C-section or Vaginal Birth--which Would You Choose (Having Had Both)

I had a c-section with my son and then a VBAC with my daughter. The vaginal birth and recovery was challenging but I much preferred it to the c-section. With the c-section I was hunched over for days with a lot of pain. You can't lift anything more than 10 lbs for 6 weeks, which is especially hard if you have other children. You can't drive for 2 weeks (or longer if you are still on the stronger pain killers). It was hard for me to go up and down stairs, get into and out of bed, and do most of my daily routine. My friend who had a c-section had a horrible infection afterwards, which is definitely a risk with any surgery, and wound up back in the hospital. Getting back into exercising was hard. A c-section is major surgery- I don't recommend it unless it is truly necessary.

Best wishes,
J.

I ended up with a VBAC, although I wanted to have a repeat C-section (baby came way fast). Compared to the C-section, recovery for me was 100X easier with the VBAC. This seems typical, though, and maybe you will be the exception to the rule. The C-section knocked me on my butt, and I couldn't lift anything for 6 weeks. With the vaginal, I was bouncing around the house 3 days later and lifting my 13 month old. I did not have a hard time getting my regular tummy back w/ the C-section.. no different than the vaginal.

I had a VBAC. My c-section was emergency & while I was well-educated it was still more than I had expected. Recovery took me over 2 months. We had a manual trans truck at the time & shifting hurt me for about 3 months because of the ab pressure (& it wasn't a hard-shifting truck, just pushing the clutch was what hurt), simple things like picking up the baby carrier or the laundry basket hurt for at least 2 months. Walking up steps was horrible for 3 months & I only had 5 to navigate & that was if I went a certain way to get out of the apt building-my apt was one floor. Intimacy was painful too, & I bled for about 9 weeks total before it was all gone.
My VBAC was amazing. Two pushes & he shot out like a rocket. I had 2 stitches because he was sucking his fingers on the way out (turd!), but choosing between 2 stitches & 2 staples, I'd chose the vag birth any day! I had pressure for several days, but I only had actual pain when I did too much. I don't know about intimacy, hubby was deployed til baby was 3 mos old & I was totally fine by then. I had a 2.5 year old to chase & a deployed hubby the 2nd time. I couldn't have expected my friends to cart me around for 6 weeks (can't drive for 6 weeks post-section) & I didn't want to be that reliant on anyone else for everything.

I have had both:
Downs of a c-section, long hospital stay, driving restrictions, lifting limits (won't be able to pick up your others for 8 weeks!), much more expensive, and I was unable to lay on my side for months, which made nursing at night difficult.
Downs of a vaginal, stitched due to partial 3rd degree tear, need for donut pillow, and hip discomfort due to pushing.
If I could choose I would always have a vaginal birth over a c-section.

Good luck making your decision.

Hi R.,
Here is my 2 cents for what it is worth.
I would definatley reccomend a natural birth unless your doctor thinks there is a particular reason that you had such problems with your previous recoveries.
I had a C-section first, and then a VBAC- and the natural birth was SOOOOO much better recovery- wise.
Especially since this is not your first child. I don't know how young your other kids are- but you will not be able to pick them up and hold them as after a c-section you cannot lift much weight. After the normal delivery I was up and around alot faster and it was much less painful. They also told me I could not drive for atleast 2 weeks after the c-section. But I would discuss it with your doctor.

I think that recovering from a vaginal birth is so much easier than a c-section. Yes a vaginal birth recovery is painful but it gets better in a few days rather than weeks. Plus with other children do you really want to recover from a c-section and take care a newborn with two toddlers running around? Since it is stomach surgery the recovery and risks are so much greater. Go vaginal if you can and I think you'll be glad. If you have help from husband or family it will make it so much easier. Stay in bed with baby and nurse for the first few days.

I've had two C-sections. My first was an emergency c-section and it was a rough recovery. I was worried about the second c-section but SO GLAD I didn't do a VBAC. The planned C-section was so smooth and I felt amazing after. I was up and cleaning my hospital room after 16 hours. Key is to take the pain meds they give you every four hours for the first week. It really does make a difference. And of course a doctor that you can really trust performing the surgery. I really didn't think a c-ection was that bad.

Hi R.!

I would have have a C-section ANY day over a vaginal birth. It's not hard to get back your shape if you work at it and the scar is not that bad.

