Wednesday, July 08, 2009

One More Reason to Regret my Caesarean

When Ayaan was born by c-section, I was disappointed and upset to say the least. Having had a relatively smooth pregnancy, a reasonably broad body structure and the baby in the right position, there was not even a remote thought of caesareans in my mind. I practised all my breathing techniques and religiously did the duck walking and squats recommended by the pre-natal class. But it was not to be. (You can find the detailed birth story here). My doctor, in her best (and in my opinion, flawed) judgement recommended and actively pushed for induction of labour, which didn’t take and then resulted in a c-section.

Now, in addition to being heartbroken at being denied the badge of honour of delivering a child the natural, God-given way, I also had to have myself cut open (with all the risks that any surgery entails) and suffer through the post-operative recovery along with the regular post-natal stuff. Even if you add to this the fact that caesareans are substantially more expensive and that they come with a higher likelihood of breastfeeding difficulties and postpartum depression, we are still talking relatively short-term effects, largely on the mother. Which is why I find this particular news story more than a little disturbing. Here's an excerpt:

Caesarean delivery can alter DNA

Researchers at Karolinska Institutet believe they have discovered the DNA mutations that explain why children delivered by planned Caesarean are at a higher risk for immunological diseases such as asthma, cancer and diabetes.

The genetic makeup of white blood cells looks different in children delivered via Caesarean compared to that of children born normally, reports Svenska Dagbladet newspaper (SvD).

An explanation for the different DNA sequences might be that those delivered via Caesarean experience greater stress than babies delivered naturally.

While stress builds up gradually during normal birth, the nervous systems of babies delivered via Caesarean are exposed to sudden stress. At the same time, some DNA genes are turned off while others are switched on.

Professor and paediatrician Mikael Norman, one of the researchers involved in the study, explained that stress occurring during vaginal birth is positive and goal-oriented:

“During a Caesarean, the baby is totally unprepared. The stress comes all at once. There are animal experiments that show that negative stress can programme offspring, something that later can play a role in terms of risk of illness.”

Ever since I got this in a mail last week, I have been brooding over the What Ifs. What if I had picked a different doctor to start with? What if I had stood firm when my doctor insisted on inducing labour? What if I had changed my doctor even at the last moment? What if I had done more squats? What if? What if?? What If???

Not a very productive line of thought, I know. But crying over spilt milk is one of my specialties…

For this pregnancy, I have changed to a doctor who comes highly recommended and I am holding out a glimmer of hope for a VBAC, but unless all the chips are lined up just right, it is pretty likely to end in a caesarean again.

Oh well, I can atleast hope that studies like this will make doctors more cognisant of the long-term downsides of caesareans as a preferred method of delivery and prompt them to be less trigger-happy when recommending them.

32 comments:

  1. My delivery was normal but I had a premature baby in 8 months but yet my doc went in for normal delivery ..nobody had hoped for that ..but at labour time ..we cannot take decisions on our own..we have to trust docs..and as for the report I am sure u can find one contraidcting this very soon...

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  3. dont fall for all these reports ....am sure your new doc will handle it

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  4. I remember before weaning the first one I was worried about how it'd go. My mom's help had a kid the same age and was in no hurry to wean - won't it get tougher I asked. Its all in God's hands she said. Sometimes I wish I wasn't so analytical and could leave things off to some god.

    Rambling away, possibly on a tangent..

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  5. I know babe, I know. Both my sons were delivered by C-Sec. It still rankles.

    It's been two-and-a-half years since the YO was born and I still can't get myself to write about it.

    One day, I will.

    All the best with your new doc. And please keep reading. Knowledge is power.

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  6. I read your post long time ago and remember your disappointment. All I can say, its a tricky thing and there are too many what ifs, you cannot say with 100% exactness, how things would have turned out.
    There are many other socio/physical factors that may put someone at a higher risk of something. May be one could take care of things one is more in control of.
    I am glad to see, this time you are prepared to have a csec/vbac coz both have too many 'what ifs' and we dont know which way it turns out. So dont worry chill and enjoy!

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  7. [Vandana] Which is what I did, I trusted my doc in the final hour but when I researched and read up later, I was left with the feeling that her decisions were not altogether right...

    [Artnavy] It's done be a very reputed university in Sweden. So I don't think it is untrustworthy...

    [Choxbox] True. Unfortunately we are over-informed, over-analytical 21st century moms. :)

    [Mamma Mia] I'd love to read your post if you ever write it...

