Too posh to push?

There is an interesting article in the Ottawa Citizen this morning that talks about how the rates of birth via caesarean section are rising, and how the added cost is straining the medical system. (But, I can’t help but ask, will the medical system be dealing with hemorrhoids for years after all that straining?)

According to a report released by the Canadian Institute for Health Information called Giving Birth in Canada: The Costs, the rate of births by c-section have climbed to 24%, as compared to just 17% in the early 1990s.

The cost of a birth by c-section averages $4,600, while a vaginal delivery costs $2,800. (This, of course, is cost to the ‘system’. It is one of the miracles of medicare that I walked out of the hospital after each of my sons’ births paying only the $200/night upgrade from a ward room to a private room, and even that was reimbursed at 50% by my supplementary medical coverage.)

The Citizen article says that in some Canadian cities, caesarean rates are approaching 30% of all births, almost twice as high as considered medically necessary by the World Health Organization.

What I want to know is how people are getting these ‘convenience c-sections’? Although I’m well-acquainted with the idea through the countless hours I spent on fertility and pregnancy message boards when I was carrying Tristan and Simon, I truly thought they were an American phenomenon.

When I was endlessly pregnant with Simon, as he moved off the large-fetus charts and onto the ‘you are gestating an elephant-calf’ charts, I begged for an induction – just an induction, mind you, at a week after my due date – and they wouldn’t hear of it.

Personally, I don’t get why anyone would choose a c-section over a vaginal birth. In fact, when my labour with Simon stalled somewhere around the 20th time in the 20th hour of labour and the spectre of a c-section began to materialize, I was terrified. To me, a c-section would have been a bit of a disappointment. There is an undeniable sense of empowerment, and a celebration of your body’s capabilities, that comes with pushing that baby out. (She said, in the hazy afterglow of two years past.)

I also can’t imagine having to deal with healing from surgical incisions in addition to dealing with everything else that came with caring for a newborn. The sleep deprivation and the cracked and blistered nipples alone nearly put me over the edge; the idea of trying to cope with incisions and whatnot, and of not being able to pick up my then two-year-old eldest son for weeks, is almost unimaginable.

Don’t get me wrong, I am absolutely not criticizing caesarean births. Heck, that’s how I got here. (Breech baby, stubborn from the womb.) But it really does surprise me that (a) someone who is otherwise healthy and capable of delivering vaginally would choose a c-section, and (b) that an obstetrican would allow it, especially given the cost is 60% higher – let alone the additional health risks and longer recovery times associated with c-sections.

It’s all very interesting! What do you think? First, I’m curious as to whether the costs in Canada are similar to those in other countries. What do you think about elective c-sections? Would you? Did you? And since we as taxpayers are footing the bill, so to speak, should obstetricians permit medically unnecessary c-sections?

Author: DaniGirl

Canadian. storyteller, photographer, mom to 3. Professional dilettante.

21 thoughts on “Too posh to push?”

  1. Interesting thoughts! I’m going to add another perspective. My OB was “old school.” Lots of experience and he had tonnes of ways which he saved the health care system money (like doing some tests in his office instead of sending his patients to a lab.)
    Anyway, we required some intervention during delivery. Forceps. Blech.
    Afterwards, when I was thanking him profusely for getting our daughter out alive and healthy, he said that the younger OBs would have opted for a C-Section in lieu of forceps. Something about the younger kids not being as comfortable with the art of forceps, fear of litigation etc etc.
    I was thrilled that I dodged major surgery! And ever so grateful we had an Old School doc.

  2. Good Lord, giving brith is cosmetic? Where does it end?
    Amelia’s heart rate dropped while I was trying to coax her into the world and they were suddenly shoving papers in my face to consent to c-section if the vaccuum didn’t work. Well the intense pain coupled with people strapping my arms to black armrests and draggin pins across my belly for sensation was all the motivation I needed. I hurled her out in 4 pushes.
    So, nope, I would never opt to have this if it weren’t a dire situation. And while we are at it, I’d like to request that for my next child the epidural remain in place for about 4-5 days until my lady bits have recovered from the shock of birth. It is down right cruel how they take it out while you are cuddling your newborn and don’t notice until they shove you into a shower 4 minutes later. Ok, maybe I am a little posh.

