Not the only reason. Time of year also matters a lot for more "natural" reasons. IIRC mid-September is the peak and it goes down on either side, so late December is going to be pretty low anyways. Then you add in C-Sections and it drops to the absolute bottom.
Tangent but it occurred to me the other day that it takes 9 years before one experiences a birthday on every day of the week. Over the course of a lifetime maybe the dispersal evens out but it seems like some of us are just destined to have more birthdays on the weekend.
The practice of routinely scheduling a c-section is basically a confession that birth medicine doesn't serve the patient. Any reasonable medical system would allow natural birth to progress until medical intervention became necessary.
Alternatively, a reasonable medical system might err on the side of a few more not entirely necessary C-sections as opposed to more not entirely necessary maternal and baby deaths.
As a legacy of upright locomotion balanced with large cranium size and infant helplessness, humans have ended up with an objectively poor design for giving birth to offspring. Death during that process is “natural”.
I think the first part is correct. There is probably an optimal rate of c-section which is materially higher than "strictly necessary" and optimizes for mom+baby health. What I am concerned about is the scheduled c-sections. For most births, there is not really a medically credible way to determine in advance that vaginal birth will be dangerous (as a relevant corrolary, consider that there is no way to meaningfully determine the weight of a baby prior to birth).
C-sections are scheduled in advance (sometimes over a month in advance) because the American medical system has optimized for cost reduction (which includes extreme risk aversion) rather than patient outcomes.
It's many years since I had children but we were curious about home birth, and what I understood from looking into it was that there is, apparently, no significant difference in overall safety between home births and hospital births.
However, there was a significant difference in the reasons things went wrong. Because in a hospital you're more likely to receive unnecessary treatment due to the "cascade of intervention"; and interventions such as C-sections have inherent risk. While at home, you're more likely to have an actual emergency.
How well do they control for planned home births having lower risk profiles at the outset? For example, even had I been determined to try labor, I would have done so in a hospital, because I was 40 and have a hiatal hernia that will always be at risk of tearing further. I’d be an idiot to have tried at home.
Unfortunately there are still very limited services for birth outside of hospitals in the US. Providers have a hard time getting regulatory approval and insurance, so they are selective in who they will take as homebirth or out-of-hospital birthing center clients. Basically, only people with very low risk profiles can make it through all the qualifiers for an attended out-of-hospital birth.
I am speaking from personal experience with births in one of the biggest US cities in the last five years. Anecdotally, I think that some less-dense areas have better CNMW practices and more access to midwives due to traditionally less access to hospitals, but it seems very variable.
I don’t recall. It’s a long time ago. I do remember that there were some other factors like proximity of home to hospital.
Mostly the advice we got was, if you have a medical condition that increases risk, then go to a hospital or a birthing centre. But if not, and you live reasonably close to a hospital, home birth is quite safe.
A c-section performed after several hours of active labor leads to a much higher chance of hemorrhage and danger to the baby than a scheduled c-section.
Additionally, there are many factors that can be used to determine the risk of natural birth.
Let's do it like with abortions- let people suffer, let's risk their health until it is clear they will die with intervention. Absolutely necessary is cruel standard.
Would have been a bit difficult to tell if my small hiatal hernia that occasionally causes scary heartburn had become an increasingly large hiatal hernia that allowed part of my stomach to slip through, requiring a much worse emergency surgery than my soothingly well-planned c-section, while in the middle of giving birth…
Not everyone giving birth is a fit 25 year old with absolutely no other health issues and a desire to have several more kids.
Tsk tsk all you like about women “waiting too long” - the majority of first-time mothers over 40 have c-sections. Would my child and I have survived a natural birth? Most likely. Would I definitely not have further damaged my diaphragm, debilitating me far more than the planned c-section did (hardly at all) at a point when we could least tolerate it? My gyno, my gastroenterologist, and I decided the c-section was a much better bet for both me and my child.
That's a great medical outcome and I'm glad you were able to have it. I don't mean to detract from that at all. My experience is that, though many mothers have stories like yours, many others have an experience where the doctor forecloses natural birth from an early stage and forces a path of increasing medical intervention. I'll bet that there are quite a few fit 25 year olds with no health conditions on the scheduled c-section plan because of medical advice that didn't put mom or baby first.