    [Preeti] I am fully preparing myself for a c-section. The VBAC would be a bonus... can't handle the disappointment again!

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  8. Oh dear. Although I wouldn't take the report too seriously, I do take your longing for a Vaginal Birth very seriously.

    I know it, have been through it, and been disappointed twice. I would say keep thinking positive thoughts, don't let youself get induced, and consider homeopathy to get regular contractions.

    Above all, find a doctor you can trust and then don't second guess her. Focus on the prize - a healthy baby. At the very least if you don't schedule a C-Section, it atleast feels more "real"

    I found the concept of scheduling one, so clinical somehow.

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  9. well..i'm too big a fan of all the studies etc people these days do, because am sure that they never always cover all bases, and I'm not too convinced of their methods. Often its turned out that the test group was just 5 people. or 10. :)

    That apart, I do think that a natural birth is preferable. Because its NATURAL. Its a process nature has perfected over millions of years. It is what's right for the babies and the mother's bodies. Unless ofcourse, there is a serious risk that modern science can diagnose.

    In a C section, neither the mother's body, nor the baby's is prepared..it's actually like the baby is suddenly ripped out of its womb.

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  10. sigh! While being informed is good, don't take everything too much to heart, sweetie.
    God's given you a healthy baby, and you are doing everything in your power to maintain it so, and God willing, Ayaan will continue to be a normal healthy kid/guy. Cheer up, and mop up this particular spilt milk. :-)

    Having said that, I HAVE heard about doctors who go in for a caesarian for monetary reasons as also personal convenience (no sudden midnite calls) etc, and maybe this piece of news will be an eyeopener to the medical fraternity as such and act as a deterrent to such unscrupulous docs.

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  11. Ro, having had gestational diabetes during my pregnancy, I was mentally prepared for a c-section. A small portion of me was hoping that I would not go through all the pain that a normal delivery entails. The hubby said not to think too much and to just follow whatever the doctor says. I did just that. My doc was very particular about a normal delivery. I was induced twice (the first did not take) and ended up having a normal delivery but some stitches were required. 2 months down the line, these stitches had not healed completely and there was an extra growth and I had to undergo another procedure.
    What I am trying to say is that it's okay. This is not something which we can control. A normal delivery or a c-section is not such a big deal. As long as the baby is out safe, that's what matters the most.
    Don't lose heart thinking about these things now. Just enjoy your pregnancy and let things take their turn.

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  12. Interesting piece of news but not sure how valid this report is.

    In my case, I HAD to undergo a C-sec, I didn't have a choice. I feel its better to have a healthy baby via C-sec than to take unneeded chances in the zest to have a normal delivery.

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  13. hey, a question and u can choose to ignore:
    Are you among those who believe that a mother aint a tru mother unless she has gone though the pains of delivering a baby through the normal way? and that the C - Section is the easy way out and that its ok to be in labour for hours and hours and not opt of C Section?

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  14. Go a little easy on yourself, Ro. Stress inhibits the hormones that make the body go into labour. Chill and your much-wanted VBAC will happen. And even if it doesn't, you will still have a healthy baby who will beat the pants off the stats that have been quoted in that report. Just. Go. Easy. And may I say something - with all the information of the net at our disposal, we can never be MDs. Never. You have selected your doctor with a lot of care. Now trust him/her. Please.

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  15. Frankly I have never understood the yearning for a vaginal birth against a Csec. Giving birth to a human being is a difficult process and will take its toll differently, but take it will.

    I am probably biased because a) I had a smooth c -sec and b) because all the natural delivery stories I have heard have been pretty gruesome and most of the women have been ruing the fact that they didn't go for a c sec instead. So I have never felt even an iota of regret.

    Also we might never know what discomfort and pain comes with episiotomy stitches and loss of vaginal sensation after.

    But I am curious to know why you have your heart so set on a C sec , because (through your blog) I have known you to be a very practical , do-what-needs-to-be-done person.

    This decision is pretty much out of our hands and I guess we should simply pray for a healthy baby and a healthy recovery for the Mom whatever the delivery method.

    Take care and don't stress yourself out with such thoughts. Whatever happens ,happens for the best!

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  16. I'll be praying you get your VBAC! It's hard to know what to believe anymore when you read the news, but I'm thinking that if you do your best for Ayaan now that he's out, it will minimize whatever sudden stress may have altered his DNA at birth. The body has an amazing way of recovering from things like that if given the proper tools.

