? Please share your stories!


Fig said...

I will send my mom over to share her stories. These days I'm feeling quite proud of her mad birthing skills. :-)

Buscando la Luz said...

Ooh! Yay! Excelente!

Faithful Lurker said...

I have 2 friends who have given birth to more than one 10lb.+ baby. One of them has had 2 that were almost 12lbs. Both vaginally. (actually all 3 without epidurals too)Go figure.

I could not agree with you more on this post. I think most C-sections are a result of too much intervention, not an actual problem with the pregnancy.

Buscando la Luz said...

Wow. Thanks for sharing, Faithful Lurker! What an awesome testament to the beautiful power of women's bodies and the beautifully orchestrated process of birth! Thanks for your faithful lurking! Keep the comments coming! I love 'em!

Anonymous said...

The mother of the fig here. (Who knew that I gave birth to a dry wrinkly fruit??? Ü ) Because she promised. Not because I have anything inspiring to say. My babies weren't really big--3 of them in the neighborhood of 9 lbs. I gave birth naturally--with no drugs to all 7 of my children. Honestly it wasn't for any noble reason. At first I was more scared of the epidural than the birth. But, to tell the truth after #'s 5 and 6 were 9lbs+ I was ready for the epidural with #7. #5was especially difficult because he wasn't positioned well and took a bit of work to push into the birth canal. Then he was over 9 lbs, as was my next son, so I was scared. The midwife who delivered my youngest (because my ob/gyn was just home from vacation and didn't want to be bothered) was dumbfounded when I asked for drugs. Turned out I was too advanced and it was too late, and it was my best and easiest delivery. Hurray for midwifery!!
(And he was only 7 1/2 lbs.)
One reason I really wanted an epidural was so that I could be more aware of the birthing process--actually I just wanted to "see it". During delivery I was too involved with the pain and the pushing to ever see the baby crown or anything else. I thought that perhaps without the pain, I might get that mirror just right for once, or be calm enough to relax between pushes. Didn't happen. Now, I'm hoping to be there when the fig delivers (whether she wants another spectator or not!) It will be a first time to see a live birth for me!

Buscando la Luz said...

Thanks so much for sharing, Mama Fig! I know what you mean about feeling like you couldn't really "see it." I sometimes wonder if I'd be freaked out watching someone else give birth because I've only ever experienced it from my weird zoned-out-dealing-with-the-pain state.

Fig's right to be proud of your mad birthing skills!

Azúcar said...

I ran across this article on big babies, I thought it fit perfectly with this discussion!

Buscando la Luz said...

Fabulous, Azucar. Thanks for the tip.