  3. When pregnant with my first, I remember having a frank discussion with my OB about how I could possibly avoid the dreaded LONG labour followed by surgical delivery I had heard about? “Babies are born one of two ways,” she answered. “We have C-sections because they save mom’s and baby’s lives in certain situations.” So this helped to convince me that she wouldn’t do an unneccesary section. She was very matter of fact.
    So what happened to me? 25 hours of labour, fever, LOTS of meconium in the amniotic fluid, 2.5 hours pushing and in the end, a C-section. The reason was diagnosed as CPD (cephalo-pelvic disproportion…aka baby’s head too big for my pelvis) His head was stuck, and they had to push him back into my uterus, essentially, to deliver him surgically. I was disappointed and scared, naturally, but after the fact, grateful that there was an option for me.
    The recovery was long and painful, but when it came time to deliver my second, I “chose” a second C-section. As much as I would have liked to try a vaginal delivery, it was explained that the likelihood of a repeat scenario was high. That coupled with any risk from trying a VBAC scared me. The second section, although still painful to deal with, was easier because I didn’t have the trauma and exhaustion of labour to recover from as well.
    While getting the epidural for the second section, the assisting surgeon (an older fellow, nearing retirement) asked me why I was having the surgery. After telling him about my first delivery, he nodded and told me about the decrease in maternal mortality rates since c-sections have become more widely used (not really what you want to hear while sitting on an OR table having a needle in your back!).
    All this to say I’m glad I had the option, but wouldn’t EVER have chosen that route if not medically indicated in the first place.

  4. H&D’s Mom and others, aren’t we so lucky that we ar having babies in a time when there are medical procedures that can save our life and the life of our babies. My best friend had a c-section I am sure if we did not have this technology she would be dead and so would her beautiful baby boy. There is no shame in taking advantage of the nescessary medical intervention to give birth to healthy babies.
    That being said, I have had 5 regular births. I think anyone who wants a c-section because they don’t want to experience pain should get a second opinion. With my 4th and 5th I walked out of the hospital 24 hours later. There is usually 5 days recovery in hospital with a c. That does not sound easier to me.

  5. I should add (after reading your link to “Health Risks of C-Sections”) that I would have tried, and would have been counselled to try, VBAC if not for the medically indicated reason for my first section. If the first had been because of a breech baby, I definitely would have gone the VBAC route the second time. And my doctor would have agreed with that decision. I never felt pushed to do a repeat surgery for no reason.

  6. I think the Ottawa Citizen is perhaps not being completely honest in their reporting–I read the report and the press release that accompanied it and nowhere did they say that it was because women were request c/sections. The closest was in teh report when they said that about 60% of c/sections were for uncomplicated cases–but whether it was doctor- or patient-requested was NOT specified.
    Let’s blame the women! Part 95092365 in our on-going series. Thanks, Ottawa Citizen.

  7. My first child was born after a long labour via a last minute emergency C-section. At the 6wk check-up with the OB, we discussed what had happened and he mentioned that without a c-section we could have lost her and/or me. So tahtnk God for hospital deliveries and C-sections. There is definitely a place for them.
    Fast forward 7 years and I delivered the twins against all odds via VBAC with induction at 40 weeks and me 40 years old. The women/mother part of me was so excited to have accomplished that feat, to have felt my body push those babies out, a sensation I had so missed from the first time around. The recovery time for my body was much easier this time around.
    I have heard that too that the younger OB/Gyn tend to “push” C-sections more as its more predictable in outcome for them, less technique sensitive, faster for them, more lucrative, less chances of litigation AND a lot of moms out of fear of childbirth will opt for that option too.

  8. It’s funny, I have too heard that younger OBs tend to to choose C-sections. Thankfully mine doesn’t subscribe to that way of thinking and he is a year younger then me.