Good luck!

M.

Go vaginal! I've had both (c-sect, VBAC, c-sect). Both c-sects had longer recoveries and more pain. I needed more help at home (which I didn't get) and still have some numbness and itching two years after my last birth. I love all my babies the same, but given the choice, I'd totally go vaginal again! PS...both c-sects were unplanned emergencies.

I only had the natural birth that many are recommending, it was total torture, I tore both directions and the recovery was awful. Personally, I don't understand the rationale that an epidural makes your recovery harder. I spent weeks sitting on a frozen glove and it took me about a month to be able to walk 20 minutes around town on flat sidewalks. It took about 5 weeks before I stopped feeling like my insides were going to fall out if I had any kind of jarring motion. I had two friends with c-sections who were in MUCH better shape than I was and seemed to be able to take 1 mile walks, lift their toddlers, and do stairs without too much problem a week after their surgery.

All to say that every situation is unique. On the flip side, I know women who had viginal births who were jogging 5 days later, had no tearing, and never sat on a frozen glove or donut, so for them, the vaginal birth experience was nothing like mine. And obviously there are women here who had a lot more problems with a c-section than the women I know who had them (who had scheduled c-sections for medical reasons and therefore didn't have the trauma of first pushing and then having an emergency c-section).

Each vaginal birth is supposed to get easier though and a c-section is major surgery, so I think it's a personal decision, and depends on just how bad your last two births were and whether you have good reason to believe your next one will be the same ...

My friends had said how wonderful c-sections were. So convenient, etc. One was even wanting to go sking the next week (she ended up waiting two weeks!). I really wanted to have a natural childbirth, but ended up with an emergency c-section. Maybe it was because mine was an emergency, but I had a lot of pain for a long time. And that disappearing scar? I ended up with a keloid (sic?) scar and so I have a thick red slash across my belly, which is still numb over a year later.

I would talk to your doctor, but depending what the "hard time recovering" was from your vaginal birth, the c-section may even be an even harder process.

Hi R.

Let me start by 1st stating that I am a Birthing Doula. I think before any "good" advice is given, it would be important to know the birth stories from your 1st 2 children...were you given pitocin, an epidural, any interventions such as forceps or vacuum? All of those things play a big part in the recovery process.

I have had both a vaginal birth and a c-section for medical reasons. That being said, I would NEVER recommend a scheduled c-section unless your doc. or midwife sees a medical reason for it. Our bodies were made to have babies and they can do a remarkable job.

A. Cowles, CD(DONA)

R. -
It seems like you're going to get as many answers as there are mothers. :)
My recovery from my vaginal birth was rough - I had a 4th degree laceration which became infected. Then developed a fistula - - - 14 months & 3 repair surgeries later, I was declared "as normal as I would get".
Needless to say, my later planned C-section was a breeze. My incision was very low - below my hair line. My baby was born on Thursday & I went for a short walk in the mall on Monday. I stopped taking the narcotics on Tues. (OTC pain killer was doing the job)
I do think from my discussions w/ others & posts here emergency c-sections seem to be hard to recover from - probably from the trauma of trying to do vaginal first....
I would like to suggest you really discuss this with your doc as well as your spouse. Good luck finding the answer that works for YOU!!

I don't think there is much I could say that the others haven't already, but as a mom who has had both kinds of births I would definitely choose to birth vaginally. As a birth doula I have attended some well-managed c-sections, but for me the difference in the experience for mom and baby after the birth is a big one and a big detraction from c-sections. The baby is never given to the mother directly in a c-section, it always has to go to the nurse and then MAYBE the baby will be handed to dad (c-section babies are more likely to require nursery/NICU time and need resuscitation). The ability to have those precious first moments of bonding between the parents and the baby just never happens in the OR. When things go well the baby is usually given to the mom in recovery, but I have just seen far more separation of mom/baby in sections than in vaginal births. For me, this is such an important part of the birth process that I would fight tooth and nail for a vaginal birth just to preserve that opportunity to be the first to hold my baby. (I'd also recommend keeping the cord intact, to insure the hospital staff isn't tempted to take the baby to the warmer!!)

R.- I have had two c-sections and no I have never gotten a normal belly back. I have never had a vaginal birth so I can't say much about that, but my c-section down time was short. Three day stay in the hospital and the next week I moved kind of slow...
so there's my two cents worth.
Hope it helped-H.

