Woman's Hour Childbirth special on now - with Kirstie Allsop

(61 Posts)
VinegarDrinker Mon 12-Aug-13 10:15:22

Not sure if this is being discussed on any other threads?

mayhew Mon 12-Aug-13 10:44:59

Not bad. Outed NCT as CS discussion avoiders…..

Seff Mon 12-Aug-13 14:30:13

I have never had any dealings with the nct but isn't blaming them for not offering enough c section support a bit misplaced?

Wouldn't it be better for Kirstie Alsopp to use her 'celebrity status' to ask the health professionals why the c section rate is high instead of blaming someone else? It's not the fault of the nct that women have c sections.

Or is it to do with the fact you have to pay for nct classes?

yetanotherworry Mon 12-Aug-13 14:37:29

I heard the first half of this. I think they were saying that people have bad birth experiences because they prepare for a 'normal' birth, then end up having to have medical intervention. These women are more likely to feel like they've let themselves down because they haven't prepared for the eventuality of intervention. Whereas when women are prepared for the fact that they may not get the birth they want, they don't feel so disappointed. Hence, NCT classes not mentioning C-sections are letting women down. I think the obstetrician said birth wasn't just about thinking positively and that by suggesting this to women, then we give them a reason to feel like they've not 'performed' their best.

The obstetrician also said that their c-section rate was about 40% because people requested them and she prefers people to feel that they are controlling their birth experience.

nancerama Mon 12-Aug-13 14:43:50

I'm sick and tired of KA and her anti NCT agenda. I had a csection and NCT classes and was never made to feel like a failure. In fact I feel I got through the experience because of the support I had from my NCT teacher when my named midwife was no bloody help at all.

For KA's experience of NCT to be regularly wheeled out as the norm is irresponsible and unnecessary.

AppleYumYum Mon 12-Aug-13 15:28:48

Well said nancerama! I am unimpressed with Radio 4 lately after their unbalanced segment about breastfeeding the other week and now this. Just because Kirstie Allsop is overexposed on tv making utter crap and has two kids doesn't make her an expert worthy of hosting a Radio 4 segment on childbirth and blabbing on about her own agenda of first world problems.

Everyone who signs up for the NCT course knows they encourage natural birth and breastfeeding. My NCT course talked about c-sections and we even had an exercise with a Playmobile c-section theatre to put together to understand who all the people in there would be. I ended up with the dreaded drip, epidural, forceps, episiotomy, it wasn't how I hoped it would be, but that has nothing to do with the NCT and why would I blame them? Why not also blame the ridiculously brief NHS two part antenatal course, they didn't talk about it much either. It was just how my birth went, I had a baby safe and sound afterwards and I hope to have another.

PastaBeeandCheese Mon 12-Aug-13 17:56:34

Perhaps the problem is people's experiences of NCT varies. There doesn't seem to be a 'curriculum' so perhaps KA had a poor teacher.

Ours did talk about c sections and the likely recovery. She devoted time to what happens if things go wrong including still birth or neo natal care. She was the only person who said 'if they put you on the drip get them to cite an epidural before it goes it so you're prepared if you need some serious pain relief and have that choice. There's no shame in it.'

nancerama Mon 12-Aug-13 18:07:31

I thought there was a curriculum. I know the teachers go through several years of training on a degree course. They're not enthusiastic amateurs. I was under the impression that they are heavily monitored and audited.

Their PR is shocking though. They do little to defend themselves or promote exactly what they do. Simply calling themselves "britains biggest parenting charity" means nothing.

Yama Mon 12-Aug-13 18:16:07

I listened and didn't actually realise that it was KA until the end.

The only opinion which irked me was the guest who said that she focused on the baby and encouraged women to 'grin and bear it'. I can't remember the analogy she used but she was basically saying that women's experiences of childbirth were not important.

I didn't pay any attention to the anti-NCT stuff, it was clear the presenter had an agenda.

RedToothBrush Mon 12-Aug-13 18:36:42

Wouldn't it be better for Kirstie Alsopp to use her 'celebrity status' to ask the health professionals why the c section rate is high instead of blaming someone else?

Why are we making the automatic assumption that CS are bad? There is a case to be made for certain groups of women to have a CS if that is what they would prefer based on the evidence we currently have available to us.

Plus there isn't a discussion about the type of CS that is taking place. A EMCS is a very different kettle of fish to an ELCS.