    My friend, whose husband's DNA produces particularly large-headed children, had all 4 of her kids by Cesarean. More than the recommended number of C-sections, but she is doing fine, is fit, and is a very capable mother. One more example of amazing recovery...

    (P.S. The kids are all fine, too!)

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  19. Anonymous10:57 am

    Long time reader, first time commenting here. Please don't stress out about the study. The sample size is very small - only 37. There was no alteration in the DNA structure (that cannot happen so easily). They only found high levels of methylated DNA for the first 2-3 days, the levels then went back to normal.
    I can tell from your blog that you are an awesome mom. I know it's hard, but please don't worry about the "what ifs".
    Veena

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  20. [Poppins] I think I am a lot more prepared mentally for a c-section this time so I hope not be as shattered. Will check with my doctor on the homeopathy...

    [Richa] Exactly. It's not that I am getting carried away by the study itself. It's just that I really, really believe that natural is better, all things being equal in terms of risks and health.

    [JLT] *pulls out her special spilt milk sponge and starts mopping* ;)

    [CoS] Ouch, that sounds painful. It's not so much that I have my heart wholly set on a c-section this time. It's more that I regret my last c-section, which I am thoroughly unconvinced was necessary and which has increased the chances of my second delivery being a c-section too

    [mmhnb] That's the thing. I am not so sure about the 'HAD' in my first delivery

    [Iya] Nope. I don't believe having had a c-section makes me any less of a mother. I just believe that if possible, natural is better and I think in my case my previous doctor closed that door prematurely...

    [Parul] You're asking ME to chill? After reading my blog all this while and knowing me??? I wouldn't know where to start :P

    [Munchkin] I need to meet some of your friends. I don't know anyone who regrets their normal deliveries and many who regret their c-secs... and honestly, I don't have my heart set on a normal delivery. A c-section would be ok but I need to be convinced it is necessary, which I wasn't the last time...

    [Talena] 4 c-sections? Wow! I should just shut up with the whining...

    [Gaelikaa] Thanks for that wonderfully reassuring comment :)

    [Veena] Hey thanks for that info, which wasn't there in the article I read. Very reassuring...

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  21. Anonymous7:28 pm

    Rohini, I would say that this is probably only one study and should be read in context (newspapers often have a way of publishing results that are totally out of context). Even if there were change in the DNA sequence, and I would very much want to read that original paper in a peer reviewed journal, its not clear what effect this has on any physiological or behavioral outcomes. And if legend is anything to go by, hey, the first outcome of a c-sec was Julius C himself!

    Although, in defense of the study I will say to its detractors that getting an effect in a small sample size actually means that the effect is pretty powerful. Its when you get a very weak effect in a large sample size is when you should be worried about blowing up results out of proportion (statistical power, anyone?).

    Just saying. btw, vaginal deliveries are not pretty things either. I've been there, done that, had the stitches and the hemorroids and the utter feeling of panic every time I wanted to use the bathroom after that. For two frikkin' months. All I'm saying is that anyone who has delivered a baby should be proud of it, whether they pushed it through a small hole in their nether regions or underwent major surgery to get it out. Believe me, NO ONE likes pushing. And as for the people who have vaginal deliveries never regretting it, its because in our society, its acceptable to regret a c-section but completely unacceptable to regret vaginal deliveries (what're you abnormal for wanting surgery to save yourself a little, ok, a lot of pain and stress?). Conversely, I've known several women who were extremely happy to have delivered by c-sec.

    Sorry for the long answer.

    n!

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  22. I had originally written a post sized comment on this Rohini, but I think I overdid it and could probably offend the entire medical profession and academic community combined. So I'm back to make it short and sweet! Don't blame yourself, it wasn't your fault. Many of these studies are very relative. The doctor probably did the best he/she could at the time. Any disadvantage your child may have suffered will be more than compensated by his wonderful mom and secure home environment. In short, be happy and reassured. I wish you a great delivery whatever way it happens. I get a bit mouthy when I'm emotional, you know and this is a matter close to my heart.

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  23. Hi

    Congratulations! Your post has been selected by BlogAdda as one of the top posts for this week's 'Spicy Saturday Picks'.

    Do mail me at harishkrishnan at blogadda dot com to collect your badge :)

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  24. You know why my doc made me have a C section? Because she was going on holiday. She scared Vicky and my mother into insisting on one.