WOW you have had a lot of responses. If you are meaning getting your shape back, the csection will make that tougher, they cut into the muscle wall, so you can imagine that it won't be nearly as easy as a vaginal birth.

I had vaginal with my first and csection with my second.
You should never choose csection unless medically necessary, there are multiple things that can go wrong.
That said, I had a episiotomy with my first and was so painful! The recovery seemed brutal, however I also had preeclampsia and was on mag sulfate so that in itself was awful. I would say after three weeks I was myself again.

I had a csection the second time,due to my son being sideways and way too big to deliver vaginally. I was sore, tender and couldn't go upstairs, drive or pick my son up for long periods. It was hard. However it was just as much of a recovery for me as the vaginal birth. I had a great dr that helped me get up walking right away and they pain wasn't awful like I had anticipated. It took a good four weeks for me to be 100% again, but my belly did not recover like it did with the vaginal birth.

Unless medically needed go with vaginal as it may be easier now you have gone through it, never elect for a csection because it may be less recovery unless your Dr advises it! It is major surgery, nothing to take lightly. A lot can go wrong for your baby and yourself.

Wow so many responses. I didn't read them all...but my question is have you had an epidural with your last two. I have done mine all natural (4). But my sister-in-law did 2 and 2. Her first two were epidural and the recovery was awful for her. The third she decided to do natural and her recovery was night and day. She was up on her feet and feeling very good. So of course she did her #4 natural and the same thing. She felt great after wards. Don't get me wrong, you still hurt. But my opinion is, do you want to suffer and get it over with or do you want to prolong the pain over the course of a few weeks. Either way your going to pay. I prefer getting it over with and so I go natural and am on my feet way faster than those who have the epidural.

Everyone's healing and experience is different, but I had a c-section and it was not bad at all. I was up and moving the next day, out for walks with my new son within a week. My doctor did a single (long) stitch which she took out before I even left the hospital. The scar is barely seen after 2 years and my stomach is flat without doing too much exercise.

Of course after reading all these experiences, I guess I could have been the exception but it can go either way. I have friends that have torn so bad with vaginal births that sounds a whole lot worse.

It is major surgery, but I wanted to give at least one positive experience. Mine was emergency, not planned, but next time it will be a planned c-section and hopefully it will go the same way. Good luck either way!

If you are thinking of choosing to have a c-section I have to say ARE YOU CARZY?!?!? They are horrible. Not only the recovery but the whole process. I have had 2 c-sections and hated them. I hate lying there strapped down on the table feeling the tugging and pulling just waiting for the baby to cry. Plus you have a higher chance of the baby swallow fluid and then they can end up in the intensive care for a few days (which is what happened to my sister's baby) Then they take you to recovery so you can't even see your baby for like an hour or two until you gain feeling back in your body, the whole recovery is awful. I mean think about it....it's major surgery but instead of going home and relaxing until you heal you have to take care of a new born. You are on pain pills which make you feel even more tired and you have a 10 lbs weight limit for like 2 weeks. Which meant I couldn't pick up my 2 year old for 2 weeks after having my 2nd daughter. Plus just the pain oh the pain. You can't laugh, cough, sit up or walk with out horrible pain. Even in the hospital you have to stay in bed for like the first day and a half and when you do get up you have to practice walking because it hurts so much. The nurses get happy if you can walk from your bed to the bathroom. So anyways I hate c-sections but that's the only way I can have kids so I do it. But if you have the choice choose the vaginal birth. IT's so much better in so many ways.

I'm sorry to hear you have had tough recoveries. You especially need a quick recovery this time because you need to be able to care for *three* kids. (Congratulatins!) COnsider taking a class that trains you well for a healthy, low-intervention birth experience, such as Bradley classes, so you can have all the odds in your favor for a smooth, normal birth. A doula woud probably be a great help to you, too. You can find one at www.dona.org. You might enjoy reading "The Thinking Woman's Guide to a Better Birth" and "Ina May's Guide to Childbirth" and even the brand-new "Your Best Birth," which will have a lot of comparison info that you are looking for.
The moms I know who have had cesarean births are often frustrated they are weak and cannot immediately hold their babies to begin nursing.
Best wishes!

