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Comment by Roark66 | Hacker News Reader

It was surprising to see incidence of death by cesarean is almost 13 per 100k. It is commonly thought as the safest way and half of all births in my country are via cesarean.

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I wonder how much of that is selection bias? In my (admittedly limited) experiences around the labor and delivery process, c-sections were (apart from when requested) advised for high-risk pregnancies and as a recourse for something having gone wrong in the L/D process. One could reasonably expect that both of those situations would indicate a higher risk for mortality from surgery.

Note that per Wikipedia [0], death by abdominal surgery in general in High-HDI countries is on the order of 100-1000/100k.

[0] https://en.wikipedia.org/wiki/Perioperative_mortality

We had 3 kids, one with an epidural and induced labor and the other 2 were natural child birth, no medication at all, and my wife much preferred the natural child birth -- all of them at at a hospital "birthing center", with a five minute walk to an OR if needed. She was more present emotionally at birth, we were able to walk out of the hospital with our baby a few hours later. She was practically bedridden for a week after the induced labor with the epidural.

Obviously, I'm only a spectator, but the overall experience seemed way less traumatic and stressful for her with the natural child birth, working with midwives and nurses rather than doctors.

The first birth is invariably the most difficult (longer, more painful), and the most difficult to recover from regardless of epidural. You can't at all compare the experience of a second birth without an epidural to the first birth with an epidural.

Also, it can be difficult for women to remember the finer details of the pain because the hormones after birth specifically function to cause a kind of amnesia. (The hormonal effect on memory isn't unique to pregnancy or women, it's just rarely so pronounced as at child birth.)

We've had two kids, the first my wife had an epidural (after rejecting it twice before expressly demanding one unprompted), the second without. The first birth lasted, IIRC, over 20 hours at the hospital (not counting initial time spent at home), and we had long conversations with various maternity nurses and our doula about women's experience with child birth. The hospital's nurses were on strike so our nurses were from around the country with experience with all different kinds of hospitals and populations.

There's selection bias. High risk deliveries tend to start at or convert to cesarian at the first sign of trouble.

In what country do you live? I've had children in two European countries, in both it was common knowledge that natural birth is safer then cesarean and doctors/hospital strongly prefer it.

> doctors/hospital strongly prefer it.

Seems to depend a lot on the hospital. We (partner is pregnant with a high risk pregnancy) were at a level 1 prenatal care center in Germany a few weeks ago where they very much insisted that in her and the child's condition, a c-section is pretty much her only option.

We're now in a different, also level 1, prenatal care center, also in Germany (though a different state), where the prevailing medical opinion is "natural birth should work perfectly fine for you. We're not ruling out a c-section in case things go sideways, but natural birth is very much our preferred option in your case."

The first center seems to be quite keen on using as many cases as possible for training their staff in c-sections, even where it's not strictly necessary/beneficial. At least that's what we've heard from other parents in similar situations.

I wonder to what degree this is a "if you are a hammer, everything looks like a nail" type of thing.

The first place might have a strong surgical team and might be inclined to solve everything via surgery?

To add to this, C-section rates seem to be significantly higher in private hospitals, when compared to public hospitals.

Poland. Both children my sister had were cesarean.

There were no complications at all, but both were as the doc put it "large" so my sister was given a choice.

I think this is going to depend strongly on population. Average age of the mother, width of the pelvic canal, and similar are going to vary widely with culture, race and country.

Its hard to measure, but for the UK at least, and depending where you are, you try natural, then if shit goes wrong you graduate to ceasarian.

So it would be interesting to see the elective vs crash ceasarian rate.

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