Why is the focus purely on method of birth, with no thought to complications that might arise from a VB? We shouldn't assume that a VB is better automatically, even if it is natural. If we were doing what nature intended, we would be having children much younger, there would be less issues with obesity and more women and babies dying.

We need to look at this from a modern point of view; which includes maternal satisfaction and takes account of other negative outcomes.

Perhaps if we did this, we wouldn't be questioning why the CS rate was so high and instead would be asking why the needs, emotions and physical and mental health of women were being ignored in pursuit of ideology over research and evidence.

VBs might be right for a majority of women. However a CS might be right for a sizeable number of women and yet they are forced to try for a VB ultimately ending up in an EMCS or complications because of this attitude that CS = Bad.

Its only bad, if there is a blanket culture that thinks this instead of treating women as individuals.

I think focusing on CS in this debate is an almighty red herring. We should be focusing on why there isn't a debate about women being treated as individuals and humans who are involved in their choices and not judged for them.

LaVolcan Mon 12-Aug-13 19:05:56

I didn't think that Kirsty Allsop had actually taken any NCT classes? If she feels strongly, why doesn't she start up a CS Birth Trust?

I must admit, I wish the NCT would go back to being about Natural Childbirth instead of trying to be all things to all people. Then people who weren't interested in natural childbirth wouldn't need to bother to go to the classes.

VinegarDrinker Mon 12-Aug-13 19:13:41

RedToothBrush I think that's basically what KA was saying, that the discussion often focusses on the risks of CS vs pros of VB and doesn't acknowledge any pros of CS or potential risks of VB (3rd/4th deg tears etc).

It sounded like they were being careful to talk about "antenatal classes" rather than NCT a lot of the time.

It's much like the thread we had on here a while back. It seems some people are strongly convinced that hearing about the potential risks of VB will terrify women and may in fact make those complications more likely.

I was only half listening tbh as both DCs were being demanding!

VinegarDrinker Mon 12-Aug-13 19:15:57

KA was pushing Belinda Phipps (?) The NCT CEO to state either way whether they support a woman's right to choose or whether that only extends to VBAC and home births. She basically refused to answer.

Bunnylion Mon 12-Aug-13 20:10:11

I had NCT classes as thought they were way over the top with preparing for the worst - natural or medicalised. I have done a lot of research myself and am fully aware of what can go wrong and I feel as prepared as I can be for any turn my birth takes.

The NCT classes that I attended went on and on about c-sections, forceps, tears, prolapsed cords etc - to the point that I think most the women were expecting it will probably end up that way and they'll be lucky if both woman and baby survive.

I guess there is a delicate balance between their role of educator and trying to manage individual expectations. But I'd prefer just the educating with clear unbiased facts and statistics, and leave the mental preparation and expectation management to the individual.

I don't care if they support VBAC or elective c-sections or whale noises or Tibetan chanting - it's of no importance when it comes to a woman making choices on how she births.

RedToothBrush Mon 12-Aug-13 21:45:43

VinegarDrinker Mon 12-Aug-13 19:15:57
KA was pushing Belinda Phipps (?) The NCT CEO to state either way whether they support a woman's right to choose or whether that only extends to VBAC and home births. She basically refused to answer.

Why would she refuse? Odd. Its really quite a simple thing to answer.

cantreachmytoes Mon 12-Aug-13 22:49:49

Vinegar and Red - I was listening and I thought the answer was that the NCT supports women in the choices that are available. KA was asking the CEO to say that they support women's rights to a CS as much as to a homebirth. As a general rule of thumb ELCS is not available on the NHS, whereas home birth is. What I understood her to say was that they support (the few) women who have been given the ELCS option, but audits not an option for the vast majority, they can't promote it as an option in the same way they can home births which are an option for far more women.

I also understood her to say that the NHS is the body who sets these rules, not the NCT.

The "grim and bear it" lady gave antenatal classes for Will and Kate. Hard to believe the Duchess had any hopes if hupnobirthing with that attitude around her!

VinegarDrinker Tue 13-Aug-13 02:15:10

Yes, she just said she couldn't answer as it is for the NHS to set policies. Ignoring the fact that a) the NCT has lobbied for changes in NHS policies many times before, and B) I doubt they would just sit back and say that if for example an area stopped offering home births on the NHS

RedToothBrush Tue 13-Aug-13 19:37:40

As a general rule of thumb ELCS is not available on the NHS

Have you read the NICE guidelines on the subject? Thats simply not true and unfortunately this myth is being peddled continually by professionals who haven't bothered to properly read the NICE guidelines.