  9. I delivered my twins vaginally. I had a shitty pregnancy, but a terrific delivery. Am I proud of that? Sure! BUT…we had absolutely no hesitation should a c-sec have been needed for any reason. Baby A came out alright (with assistance of the vac) and had baby B not twisted into position after baby A came out, I would’ve had a c-sec for him.
    I remember starting to beg the OB to take them out as early as 33 weeks, since I was so very uncomfortable and sick, 100% bedrest, etc. He flat out told me “NO” we don’t do anything elective, only for medical reasons.
    I am fairly certain of a policy in the Ottawa Hospital system that elective c-sec are pretty much disallowed. Can’t say for any other hospital though.
    I would never judge anyone for their decision, but ulimately, all I cared about was the health of the babies. I would’ve done it any way needed.
    twinmom = didn’t know that about your big girl, scary!!!
    I have to wonder (I may get shot down here) if the docs doing c-secs get to bill for more $$ each time???

  10. Considering I had my little guy at home, I hope I wasn’t taxing the system too much.
    I too read that article and was rather surprised that it was becoming more of a request than a necessity. The last thing on earth that I wanted when I was giving birth was a c-section, they would have had to knock me out to take me to the hospital if it was needed.

  11. I’ve heard it’s in part due to doctors and their practice insurance. The idea is with the risk of long labour and complications that can ensue, it may be easier and less risk to say “ok this is going to be c-section” instead of risking litigation after the fact. (I hear doesn’t mean it’s true though)

  12. With my first pregnancy I went to the hospital for the birth and was not completely happy with the experience. My doc was not ‘on call’ that weekend so I ended up with someone I didn’t know. I didn’t end up with a c-section though, thankfully. The next pregnancy I decided to go to a more nurturing environment. I was not comfortable doing the home birth thing (either was Hubby!) so we went to a birthing center and had a midwife. It was basically a remodeled house, very homey feeling and most of all an easy place to relax (therefore easier to get the kid out). For the birth I had the midwife and an RN for her assistant. If anything was to go ‘wrong’ then we would have headed for the hospital. Luckily everything went pretty smoothly and she was born into a hot tub (my water baby!). I guess my answer to your question is that for me personally, I would have done whatever necessary to safely bring my children into this world, even if it meant c-section. BUT I also wanted to do whatever possible to prevent from having to go that route.
    roxanne

  13. I had my little boy via c-section 10 days after my due date, after a very long day of induced labor. Everything went well until the last cm when labor stalled and he started to go into distress. He weighed a 1/2 ounce shy of ELEVEN pounds at birth. No wonder I couldn’t do it on my own. I probably could have given birth without a c-section if he’d “only” weighed 10 pounds instead of 11. (In case it matters, I didn’t have diabetes or gain too much weight or anything. He was just a really big baby.)
    I’m sure things would have gone very badly for us without the option of an emergency c-section. However, it is not likely he would have been such a big baby in the days before c-sections were commonly available. I’ve read that birth weights have been increasing, so maybe there’s a direct correlation between increased birth weights and increased c-section rates.
    At the beginning of the modern age increased birth weights were just a factor of better nutrition. I don’t know why more 10-12 lb babies are being born these days. I have a theory though. My husband is 6’4″ tall and was a 10 lb baby. He was born via emergency c-section after 2 days of labor. He son was even larger at birth. C-sections are wonderful medical tools that save lives, but large babies of slender mothers who survive complicated births go on to have their own children. Maybe that’s a factor – cheating natural selection and all that.
    I’m certainly not trying to say that babies who couldn’t survive without a c-section shouldn’t grow up to reproduce or anything. Of course not! I’m so glad my husband and son are alive. I just think that maybe the increased c-section rate has a lot of contributing factors that we can’t do anything about.
    Well, I seem to have written a novel here, so I’ll skip writing my thoughts on a possible planned c-section for my hypothetical, not-yet-conceived 2nd child. I don’t really know where I stand on that anyway, but I’m certainly not going to try to deliver any more 11 pound babies on my own.

  14. I blame my own preferences on wanting to control my situation. I had my son vaginally and with my second I had a hard time thinking about the situation being any different. I knew that realistically a c section is always a possibility but I guess I had a romanticized view of how things would turn out. Like many of the others, I too had a very long labour. It was very busy night in L&D and they were short staffed a few nurses. I watched the board across the hall as delivery rooms emptied and I got frustrated. Once the shift change came around, I was at a stand still (7 cm for 6 hours) and the only Mom left in L&D. I had three nurses attend to me. They gave me a sponge bath and changed the sweaty sheets. Just as they were getting everything prepped to bring me in for a section my OB came in for a scheduled C section.He checked me out and said “she’s done this once before, I believe she can do it again, I’ll check her again when I am done” The change in attitude and atmosphere was all I needed to relax. Thirty minutes and three pushes later, I had my precious daughter.