R., I have had 2 c-sections, no vaginal births. IMHO, you should stick with the vaginal birth unless there is a medical reason not to do so. I had no problems recovering from either csection BUT please remember that it is major surgery. Also, side effects such as abdominal adhesions frequently creep up years later and are very painful. I also developed a small hernia from my last c-section. . . a common side effect. Although it is small, it is bothersome and I either have to live with it or have another surgery. I would stick with vaginal unless something comes up that makes it medically dangerous for you to do so.

This is from a mom with c-sections...

It takes a long time to recover. Remember your gut has been cut open. You have to change dressings, you can hardly move because your stomach muscles have been cut. At first there is a lot of pain because the nerves are growing back. You can't take a bath for awhile and showering is only letting the water run on you. For me I have to have a tummy tuck to get my flat tummy back. Most moms I have talked with that have had a c-section had or have to have a tummy tuck. There are some, that don't, but I haven't ran in to them.

Now, after all that, I prefer c-sections because I am frightened of a vaginal birth, my first child was an emergency c-section and the twins were planned.

I would definitely NOT have another C-section. My recovery was much longer, I still have numbness and itching (C-section was almost 3 years ago!!), I had to take strong medications for the pain right afterward, which were tough to handle, and tough to stop... If you list out the pros and cons of each, I really think you'll find a vaginal birth a more natural and easier approach. A C-section recovery will be different for sure. The pain will be different, and the entire recovery will be different. For mine, I would definitely say that each of my vaginal births were much quicker for recovery than my C-section. You also have to remember that a C-section is a major surgery. It puts a lot of stress and strain on your body. There is a lot that can go wrong with a surgery like that... All I'm saying is if you have a choice, I would strongly recommend just going with vaginal. In my opinion, a C-section should only be used as a last resort. But those are just my thoughts and experiences. I have a friend who had a vaginal birth, then a C-section, and then decided to just schedule C-sections for each of her next 3 (5 kids total - 4 C-sections). She said it was just "so much easier." But in reality, I think her "easier" was just that she knew when she was going to be going to the hospital, and it was easier to schedule accommodations for her family and other children, etc. Not that the recovery time or pain was any easier. I can't imagine how it would be. Anyway. Just make sure you're completely informed before making your decision. Good luck and congrats on #3!

Oh, and as far as getting the belly back: My "belly" is fine, but if I'm looking at my body in the mirror, or looking at myself in a swimsuit, etc... I can actually see a little "flaw" where the C-section incision was. It's not completely smooth and flat. My belly shape is fine, but there's just a little inconsistency. It's hard to explain. It has to do with when the Dr. sewed me back together there. Your skin is never as pliable and flexible where the scar is.

I know that you have been given a lot to think about but I also need to add my experience. I had a c-section with my first because it was medically necessary (baby was breech and with the cord around her neck 2x, low amniotic fluid and no labor being 11 days over due) and it was also an emergency situation (heart rate dropped to 60 and wouldn't recover. For my c-section I was put under general and didn't feel a thing or remember anything until 6 hrs later. The bonding for me was hard because she was already a day old before I remember seeing her and holding her. I have since gone on to have 5 VBACs and the difference is night and day. Given a choice I wouldn't have another c-section unless my life or the baby's depended on it (literally). Each recovery time with my VBACs was less and less. My first was about 5 days before I was feeling really good, and then it got shorter and shorter. With the last it was a couple of hours and then I felt like I wanted to go home. I am in the minority with this though. I have to fight tooth and nail to have a VBAC even though I have had so many. IF you don't ever have to do a c-section it would be to your benefit. Not many doctors now (or hospitals) are willing to let you do a VBAC. Any more it is once a section ALWAYS a section. I wouldn't recommend doing it without a medical necessity. Like all the other women stated it is major surgery and you wouldn't normally elect to have major surgery without a medical reason would you? But that being said, you have to weigh the benefits and risks in your own mind and decide what it best for you and the rest of your family. Good luck in your decision and congrats on the upcoming baby.
J.--SAHM of 6

I just had a C-section. I took me about 3 times as long to recover and I hate the scar. The vaginal was much easier for me.