    I talk about it. I've found other instances of her quackery and I tell people, mentioning her by name.

    And oh, if my Blobbie is delivered via C Section, I will let you share my dark chocolate sundae. A girl must be consoled, after all. :)

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  25. This report sounds scary, Ro, but now is not the time for you to scare yourself. I always thought that c-secs wee less stressful for the babies, to the point of wondering why moms didn't come equipped with zips in the right places:)
    Khair, what's done is done. Relax, have full faith in your present doctor, and don't worry about the modus of your delivery. A healthy Mom and Blobbie are all that is required.

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  26. oh well. there is something new coming up everyday and i would take it with a pinch of salt! and like Parul said, all our eading doesn not amke us doctors.

    i always advocated trusting the doc and thats that! you have chosen one with care and its not for us to question the decision till something goes terribly wrong!

    i am not senti about whole antural delivery business! maybe 'coz i had a terribly easy c-sec! and i dont think it makes any owman any less of a mother depending on how the child was born! :)

    cheers!

    abha

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  27. I wish u good luck Ro and will pray for a successful VBAC for u. However please do not stress urself over this. I totally understand the barrage of what if's flocking ur mind but at the end of the day a healthy baby is the most important right.
    Just for a counter view think of a mom who insisted on a vaginal delivery against her doctor's judgment and something went horribly wrong. you can never know right? Really do leave it to God!

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  28. [n!] The socially acceptable part of it is so true. I had a relatively easy c-section and recovery, all things given but the general sighs and if onlys from family, etc was what did me in...

    [Gaelikaa] Hey, your last comment was fine too. Thanks for coming back and reassuring me twice over :)

    [Harish] Thanks

    [Sue] Same here. I have made sure the doc hasn't got any business from anyone I know...

    [Dipali] Zips? Now wouldn't that be cool ;)

    [Abha] I know you're right. But that's the thing about regrets - they are rarely rational...

    [Neera] I am totally leaving it up to the doc... but one can hope, no?

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  29. 1. Come on, now, Ro. No point in reading weird 'news stories' about obscure 'studies' which make you worry. Not at this time. And there's no need to believe everything that you read.

    2. I went back and read your birth story before commenting. It does sound weird for you to be induced just a day past your due date (usually it's done 7 - 10 days later).

    3. Hmmmm. what if, what if, what if....what if you *had* changed your doctor? what if she/he had waited? what if they had done everything and you still ended up a C-sec? See, there's no way to know for sure what would have happened because it's all based on your - or my - conjecture.

    Let it go and don't ruminate, Ro. (OR, if you are *really* **really** bothered about it and are convinced that your doc took a wrong decision, get hold of your hospital notes somehow, hire a good lawyer and sue her. But don't delve into what-if scenarios because they only end up achieving nothing.)

    4. I understand the grieving for the natural birth because, for a time, I felt that I was cheated out of it too. (Might write about the birth story if I get time). However, after thinking it over and talking it over with endless OB-GYN friends over the course of 3 years, it finally struck me that my doc's decision was right. Now I'm not saying that you will come to that decision too - you might not. I'm just saying that, yes, I understand some of your pain when you talk about missing that natural birth because I had set my heart on one too and it didn't happen.

    5. Enjoy the 'now' and don't get worked up over silly studies - God-willing, you will have a healthy pregnancy and an easy delivery - whichever way it goes, whether it's a VBAC or a C-sec. Relax and think positive, sensible Ro! Makes sense?

    *Hug*

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  30. As someone who had similar thoughts... first one was a c-sec (altho I agreed with my doc on that one) I wanted the second to be natural. It wasn't meant to be. My advise -- don't wed yourself to the VBAC idea. If it happens great, if not, don't think too much about it. Otherwise it will really bother you!
    I was really bothered about it for a while. Now I'm at peace with it. It's easy to explain to the kids if they ask where they came from .. HAHAHA!

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  31. aw, ro, everything wise and nice has already been said here. hugs and i really hope you have a VBAC. what happened with Ayaan's birth is what was meant to happen, don't forget that and don't kill yourself with the what ifs okay?

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  32. hi, at the end of it, it matters well when u have a baby hale and healthy in hand, and nothing more matters really, everyone recovers from all that comes to them , and all babies have just their way of entering the world. I had a first C section in India and then a normal VBAC in London. I do not regret either. But I would really have a few words to say if u are trying a VBAC delivery in India. Do get in touch.

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