Hacker News Reader

Comment by rayiner | Hacker News Reader

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.”

View on HN

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.

Reply on news.ycombinator.com