The example that sticks in my mind is from one of the Ina May Gaskin books where the doctor tells a woman that she has a "big baby, but only an adequate pelvis." I can't imagine the amount of damage this kind of doctoring is still doing to people, but it's surely significant.
It's not like you have to wait till the last second to decide that natural birth will be too risky. With regular sonograms it's entirely possible to note when a baby is in a risky position (feet down, umbilical wrapped around the neck for example) and decide to schedule the c-section. If the baby moves into a proper position then the c-section can be cancelled, but if not they can avoid a lot of complications. Also, there are likely lower error rates from having a well planned and orderly procedure instead of emergency ones. The mother and baby could be in much danger if she needs an emergency procedure right at shift change.
I agree with a lot of this. Let me be clear that I don't think we should do anything to materially increase the need for emergency c-sections. It just seems to me that the prolific, and often early scheduling of surgery leads to a lot of unnecessary intervention.
Why is scheduling c-sections bad? I think it just reflects the reality of our society. First of all, people don’t seem to like giving birth. A vast majority of those who give vaginal birth get epidurals. Is that really preferable? Or is it preferable to writhe in unspeakable pain? Also, women are busy. Scheduling the procedure helps birth fit neatly into a chaotic life. Is that wrong?
Getting epidurals (or pain medication in general) is a cultural thing. Just compare with the Netherlands, where home births are fairly common and pain medication is relatively uncommon.
Absolutely incorrect take. Also, irresponsible to spread this kind of nonsense when you are a public defender, and not remotely close to being a medical professional.
It’s important for purposes of integrity that other commenters know why the person is not a credible source, most especially for important medical information.
* Not the person you replied to, just my two cents.
You don't have to be trained and practicing in a field to know some things about it. Nobody should be making medical decisions solely on the advice of strangers on internet forums, but being a public defender doesn't automatically disqualify someone from being a credible source of sound medical information just like being a doctor doesn't automatically make a person credible.
After all, in my country we have a doctor telling people that their illnesses were caused by demon sperm and being on record saying that medical treatments come from alien DNA yet they're still allowed to keep their medical license and practice thanks to the Texas Medical Board.
It's possible that our public_defender is entirely wrong, but isn't better to attack the false claim than to attack a person or dismiss their opinions on the basis of their job title? Don't you suspect that you yourself have some useful information on things outside of your job description?
No, but this opinion is demonstrably wrong. Read any of the ACOG literature, there are dozens of peer-reviewed studies about the safety and efficacy of induction, assisted deliveries like vacuums, and both scheduled and emergency c-sections.
Scheduled c-sections outperform emergency c-sections in every metric tracked. Scheduled c-sections are no worse for the baby than natural delivery, and if you take into account recovery time from surgery, no worse for the mother.
You can have an opinion on whatever you like, but to be blunt, if it's as stupid as this one you should get called out for it.
My opinion isn't stupid, I have just considered and valued sources that you have disregarded. The ACOG is a trade group that supports medical intervention in birth. It doesn't make their contributions to research on the efficacy of medical intervention in birth irrelevant, but you should consider their contributions in the same light as Exxon's sponsored research into the environmental impacts of oil extraction.
There is no good reason to have a medical doctor attend every birth. Of course in a country with a 30% c-section rate, there is much more for doctors to do. I don't think that any credible source will defend 30% as an optimal rate of surgical intervention in birth, but feel free to rebut me.
C-sections are only "no worse" for the mother and baby if you only consider mortality. Let's also consider:
1) Mother-child bonding time in the first two hours after birth.
2) Inoculation of the baby to mother's flora in the birth canal.
3) Mother's ability to care for the baby while recovering from surgery.
4) Postpartum mental health of mother who has been denied natural birth.
There's a huge difference between arguing that many scheduled c-sections are not for medical reasons vs that there are not medical reasons for a scheduled c-section.
Well, good thing nobody is taking the second position. My point is that natural labor is not allowed by the medical system to progress in many cases where there is no medical reason to intervene.