An letter in the BMJ recently by sent in by Mandie Scamell, a lecturer in midwifery, Alison Macfarlane, a professor in women’s and child health, Christine McCourt, a professor in women’s and child health, Juliet Rayment, a research fellow, Judith Sunderland, a lecturer and programme lead in midwifery, and Mary Stewart, a research midwife stated:

“NICE says caesarean section is not available on demand unless clinically indicated”

However what NICE ACTUALLY say is and I quote word for word:

- For women requesting a caesarean section, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, a planned caesarean section should be offered.
- An obstetrician unwilling to perform a caesarean section should refer the woman to an obstetrician who will carry out the procedure.

The need for a CS to be clinically indicated is simply not there. Nor does a woman have be referred for support (note words - 'offer of support' - it is optional). It still says that regardless a woman should still be offered a planned CS.

There is a world of difference out there and people need to start sitting up and taking notice as it is important to question why various groups are deliberately misquoting NICE and suggesting the guidance is completely different to what it actually states.

CS on demand IS technically available - its just hospitals are choosing to ignore NICE and the reasons behind why NICE made this recommendation and issued this guidance. Women are not asking for ELCS because they are 'too posh'. And the sooner we acknowledge and properly address why women are asking for ELCS I honestly think it will benefit ALL women, regardless of how they choose to give birth.

People keep asking the wrong questions and blindly accept what they are told without properly looking into the matter. The media has a hell of a lot to answer for.

Minifingers Wed 14-Aug-13 08:29:58

"CS on demand IS technically available"

The operative word here is 'technically'.

Guidelines are guidelines. They are routinely not being followed in a huge number of areas because resources are not there to allow them to be implemented.

"its just hospitals are choosing to ignore NICE"

Because they scarcely have enough consultant cover, theatre space and anaesthetist services to run a half way decent service with the present number of operative deliveries. They also don't have enough bed space on postnatal wards, or midwife cover in hospital or in the community to do this SAFELY. Massively increase the number of operative deliveries on healthy women under present financial and organisational constraints and the women who will be paying the price will be those with complex health needs, who will find themselves waiting longer for emergency surgery, and receiving less attention on even busier postnatal wards.

"And the sooner we acknowledge and properly address why women are asking for ELCS I honestly think it will benefit ALL women"

Often it's because of a lack of trust in a service which is under resourced, and where women are unable to access optimal one to one care in labour.

I am with you in wanting to see improvements in maternity services, but I think the place to start is bringing down the rate of emergency c/s by increasing midwife numbers, improving consultant cover in hospitals, widening access to birth centres and case loading care, and improving antenatal care for vulnerable women.

RedToothBrush Wed 14-Aug-13 18:48:52

Well lets be honest about this all then. Lets not say that ELCS on maternal request without clinical need is not available in this country. Lets actually state what the real situation is, because if you do that it raises all the questions above that you state and that begs some very big questions about how maternity is funded and how there is a total disregard for treating women with dignity, respect and properly gaining consent.

Lets not lie about it and say its not available. Let say that hospitals are refusing to uphold best practise. Lets talk about why NICE made those recommendations.

(BTW, NICE also said that there is a level at which the percentage of women having ELCS rather than VBs, ELCS actually become the more cost effective approach... so I think if we really want to talk about how money driven this all is, we should actually be making all women have ELCS. Which is not what anyone really wants. So I refute that aspect of the money arguement on this).

And I totally refute the 'money isn't available' bullshit. Not when maternity accounts for so much of NHS litigation claims and pay outs and the two pots of money remain completely unconnected. Do some joined up thinking and actually the money is there; you just give better care and reverse the number of claims being made. And yes I do believe its that simple if the powers that be got their heads out their arses and stop obsessing over CS rates without looking at the issue properly and in depth. Its not as simple as 15% = good 33% = bad. Its high time they started looking properly at levels of care and how women feel they are being treated.

Stop making excuses for poor care and justifying the status quo. All you are doing it being complicit and tolerating a situation which is unacceptable. Until you start kicking up a fuss and asking the right questions and really forcing people to look at this as a problem rather than something we all have to just deal with, no one will ever change it.

