Doctors warn of alarming C-section 'epidemic' | Hacker News Reader

Doctors warn of alarming C-section 'epidemic'

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131 pointswalterbell184 comments

Women feel enormous pressure (at least here in the UK) to give birth naturally, from both their peers and health professionals.

How a baby is delivered is none of anyone's business but the mother herself.

My wife (an epidemiologist) deliberated for months over having our second by VBAC (vaginal birth after csection) and opted to go for it, due to the overwhelming expectation from everyone around her that she should do it naturally, and despite having read an Australian study indicating higher rates of stillbirth during VBAC [citation needed]. Sadly, our daughter didn't make it through the labor.

Needless to say, the csections that safely delivered my first, and recently (yay) third children seem like a miracle of modern medicine to us both.

Even before this personal tragedy, I was astounded by the sheer force of opinion surrounding the cesarean section and childbirth in general. This is creating an environment where women are not able to make their own choices and I fear that the doctors in this article, however well meaning, by warning of an "epidemic" are only adding fuel to this fire.

> How a baby is delivered is none of anyone's business but the mother herself. I'm sorry for your loss.

Caesarian's costs the NHS around £1,700 a time compared with £750, for a normal childbirth and women also stay in hospital for twice as long on average. There is a general presumption in the UK that avoiding what is an invasive operation is preferable for both baby and mother alike, in the absence of other factors.

I would argue that clearly How a baby is delivered is other people's business since other people are involved. However the ultimate choice should be the mother's.

Vaginal delivery is associated with better outcomes for the child too. IMO that makes it not strictly the mother's choice. Indeed surgical procedures should never be entirely elective.

No, you don't get to make major body and life decisions for a mom because maybe infant outcomes are 1% better in certain circumstances. Somehow I doubt you donate 90% of your income to children in need, which would actually drastically improve outcomes for 1000s of babies.

If I donated 90% of my income then my children would starve.

However, we do have a process whereby use of my wage income is not entirely elective, it's called taxation and in part is used to improve outcomes for other people's children.

In your opinion should infants have no advocacy, should mothers (parents presumably) have complete determinency over the medical needs of their children without regard for medical outcomes.

> Vaginal delivery is associated with better outcomes for the child too. IMO that makes it not strictly the mother's choice.

Strongly disagree. The mother's freedom is not subservient to the child's wellbeing. Stable families are also associated with better outcomes for children, does that mean a man should not be allowed to divorce his spouse after they have children? What about second hand smoke or the psychological effects of parents' alcoholism on a child? I could go on (consider Vaccinations), but if a child's outcomes are the primary concern why stop at C-sections?

> Indeed surgical procedures should never be entirely elective.

Why not? What about plastic surgery, liposuction, or gastric bypass? This is a weird sort of medical puritanism.

You’re kidding right? The fact that parents are legally required to care for their children for 18 years throws a wrench into the theory that the freedom of parents is paramount. I don’t think there’s any precedent in culture or our legal system that puts freedom of parents at a higher priority over well being of children - nor should it. Children have no choice whether they are brought into the world, potential parents have full volition. Thus morally it is perfectly fair that the party with zero choice - the children - are protected.

> The fact that parents are legally required to care for their children for 18 years throws a wrench into the theory that the freedom of parents is paramount.

Except they're not. It's called adoption.

> I don’t think there’s any precedent in culture or our legal system that puts freedom of parents at a higher priority over well being of children - nor should it.

I just listed several including divorce and the freedom to choose to vaccinate (or not). I never said that the freedom of the parents is paramount, but it's also not fully subservient to the child's wellbeing. It's a balance. And my larger point is that mandating that someone go through a painful and potentially physically scarring natural birth for a dubious improvement to the child's development does not make the grade by this standard.

Nobody gives a stuff about the cost, you'll get the same pressure if you plan to deliver privately.

There's fewer than 700,000 births a year. If every one was a c-section it would cost an extra £700m a year, less than 1% of the NHS budget.

NICE guidelines state that the woman should discuss the pros and cons and then it's her choice.

> then it's her choice

Well, yes, but that doesn't mean it's a choice between two roughly equivalent options. C-Sections are invasive surgeries and come with added risks. I would argue a healthcare provider's duty is to advocate against them unless there is an appropriate medical reason.

That would be the discussion of the pros and cons.

Exactly. I don't know what your experience has been but generally the pressure from medical professionals is because C-section risks outweigh the benefits most of the time.

> I would argue that clearly How a baby is delivered is other people's business since other people are involved.

This is one major reason to oppose publicly funded health care. _Every_ decision becomes a public one.

The situation isn't terribly different for private health insurance. You're still spending out of a shared pool of dollars, and you don't have complete freedom in how you choose to do so.

And I would never choose a health care system mostly funded out of private insurance either.

Much better for every decision to be a private one made by insurance executives on your behalf.

Even if that were true, which I don't think it is, it still seems very much preferable to not getting necessary treatment because it's too expensive.

£950 for something that occurs once per lifetime seems extremely negligible.

And probably can be divided by 2 or 3 (twins, triplets) more frequently than non-caesarean births can.

and that’s why we don’t want socialized healthcare in the US. because it shouldn’t be other people’s business

In the US, we still make it other people's business. It's just that here, those other people work for insurance companies whose goal is to turn a profit (even if they claim otherwise by getting themselves classified as non-profit organizations), in part by paying out as little as possible to healthcare providers. Yes, it's theoretically possible to pay out of pocket, so one has a "choice", but doing that for e.g. a C-section would bankrupt most of our population.

I've lived in a country with socialized medicine. It's not perfect, but at least they don't have a huge chunk of the population walking around with easily-treatable conditions that slowly destroy them because normal people don't get decent health coverage.

Sorry for your loss. And I agree on the pressure around birthing choice. My wife just delivered our 3rd child, and at this point we felt confident in our choices. But the birthing class we attended before our first child was born was full of fear, pressure, and pseudoscience.

There is an unbelievable amount of woo marketed at first-time parents. I suspect its a bit of an artifact of smaller family sizes, so that there is less practical experience in general circulation. I wish my grandmother who had nine children and a dozen or so pregnancies was still alive be a source of advice.

I see a lot of people in this thread idly sniping talking points on the benefits of vaginal delivery, insurance/costs, etc. - illustrating the point in your last paragraph.

My son and wife's lives were saved by a C-section three weeks ago. Watching that fetal heart rate monitor dip to zero and then slowly, unsteadily rise back up over and over again was the hardest thing I've ever done. The hospital staff pushed us to do a vaginal birth the whole time. I understand and appreciate what they did, but at the same time I hope there is a better way, because in hindsight I would have never put my wife and son through this again.