  15. I don’t know what the situation is like in Canada, but in the US I think part of the reason for “unnecessary” c-sections is maternity leave. Some women get no paid maternity leave. The ones who do only get between six weeks and six months of maternity leave. If you want to spend all of it with your baby, scheduling a delivery may be the only way to do that. I’m not saying it’s a great idea, but I can understand it.

  16. “a c-section would have been a bit of a disappointment. There is an undeniable sense of empowerment, and a celebration of your body’s capabilities, that comes with pushing that baby out.”
    That’s a wee bit insulting to someone who had 2 c-sections! I know that you didn’t say, “I birthed my baby b/c I pushed him out”, but that is certainly what it sounds like…
    I hate to go to other folks blogs and cause trouble so please understand that I am just leaving my opinion here. I have a pelvis shaped like a heart, not an oval as most are. EVery doc from the time I was in my early 20’s said that birthing a baby through my vagina would be difficult. Yet, they still made me try…that trying resulted in 3 herniated discs in my back, and emergency c-section and almost losing me when my b/p got to 240/190. If I had 10 more kids, I would ask for a c-section as I did with my 2nd child. It doesn’t matter how a child gets here, vaginal delivery, c-section delivery or adoption it is a miracle in process and no one should feel that the can judge one person or another because they gave birth differently.
    I’ve been reading your blog for a long time and I love it, it just disappoints me to see this on your blog. I personally understand the costs, the risks and the recovery time but I had worse recovery from my hyster than my c-section (again a necessary surgery). I know plenty of women who have given birth vaginally that were down and out much longer than I was with either of c-sections and well, I herniated 3 discs with the first attempt of a vaginal birth and had 3 herniated discs during the second one which had me paralyzed.
    I know the costs and the dangers are there, but they are there for any procedure that involves a hospital or openings in the body for that matter. I had to sign about 4 release forms just to have a mole removed in the office. Nothing is easy as pie.
    Again, I’m sorry if I sound like I’m bashing, I’m not, I just don’t think you fully thought this out before posting it.

  17. Thank you, everyone for your stories and insightful comments.
    And I’m so sorry, especially to Jeri Ann but to all of you, if it came across in ANY way that I think c-sections are any less ‘valid’ or ‘worthy’ or whatever way to have your baby. I absolutely don’t believe that, nor do I believe other women should judge those who do or don’t choose an epidural, or to breast or bottle feed, or whatever. I think c-sections are miracles and, like I said, I might not be here if they didn’t have them in 1969.
    There are plenty of excellent, important, inargable reasons for having a c-section. You all have illustrated more of them than I could have come up with on my own. My only argument (that word is too strong, I think – let’s say my only query) was about scheduling a c-section for reasons purely based on convenience – and Veronica gave me an answer I never considered, but which makes a lot of sense.
    I *do* believe that there’s a sense of empowerment delivering your baby vaginally, and I *was* upset at the idea of facing a c-section with Simon, and I *was* ultimately relieved to be able to deliver vaginally. But maybe I should have been more careful in my wording because I certainly didn’t mean to infer that mothers who have c-sections (or mothers who have surrogates, or adopt, or whatever) don’t experience the same joy, the same sense of the miraculous. I’m sorry if it came across otherwise.

  18. P.S. Sally, ELEVEN pounds? Oy!! I’ve been joking in a “ha ha, it’s not so funny” kind of way that Tristan was 9 lbs, Simon was 10 lbs and I must be crazy to consider a third to carry on that pattern!
    And thanks, Jeri Ann, for taking the time to disagree but being so respectful in the process.

  19. I hated my c-sec from my twins and have done everything possible to avoid doing it again. Coming up on my 2nd VBAC and wouldn’t want it any other way.
    I don’t understand what would make someone WANT to have major abdominal surgery…

  20. I don’t get electing to have a C-section. It just seems wrong to me, and I don’t understand why doctors allow it just for convenience sake.

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