I said wait until medical intervention becomes necessary, not force active labor on everyone. As others have pointed out, we can detect the need for medical intervention at an early stage sometimes. That's great, people should have the medical care they need. They should not have surgery forced on them.
Sorry, I was misreading "wait until medical intervention becomes necessary" as "Do not perform scheduled c-sections, only perform unplanned and emergency c-sections".
Anyway, I really don't think the issue with the majority of scheduled c-sections is surgery being forced on patients. It's patients and their doctors discussing the risks of an attempted natural birth vs a scheduled c-section and opting for a scheduled c-section. In some many cases the patients involved have no increased risk for a natural birth but may still opt for a c-section. And yes, on the flip side, no one should be forced into an attempted natural birth.
"Scheduled c-sections outperform emergency c-sections in every metric tracked."
The comparison is natural birth to c-sections. Comparing scheduled c-sections to emergency c-sections is a ridiculous thing to track, go compare GP visits vs admission to emergency while you're at it.
How is it a different comparison? If you knew whether or not you'd need an emergency c-section, you'd never have any emergency c-sections. There are four types of labor:
1. Unassisted (with and without medication)
2. Assisted (vacuums, etc.)
3. Scheduled c-section
4. Emergency c-section
The problem with #4 is that it often happens after attempting 1 and/or 2 unsuccessfully. The baby is in a much worse position, sometimes medically and often physically within the mother's body. You can't compare 1 and 4 without also comparing 1 and 3, 3 and 4, etc. Everything is interrelated.
Comparing outcomes of emergency c-sections to scheduled c-sections is always going to come out in favour of scheduled c-sections. On one side something is going wrong 100% of the time and the other something is not always going wrong. Not sure how to make this anymore obvious. This is a pointless comparison.
Comparing outcomes of natural births as a whole vs scheduled c-sections is far more useful comparison.
I don't know about the other numbers, but my wife has had two scheduled c-sections and the recovery for both suuucked when compared to everyone we know that had natural birth.
Of course, the process of going through labor pains for many hours might make things even between the two...
I can assure you, it's a much much better situation than three hours of active labor followed by an unplanned or worse, emergency, c-section. Consider yourself fortunate. Labor isn't just painful, it's trauma which makes surgery much more risky and difficult to recover from.
> Of course, the process of going through labor pains for many hours might make things even between the two...
It's not. Labor pain is more time limited and the mother is kind of "out of it", and doesn't usually remember it clearly - plus there's a prize at the end :)
C-section pain is worse, and it lasts several weeks exactly at a time when the mother needs to do stuff. It's worse in every way.
My understanding is that when things progress naturally, the mother’s body and mind should be in a state that helps them cope with the pain, but it doesn’t reduce it or help you forget anything.
My wife remembers every instant of all of her births.
What? c-sections are MUCH MUCH worse for the mother in every single metric including pain. C-section pain is longer and more severe than natural birth pain, and natural birth pain can be ameliorated which makes it even better - but even with no intervention at all natural birth pain is less than c-section pain.
If you are scheduling a c-section it means you are not trying for a natural birth and that means your outcome for the mother is strictly worse.
If it were a simple choice between natural birth and a planned c-section then sure. But it's a choice between a planned c-section, and the high possibility of an unplanned c-section, an emergency c-section, or in some cases very serious complications like uterine rupture. Doctors and patients decide on a planned c-section with the known risk factors for the patient in mind.
Oh, how I wish that were true. It's not. Do your own research and you'll see - the majority of c-section are unnecessary, or caused by excessive use of Pitocin (uterine rupture is vanishingly rare - except when Dr.'s administer Pitocin).
In retrospect, this guy is practically the prototype of villain in healthcare. He's Eric Lander levels of villainy.
He shouldn't be considered a credible voice just out of corruption. There are many doctors who can write.
Consider his role at Partners (now "Mass General Brigham"): overseeing the growth of a notoriously money grubbing institution, run anticompetitively, despite the excellence of its providers. He has parlayed... saucy New Yorker writing into becoming the very hospital administrator who is responsible for all the fuckups he shits on.
