Moms who planned Cesarean births report high satisfaction

Mary - posted on 05/08/2011 ( 34 moms have responded )

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http://www.baltimoresun.com/health/bs-hs...,0,6976532.story



This article was on the front page of my paper this morning (I guess they found it topical for Mother's Day.) I would c&p the whole thing, but it is a bit lengthy. I found it...interesting.



I will put up a few excerpts, but I strongly encourage reading the whole article to get the big picture. Sadly, unless I want to pay for it, I cannot get (as yet) find an on-line link to the actual study, recently published in the American Journal of Perinatology.



The doctors found that women who planned C-sections were much more satisfied with their experiences than those who planned vaginal births — partly because more than a quarter of the latter group ended up with unplanned cesareans.



"...There is not enough evidence that we should offer everyone a C-section; we're not at that point," said Dr. Joan Blomquist, an obstetrician-gynecologist at GBMC, which has the fourth-busiest maternity department in Maryland.



"But for the right patient, it might be the right decision," said Blomquist, who was Cofiell's doctor. "At least we need to make sure they understand all the possibilities, that they don't have unrealistic goals."



The findings, reported in a recent issue of the American Journal of Perinatology, were surprising in that C-sections have been linked to higher rates of postpartum depression in past studies and vaginal births have been found to be more satisfying for mothers.



The research by Blomquist and Dr. Victoria Handa, an obstetrician-gynecologist at Johns Hopkins Bayview Medical Center, grew out of a conference at the National Institutes of Health about the growing number of C-section requests. The officials wanted to know what women were expecting from cesareans, and they funded the doctors' investigation.



The study polled 160 women planning vaginal delivery and 44 planning C-sections. The women were asked eight weeks after delivery about their fulfillment, distress and difficulty. They rated their satisfaction with the childbirth experience on a scale from one to 100 and how they felt right after birth using descriptors such as "disappointed," "enthusiastic" and "cheated."



Those planning C-sections reported higher satisfaction, higher fulfillment and lower distress and difficulty, and a more favorable overall experience than those planning vaginal birth..."




Now, it does state in the article that part of the dissatisfaction experienced by those planning a vaginal birth occurred when the birth ended up being an unplanned c-section. It also talks to more than one OB who is NOT in favor of elective sections.



I do want to clarify that I think the purpose of this study was not to encourage purely elective sections, but rather to look at the general assumption that women who have a c-section have lower levels of satisfaction with their birth experience, feel "cheated", or are more likely to experience post partum depression. The big distinction (to me) is that they were exclusively looking at women who chose this form of birthing, as a separate entity, and not combining them with those who wanted a vaginal birth, but were unable to have one.



Thoughts?



**Edit** Despite numerous attempts, I cannot make the link work. However, if you click on it, and type cesarean satisfaction in the search, it will come up.



Another link, which is not as informative is this



http://www.gbmc.org/template_bodyvideo.c...

MOST HELPFUL POSTS

Mary - posted on 05/09/2011

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Heather, since I worked in L&D, I've seen a bunch of primary scheduled sections, for a variety of reasons. And, while I see your point, it's just as possible that many of the women in this study in the vaginal delivery group were 2nd or 3rd time mothers, so it could be argued that they would be just as "prepared" for what to expect, unless they ended up with an unplanned section.

In any study, there are going to be so many variables that can affect your emotional and mental outlook 8 weeks after birth. I think the most relevant finding is not really so much a comparison between those who birth vaginally vs surgically. Rather, I think this is noteworthy because it does chip away at that longstanding myth that a c-section automatically equates with some type of disappointment or negativity in the mother.

Dana - posted on 05/09/2011

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I think a small percentage of PPD can depend a lot on what your exceptions are, regardless of what kind of birth you had. If you're prone to put yourself down or be disappointed in how things turned out, then of course you have greater risk of PPD, whether that comes from a emergency C, you had drugs, you had an epidural, etc...