This isn't a programming language preference. If you don't know the details of clinical practices around C-section, if you're not an expert or a patient, then you really shouldn't be pushing your opinion on others. Refrain.

James Titcombe and others are campaigning pretty hard on this. Women need to be given correct information, but their wishes also need to be respected.

These campaigners have persuaded the CQC to stop pressuring trusts over rates of C-section or normal birth, and to get the NMC to stop paying normal birth so hard.

I'm very sorry for your and your family's loss.

In the information age, there are so many irresponsible and incomplete bits supporting this, that or the other in as many superlatives as possible. What can a person do? I thought that VBAC was more dangerous for the mother than the newborn, for a healthy young woman, coupled with even a tiny amount of pressure this could easily lead people to make a decision they were not really comfortable with. The "sheer force of opinion surrounding ... childbirth in general" is astonishing; I agree with you here. The information age is badly curated and gives far too much weight to the inexpert opinion, imh (and non-expert) o. Mothers must give birth naturally, mothers must nurse their infants for x months, fathers must cut the umbilical cord.

All the modern medicine in the world coupled with the power of the information age can't make these decisions for us. Maybe, in the future, machine learning methods can pull relevant information out for people to counter some of the cultural pressures.

contributing to your social critic on everyone having an opinion; why not see the first c-section as the root of the problem?

They may not have had the option to avoid the first c-section, depending on the circumstances of the first pregnancy.

I’m very sorry for your loss - my wife and I went through this and it was very difficult and awful, especially when you rationalize or question choices presented to you.

In the US, there are a couple of tiers of pressures and thought process. People make these choices from reasons varying from the medically advised, to cosmetic, to schedule based, to something else. Some people make choices for trivial reasons that are disturbing to the doctors who are placing people at risk, at their direction.

I think the medical concern is that there are more complications, the less informed people tend to correlate to folks who are less able to care for themselves afterwards in recovery and overall risk of anesthesia and other things.

> How a baby is delivered is none of anyone's business but the mother herself.

* It's the doctor's concern because of the Hippocratic Oath

* It's the baby's and therefore father's concern (but not choice), since vaginal birth is correlated with better outcomes.

* If insured, it's the insurer's concern, as it's over twice the cost of vaginal delivery. (In the case of the UK, this is the government, so literally everyone.)

I feel doctors should be allowed to refuse alternate procedures that heighten risk for the patient.

That is an incredibly slippery slope. Apply it to other healthcare scenarios, particularly pregnancy, and it’s got a poor track record. Take this thalidomide, keep this pregnancy etc etc.

Very sorry for your loss. After her first C-section, a relative of mine was told by her physicians that all subsequent births should be the same because that was safer. It's interesting how the standard of care varies between nations.

Standard of care may not be relevant. Stats are great for making policies to improve population health and wellbeing, but when you are the one in a million to whom a rare and catastrophic event occurs despite best practice, where does that leave one?

My understanding is that GP poster's wife was in the same position as my relative, being pregnant and having previously had a C-section. That they got different advice, is precisely a difference in the standard of care. Problems with birth are certainly not one in a million.

It quite possibly is related to different practices but good quality healthcare still has bad outcomes. Advice on treatment has a lot of variables and previous c-section is not going to be the only factor.

> How a baby is delivered is none of anyone's business but the mother herself.

Try telling that to some of those here, in the US. The mantra is "do what I say, not what I do."

This really seems like one obvious way in which we are effecting our own evolution and would not be surprised if in a short time (on an evolutionary scale) that humans will require c-sections for successful birth.

This may not be a bad thing, the reason child birth is so difficult for humans vs most other animals is our head size vs the female pelvis. C-sections bypass the evolutionary constraint allowing more large headed babies to smaller pelvis women which could allow greater head size and perhaps even more intelligence.

https://en.wikipedia.org/wiki/Obstetrical_dilemma

I think it's more likely that it's a bad thing. Babies are supposed to get seeded with microbes, which probably affects the immune system.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110651/

There's probably some truth to this, but it doesn't take much imagination to imagine how the babies could be "seeded" after a C-section birth.

There probably isn't enough research to come to conclusions yet, but see also this:

https://www.sciencedaily.com/releases/2018/05/180530113126.h...

It is believed that this is already happening: "The regular use of Caesarean sections is having an impact on human evolution" https://www.bbc.co.uk/news/science-environment-38210837

If there is indeed a causal relationship, then the only alternative was not to let those parents be born through c-section. We anyway already heavily depend on medicine for our survival.

French bulldogs mostly can't have natural births. 80%+ of the births are c-sections.

They've been specifically bred to exaggerate characteristics that are not healthy. The predominant result is brachycephalism which causes breathing and heat regulation issues amongst other things. This is also why they can't give birth naturally.

Do babies with too-big heads regularly die at birth if C-section isn't available?

As far as I know, no, because emergency Caesareans are available (I was an emergency Caesarean - my mother was told I was 'small', and I ended up being close to 13lbs[1]), but it can cause other complications - my sister still has a small scar from a forceps birth, and the recovery time was longer for my mother.

[1] The entire pre-birth care was flawed - at one point they couldn't find a pulse for over 24 hours and they were telling my mother to induce labour (because I was dead...).

Edit: spelling fix

In the world of modern medicine where complications like this would lead to an immediate c-section? No.

Roll the clock back a couple of centuries or so and both mother and child would die.

Yes, and it can kill the mother as well.

I don't have statistics, but my wife and/or son wouldn't have made it without a csection.

In 2015 the WHO has issued this [0] [1]:

>Conclusions

Based on the available data, and using internationally accepted methods to assess the evidence with the most appropriate analytical techniques, WHO concludes:

1. Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons.

2. At population level, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.

3. Caesarean sections can cause significant and sometimes permanent complications, disability or death particularly in settings that lack the facilities and/or capacity to properly conduct safe surgery and treat surgical complications. Caesarean sections should ideally only be undertaken when medically necessary.

4. Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate.

5. The effects of caesarean section rates on other outcomes, such as maternal and perinatal morbidity, paediatric outcomes, and psychological or social well-being are still unclear. More research is needed to understand the health effects of caesarean section on immediate and future outcomes.

[0] https://www.who.int/reproductivehealth/publications/maternal...

[1] (PDF) http://apps.who.int/iris/bitstream/10665/161442/1/WHO_RHR_15...

Well said, I think where all things indicate it will be healthy normal births should be the default, but when medical risks indicate otherwise than c sections can provide life saving help.

Yep, if you think about it, the above advice is nothing but "common sense" and good medicine practice.

The point is that the decision between a normal birth and a C-section is to be taken on a case by case basis by a (hopefully) competent doctor and not "planned" (one way or the other) in advance or decided because of other reasons.