Trust me, if he has something to say about, I don't know, fucking childbirth, it has been known to everyone for years. The difference is his presence in The Magazine New Yorkers Care About lets him omit anything shitty to say about himself and his Partners.
With all due respect your post sounds a little like a conspiracy theory without a set of good sources.
Is the claim that someone is evil even an intellectual position (versus, a religious one)? And finally but not facetiously, does being evil invalidates a technical statement they're making -- sounds like an ad hom?
This is a good example of how in the real world, everything is correlated with everything. Understanding this principle, I would expect uneven birth times and birth dates. I may not be able to guess what will cause it to be uneven (though in this particular case I would have gotten pretty close), or by how much it will deviate from uniformly random (I would have gotten this wrong to the low side), but it's sure to be something.
To put it another way intuitively, in a complicated world with so many things impacting so many other things, to have a totally uniformly random birth times or dates would essentially require some active force to smooth the times and dates out, because it is beyond implausible that absolutely nothing would have an impact. From diurnal hormone cycles, traffic cycles, preferences about surgery times, and probably another dozen things you could think of that could impact the times, it is implausible to expect that they would all be completely wrong or that they would all precisely cancel.
Uniform randomness is a very convenient mathematical fiction for making Statistics 101 problems easy enough for students to do. This is a necessary thing and it's hard to imagine how to avoid it. But in reality almost nothing is ever truly uniformly random. There's always something out there that's going to correlate it with something. It is a sad side effect of this need to simplify problems enough to be tractable by students that we end up teaching that uniform randomness is somehow the "default" distribution and the others are exceptions or something.
If the medical staff influence the delivery time, they in turn are influenced by everything else, like vendors and traffic accidents. While obstetricians are not fungible with trauma surgeons, and nurses are only slightly more fungible (because they tend to work in a particular ward), they all have to deal with the pharmacy and anesthesiology, etc. I don’t know if they share surgical theaters, but you can’t reuse a surgery until it is clean and functioning, I think those crews would definitely be floating.
I don’t know much of anything about the other people in the OR, if the assistants stick to a particular group of surgeons or float. The people handling tools and gauze pads (which sounds like a dumb job but someone has to be sure that 12 pads and a clamp went into your abdomen and exactly that number came back out at the end), clamps, retraction, suction, IV and gas monitoring, etc etc. Those are somewhat specialized to the task but I don’t know if they are specialized to a surgical unit or if the same people who help with a appendectomy also assist with a finger reattachment or spinal surgery. If they do a surgery could get bumped for scheduling conflicts, or shift changes.
There’s a difference between lots of different factors having an impact and one giant one forcing everything to be at the same time.
With the former you’d expect a normal distribution (not uniform) due to the central limit theorem - the sum of a large number of variables with some error distribution will result in a sum with a normal distribution. This isn’t math 101 but an incontrovertible fundamental finding of Calculus (and 100% applies to the real world).
The article explains the latter phenomenon though. Births are being scheduled due to C-sections. This isn’t a confluence of some interesting factors into a surprising result but the presence of one factor that overrides all others and one that has grown in popularity due to the efficacy of modern techniques.
"With the former you’d expect a normal distribution (not uniform) due to the central limit theorem"
You'd expect it, but in the real world you'd be extremely frequently wrong. Correlations in the real world very frequently end up defeating the central limit theorem in practice.
The central limit theorem, being a mathematical thing, is correct; it can't be "wrong". However, while adding together a lot of distributions will absolutely trend towards a normal distribution, it does not make very many promises about how "quickly" that will happen. In practice the real world is filled with the sort of pathologies that result in it being "very slow". Scare quoting some words here because they are rather vague in math terms and I feel bad about that, but putting real mathematical meat behind them would be beyond the scope of an HN post. Many, many, many things are not normal that "should" be, and you can make some grave mistakes in the real world if you overestimate the normality of real world distribution. I recommend Taleb's works here, if you need more details.
Yup, that's what I meant by "diurnal hormones". Personally I'd still guess there's an effect there, it's just so swamped by the c-section surgery nothing else is visible.
Also related and shown in the diagrams in the linked article, why are so many babies born on Friday, and less on Saturday? Doctors/nurses want their weekends too, so inducements / c-sections also go up on Fridays.