So many women (it seems from reading posts on CoM over the past couple of years) have high expectations of birth to the point that they're not being realistic to the fact that things go "wrong".

Mary - posted on 05/08/2011

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I thought this was interesting for a couple of reasons. Are the numbers small? Yes, but that is typical for an initial probe into any subject; all the docs commenting on this say that it is a subject that warrants further exploration on a larger scale. It is noteworthy in that it is one of the rare (and perhaps only) time they differentiated between planned and unplanned/emergent sections.

One of the big arguments made against c-sections is that it often has a negative emotional and/or psychological impact on the mother, and is a huge contributing factor to pp depression. The results of this study suggests that it is not, in fact, the method of birthing itself, but rather the mother's level of "satisfaction" with whatever birthing experience she has that is the issue.

I totally agree with Krista - if things go as planned, or, you are more focused on the outcome rather than the experience, your odds of being content go up drastically.

Dana - posted on 05/08/2011

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Janessa, there's a huge difference between a C-section 20 yrs ago and one now though. And it also depends on what country you live in, what hospital you have one done in, what doctor you have. There are so many variables.

Anyhow, the study makes sense. It's all preplanned and it's not in your hands, it's in the doctor's hands. Although that being said, I'm still scared to have my planned C-section, so I'm sure it's not a walk in the park either.

[deleted account]

Nature be damned in my case. Had I been able to have another child, that c-section would have been planned first thing (owing to my son's very traumatic labor & birth). I think it's great. I think we as women need to support each other's choices and not inspire guilt of one mother being better than the other because she did it all natural vs medical stuff. Embrace choice!

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[deleted account]

I agree with Angela C- it's a personal thing that IMO no one else except the other parent of the baby has a right to pass comment or judgement upon.

Angela - posted on 05/11/2011

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@ Casey - firstly, good luck with the birth of your little bub. I hope all went well. Secondly, in regards to what you wrote at the end of your response :

'Honestly anyone who thinks having a c-section or a planned c-section is the easy option is mental and doesn't have clue!!!'

I am a little disappointed that you would even write that. Everyone has their own reasons as to why they decide upon a 'planned c-section', myself included. I mentally, emotionally and physically broke down during my first birth because of what i and my little girl went through. There was NO WAY that i was going to experience that again. I was not given a 100% chance of things going smoothly, nor was i given even an 80% chance so i was not going to risk anything the second time around so i opted to have a planned c-section and i am so glad that i did. I felt every positive emotion a mum is to go through when they have a baby so i don't think i felt cheated. I knew exactly what i was getting myself into so i don't consider myself 'mental' or one who 'doesn't have a clue', i consider myself a mum who did what was right for my baby and for my own physical, mental and emotional welbeing.

Casey - posted on 05/09/2011

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Ok I am actually having a planned c-section tomorrow (yes I am serious our baby's birth date will be the 11/5/2011) and although it is good to know in advance the date and everything so I can be organised it also sucks majorly as well because I have had the past couple of weeks to think non stop about the surgery and stuff and now I have myself so worked up and stressed out about the whole procedure that fear and and nerves have completely taken away from the actually excitement that I am having a baby tomorrow right now I am struggling to think past the surgery the baby has barely even entered my mind yet.
I had an emergency c-section with my first baby 2 years ago and after 28 hours of labour they have found out I have a twisted pelvis so my babies never "drop" into my pelvis so hence the reason for the c-section, but to be honest with you I would much rather still go into labour naturally and at least experience some labour and have the baby choose it's own birthday but even I know this is pointless as a c-section will be the only result anyways so thats why I have gone with a planned one.
After I had my emergency c-section I felt a little bit "cheated" cause I really wanted to experience a natural birth but I felt comfortable with the fact that I had tried my best but with this planned c-section I feel very cheated and ripped off and I almost feel guilty for having a planned c-section it's an awful feeling and I really just can't wait for the whole thing to be over. Honestly anyone who thinks having a c-section or a planned c-section is the easy option is mental and doesn't have clue!!!