Anecdata, my uncle was a surgeon and he always repeated us that "if it is really-really, and I mean really needed, than go for it, but otherwise never let anyone cut through your body".

Relevant counterpoint: http://www.skepticalob.com/2018/03/what-if-c-sections-are-be....

The article doesn’t actually say why C sections are bad, it presupposes that fact, and assumes that rising C section rates must indicate some sort of “epidemic.”

Caesarians are way more dangerous than vaginal births. A C-section patient can die of pulmonary embolism from the blood clots from the procedure, directly from bleeding (the surgeon can nick an artery or the incision can lacerate during the actual birth), the wound can get infected (it's quite a large wound), and, of course, it's major surgery, so the anaesthesia can kill you (even if you're not all the way under; my wife had a near miss when our first was born). The risks get worse in subsequent Caesarians.

You would think this is true, but the mortality rate for c-sections tends to be higher because they are often performed in the presence of other extreme complications that contribute to the higher mortality rate. The mortality rate for non-complication (elective) ceasarian is actually lower.

The Birth Trauma Association found that mortality rates are lowest for women who have elective caesareans. [0]

https://amp.theguardian.com/lifeandstyle/2017/jan/21/how-ris...

All the link you're providing says is that uncomplicated C-sections are less risky than complicated ones. Sure, that sounds right.

Direct quote from the very first paragraph of the article:

> The Birth Trauma Association found that mortality rates are lowest for women who have elective caesareans.

The context is comparing maternal death rate for vaginal delivery vs caesarean.

Here's a Telegraph article that goes into more detail, including giving actual numbers: https://www.telegraph.co.uk/news/uknews/1584671/Women-choosi...

From the Telegraph article, the maternal death rate for pre-planned caesareans is 3.1 per 100,000 women, whereas the maternal death rate for everyone else (natural birth plus emergency caesarean) is 3.9 per 100,000 women (and the original article gave the maternal death rate for vaginal birth at 4 per 100,000 women).

I read the Guardian article differently than you did but concede the Telegraph article makes the comparison plainer.

This depends entirely on why you’re getting c-section in the first place. When my son was born, we luckily detected that the umbilical cord had velamentous cord insertion, which basically means it’s not completely connected to the placenta. This can often lead to detached cord during vaginal birth, and cause still-birth and worst case also kill the mother. We also discovered after the fact that the pregnancy was also suffering vasa previa. Luckily the first was discovered before birth with modern ultrasound equipment that also tracks blood flow (not all hospitals have this apparently). And we were extremely luckily that we didn’t risk vaginal birth even though with just the first condition the risk was still within decent margins.

You can read some horror stories about these conditions when they go undetected. Luckily for us they were detected, and so we scheduled a c-section and everything was smooth. If we had listened to the peer pressure, which there was a lot, it’s possible that neither would be around today.

Both of my kids were delivered by c-section. I'm not arguing that they're bad. I'm arguing that they're riskier than natural birth.

This page from the university of Utah suggests that C sections have a higher mortality rate, and are more expensive — while necessary in roughly 15% of deliveries:

https://healthcare.utah.edu/the-scope/shows.php?shows=0_w7uq...

Edit: This Time article points out that while maternal mortality rates have dropped significantly worldwide, they have actually risen in the US by 27%. They list numerous possible factors, a rise in unnecessary C Sections being one of them:

http://time.com/4508369/why-u-s-women-still-die-during-child...

I would describe that post as propagating junk science. It’s cherry picking stats and skewing them. Odds ratio difference for pelvic organ issues for women who have a C section vs natural delivery. That’s just establishing strength of association. It’s surprising that there is any association for women who have a c section. The ‘safer for babies’ paragraph makes the claim that 692 babies would be saved if 1 million women chose c-section over natural delivery. So 0.069%? I hear you about wanting to be skeptical but there is conclusive research on negative effects to children who are delivered via c section. https://www.economist.com/science-and-technology/2017/10/14/... Not to mention that it’s a massive surgery for the mother with all the inherent risks of one.

My sister-in-law just had her first baby, and got very into all of these statistics and the "medical industrial complex take on childbirth"

I believe the WHO recommends around 10-15% of births should be C-Section in a healthy population, but the figures in first world countries are at least 3-5 times that.

There are about 3 million stories of ladies "booking in" their birth a month or three in advance. I.e. I want my baby on the 3rd of May, lets schedule a C-Section now. It's more convenient that way. Also tons of stories of doctors wanting to go home for the weekend or to play golf, so they do a C-Section after only an hour of labor so they can hurry it up.

It's horrifying that hospitals will market a "natural birth" as anything that is vaginal. i.e. it doesn't matter how many drugs they give you, it doesn't matter what drugs they give you to speed up the afterbirth, etc. etc. It's still "natural".

We don’t have a great way of knowing the optimal c-section rate. But plotting national c-section rates against perinatal outcomes (an obviously imperfect approach) shows that increasing c-section rates are associated with significantly better outcomes until about 20% after which there is no real effect one way or another.

http://www.skepticalob.com/2015/12/world-health-organization...

I’m not sure why it would be “horrifying” what kind of birth a hospital labels natural. It’s all bullshit anyway. No births in a hospital are like births in nature, which is why so many more babies survive the experience these days.

> It's horrifying that hospitals will market a "natural birth" as anything that is vaginal. i.e. it doesn't matter how many drugs they give you, it doesn't matter what drugs they give you to speed up the afterbirth, etc. etc. It's still "natural

That's definitely not the definition used in the UK. Normal birth in the UK doesn't include epidural but does include some other pain relief. This is controversial because epidural is probably safer.

> Also tons of stories of doctors wanting to go home for the weekend or to play golf, so they do a C-Section after only an hour of labor so they can hurry it up.

There is a world of difference between a doctor pressuring a woman to have a C-section because it's more convenient for them, and a woman freely choosing to have one for her own reasons.

The lack of mention of epidural or not is a big thing I think. Among the mothers I know, epidural makes everything but the pain worse.

"wanting to go home for the weekend or to play golf"

That is 100% real. A friend got hurt for that purpose. In her case, it was a huge and brutal episiotomy. The moment the kid was out, he ran out to play golf. Another friend got just about exactly the same, but because the doctor's house was flooding.

Doctors are human. Humans are often uncaring or even evil. Customers get dehumanized, like mechanical widgets on an assembly line in a factory.

My wife had a natural child birth with just a shot of pitossin at the end for the afterbirth. At a hospital. No medication at all other than that, not so much as a Tylenol.

Instead of death of baby and mother, babies growth into mothers, with genetic incline toward same problem, so you need to add another 10-15% to account for that.

