Customer Reviews

Just Take It Out! : The Ethics and Economics of Cesarean Section and Hysterectomy

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1 star:		(3)

 

 

I want to thank Dr. Walters personally for writing this helpful book about the valid reasons for cesarean delivery and the bind that doctors are in as far as offering the full range of delivery choices to their patients. Dr. Walters includes some great patient case studies and debunks some of the misinformation currently circulating about cesarean deliveries. He also has some interesting musings about how childbirth may change 100s of years from now. After my first child was delivered by emergency cesarean, I realized by other women's reactions that vaginal delivery is a rite of passage -- plain and simple. It doesn't matter what precipitated the cesarean -- you just didn't try hard enough or had a very incompetent doctor. This is the first book I've seen that actually validates my delivery experience. When I became pregnant with my second child, after talking with my doctor and personally thinking over the factors that led to my emergency cesarean, I decided that a scheduled cesarean was a much safer choice for my baby and me than a VBAC. Since making that choice, nearly every woman I've come in contact with has asked disapprovingly why I am not attempting a VBAC. This is the only book I've seen that supports the reasoning that went into my decision.

I was very relieved to read Dr. Walter's book. He puts forward an idea that I find eminently acceptable, that is, an elective cesarean section is a viable option for birthing one's child. He discusses the misconceptions regarding this mode of birth, the most important one being that a cesarean section (CS) is more dangerous than vaginal birth. He points out that while an emergency CS is indeed more dangerous than a successful vaginal birth in terms of maternal mortality and morbidity, these statistics cannot be used to determine the relative risks of an elective CS versus an attempted vaginal birth. If one compares women who choose to have an elective CS prior to labor to those who attempt a vaginal birth (most of whom will be successful but a good proportion of whom will require emergency CSs), it is plain that an elective CS is no more dangerous than attempting vaginal birth. I am a medical scientist and consequently was able to check his facts thoroughly, which took me a couple of months of medline searching and analysis of the key papers. My first observation from all this literature analysis is that an elective CS as a birthing option is clearly a very politically fraught subject. Many people obviously have very emotional feelings about childbirth, and this is reflected in the medical policies and also - often - in the interpretation of scientific data regarding elective CS. I observed many times that authors made conclusions that toed the current line of thinking in obstetric gynecology - i.e. that CSs are dangerous and that everyone should be hellbent on getting women to attempt vaginal birth - despite the fact that these conclusions were not backed by their own scientific data. Essentially, Dr. Walters's statistics regarding maternal mortality are correct. In addition, the scientific evidence I found also supports his assertion that an elective CS is safer for the baby. Finally, in weighing the pros and cons of elective CS vs vaginal birth, Dr. Walters also discusses the long-term maternal consequences of vaginal birth, namely one has a greater risk of suffering permanent urinary and fecal incontinence and pelvic prolapse problems, not to mention an increased likelihood of sexual dissatisfaction. My only criticism of this book is that he does not give an idea of how frequent these long-term problems are, but I found from the scientific literature that 50% of women giving birth vaginally feel sex is not the same as before the birth, and that 5% of women may suffer long-term urinary incontinence, while 1% may suffer long-term fecal incontinence. Elective CSs appear to protect women from these problems. What I also discovered from the medical literature is how underreported these long-term problems are. One study found that of 70 women giving birth vaginally, 7 still had problems with fecal incontinence a year later and 3 of these were soiling on a daily basis, yet only one had seen a doctor about this. Perhaps women believe that this is what they have to put up with to have their child, so there's no point complaining about it. I will be giving birth to my child by an elective CS. I had to go to another country to arrange this, as I was denied this choice in the Netherlands. While I completely support the right of women to give birth vaginally, I also think that my right to give birth via an elective CS should be accepted, no matter whether people think this is `unnatural' or not, because the medical evidence is not consistent with the assertion that an elective CS is more dangerous for mother and child than attempting vaginal birth. For having the clear-eyed courage to go against the grain, I give Dr. Walters top marks for writing this book.

This book is thought-provolking and bold. I am a practicing ob-gyn and I offer my thanks to Dr. Walters for saying almost exactly the things I have been thinking for years. There is already too much extremism on the left of these issues. The demand for cesarean deliveries and hysterectomies is patient driven and not physician driven. In fact, these procedures are both safe and life altering. The impression that doctors are victimizing their patients to get rich is widespread and false. A must read for ob-gyn doctors and the patients they care for.