Angela - posted on 05/09/2011

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with my first i had every intention of going naturally....16 hours later of induced labour and not dialating any more than 3cm, they noticed my little girl going into distress and needed to get her out so i had an emergency c-section. She came out not breathing and needing assistence. She was whisked away straightaway so you could imagine the fear i had for her. I had 3 doctors/specialists trying to calm me down and keep re-assuring me she was in good hands but as a first mum, all i wanted was to hold her and kiss her. It was the most terrifying experience for me and i cried throughout the whole c-section til i was able to hold her which wasn't until the next day for a few minutes in the neo-natal intensive care unit. With my second child, i was not going to experience anything like that again. i was sooo traumatised by the whole thing that i asked to have a planned c-section this time around. It went exactly how i expected and i was able to hold, kiss and be in awe of my baby girl straightaway.

Lady Heather - posted on 05/09/2011

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Well, I totally agree with you on the last bit. Still, going into my next birth I don't feel anymore prepared then I did the last time. I feel like I only know what might happen rather than what will and it's not really much less nerve wracking. Maybe if this was number 4 I'd feel differently. One labour isn't enough to make me feel like an expert though! Haha.

Lady Heather - posted on 05/09/2011

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Yeah, and those problems aren't super common. Breech would be the most I suppose, and even for that they don't always automatically schedule a c-section. My point is that the women who had the c-section knew what was happening or knew it had to happen so the mindset is completely different. That's all. In any case, I still stand by my assertion that most planned c-sections are not first time births. Really, how many women do you know that were in that scenario compared to how many weren't? I don't even know any personally. I came close, but everyone I know either had vaginal or went in thinking vaginal and came out with a c-section. Pretty easy to be disappointed if you are expecting one thing and end up with the other.

Mary - posted on 05/09/2011

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Eh - there are lots of reasons for primary scheduled sections - malpresentation, history of a deep myomectomy (for fibroids), multiples, some form of placenta previa, and a host of other maternal health-related issues. I would love to see the actual facts and demographics about the study participants. As well, the article doesn't specify if the vaginal group were first time mom's, or had prior deliveries. My guess is that the entire group, both those with sections, and those who delivered vaginally, were a mix.

Lady Heather - posted on 05/09/2011

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Everyone I know who had an elective c-section did so because they'd had previous c-sections and they either couldn't find a doctor to do a VBAC or didn't want one. So this makes total sense. They knew what to expect because they'd done it before and there's no room for disappoint because things are going to go exactly as planned for the most part. I doubt very many women in this study were first timers, and if they were they were the rare folk like me who had a problem requiring it. I would have been completely satisfied to have my planned c-section if Freja hadn't proven us all wrong first. For me vaginal birth was like a bonus rather than a c-section being a disappointment.

Basically it's not the same people being studied if you compare elective c-sections to non-elective and vaginal births.

Dana - posted on 05/09/2011

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Well, Kate, I'm not sure you KNOW what's going to happen with a C-section, it's not all easy breezy either. There can be unexpected things that happen with any birth, whether it's vaginal or C-section. But, I do think it's easier (at least for me) to have confidence in the doctor to do his job, your job just ends up being to making sure you don't freak out.

Sarah - posted on 05/09/2011

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I had PPD with my eldest, who was delivered vaginally. I also had a really long recovery time, needed a blood transfusion and I think it seriously affected me in a really bad way for quite a long time.

With my youngest, who was delivered via emergency C-section, I had no PPD, recovered really quickly and easily and I felt nothing but positive about the experience.

I think it's good that this study points out that a C-section can be a satisfying experience.....that just because you are having one, it doesn't automatically mean you will have a terrible experience.

I think C-sections are just like vaginal births, in that some are great and some totally suck! I don't think with any type of birth it's a "one size fits all" kind of thing. People are different and react differently.

I never dreamed that I would have a C-section......I thought that being cut open would be awful and I would hate it.....but it was actually (for me) a far superior birth to my vaginal one.