> I believe the WHO recommends around 10-15% of births should be C-Section in a healthy population, but the figures in first world countries are at least 3-5 times that.

Apparently 45% in China, 25-35% in many Western countries. I had no idea that the numbers in many countries are that high; Northern Europe (where I'm from) is evidently something of an outlier at 15% or so.

Where has ‘at least’ a 75% C-section rate (5x 15%)? That is alarming.

"natural" like half of women dead in childbirth natural?

When there are problems, you operate. Otherwise it’s preferable for natural birth for mother and baby, for reasons mentioned above.

no.

There are a whole host of reasons for having a c-section. The risk of having a massive tear (ie vag to arse(4c tear), or literally tearing a new arsehole) is 1 in 4. This has long term life altering consequences.

An "elective" c-section is not the same as "booking in". The less "identity politics" that are wrapped up in this, the better.

No.

> The risk of having a massive tear (ie vag to arse(4c tear), or literally tearing a new arsehole) is 1 in 4.

Yes and it usually heals very well. The tissue there is made to deal with that. My sister had that happen 5 years ago, it even continued into her gut for a few cm. So that was a very bad case, but it still healed perfectly, although it took about 3 month.

... 3 months. Unless she had corrective surgery then she's almost certainly got some level of incontinence.

There will(or should) have been physiotherapy to get some semblance control back.

Look, there is nothing wrong with a c-section or a vaginal delivery. To make women feel that they are somehow inferior for having one is totally unacceptable. Something like 10-20% of births endup in caesarian, otherwise there is a massive chance of a bad outcome for both child and mother.

Source: wife who is a paediatrician and attends lots of births where the child is in distress.

This was me pointing out the word "natural" is loaded BS. Whatever one's view is on whether a baby should be delivered by C-Section or vaginally (which should depend on the circumstances, obvbiously) "natural" as a description is really silly. We aren't cave-people. We are incredibly thankful for it. We don't consider it a good thing to watch our children die and will intervene in all kinds of ways animals can't to avoid it. Anyone touting "natural" for anything, especially childbirth, should be treated with extreme caution.

Look how it's done:

If you're a fit, 19 year old mother with a healthy, correctly oriented fetus vaginal birth may be preferable to c-section.

Take "natural" the hell away from all of it. It's a sign of thinking being replaced by emotion which probably isn't a good idea if you think evidence based medicine is a good idea.

"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize." Doing otherwise leads to tedious flamewars.

https://news.ycombinator.com/newsguidelines.html

Such a great myth that our culture perpetuates.

You genuinely think half of women are dying in Childbirth in undeveloped countries right now?

I'm in Africa typing this, and I can honestly say you have no idea.

FWIW, my sister-in-law had her baby at home, zero medical anything, just a widwife keeping an eye on things.

Do you really think underdeveloped is the same as cave-people? That Africans have no education and expertise to do their absolute best looking after mothers and babies? I have to disagree strongly there...

As ever more money would probably lead to better outcomes still. Poor Africa is unbelievably wealth compared to pre-history. https://www.iol.co.za/lifestyle/health/africa-200-000-women-...

Is the rate of non-intervention childbirth in pre-history 50% or 1%? This is not really even an interesting question. With absolute certainty you can say it was more than 1%. In modern times we've made that massively lower. /Even/ in very poor parts of Africa interventions of many different kinds happen to get that natural rate down.

It's not "natural" to take antibiotics for infection either. Get natural out of this discussion. Childbirth is dangerous, we have made huge progress as a species so that it really shouldn't be anymore. That progress is not "natural" what it is, is actually morally good.

Prosletysation in evidence based medicine should require peer-reviewed studies with data available cited as evidence. Where is that when all these people say "natural" is better? Evidence would convince me. Really.

Find it interesting that the article seems to place the blame on the women, when it's long been said that the docs and hospitals, ever in search of time compression and profits, were encouraging c-sections versus vaginal birth. That, to my knowledge, is the likely cause of the procedure appearing "fashionable" and "modern."

I actually think it is probably more insidious than that. We have a lot fewer full-time homemakers. Women are much more likely to have paid jobs.

The only way to schedule the birth is by scheduling a C-section. Waiting for the baby to show up when it decides to do so is a very organic, let nature take its course, humble thing to do and it is pretty alien to how most people live these days in developed countries.

Historically, we farmed. We had to figure out how to respect nature and work with it. Most jobs today don't really do that. We think we are in control.

Actually historically, we foraged and hunted. After reading Sapiens I’m convinced that farming actually set humans on the path towards this very suffering. Large scale war, famine and pretty much every post agrarian revolution ill, is a direct consequence of having food surpluses.

This was also the theme of Ishmael, a terrible book wrapped around an interesting idea—that the native Americans practiced the right balance with the rest of nature.

What made it terrible?

The writing was awkward, lecturey, and belaboring points. I get it, it's an essay wrapped in something else, but something less palatable, not more. Like sister post, I often find that my taste wasn't great when I was younger, but this is one that I remember sucking even back when I read it. Still, the idea being explored is worthy. though only now am I trying to go mostly meatless.

I thought it was great when I read it in high school. Presumably if I reread it now issues of logic and style might stand out a bit more? I've found that for other books I loved a long time ago.

> I’m convinced that farming actually set humans on the path towards this very suffering.

I would say this more often, but it doesn't generally play well w/ much of the bell (or tails) crowd. But yes, most of our advancements (agricultural and "medical") actually exacerbate problems more than help them. Occasionally, a doctor will agree w/me.

Ah well... back to chasing "money."

If you've never watched James Burke's series Connections [1], you'd probably enjoy it. I binge watched it years ago on youtube, and walked away with the distinct impression that our path to calamity started with the plough.

[1] https://en.wikipedia.org/wiki/Connections_(TV_series)#Connec...

Without agriculture we'd still be hunter gatherers with little to no technology and everyone would be struggling just to survive. Sure, there are unpleasant side effects that come along with technological development but quality of life is still vastly better as a result.

I don't think this suffering is worse than what people lived through back then.

Imagine if your full time job was just finding food to put in your mouth and wake up the next day.

I appreciate the comforts of modern society. I doubt I'd have been a good scavenger...

I haven't had my first coffee in the morning yet, so it may be me, but I'm struggling to see the link between food surplus & farming and war?

Hunting/gathering/swiddening tribes may have wars but they're just tribal wars, which are more like random murders. Lots of regret but those left alive can move on. In order to get awful generation-destroying authoritarian war wars, you have to have a sovereign. A sovereign requires what James C. Scott has called "legible" surplus. This is a surplus the sovereign can expect at regular intervals in the same locations. That is, fixed agriculture, preferably of grains or similar crops that don't spoil easily but require lots of related industry in order to support life.