Says the dad of the child born at 4pm on a Friday...
An unfortunate side effect of the US hospital business is that you have a large number of customers and have to push people through the system as quickly as you can. That's probably why there has been such an increase in birth centers for mothers who want the time to go through labor naturally.
Nah, in completely socialized systems doctors and nurses also usually want to have weekends and evenings off, hospitals aren't staffed as well as during business hours, and people try to limit the workload on their colleagues remaining on duty.
The contrast to "the US hospital business" is not necessarily "socialized systems". A better contrast is, as the original commenter pointed out, birthing centers (or home births). A contrast to a hospital OBGYN in the US is a certified nurse midwife.
Even midwife systems often end up with a "ball of midwives" where you may not even know who you're going to get, and then they go off the clock at 6 PM and someone new steps in.
Everything is a cost/benefit/availability tradeoff, and time is just one of the many variables that are being juggled.
Of course, if you have money to throw at the problem you can reduce the other issues.
As far as I'm aware, the majority of US midwives (or CPM's) are not hospital nurse midwives. They do not go off-the-clock, though they sometimes have multiple patients due at the same time so you might still find a backup midwife is covering for your primary care provider.
I'm sure it varies from birth center to birth center - one would have the midwife scramble at any hour of the day or night to get into the room, the other we used had the ball.
I can see the advantages to the ball but the first was overall better I feel (but there are so many variables it's hard to really tell). We've technically never had the doctor/midwife "assigned" on-hand during the actual delivery for various reasons.
Kind of a circular argument to say that we are seeing an increase in birthing centers because the practice of medicine in recent years reduced the use of birthing centers.
I witnessed this phenomenon first-hand when my second child was born and during the labor, which was not exceptionally long, only 7 hours, the doctor started making "this is not progressing" noises toward 5pm and I had to sternly tell him to fuck right off. Based on a strip chart of the time between contractions the labor was clearly making normal, bordering on rapid, progress.
Doctors are pretty much dicks, and the entire American system is massively broken.
And from anecdote, so should mothers. Early morning (~8AM) you get the A staff at their prime and are often the first case so it is usually timely.
The worst time is 6:30AM (or whenever half an hour before changeover is). You either get C staff and/or people who have been awake for 24 hours. The surgeon probably called that time so they could book night rates.
Surgeons usually prefer to start operating before 8AM. They are awake, the OR is clean, the staff is fresh, and they have all day afterward to monitor for complications (and jet out early if everything goes well). The worst surgery times are probably starting around 7PM and going until 6AM. Those are usually emergencies, the OR has been in use all day, the surgeon probably has less experience as they are earlier in their career, the preferred materiel might be waiting to be autoclaved, etc.
In my experience with surgery for family members, surgeons want scheduled surgeries early because they have a shit ton to do. The brain surgeon was rallying the troops at 5:30am and was pissed they were already behind on the first surgery. He needed to do the scheduled surgeries early because he needed to have a certain amount of time for emergency surgeries. If those occurred early, then he could push the scheduled surgeries later. If the emergencies occurred later, then he’s done with the scheduled surgeries by then.
Then in the late morning and rest of the day, it was patient rounds and consultations, teaching at the local medical school, and performing research. Guy was a machine and on another level. I don’t know when he was ever able to have a non-medical or patient related thought.
The surgeon is usually an OBGYN. At least that’s what’s most common at the hospital we had our 3 at. It was the attending OBGYN from the practice my wife goes to. They are both run by the same place.
You have to remember that you are not the only patient in the hospital. A Caesarean section requires a lot of setup including OR, anesthesiologist, ensuring adequate care for the newborn, etc. Any of these can cause a delay. Of course there is other cases triaged by urgency like crash sections. It would make no sense to show up to the OR 30 minutes before you can begin operating. An elective Caesarean section will always get bumped for emergencies.
Hospitals and the medical profession have a lot of work, and for efficiency they stack the work up. A rule of thumb whenever dealing with a hospital is that everything will be massively later than you expect. It's a good idea to set your expectations ahead of time so that a bit of a wait does not take you by surprise. For a hospital procedure, half an hour late is pretty much right on time.