Ez - posted on 05/08/2011

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The correlation between PPD and c-sections definitely needs more investigation. But I agree it would not be at all surprising if there is no link for women who have a scheduled c/s. In those cases, the woman has time to prepare for what is to come, and accept it for what it is. Someone like my friend, who had her IUGR baby by c/s under GA after a failed induction and failed epi, is a completely different situation to someone who has had weeks or months notice.



Edit to clarify: I am in no way saying that my friend's c/s was unnecessary. That baby stopped growing sometime in the 35th week. Her BSL was only 1 when she was born. She very much needed to come out. But my friend was (is actually, since this only happened last week) still left reeling from being under GA when her baby was born.

Kate CP - posted on 05/08/2011

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Honestly, I think that for every woman a birth is scary because no one knows for certain what's going to happen. With a c-section it's all planned out and you KNOW what's going to happen. And you KNOW what recovery will probably be like and what to expect. A vaginal birth can go so many ways and there are SO many horror stories that usually end in a c-section anyway...

It doesn't surprise me that a PLANNED c-section is more satisfying for a mom than a possibly traumatic vaginal birth experience. I don't think this means we'll all have c-sections in the future, but I can understand why some women opt for it.

Rosie - posted on 05/08/2011

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i think it makes sense. you get what you expected, you don't feel cheated out of something you thought you were getting.

Schyla - posted on 05/08/2011

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Katherine, although if my body had allowed me have natural births I would have done so I elected to do c-section with both my second and my third (the first was an unplaned c-section) I wanted to tell you that I gave birth to my oldest a week before my sister natrually gave birth and 5 years later she still has issues realted to her daughters birth while I was up and moving around less then 2 weeks after my daughter I also gave birth a month before my sister in law and three years later is still having issues while I was up in less then a week and With my third I was just fine within hours of his birth I'm a HUGE baby when it comes to pain so Recovery from a c-section is not really that long. Everyone I know who has had a c-section has within two weeks been up and moving around and OFF pain meds while some of those who were able to go natural are still sore and uncomfortable and having issues. I'm not saying this is true for everyone but from my experience recuperating from a c-section dose not take as long as it's made out too.

Mary - posted on 05/08/2011

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Oh - and I think Dana is right as well; you really cannot compare a section done 20 (or more) years ago to the experiences of those done today - particularly with planned, elective sections. A huge difference is in the advances and changes in anesthesia and post-operative pain management. They are vastly improved from 20 years ago, and have a huge impact on the mother's mobility, healing, and over-all sense of well being.

Charlie - posted on 05/08/2011

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If things went the way you planed of course you would be happy !

Krista - posted on 05/08/2011

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It makes sense. If one's plans pan out and one feels in control, one is happy and satisfied.

That's exactly it, I'd say. If things work out the way you've planned, OR, if you're able to just let things roll and don't get too hung up on your plans, then you're a lot more content than someone who had their heart set on a certain type of birth and didn't get that.

Constance - posted on 05/08/2011

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I ahve had 4 births. Two of which were vaginal and two by c-section. For me it is mixed for me. I had a very smooth delivery with my first 2 and planned on vaginal for the last. But my 3rd came by emergency c-section and my 4th was a planned section something I really didn't want but my doctor wouldn't budge.
With my 1st I caried her until I went into labor but not to bad. My 2nd I was having major problems with pain so I was induced. Which I loved. I was only in labor start to finish 3 1/2 hours. My 3rd I pushed to be induced because I knew something was wrong just didn't know what. I was right and ended up having an emergency c-section. Which ended up being a horriable recovery period. I wasn't healing because as it turned out I was allergic to surgical staples. So I was in severe pain and I couldn't do anything by myself. My 4th ended up being schedualed c-section. But because we knew what went wrong the first time. I knew I would probally avoid the problems the second time. Which luckly it went fine and I even had very little pain and healing time was cut 2/3 of the time of the first.
But for me I can't really say I had more satifaction from the c-section over the vaginal birth. But what I can say is that when I had a date actually planned to go into the hospital to deliver was so much more rewarding because I didn't have to wonder when I would have the baby.