Farming first leads to food surplus, but also to a food supply that occasionally collapses without alternatives. It also leads to large hierarchical society structures and problems around ownership of land/resources, which basically is what war is about.

Sapiens is a great book!

We became domesticated by wheat.

> The only way to schedule the birth...

Wow! Hadn't considered that at all. But, yeah, I guess, that would align w/ some other things I've heard(, but never actually experienced). Yikes!

> We think we are in control.

Yeah. (Thriller laughs)

(edit) Btw, one of my college profs used to send a lot of time in rural India. He said women there would go into labor while in the field, leave and give birth, and then pretty much return to work immediately.

Civilized countries have parental leave, where this is not an issue.

Are you talking about the US? Many countries with state/cheap healthcare also have high rates (Europe).

In the UK, I’d say there’s a bias towards “the natural way” (not offered epidural, counselling for elective CS, NCT antenatal courses tend to focus on natural methods etc). Eg https://www.rcm.org.uk/news-views-and-analysis/analysis/mate...

Blame definitely on the docs (liability). That being said, most new obgyns are women. So ¯\_(ツ)_/¯.

Interesting article. I also thought that encouraging cesarean sections was something obstetricians did often to avoid the time spent waiting for delivery. However, in my training I witnessed quite the opposite. My resident and attending physicians were very cautious with going forward with cesarean sections, and would do whatever they could to continue with vaginal delivery when the mother wanted that, and also encouraged patients that wanted cesarean to consider vaginal delivery.

Obviously this is one hospital, but it did help me not be as cynical of the profession, and will probably help serve as a reminder to do what's best for my future patients.

With the birth of our daughter, we had a different, and more complicated experience.

Pre-delivery there was no pressure to do a c-section. None at all. My wife definitely did not want one.

At the time of delivery, though, there was very much pressure to do a c-section. Although the admitting resident didn't seem to pressure my wife, care was quickly transferred (because of shift reasons) to other physicians (resident and attending) who did.

The way this manifested, though, was sort of subtle. For example, my wife had a procedure done to speed up the delivery; however, as we found out later, we were definitely not sufficiently informed of the consequences of the procedure, one of which was increased likelihood of a c-section. They tried to talk my wife into a c-section, and then when she declined, they tried to talk her into other procedures that would speed up the delivery, and would omit mention of the fact that they were associated with increased likelihood of c-section. Overall, even if c-sections weren't being explicitly mentioned, they were kind of relied on or assumed, for time and convenience reasons. The discussion was sort of like "Oh you don't want a c-section? Ok, then how about X to speed things up? Oh--I forgot to mention that now we probably have to do a c-section? Oops!" It came across as manipulative to me.

My wife did not have a c-section, but this was probably only because the nurses there (who were phenomenal) were actively arguing with the physicians to not do one, and to wait. We weren't really in the hospital that long either.

This is a well-known phenomenon called the cascade of intervention: http://www.childbirthconnection.org/maternity-care/cascade-o...

With the birth of my son, we switched obgyn's because she basically told us it was pretty certain we'd have a c section, because she didn't have time to wait. We switched doctors and it was the first question we asked when interviewing prospective doctors. This was in 2000.

I had no idea that interviewing doctors for delivering your child was a thing. Do they charge for it? Is it common?

We had a Doula, and she recommended that we ask a bunch of questions on our initial visit. It wasn't a separate interview. We knew we'd move on to the next on the list, should we not like some of the answers (the c section one was the primary issue).

My wife interviewed several OB practices in the Chicago area before settling on one for delivering both of our children. In her group of friends, it was common. There was a small charge at each as an initial consultation.

Did you find that obstetricians encouraged inducing labor as a way to avoid spending time waiting for deliver?

Yes and no. I can only speak for this one hospital, but most of the time we would only induce if there was indication for doing so (twins is one example that comes to mind) or if the mother truly wanted induction. I don't recall specifically encouraging for reducing time, though the residents would joke about wanting to do so instead of waiting.

I wonder if this is more common at teaching hospitals, so that attendings can hand off the waiting to the residents in training.

Your initial suspicion is alive here in Mexico where you need to rent your own obstetrician and install them at a private clinic facility while you wait for baby.

My opinion based on living with a midwife for most of my life. Not fair to blame the women for this The reason is more to do with the doctors or medical staff being cautious about complications from a normal birth than caused by the preference of a women for chosing a c section.

C-section babies are prone to certain ailments later in life:

"Giant study links C-sections with chronic disorders" -

http://sciencenordic.com/giant-study-links-c-sections-chroni...

My guess is that this is tied to the reduced exposure to the mothers' vaginal and anal microbiome that occurs during vaginal delivery but which is absent in C-section.

Much as childhood exposure to animals reduces autoimmune disorders in later life, natural birth also likely does the same.

"Study: Children who grow up on family farms and drink raw milk have fewer allergies, autoimmune disorders"

https://www.naturalnews.com/035802_raw_milk_farms_allergies....

As the article says, the cause is not certain. From some study, higher c-section rate correlates with higher income, so my guess is that it could just be an outcome of better hygiene according to the hygiene theory.

I wonder what its correlation with induction is. Artificially inducing labor does not tend to give the body enough time to adjust and progress.

Elective induction of labor at 39 weeks results in a lower c-section rate than expectant management (waiting to see if labor will start naturally).

https://www.nih.gov/news-events/news-releases/induced-labor-...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049989/

Normally though, induction happens because there is some problem or because the pregnancy has gone past the due date, and in these cases your risk of a c-section is already elevated.

Makes sense. As mentioned in the comments, there are different ways of inducing labor. I was referring to usage of pitocin or similar too early in the process, instead of gradually inducing the labor with other medications. We had success with just misoprostol during our labor, but the process was quite long.

These inductions would have been primarily pitocin and / or cervical ripening agents like cirvidil.

Misoprostol is also a cervical ripening agent comparable to cervidil.

I don’t think c-section after successful induction is common. There are some number of failed inductions (i.e. nothing happens) which result in c-section. Bear in mind that this is generally done - like the original induction - because “giving enough time” after 42 weeks costs lives.

This review finds the rate is actually lower after induction, contrary to popular claims:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049989/

[citation needed]

induced labour happens in so many different ways, that broad statement is not going to fly.

Also there are many way to induce labour, none of them are quick. Some take a few hours, others days.

For example a "sweep" is where someone goes in and stretches the cervix, with their hands. There are pessaries too. None of it is quick.

Sorry for not being clear, I was specifically talking about pitocin level induction.

