Crib, clothes, baby gear: many thousands. Doctor's fees, hospital care: twenty five hundred. The look on Heather's face as Catherine estimates a medium-to-large baby of 8.4lbs: priceless.
Got to my haircut early so I was able to surprise Heather by being at the doctor's appointment. No further dilation today but Catherine predicts an 8.4lb baby and worked her magic to "move things in our direction." She's on call a few days this week. We'll see.
Heather got a bit of a wake-up call from three of the realities of child birth, namely the ones that she's over-optimistic-ized. First was the size of the baby. Second was her notion that things will slowly progress each week and that she'll have plenty of warning when Ava comes along. Third was her notion that her water will break in a dribbling, controlled manner.
Sometimes it dribbles, but generally it explodes. Thus Hollywood's portrayal.
She mentioned the word c-section flippantly which concerned me a bit. It's a great option, but one that I want Heather to consider as a major surgery, not an "I'd-like-a-baby-with-fries-and-a-c-section" option. She's smart, in control and I trust her. But I don't think she sees it as the major surgery that it is.
From a publication in the National Library of Medicine: The maternal mortality rate after cesarean section is currently very low, but cesarean section is more hazardous than vaginal delivery by a factor of 2-11. Maternal mortality rates of 0 in large series of cesareans have been achieved in some settings, and this suggests that careful attention to good surgical technique and postoperative care could lower mortality after cesarean even further. Infection is the most common cause of morbidity after cesarean, transfusion being second. A large number of factors modify the risk of infection, the most important being prophylactic antibiotics. There is weak evidence that women are slightly more depressed after cesarean than after vaginal delivery. On average, cesarean sections cost more than vaginal deliveries.
From childbirth.org: Cesarean birth is major surgery, and, as with other surgical procedures, risks are involved. The estimated risk of a woman dying after a cesarean birth is less than one in 2,500 (the risk of death after a vaginal birth is less than one in 10,000). These are estimated risks for a large population of women. Individual medical conditions such as some heart problems may make the risk of vaginal birth higher than cesarean birth.
These may both be dubious sources (I have no idea) but they're ones that seem to reflect the general tone in the research community as of 2005. Bottom line is that you don't plan for a c-section. You are forced into it when complications require it. It has higher risks associated with it. Longer recovery times. More complications in future deliveries. This is certainly a choice for Heather, but one that I'll discourage until it presents itself as the least risky one. To me, it's best to let the doctors try a natural childbirth with an epidural and then let them escalate you to a c-section as they see fit. I don't want Heather's concern of pain to hurt her. I certainly understand the pain and the desire to find a way out of it. But I want to make sure she knows what she's getting into. With the epidural, there's no reason to chop yourself up.
Overall summary is that Heather's healthy but we still have no better indicator of when she'll pop. Could be tonight. Could be two weeks from tonight.
A good clip from South Florida Parenting Magazine: How and why the rate of cesarian sections is increasing - and what expectant parents should know to avoid the risks of surgery.
It's a telling sign of the times that the hospital with the state's highest rate of deliveries, where more babies are delivered by cesarean section than vaginally, last year was chosen by South Florida Parenting readers as the best place in Miami-Dade County to give birth.
A generation ago, expectant mothers nationwide demanded relief from the rising rate of what they saw as needless butchering. Their outcry inspired doctors to drop their scalpels and with it, the rate of c-sections nationwide. Through much of the 1990s, cesarean deliveries hovered just above 20 percent of all births. Then around 1997, c-sections began to climb once again. Today, 27 percent of babies born in the United States are delivered by c-section - the highest level ever reported, and the numbers continue to increase each year. In Florida, the rate is just over 30 percent. Miami-Dade County has the highest rate in the state, more than 40 percent. Palm Beach and Broward aren't far behind.
Mothers this time are strangely silent, accepting, even embracing, the growing likelihood that giving birth will involve major surgery.