Well I haven't had a c-sec. but I had my first at the hospital... doctor threatining csec the whole time. had epidural, pit, meds, the whole nine yards. It was probably a year before I felt truly recovered.
My next was totally natural at home, water birth. I felt sooooooooo good. While the birth was painful, it was amazing. This baby was almost a pound bigger yet I felt so much better and felt really well within a couple of weeks!!
I would reiterate that csec's are major abdominal surgery and comes with dangers and side effects. I would really question any doc. that would be willing to do one for a non medical reason. One really important thing to remember is that you can be left having an emergency historectomy (sp?) during a csec too!!
Do some research and find what you can really be comfortable with!
S.

My first was a C-section as he was almost 10 lbs and was not going to come out anyother way. My second was a scheduled C-section, but came early and fast and I ended up having a vbac. Although the vbac hurt more at first the recovery time was much, much shorter. I also noticed that my regular belly came back much faster with the vbac. Every woman's experience with surgery is different, my c-section was a piece of cake, but had to wait weeks befor lifting, driving, going up and down stairs and with the vbac I was doing those things with in a couple days. I would talk to your doctor about how difficult your first two vaginal births were and get a pain management plan set up so it's not so painful.

I just have to add my two-cents worth. Having had c-sections, I would also mention some of the long-term effects you will likely experience. Even five years after my last c-section, I still can not sneeze hard or roll over quickly in bed without a burning pain in my abdomen. This is not unique to me. I have friends and sisters who have the same experience. Also, because of scar tissue, I have abdominal adhesions which tear (producing the same burning pain) when I jog or exercise vigorously. One other thing that always bothered me about my c-sections is that you are essentially drugging your little one if you breastfeed during those first days (which I was) when the pain medication is so necessary. Just a few things to think about.

I'm an emergency-C, the VBAC Mom, and I would echo the thoughts of many others here... Vaginal birth, 100%, hands-down. Check out ICAN website.

I have had both and I have got to say that I would have another C-section. Recovery time was very minimal. My doctor sewed me up so well that my scar is hard to see. My stitches from the c-section disintegrated in less than a week.

My belly was never the same after the first kid. For me, it did not matter whether it was a vaginal delivery or not. I just could not deal with the stitches after the vaginal delivery.

HI R.. I have had both, due to my first one being breached... and I prefer the C-section. I just listened to my body and the doctor and after that first week of taking it really easy I was pretty much back to normal. I was even out playing softball 3 wks after all 3 of my c-sections :). With my vaginal it was weeks and I still have bladder and other issues from the taring and delivery.... As for your belly I also had a better looking tummy after the C-section, I never looked like I was still pregnant like i did with my vaginal. Also I think it depends on which way they need to cut you. My doctors have done an awesome job at making my scars pretty much non visible and have been cut horizontal every time.. But I do think everyones bodies are different.... Hope that helps!

I first had a c-section and then a VBAC. The recoveries were completely different. It was a bit harder to sit comfortably after the vaginal birth, but overall ease of recovery was better with the vaginal birth. I believe in having babies in hospitals in the event of an emergency, but I think that often doctors cause harm for convenience sake. If you have to have a c-section because it it TRULY medically necessary, then do it, and don't second guess yourself....BUT if you are considering having a planned c-section for convenience, then do your research and think twice about it. It is harder on your body, less safe for the baby, and if you have a c-section without even going into labor then you run the risk of complications (which are higher with c-sections anyway) since your baby's system hasn't been "jumpstarted" by labor. Like I said, I have two children, delivered both ways, I did a TON of research about this, and even though both labors were rough, I would choose the vaginal delivery, hands down.

Good luck!

I had a c-section with my first and then 2 vaginals after that and I would say that by far my choice is vaginal birth. I still have nerve damage from where they cut through the nerves in my stomache (feels like my tummy is coming back from being asleep everytime I touch it.) and When they got my daughter out they had to stretch me on one side and that really hurt afterward...it felt like I had the tape resin that wouldn't come off. And it is major surgery so it involves at least 6 weeks of recovery time.

I also struggled with nursing becuase it would seem that the first latch in the first 30 minutes of your babies life is the key to a good nurser. By the time that you are finished getting stiched up, that window of opportunity is gone. I fought to keep my first daughter nursing for 6 months after her birth and she fought me all the way. My other two nursing was much easier because of that initial closeness and being able to hold and cuddle them right away.