Several papers were released as part of a series, and are available currently in full text form:

https://www.thelancet.com/series/caesarean-section

The more sensational language being reported appears to come from the FIGO position paper rather than the research. I’m not sure about the relationship between the two but they look to have been published together.

C section saved the life of my child. I do not care if there is an "epidemic" (what a heck does it mean in a context of a surgical procedure at all???).

It means that in some cases the procedure is life saving, and in other cases unnecessary and potentially riskier than vaginal delivery. (Happy for you and your family that your child made it out OK — don’t know if it was recent, but congrats nonetheless!)

Well I was kind of interested how can somebody use epidemic as a noun for a surgical procedure. There are many factors to this but c-section is often safer for the child than normal birth. I am not sure if there is any problem with c-sections, in my country it is widely used even as an elective option without issues. It is hard to see the downside.

Again, study is pointing out that c section is being performed more than necessary, in fact so much more that it's epidemic. From data WHO calculated that about 20% deliveries should require c section. But numbers are reaching to 45%. Bad Effects in children born with c section are un clear and major surgery has risks for mother as well. Doing a surgery when not necessary is always a bad idea. So if you had a good out come, good for you. But understand you're one data point and can not be reflective of what should be.

My mother was in labor for over 36 hours (maybe more, she told me but I forgot) in 1976. You know that would be a C-section nowadays. She had two more children after that. I don't know how long her labor was for those but I assume it wasn't as bad.

My wife was in labor for 40ish hours in 2016. There was never any pressure for a c-section.

Every article I read on c-sections misses some really important facts:

1. c-section mortality and complication rates are often not separated between the women who get c-sections pre-scheduled and women who get them after hours of damaging labor and something already going horribly wrong. In fact, when I looked at the data for my own c-section, it seemed to indicate that scheduled c-sections were as safe if not safer than vaginal birth.

2. Vaginal birth leads to lifelong incontinence and sexual dysfunction in many women. Would I take a miniscule chance of death in exchange for not peeing my pants for the next 50 years? Yes. In exchange for having a way higher chance of a pain-free sex life again? Yes. Quality of life matters. Your relationship with your partner and with your own body matters. So many of these studies basically end in the hospital - i.e. did mom and baby survive, but then do not look at long-term outcomes of the MOM at all. I know many women with these issues. Women with horrific tearing and scarring, too. They're still dealing with it years later. It's not trivial even though these studies make it sound like the only thing is whether you live, not how you live.

3. c-sections do not carry the risk of baby being deprived of oxygen during birth. No risk of cord getting stuck around the head, etc. The people trying to convince me that I shouldn't have a c-section because of very ambiguous studies dealing with asthma or allergies are totally missing the forest for the trees on this one.

Lastly, and this is an experiential point from someone who has actually had a c-section: the whole thing was completely painless. I was on my feet the same day. I only had a bit of trouble going from laying to standing in the first couple of days, but I otherwise was in pain and could walk, sit, take care of the baby, everything else. By the time I was out of the hospital on day 5 I felt completely back to normal and could do anything and everything. Is it major surgery? Sure. But I can tell you that women who had vaginal deliveries were still in pain weeks after the delivery and for months if they had extensive tearing or episiotomies. Most of my friends on the "natural" train, now having done that and seen my experience in comparison, wish they hadn't gone that route because they're still dealing with the damage it caused them.

Otherwise not in pain.

Thats nothing.. perth western australia has been the csection capital of the planet

Heres 2012 figures

https://www.birthsavvy.com.au/caesarean-section-rates-perth-...

Hello from Perth. Just recently had our daughter at SJOG Murdoch but was not a Caesar. However we went with our obstetrician partially because he was less likely to push towards Caesar and that ended up being our experience. He was happy to wait and deliver late.

We had some non trivial complications though from going natural.

There was however clearly a high rate of those around us but I think basically it’s one of the more well known private hospitals for people to visit where you get the choice so plenty of people are just choosing to go that way for various reasons. also we are 30 but most of the people in our prenatal class were older except one.

Interesting perspectives from cesarean born people:

https://cesareanvoices.com/

See in particular this presentation by Jane English:

https://cesareanvoices.com/SHOW-small.pdf

Babies ingest vital microbes during natural birth helping kick start their immune system when exciting from the mothers vagina. It also helps to get the babys breathing started. The microbes that babies get in contact with during natural birth help form their gut microbes. Gut microbes are essential to human health. If we eat food from animals that have been given antibiotics or we take antibiotics, we mess with the gut microbe system that prevents us from getting sick.

To clean environment is not good for humans. Ie with a little dirt our immune system is better. That is why for example people growing up on the country side has less allergy.

https://www.wired.com/2014/04/missing-microbes-antibiotic-re...

The Normal Gut Microbiota: An Essential Factor in Health. Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983973/

I know most people on HN are guys, but I've heard a lot of women talk about the peer pressure. In fact some women look down on those that have children via a C-section. It's despicable.

C-section all in all hurts more and you heal longer after that and you need more help afterwards. Plus it limits how many kids you can have safely.

The dominance of guys shows up mostly by completely ignoring practical considerations.

I'm surprised C-section rates are higher among wealthier, education women. I would assume educated women are more likely to understand the risks associated with C-sections.

Just because they are wealthier or educated, doesn't mean they will make the most scientific decision; otherwise no doctor would ever smoke. Background/nurturing/societal norms also play a role. I have heard multiple well-off/educated women say, "no way I would put myself through so much pain when I can have quick c-section". Note that I'm not passing any judgement as it is their body and they are the one who will experience the pain so it is their decision.

Highrr age of mother during first childbirth and money probably make difference.

Heads of their babies are larger, while vagina is same, so higher risk to rip vagina and die, so higher C-section rate.

It's not the size of the vagina that's the issue, it's the size of the pelvis. The vagina is extremely flexible. Bones much less so.

Years ago c-section rise was due to medical malpractice lawsuits from people like John Edwards, now it’s a fashion trend by the well to dos. Wow.

Ok so no mention of the health implications of so called "natural" childbirth, which aren't trivial and have an increasing risk as your age. No mention of the rising age of mothers in wealthy countries. No mention of different trade offs for fit 19 year olds and less active 35 year olds. A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives. Word gets around and it undermines trust in doctors advice when they don't even mention the issues. A higher proportion of doctors make the c-section choice. They're kind of educated, doctors, less likely to be bullshitted into higher, unnecessary fees too.

But you're not an idiot so you want the actual numbers. So did I. Not available, no research done and/or no doctors know of it and can hand you print outs of the papers.

So much for evidence based medicine... There's an epidemic of women not just doing what they're told! FFS Lancet. How's their credibility nowadays? Taking hits?