What a wonderful and long overdue book! I am a practicing Ob/Gyn and the mother of two boys and as both a doctor and mother I applaude Dr. Walters for his courage in fighting to give women back choice in their health care decisions. Twenty years ago women weren't given the choice to have a vaginal delivery after a cesarean. This was subsequently rejected as chauvanistic and paternalistic. Now women are not given the choice of having a cesarean if they choose to. But this is seen as progressive. Personally, I had a long labor culminating in a cesarean delivery of my first son. Because I was a part of the profession, I was able to choose to have a scheduled cesarean for my second son. And many of my female colleagues have requested elective cesareans for their first deliveries in order to avoid the immediate risks of fetal distress and shoulder dystocia as well as the long term risks of pelvic prolapse and incontinence. The general population is not given this choice. This bias, supported by insurance companies, is not challenged by women's or consumers' groups who assume that vaginal birth is always better and safer for mom and baby. Doctor Walters challenges these assumptions with wit and insight. In the same manner, he tackles the subject of hysterectomy and the lack of choice given to women and their physicians regarding this surgery. By the end of the book, you will be amazed to realize that insurance companies have managed to convince us that a lack of choice is in our best interest. This book is a must for women, their health care providers, and anyone interested in women's studies and issues...Thank you Dr. Walters.

I am writing this review as a woman, mother, and health care professional. I delivered two children vaginally, twins by scheduled c-section and had an elective hysterectomy two years ago. Due to the "normal, uncomplicated" vaginal births I developed a rectacele, which is a prolapse in the vaginal wall between the rectum and vagina. When I found out I was having twins I opted for a scheduled c-section. My babies were born healthy and were delivered with NO complications. I can honestly say I bonded immediently with my babies, and NURSED BOTH babies with NO difficulty. Two years later, my scar is nothing more than a very fine line about 2 inches long. After successfully delivering four children I opted for a hysterectomy when my periods were causing me pain.
Now having all that said lets discuss all of this in detail. First, these were all my choices. As a woman I feel it is my right to decide what I think is best for me. Dr. Walters book gave me comfort in my decision with a section. As a nurse I have seen the results of physicians who wait too long to section. Also, in my investigation of c-sections there is very little medical research in today's medical journals speaking out against sections. Malpractice is too risky. Also for those of you trying to make that decision remember: Most women who have a section the first time REQUEST a second one. Mine, because it was scheduled, was a piece of cake. Thank you Dr. Walters for caring enough about women to give them this book! I recovered from my section much quicker than I did from the rectacele.
I chose the hysterectomy to eliminate my pain. I have not regreted my decision for one minute and have NEVER talked to a woman who regreted having a hysterectomy. I have now eliminated two potential types of cancer and have a very enjoyable, pain-free life.
As a health care professional I can speak first handedly about everything Dr. Walters writes about. Dr. Walters speaks candidly about issues that need to be discussed in our "sue-happy" society. As an obvious "poster child" for Dr. Walter's book, I give it my full support and hope more women will benefit from his expertise, insight and concern. This doctor truely cares about women, their decisions about their bodies, and their unborn babies.

As someone who has no medical choice but to have her children by cesarean, I was pleased to come across this book. With all of the negativity surrounding cesarean birth, it's nice to read a different perspective and have a medical doctor verify what I have long since thought-that c-sections are not the villians that society makes them out to be. Thank you, Dr.!

If only other doctors had the courage to stand up and speak out to defend a woman's choice in healthcare, we would not have so many injured mothers and injured babies. The limitations that are being placed on these services are causing unnecessary pain and suffering to women and children across the country. Every woman, every doctor, every government official and every insurance company executive should read this book!! It will change the way you see women's healthcare issues. As a parent of a child with a permanent brachial plexus injury it bothers me that more obstetricians don't take the time to have frank discussions with their patients to let them take part in decisions regarding their care. I truly wish I had read this book before I had children - my daughter would not have been injured. The trend in hospitals and birthing classes is toward natural, vaginal childbirth without pain relief. C-sections were to be avoided at all costs. I feel this is a great disservice to women who can benefit from this procedure. I applaud Dr. Walters for sticking up for his patients and women across the nation. We should take his lead and fight for the right to decide!

PLEASE PAY ATTENTION TO THIS: THIS REVIEW IS A REVISION TO ONE I SUBMITTED YESTERDAY. Upon reviewing the guidelines I realized that a few comments could be construed as spiteful or sarcastic, and there was one incorrect observation. Please print the revised review.