You have to register with the hospital. You have to change into a hospital gown. You have to get an IV and labs (which take an hour to come back). You have to do a nursing intake interview (which is surprisingly long).
I'm an anesthesiologist. My wife needed surgery. And the surgeon is a friend of mine from childhood and needed to leave that afternoon. We had a free OR. Even then, it took 2.5 hrs to get her registered, up to the surgical floor, and to the OR.
So, maybe that doctor is a jerk, but realistically, it takes a while even if you have the inside track on everything.
The amount of effort to file a grievance against the guy because he was late seems a little extreme. Especially since I haven't slept in 5 days now because of the aforementioned beby.
Although it was incredibly telling when I asked the nurse. "Hey so I know nurses have a list of which Drs. Are a-holes and which ones are good to work with, is our Dr an a-hole?" She responded by saying she couldn't answer that one way or another.
That's fucking hilarious. I filed a grievance when the medical professionals performed care on me against my (fully conscious and alert) consent, without a warrant, and without a court order nor arrest -- at the direction of a federal officer who had me "detained" but not "arrested" because there was no probable cause of a crime.
I wrote an incredibly detailed, 100 page report with several witnesses painstakingly describing the violation and details and associated license #. Included was my full medical report where licensed doctors clearly noted I had denied consent for care. Included on the report was the signed, official report showing care was rendered without consent.
After what I imagine was about 5 seconds of glancing at my report, a low IQ triage official who worked for the state board claimed anything the medical professionals do are excepted because they magically become police officers, except ones exempt to the 4th amendment, if they do anything wrong. So you can file a grievance, and an idiot from the board will probably tell you to fuck off or invent a fake rule, and there is no appeals process.
> . I filed a grievance when the medical professionals performed care on me against my (fully conscious and alert) consent, without a warrant, and without a court order nor arrest -- at the direction of a federal officer who had me "detained" but not "arrested" because there was no probable cause of a crime.
That’s more of a civil battery (and possibly also federal civil rights) lawsuit than a professional complaint situation.
You may be able to sue the government for the violation of your civil and constitutional rights and the damages it and its doctors caused to you. That will be true regardless of whether the doctors themselves violated any ethical rules. I suggest you contact a competent lawyer in your jurisdiction if you are interested in pursuing this.
Not just hospitals, but my N=1 anecdote having seen a C-section in the afternoon vs morning is that the doctors are sharper and more focused in the morning.
Afternoon, after the first cups of coffee have worn off, and after the natural exhaustion from a long shift is not when you want to be having a C section.
I was going to guess without reading the article that it has to do with Drs etc arriving at work at 8am and mothers waiting until they arrive to have the baby extracted- seems about right
Can you please not fulminate or post flamebait to HN? We're trying for curious conversation here and those are two of the things that most prevent that. That's why they're against the site guidelines: https://news.ycombinator.com/newsguidelines.html
Of course this doesn't mean you're wrong—it means you need to present your view thoughtfully and in a way that appeals to curiosity. That's especially important if your view happens to be right, so it's in your interest. (I'm adding this because the field around childbirth is intense and there are such strong feelings about it—justifiably.)
And it looked like a butcher shop to you? I honestly have no idea what you're getting this from. Do you remember you/your wife giving vaginal birth to her placenta? Didn't that look like a butcher shop?
He might mean butcher shop as in being treated like a piece of meat to be handled as conveniently as possible, rather than consulted or even allowed to guide her own birthing experience. My wife had made similar remarks.
I understand why a phrase like that can be emotionally activating, but please don't perpetuate flamewars on HN. You made your point already. Escalating ("your doctors sucked") is unhelpful.
What are you talking about? This doesn’t have anything to do with the quality of individual doctors, or whether any particular procedure has value. (At least, as I understand the point of the descriptions of systems in action in the article.)
I'm responding to the butcher shop comment, not the article. The article has no reference to c sections or labor and delivery in general being butcher shoppy, unless you think scheduling a time for a c section or inductions makes it a butcher shop. I assumed OP was talking about c sections specifically, since it was in response to a comment about c sections, and c sections might use similar tools to a butcher shop(a knife).