In Thailand a lot of woman prefer C-section in order to choose a lucky day for the birth of the child [0].

---

[0]: http://www.nationmultimedia.com/detail/national/30355415

Women have been giving birth since creation with minimal enough problems for humans to survive and succeed as a species - it absolutely is natural, no idea why you put that in quotations. Why stop at C-sections? Raise them in test tubes a la Brave New World, skip the biological process entirely. After all, it's much safer, quite possibly even zero risks on the woman's part.

The thing with C-sections is that until fairly recently, children weren't inoculated with the mother's vaginal canal microbes. Now they know better and do a smear, but that means many children failed to receive a proper immune boost when they needed it most. There's an growing body of evidence that suggests early microbial exposure is required for proper immune development and function, and that the lack of this exposure is linked to allergies and other self-inflicted immune diseases. I can't speak of any data off the top of my head, but perhaps the doctors recommending against C-sections are aware of decades of data on C-sections and childrens health?

Real natural childbirth involves “minimal enough problems” if you don’t particularly value the lives of individual babies, a significant minority of whom would die during birth or late pregnancy if we just let nature take its course.

And putting “natural” in quotes is entirely appropriate when discussing most vaginal births, even drug free vaginal births, in the first world. There’s nothing natural about 9 months of prenatal care and monitoring, careful observation of the fetal heartbeat during labor, prophylactic administration of antibiotics to women with group B strep, early delivery of women with gestational diabetes or pre-eclampsia, and the availability of c-section any time labor starts to go south. The women who end up delivering vaginally have very good outcomes, in part because a bunch of “unnatural” interventions before the moment of delivery weeded out all the women and babies who would not have done so well. If you want to see what real natural childbirth looks like, you can look at the maternal and neonatal outcomes in countries without modern health care. It’s not pretty.

We need to stop using the world “natural” as some kind of signifier for goodness. “Nature” doesn’t care that lots of tadpoles or lion cubs, or salmon fry don’t make it, and it doesn’t care that lots of human embryos miscarry or lots of babies die in birth. WE care about human babies, and so intervene.

Also, is there some reason we wouldn’t gestate fetuses in artificial wombs if that was safer for women and babies? Are we just obliged to suffer and risk our lives for no benefit? Because it’s “our place”, I guess?

At a species level yes, childbirth works fine.

Before the modern era deaths of both child and mother were very high (10%+) when giving birth.

That said, the U.S. approach to childbirth is clearly not working, with childbirth deaths at 3 times that of Canada, and higher than the rest of the developed world.

Like lots of things in USA this is tied to racism. Whites in USA have risks similar to those of other developed nations. Analysis has found that nonwhite immigrants have largely the same results as USA whites. However, their daughters have the same elevated risks as other minorities in USA. Public health experts don't have any idea why this is, so they're no closer to solving this problem than e.g. the public education system is to fixing its own racist outcomes.

> Women have been giving birth since creation with minimal enough problems

This bears no resemblence to the actual history of childbirth.

> There's an growing body of evidence that suggests early microbial exposure is required for proper immune development

Yes. But that's not linked to "seeding" which doesn't have any conclusive evidence to back that up(yet) compared to colostrum/breastfeeding[1] I'm aware of one study that has tried seeding. It's hypothesised, but needs much more research before being counted/discounted

> Women have been giving birth since creation with minimal enough problems for humans to survive and succeed as a species

Yes, but up until decent, clean deliveries with the option of c-section, and anti-biotics child birth killed 5% of mothers[2]. Bear in mind that without birthcontrol (pills or condom) most women would have about 6 pregnancies in their life time. [3] my bad maths makes that a ~1/4 chance of dying in childbirth/complications arising from.

The study that link obecity and asthma to c-section is small[4] however it is worth widening and expanding to more than scotland. Brazil would be a good target as 50+% of births are c-section.

[1]https://www.nhs.uk/news/pregnancy-and-child/breast-milk-rais... The only link I could find that wasn't selling something (either hippy nonsense or a drug)

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/

[3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865739/

[4]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055095/

TL;DR: 5% of child births were fatal to the mum, modern medicine has made that drop to <0.1%. There is some evidence that you might be fatter if you were born by optional c-section. However this is a limited study in one country.

>Yes, but up until decent, clean deliveries with the option of c-section, and anti-biotics child birth killed 5% of mothers[2]

But you are conflating very different issues. You can't give c-sections the credit for the benefits we gained from learning what bacteria are. Most women who died during childbirth died from infections, c-sections don't stop infections, hygiene and antibiotics do. You need to compare modern normal births to modern c-sections, not pre-germ theory normal births to modern c-sections.

The second paper of the series does review and compare several aspects in comparison to natural birth:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Sorry for being naive but:

"A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives. "

Is this a real risk of vaginal child birth? And how risky is it?

Yes, vaginal birth increases the risk compared to c-sec. However unlike what GPs wording suggests you don't go full throttle like a toddler learning to sleep without a diaper, it's more like a few droplets. If you had it during pregnancy already, chances are higher it'll continue after birth. In most cases it stops after a few weeks, but it can be permanent, so it will happen every now and then, when you're sneezing hard etc. You can get it under control with exercising.

You can look up further information from your country's health institutions, usually including numbers on how prevalent it is where you're from. Being older when giving birth, being obese and some other factors do increase the risk.

This is a real risk of vaginal birth. Long term complications of vaginal birth are not usually studied (this may be related to an ongoing issue in the medical community in failing to address women’s health). For example, painful sex has been reported in a quarter of women 18 months after birth. Painful sex is common in 90% of women in the shorter term after giving birth. Women overwhelmingly experience at least one complication within 6 weeks after birth and are recommended to wear adult diapers as the uterus continues to expel. Women also report at least one long term health complication about a third of the time. (https://en.m.wikipedia.org/wiki/Postpartum_period)

(Edit: this doesn’t differentiate between vagina and c-section, but for example I’ve seen in passing that vaginal birth causes more issues with incontinence and painful sex)

The majority of incidence of female incontinence is attributed to child birth. It's a very high risk that no one like to talk about...mostly because who cares about women? And who cares if they pee themselves for the rest of their lives? They're alive aren't they?

I'm not joking, when I talked to my doctor about this they totally dismissed this concern in a manner that suggested that women should just be fine with a diminished quality of life after child birth. That that's just the way it is and should be and if you don't like it, then don't have kids.

"A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives."

Not specifically only for those reasons, my wife always wanted a c-section birth due to the risks with vaginal birth and recovery times.

I would imagine the recovery times for c-section are longer

Possibly not always true.