Now I wasn't expecting a c-section, so emotionally that is tied into my bad experience, and my vaginals have been really good births since then with little to no recovery time, but I suppose if I had a hard go of it with my vaginals I might consider a c-section too. I hear there are ways to do c-sections well. I have been told that if you have one moving is the key. As soon as the drugs wear off you need to move in the bed, rock and turn, to help you gain your mobility back. Some women swear by their c-sections so don't let too many sway you if that is what you feel you really want...as for my I prefer the non cutting proceedure. Good luck!

wow... you have a lot of c-section horror stories here! I've had 2 babies, both by c-section. The first was unplanned (but not really emergency) due to failure ot progrees in labor (stopped dialating at a 5... and we waited 6 hours, stuck at a 5, before opting for a c-section. Second was a scheduled c-section.

My biggest concern with my 2nd c-section was taking care of my toddler. I, luckily, apparently have amazingly good recoveries. My mom stayed until my son was about a week old, at which point I was able to lift my daughter on my own (she's small, only about 20 pounds). I was easily able to get about and around on my own before leaving the hospital. The day would catch up to me and I'd be tired and a little sore at the end of the day, especially if I'd forgotten to take pain killers (just OTCs). As far as getting your regular belly back... is that possible after its been stretched out by a nearly 9 pound baby? LOL! =) Good luck with your decision. In my opinion, even thought I'm not anti-section and I've had 2 very good ones, I do think that it will certainly be harder to have a c-section considering that you have kids at home. Good luck with your decision.

R.,
As a labor doula and also as a 4 time C-section Mom, I would never recommend having an elected C-section. Even if you had a difficult time recovering from your previous vaginal births, a C-section is MAJOR surgery! My first and last one almost cost me my life, due to excessive blood loss. If you are able to deliver vaginally, it is by far the way to go. If you do opt for the C-section, be prepared for a long road to recovery.

Good luck!
M. in Denver

I think it may depend on the individual but I can tell you that I had 2 vaginal births followed by a c-section. I would choose the c-section again if given my choice. I recovered much faster and didn't have nearly as many issues with it.

Hi R.,

Vaginal Birth!!! I have three children. The first two were vaginal births and the last was a C-Section. Both recovery and getting back into shape are much easier vaginally. A C-Section is a surgical procedure; it is not intended to be a "choice". I would never opt for surgery that wasn't necessary. It's just not worth the risk. The delivery itself may be faster, but it's not like there's not pain associated with it. The muscle cut takes a long time to heal. You already have children so remember that lifting and a lot of other activities use this muscle. You WILL be limited.

Best wishes,
L.

I would choose a vaginal birth without question for my next kids. I had an emergency c-section with my first and the recovery was slow. I felt like I had been cut in half and even now (two years later) when my kids poke, crawl into, or kick my scar the right way, it really hurts. I had a V-BAC (vaginal birth after c-section) with my second child and was wonderfully suprised with how much easier it was. With a c-section you can't lift very much and moving in general if difficult. Also, if you already have two kids, it could be difficult to get them to be gentle with you after the surgery.

My main point is a c-section is surgery; it takes a great deal of recovery time (including no driving for 2 weeks) and more time in the hospital after the baby is born. For me, I hope that I never have to have another c-section. I hope that you get lots of helpful feedback from the great Moms in this group before you have to make any decisions. It sounds like either way you choose, you may have a tough recovery time. I wish you all the best and congrats on your upcoming 3rd little one:)

Peace, M.

I Have to agree....hated my C-section, loved the natural births. I recovered quicker, was able to pick up my children faster and move into normal life much more effiently. And, I have to agree with Andrea, I was mortified to be strapped to a table, screens up and someone YANKING on my poor baby to get her out. Still freaks me out thinking about it! lol

It sounds like most people are recommending a vaginal birth, so if you go along with that, you'll need a plan to make this next birth better. You do not say, but I assume that you have had the typical hospital births - epidural, continuous monitoring, delivery on your back & episiotomy. There are side effects to those interventions, and in some ways you are postponing the pain until after the birth. People who I've talked to that have gone without routine medical interventions say recovery time is easier (I've only had one birth so I can't compare). I would recommend learning about the proven ways to help your labor be easier - freedom to move, continuous labor support (doula), and an upright delivery position. Find a non-hospital, independent childbirth class with high rates of unmedicated births, and then hire a doula. (My recommendation for a class is Bradley, which has an 87% unmedicated rate.)