"The general attitude of the more informed mothers is not to take any chances," said Dr. Nathan Hirsch, chairman of obstetrics and gynecology at South Miami Hospital, which has the state's highest c-section rate, nearly 54 percent. "They say I'm only going to have one baby, maybe two."
How did surgery come to be seen as a safer way of giving birth than the way nature intended?
An Illusion of Safety: A clue lies in the state Agency for Health Care Administration's statistics showing the rate of c-sections in Florida and the United States. Although Florida's rate over the past decade dipped and rose in sync with the rest of the country, it stayed consistently higher. The reason is Florida's high rate of malpractice lawsuits. A newly enacted amendment to Florida's constitution revokes a Florida physician's license to practice if he has three malpractice judgments against him. Doctors who've long lived in fear of lawsuits now are outright terrified.
"The medical-legal problems in America today don't allow the doctor to take any chances," Hirsch said. "Everyone expects a perfect birth and a perfect baby." Surgery does not guarantee a perfect baby. Infants delivered by cesarean are more likely than those delivered vaginally to suffer from respiratory distress. According to Family Practice News, 73 percent of infants delivered by elective c-section required resuscitation oxygen. Fourteen percent were admitted to an advanced-care nursery, compared to 5 percent of babies born vaginally. C-section babies also face a small risk of being cut during surgery. Scheduled c-section may result in a premature delivery if the due date is miscalculated.
"A c-section is definitely not safer," said Dr. Maureen Malee, chief of obstetrics at Jackson Memorial Hospital in Miami. "It's surgery." Almost any obstetrician would agree. It's the illusion of safety that drives them to the knife. "Some practitioners believe that if you provide a c-section," Malee explained, "you won't be faulted retrospectively."
They consider such problems as infant respiratory distress minor and easy to treat. Most babies born in respiratory distress are breathing normally within days. Nor do doctors worry excessively about hemorrhaging and uterine infections, which are more common in women who've had c-sections. Transfusions and antibiotics normally do the trick. The fear that drives them to perform c-sections on four out of 10 mothers is delivering a baby with brain damage. Obstetricians once believed that sparing babies the trauma of passing through the birth canal would drastically cut the rate of cerebral palsy and mental retardation. More recent studies have proven that brain disorders are rarely related to childbirth, and that the surge in cesarean deliveries has not diminished the incidence of cerebral palsy.
Obstetricians know of the studies, yet they also know how easily jurors can be swayed by testimony from "medical experts" who'll say that if the doctor had only done a c-section, the baby would have been fine.
This article indicates that malpractice suits and public lack-of-awareness have contributed to the notion that c-sections are simply another way to have babies, completely ignoring the fact that it's major surgery. It just makes sense to me. I don't want my wife cut up if she doesn't have to be. If she's worried about the pain, there's the epidural. The argument that "everybody's having them" has never made much sense to me. Sure, it's low risk. But why not go for the lowest risk with the lowest complications and the easiest recovery? The epidural takes some/much of the pain out of the equation.
Date: 2005-07-13 13:29:52 Name: Jen This comment is more for DT...a c-section should never be just a another choice of delivery unless it becomes a necessary thing. I know what I'm talking about, I've had two emergency c-sections. The recovery from the first one was horrible (developed an infection, had to be re-opened, took 4 MONTHS to heal). It wasn't until I had my second c-section that the doctors realized because of medical reasons, I can never deliver a child vaginally. I won't go into my complete medical history, but I was informed by my doctor that because of the c-sections, even having one more child would be a major medical risk. So not only has my option of delivery been taken away from me, so has the option of having as many children as I want. Like Joe said, don't be cut up if you don't have to be. The hardest part for me was after they delivered my babies, I couldn't hold them until after I had been closed up...everyone else held my babies first. Now that I've had two c-sections, I wonder what future risks I have since it is a major surgery. The only thing in defense of a c-section is for people like me, it prevented our death and our child's death. Before c-sections, a baby not being able to be delivered would have most likely killed the mother. I do have 2 beautiful children, no matter how they were brought into this world.
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