The comment makes even less sense if they're talking about labor and delivery generally, which maybe they are. Maybe hospitals are a little too clinical for some, but that doesn't make them a butcher shop, and that's why you can bring your own doula. And maybe the clinicalness is part of the reason hospital births are far safer than home births.
I see. Sounds like you and the OP might have significant ideological differences, and you are unhappy about an idle comment by my wife because I tried to clear up confusion around OP’s metaphor. Sorry for adding to the confusion.
Is there data on this? Specifically I wonder if women who refused it for a first birth still refuse them for subsequent births (or maybe they change their mind?).
I don't have any good data and would also be interested. Anecdotally, I do know women who didn't use them at first and started using them later for multiple reasons: aging, advice of medical team changing, unexpectedly low pain tolerance, and in a couple of cases, just wanting to experience an epidural with the last kid. :)
I also know some who stopped using epidurals, but fewer and most of them simply had become interested in more natural births between children.
Wife never had a C section, but how they treat you until you get discharged would be literally torture in another context. Wife got woken up every 30 mins to 1 hour for this and that test, paperwork, questions, etc.
You are paying a lot of money to be in that hospital bed, you can tell them to pound sand and let you sleep. They will get pissy but I figured after what my wife went though having some nurses think I'm a asshole is the better part of the deal.
> You mean a generally-recommended-as-medically-necessary-only procedure that would result in far more complications were it not performed?
A Caesarean is often performed even when it is not medically necessary. Hence "why are so many babies born around 8:00 AM"? Additionally, above a certain rate in industrialized countries, they are not even associated with better birth outcomes.
> And anyway, people get surgeries all the time, how is this any different?
Because childbirth is not an injury or deformity that requires fixing (or any intervention) in the large majority of cases. Surgery should be done when medically necessary. A Caesarean has many potential side effects for the mother and the infant, and doing it just to hurry things up is (IMO) unethical.
What leads to many Caesareans is the "cascade of interventions" which might include unnecessary induced labor (e.g. if a mother is not dilating "quickly enough"), an early epidural, or continuous EFM. Many of these interventions, including the ones I listed, increase the likelihood of having a Caesarean.
In such a highly emotional situation, many mothers will feel pressured to do what their medical provider recommends. So, yes, it's technically true that it's the mother's decision, but many mothers don't realize they have the right to refuse these interventions, or are too scared to advocate for themselves in these situations, or are not fully aware of the risks -- both to the mother and the baby. In that sense, the decision is largely made by the medical provider, and this decision is often made because of an unnecessary urgency to get the birth done (or other reasons, such as a lack of experience with vaginal births or a fear of being sued, but in any case these reasons are not primarily the mother's). That is the part I was referring to as unethical.
To be clear, if it is medically necessary, a Caesarean should absolutely be done.
Personal experience with the mother telling the nurse emphatically not to use an intervention, to have it ignored and done anyway at the behest of a doctor that isn't even on site. It was convenient for the doctor and had nothing to do with the health of the mother.
Also a personal experience of a nurse yelling at the mother to stop pushing when the baby is already partially out because the doctor is not there yet. Some babies just don't care to wait for the doctor if he is late.
Unfortunately, in my personal experience, the mothers desires are not generally held in high regard inside of a hospital.
Many doctors nudge, or even push, decisions towards things that are convenient or good for them. Time table for the birth, treatment that enriches them... This includes unnecessary surgeries and labor inducement.
The decision is left up to the mother, sort of. Inside the hospital is an environment that the doctors are very familiar and the mother, not. It is very interested in following procedure, within which the doctors orders are held in high regard and the woman's desires not so much.
If you try to buck the desires of the hospital+doctor you had better have a will of steel and a willingness to walk out. Ornery nurses and doctors can make your stay an absolute hell.
In times and in countries the number of C sections have varied widely from "you might as well get it because it's quick and safe" to "nobody should have one unless they are literally carrying Julius Caesar".
And poking the "birth options bear" is not something you want to do unless you're really in for a fight. There are strong opinions available.
After watching The Business of Being Born, Gawande's article was really helpful in understanding why things are done the way they are.