Women are fairly frequently given episiotomies. This is intended to prevent vaginal tearing, which is far more harmful than a clean cut and much harder to repair and much more likely to leave a bad scar. Scars in the genitals can be pretty unpleasant. Scar tissue in female genitals tends to not want to cooperate with that whole sex thing.

Furthermore, sutures in the genitals make it impossible to comfortably or safely sit. They can become infected or tear open when you are using the toilet. You are typically given a stool softener to try to reduce the odds of tearing your sutures post partum.

Taking care of sutures in the outer genitals is inherently challenging. You can't see them without help of a mirror and they are difficult to reach for purposes of tending to them.

I imagine sutures across the lower abdomen are, in many cases, a piece of cake compared to that.

The rate has fallen a lot in some countries, so there are large differences (https://patient.info/doctor/episiotomy-and-tears).

The main reason it has fallen is that there’s little difference in short or long term consequences, and non-selective use of it is associated with higher incidence of severe trauma.

https://www.cochranelibrary.com/content?templateType=full&ur...

Perhaps I wasn't clear: Some percentage of vaginal deliveries will involve either vaginal tearing or an episiotomy. Both of these involve trauma and sutures.

When a woman has sutures in that area, bowel movements can rip them out. Both bowel movements and urination can contaminate the wound with bodily wastes.

So a woman having any stitches at all between her legs for any reason whatsoever is highly problematic.

Is an epidural assumed in all this discussion? The mothers I know who didn’t have the epidural didn’t have these nightmare symptoms, while those who did or had a C section were worse off.

(I’m assuming competent medical staff and follow up, but I realize that’s a difficult one in the US and elsewhere)

I have had two vaginal deliveries. They both involved an episiotomy. I have never had an epidural. Both deliveries were completely drug free.

Episiotomy: A surgical cut to the vaginal tissue to prevent tearing.

Epidural: Spinal pain block.

Totally unrelated procedures.

What you think about artificial womb? Would you prefer to make forced birth one month earlier, when baby is small, and then raise it in artificial womb for month or two?

https://gizmodo.com/for-the-second-time-researchers-have-use...

I have never heard of this before. I'm not going to give an opinion off the cuff on something I know nothing about.

What would an epidural have to do with tearing and episiotomies?

Higher rate of complications during birth, more interventions (instruments), which in turn are associated with tearing/episiotomy. The implication that this never happens without an epidural is wrong of course.

Gotcha, makes sense when I think about it. But it's tough to say MN a given case whether complications wouldn't have occurred without the epidural. Sigh, it's a tough call.

Depends.

If you have a tear (1/4 chance) it can take longer to heal, but it's not as debilitating in the short term. It doesn't affect your ability to get out of bed, as much.

However a bad tear will have long lasting impact on your life. Incontinence, infection, painful sex, amongst a whole host of other problems.

C-section has a higher risk of infection, There is significant muscle damage to, which limits your ability to lift and sit up. In terms of pain (emergency c-section compared to a 4b tear, the wife says the c-section was easier to recover from. )

You would imagine wrong.

Smoothly cut, cleaned and expertly closed up wounds heal a lot faster than ripped tissue that doesn't even get properly cleaned because it's in there somewhere.

Don’t be so sure. I can’t find good research comparing the two, but it seems generally held that CS recovery times are longer. I see NICE quoted as saying no risk difference between the two methods but longer recovery times for CS (https://www.theguardian.com/politics/reality-check-with-poll...).

If we perfect the art of surgery to a point where it's painless/seamless/benign it won't even be a question, it seems so much more efficient and clean. Open, extract, close.

There are a number of factors which make natural childbirth better, the mother recovers much quicker, a day or two vs weeks. There are things that happen during vaginal childbirth with hormones released by mother and child which do not happen with c-sections, like the bacteria which transfers from mother to child which is essential for gut function.

The baby is also prepared for birth during the process and is more awake and able to suckle faster with natural birth.

https://www.mamanatural.com/natural-birth/

You are describing some idealized optimum vaginal birth. Those are not the norm. I've spoken to one woman who indicated she recovered rapidly from one birth. It was her first child. She attributed it to youth. Subsequent births were harder on her.

I've had two children. Both births were relatively uncomplicated vaginal births with episiotomy. It took me 5.5 weeks to stop bleeding after the first one. It took me six months to regain the weight I lost while throwing up for 8 months. Etc.

I had unusually good medical care. I was relatively well educated for a young woman. Etc.

I did have an undiagnosed serious medical condition complicating things. Medical staff came to get me off the floor after people in the waiting room harangued them about ignoring what a terrible state I was in and I got an admission of error on the part of staff to some degree. They had dismissed my complaints as "You don't know what pain is. You have another 8 hours to go." without checking me. No, I did not have 8 hours to go.

Although I have also read that vaginal flora may be good for the baby, you are conveniently overlooking the fact that it can also be bad for the baby. C-sections are sometimes recommended to protect the baby from the mother's STD -- for example, if she goes into labor while having an active herpes flare.

I'm pro vaginal birth. I'm not thrilled at the high rate of C-sections. But I don't think you do any good by so completely distorting the facts.

Women need substantial support to successfully birth a healthy baby with minimal complications for mother and child. We still tend to fall short on giving women adequate support. So, in essence, I'm not willing to argue that any particular woman was wrong to choose C-section for herself.

https://www.medicalnewstoday.com/articles/264473.php

https://www.cdc.gov/std/pregnancy/the-facts/std_pregnancy_br...

Idealized is much better than that. I knew a lady who slept through labor, waking up just a few minutes before birth. There are even women who have birth orgasms.

A lot of that seems like unsupported woo which appeals to the sort of people wishing to rebel against the science / chemical / medical mainstream. That doesn't make it true or untrue. It reads exactly like someone who has decided what is true went to find evidence to share to support the claim.

You can pick any position at random and find a wealth of evidence to support your claim.

From a source in the above article:

>Although these new findings and proposed potential mechanisms are novel and exciting, further exploration and replication in larger cohorts of children ... are needed.

Most scientific results are not intended to be consumed by ordinary folks to instruct their final decisions. They are almost always only evidence, not containing any decisive conclusions.

My wife is in the medical field, and she’s the one who explained the advantages to natural birth. There are definitely advantages which have been proven, fewer complications and quicker recovery. I think patients should still make the choice given the information.

There's no evidence for bacteria transfer, and some children have been harmed by mothers taking vaginal mucus to transfer bacteria after a c section.

Don't bother pointing out that those cases are abnormal, and the mothers have diseases...

OTOH, you seem to argue that since you couldn't find any papers on that, doctors and media must be lying and c-section is just better. That sounds an awful lot like the typical conspiracy theorist.

> A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives.

I heard of that child once that died after it got the flue shot. We all should stop vaccinating now.

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