Ez - posted on 05/08/2011

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Like Jessica, I am slightly skeptical simply because of the small numbers involved in the study. But otherwise I can see it making sense. If a woman plans an elective c/s, she has time to consider her options and be comfortable with her decision.

Janessa - posted on 05/08/2011

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I would not want a C section no think you. For those who had to have them like my boyfriend mother she still bitchs about it because the meds she was given still affect her back to this day and her last child was 21 years ago. Anyways yes giving birth hurts for awhile but the after results are better compared to C section and my mother complains about her C sections and many others. Plus it is very dangerouse to keep having C sections.

Jessica - posted on 05/08/2011

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Did I read that right? They polled 160 women planning vaginal births and only 44 planning c sections?

Even aside from that, I think it makes sense... if you''re already prepared for a c section, then you pretty much get what you expected. But if you are wanting a vaginal birth, then the "worst" thing that can go wrong (aside from harm to your baby, obviously) is ending up "needing" a c section... which is more likely if the hospital has a higher c section rate, and that would of course lead to a greater percentage of those women feeling dissatisfied.

[deleted account]

I was super proud of my c-section scar too.....a reminder for life of her birth&birth story.Only it healed so well, its invisible.If you press down you can feel the raised line but other than that its invisible.My friends would ask to see it before hand, i was proud to show it.The only scar i have on my body i am proud off.:-)

Now i have nothing to show lol, other than the best part,my baby girl whos super healthy now.

Jenn - posted on 05/08/2011

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We couldn't turn my breech baby who was firmly sitting in my pelvis, so I chose a csection and while I was disappointed not to have her vaginally (only slightly disappointed) I recovered very quickly and had minimal postpartum issues other than the normal hormone rages associated with breastfeeding.

[deleted account]

I was delighted they said "you need to be c-sectioned".They allowed me to labour myself to the very end.Until the had no choice.I would not dilate.I had to beg for them to take her out.When i kept bleeding and passing clots

That would of killed her if i had of dilated.Only when the cut me open the found the problem.Placenta half away from the wall, and jam packed with clots.



I recovered great, better than my vaginal birth.B/f was hard to do with the pain etc.I was home 2days later.I was satisfied.Now i think when you know whats going to happen and it all plans out.Its going to be better than setting yourself up for all natural and ending up being rushed for a c-section.So they study sits well with me.

Tah - posted on 05/08/2011

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I think it's interesting as well, I had a emergency section and I can o ly speak for myself when I say I was enthusiastic that the baby survived and I just didn't like having to roll on my side to get up with the staples in my stomach, but I didn't consider the birth disappointing or a failure because I didn't go in deadest on any one plan. Birthing can change without notice and if you go in with a plan set in stone not realizing that, I would think if problems did arise and had to undergo a c section when you were set on a vaginal birth, you would feel disappointed.

Minnie - posted on 05/08/2011

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It makes sense. If one's plans pan out and one feels in control, one is happy and satisfied.

Katherine - posted on 05/08/2011

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Hmmm interesting.
I as a woman would not elect a c-section just because it's not the "natural" way to go. I would of course if I or my baby were in danger. I just don't and never could understand why someone would CHOOSE to have that kind of surgery!!! It's sooo invasive and it tales so long to recuperate.
The findings, reported in a recent issue of the American Journal of Perinatology, were surprising in that C-sections have been linked to higher rates of postpartum depression in past studies and vaginal births have been found to be more satisfying for mothers.

That's interesting because I though PP had to do with hormones, not just emotions.
Good topic.

Mary - posted on 05/08/2011

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I also want to note, GBMC is NOT the hospital I worked at. At 45%, they have one of the highest section rate in my state. Interestingly enough, the co-author of this study works at a different hospital, whose section rate is less than 19%.

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