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I have to say that while I disagree with many of the points that Dr. Campbell addresses in "Just Take It Out", I do agree with him on one issue: freedom of choice, as long as a woman is properly informed. The problem is that very few women are adequately informed and this book does nothing to help matters. In fact it plays upon the fears of woman to promote an agenda that consists of two things: Lawsuit avoidance and "daylight obstetrics" promotion. Instead of encouraging women to develop confidence in their ability to give birth and educating them on how to reduce their chances for a first time cesarean, Dr. Campbell dramatizes worst-case scenarios which in actuality are quite rare in an attempt to convince women that cesarean section is the preferred way to give birth.

Dr. Campbell mentions that the majority of women in this country deliver vaginally with no complications at all, but he buries it in one sentence at the very back of the book. If this were my first pregnancy and I would have read this book, I would have been miserable and terrified during the entire pregnancy. Unfortunately, "Just Take It Out" is silent on the fact that many women suffer emotionally after having had a cesarean. They feel as if they have run a race and did not get to cross the finish line. Many women who deliver by cesarean also have difficulty bonding with and breastfeeding their babies.

Dr. Campbell espouses the doctrine of "Science will make all things better". This is not always so. Many years ago science thought that it could develop a baby formula superior to breast milk. It has now been established that this could not be done and now we are once again admitting that nature could not be improved upon. I find it dangerous that this representative of science is suggesting that cesarean delivery is or could be superior to vaginal birth except when a demonstrable medical situation warrants it. Do we see veterinarians sectioning animals in the name of superior technology? Are we to believe that we are the only species on earth incapable of safely giving natural birth to our offspring?

I would like to revisit the freedom of choice argument and take it one step further. If physicians are saying that women have the right to choose how they give birth as long as they are properly informed, then it should be argued in all fairness that homebirth should be accepted in all states and that a woman who wants a midwife to attend her birth should have one. Therefore the practice of midwifery should be legal in all states. Women who choose homebirth are actually more informed about birth than your average woman who chooses a hospital birth. In support of a woman's right to choose physicians should volunteer to support homebirth as a backup for the midwife. I don't think women would have a problem signing a consent form for homebirth.

And last but not least I would like to address the fact that on the one hand Dr. Campbell states that cesarean section for a live baby is safe and actually tries to frighten women into choosing one, but on the other hand in his chapter "Dead Babies" he says that they do not perform cesareans to remove a fetus that has died because it is placing the patient at unnecessary risk. In fact he states that it is a cardinal sin of the greatest proportion to deliver a baby that is known to be dead by cesarean section. For the sake of argument, let us take the baby out of the scenario. Are we to believe Dr. Campbell that a cesarean is better than vaginal birth for the mother in one case but places the patient at unnecessary risk in the other? Are they not undergoing the same operation in both cases? He contradicts himself by admitting that this is a risky if not dangerous procedure. If so, then why recommend it at all unless medically necessary?

This makes you think doesn't it? I am an informed woman who has had a cesarean and a vaginal birth after cesarean without an epidural. My cesarean was medically necessary. Comparing the two experiences, I would still choose vaginal birth hands down.

This book is well written and well organized. It convincingly makes the point that avoiding cesarean delivery and hysterectomy at all costs is not always in the patient's best interests, and that refusing hysterectomy or cesarean on demand is paternalistic. As a specialist in incontinence and reconstructive paelvic surgery, I repair the damages done to the vagina, bladder, and rectum by vaginal delivery every day, and clearly the only way to protect these organs is to be more liberal in our use of cesarean. After you read this book, you will agree with me.

I was enormously relieved to read Dr. Walters' book and hear a voice of reason in what is a politically fraught area. As a young woman trying to decide whether to deliver via repeat c-section or VBAC, this is the ONLY book I could find in support of choosing a c-section. There is so much pressure on women today to have a vaginal birth that I was hard-pressed to find any information or statistics in support of elective cesarians. However, after reading this book, I am confidently scheduling my section and convinced it is the safe choice for my baby and for me. One of the most enlightening insights is the explanation of the truth behind the c-section death rate statistics. There is a lot of useful information here, which has shed a fascinating new light on my experience, as well as that of my mother and several friends. I hope it reaches women and doctors who are interested in exploring the truth about these issues, and I hope that Dr. Walters is just one of many MDs who will work toward better, more advanced OB care for women in the future.