Hence my point in the first place. Maternal request is deemed as cost effective, is comparatively safe given the evidence we have available and prevents so much of the distress that has gone hand in hand with refusing women one has done previously. NICE changed their guidance to recognise the problem and how it was causing an unacceptable level of anxiety and harm to a certain group of women. And yet, here we are still with the same problem even after the guidance was changed because the hospitals want to ignore the core issues and make it black and white rather than being an issue that goes far beyond maternity.

If you forced hospitals to offer ELCS, do you think it would focus their minds to find other ways to reduce this demand by other means?

I think there is a case to be made here; if evidence was properly done and presented to them about why women were asking for ELCS then I rather suspect it would ask huge questions about maternal care across the board - which is to the benefit of all women. Yet no one has done this. They don't even properly and consistently record reasons for ELCS across the country, which means that no one can collate this information in a way that is truly meaningful and useful. What does that really tell you?

I am totally convinced that there is too much power politics and too much self interest involved in this debate to get the people who are running maternity wards and work in maternity units to really be honest and face up to the magnitude of their failings to women.

We need to stop supporting what is allowing them to bury it.

RedToothBrush Wed 14-Aug-13 19:29:24

Two other points.

NICE changed their guidance with the belief that the change would not significantly increase the rate of maternal request ELCS.

EMCS and ELCS are not mutually exclusive variables. Increasing the number of ELCS may in effect reduce the number of EMCS. There are a number of hospitals in this country which have a comparatively high ELCS rate and low EMCS rate. Why is this?

badguider Wed 14-Aug-13 19:43:47

If any woman could choose an ELCS for any reason, why would they then want to fork out hundreds of pounds for an NCT class which is obviously going to spend at least half the time on VB, if not more than half..?
I just don't really understand what people want from the NCT in terms of C-section discussion. I didn't do NCT, I did birth prep classes with a different provider but my friends who did NCT were all informed what would happen if they had a CS etc.

K8Middleton Wed 14-Aug-13 19:45:35

If you listen to the programme you will hear Belinda clarify the right to c-section as per NICE guidelines. I thought she made valid points and was quite fair. She also pointed out NCT was involved in the consultation to determine NICE guidelines and that promising women something that NHS can't/won't deliver is not helpful. I agree.

I thought it was daft to go to an antenatal class half way through and complain half the stuff relating to birth hadn't been covered... well durr! Much better to ask people at the end of a course what they thought/covered.

It's on iPlayer if anyone wants a listen. I do wish Belinda had stressed the point that women who feel listened to, in control and respected feel more satisfied with their birth experience regardless of interventions or how birth occurs. I also wanted more from the Birth Rights lady.

I also wanted to slap Kirstie every time she said only healthy babies mattered... like how a woman feels isn't important or if her human rights are totally disregarded.

K8Middleton Wed 14-Aug-13 19:51:58

I thought NCT was about informed choice, based on evidence? Therefore they cover off everything (c-sections, pain relief options, physiological processes, interventions) because it's all possible and you need to know in advance so you can make an informed choice because there's not likely to be time to do your own research during labour.

badguider Wed 14-Aug-13 20:00:52

That's what I thought too K8 but Kirstie Allsop seems to resent the fact the nct classes start from the assumption that most women will want to go into labour naturally and give birth vaginally unless something prevents that from happening.

As I say, I am not sure what she would rather the NCT do/say in their classes to make her feel that they are more in favour of CS?

K8Middleton Wed 14-Aug-13 20:15:18

It's funny isn't it? Kirstie seems so ballsy and not to give a crap about what other people think of her (or the unimportant ones any way) and yet she seems to need her birth choice validated? A birth choice that seems totally sensible to me - she has enormous babies! Why not a planned c-section if that's what she wants. I would.

lulugukil Wed 14-Aug-13 20:50:23

Point 1. untrue that the NCT course did not cover Csection
Could you make it clear that the NCT class Kirstie attended did discuss CSection in the following lesson as Belinda Phipps made clear and that other interventions such as forceps had been mentioned. Kirstie attended the class and judged the content of the whole course on one eighth of it. Perhaps she would be entitled to say we were biased if she had attended all of it.

Point 2 - safety of c section
There are risks attached to Csections. They are a major operation with the associated risks attached to that. Recovery takes up to six weeks. Would you recommend that someone went to have a stomach operation on the same day that they came home from hospital with their new baby ? If you want a summary of the risks go and have a look at the National Sentenial Audit 2000 on CSections.

In some ways you can say the pain of birth in a csection is taken from the day of birth to the days of the post birth recovery with a csection. it is painful and hard to pick even your baby in the first 24 hours or so. Whereas with vaginal birth even with a small tear you are back on your feet, driving and able to pick up your baby straight away in most cases

C sections are great life savers for mum and baby but not to be taken lightly.

This is why consultants will encourage vaginal births to help preserve the health of mum and baby not to save money.

lulugukil Wed 14-Aug-13 20:54:03

Point 3

Finally what I don't get is why people who are scared of tearing in vaginal birth then volunteer instead to have their stomach"torn" open in stead for their baby to be born?

lulugukil Wed 14-Aug-13 20:54:49

Point 3

Finally what I don't get is why people who are scared of tearing in vaginal birth then volunteer instead to have their stomach"torn" open in stead for their baby to be born?

K8Middleton Wed 14-Aug-13 21:06:52

I have never met anyone who has chosen a c-section because they are worried about tearing with a vaginal birth with the exception of women who have had a birth injury that has caused significant and lasting problems. I expect there is probably someone who thinks like that but they must be a tiny minority.

I get annoyed with the rhetoric that suggests women cannot labour - I find that unhelpful, untrue and couched in patriarchy. I also find the suggestion that a planned c-section is to be avoided at all costs sits at odds with evidenced based decision making. Both come from the same idea of women being homogenous and unable to make good decisions which just isn't true.

I meet a lot of women who have just had babies.

VinegarDrinker Wed 14-Aug-13 21:55:04

BFing so can't type a long reply, but the long post above (sorry, can't remember poster's name) is absolutely classic of the false comparisons made between VB and CS.

Why is it commonplace to compare the worst case scenario of CS complications with the best of VB? Just a cursory glance through the "raggedy bits" threads give a tiny taste of how common it is to have severe and long-lasting trauma due to VB (not all of which are assisted deliveries). Whilst hundreds of MNers who have had straightforward elective CSs wouldn't recognise the description of CS recovery given above.

Now obviously MN is no scientific study, but the oversimplified "CS bad/VB good" argument is just so lazy, divisive and inaccurate.

Xmasbaby11 Wed 14-Aug-13 22:04:13

In my experience (and those of my friends), midwives are unwilling to intervene in a birth unless necessary. This usually results in a natural birth, but in some cases - like mine - women are left to labour for too long. I have a severe prolapse because of this. My consultant admits I was left too long and the prolapse is the result. Now I am having a c section for my next baby and then I will need surgery to fix the prolapse.

Xmasbaby11 Wed 14-Aug-13 22:05:38

And my friends who had c sections recovered more quickly than I did. And they do not have lasting damage like I do.

I know I am just talking anecdotally, but it does annoy me when cs is presented as negative and vb positive.

Minifingers Thu 15-Aug-13 15:32:35

Redtoothbrush - where is the evidence that denying access to planned c/s for healthy women results in poorer outcomes for birth?

As for 'forcing' hospitals to offer greatly increased access to surgical birth without increasing midwife numbers and consultant cover - yup, great idea. If you actually want to see more maternal deaths. hmm

RedToothBrush Thu 15-Aug-13 18:10:11

sigh

If you really want me to start pulling studies out, I will, but you'll have to give me a couple of days to do that as I've got a lot on at the moment.

Its frustrating that you feel the need to ask, because NICE didn't update the guidelines to allow ELCS with the cavet about if a woman still isn't happy after being offered support that she should be referred to someone who will perform a CS.

It is the guidelines, and its available elsewhere. But hey ho... its not something you consider important or a problem therefore they shouldn't do it. Speaks volumes.

Minifingers Thu 15-Aug-13 18:25:59

"If you really want me to start pulling studies out, I will"

Yes please.

I've not seen any large scale ones done on healthy women with no medical need of c/s.

I'm referring to studies on women without a diagnosis of tokophobia by the way. Women with a diagnosis of tokophobia are entitled to a c/s on medical grounds.

"its not something you consider important or a problem therefore they shouldn't do it. Speaks volumes."

That's a bit childish isn't it? Where have I argued that it's 'not important' that women have birth choices? My posts have just pointed out that there is a rationale for rationing c/s on non-medical grounds which is based on concerns about how current resources are use.

Whenever this subject comes up those posters who beat the drum for a large increase in the numbers of c/s on demand for healthy women refuse to acknowledge the very fundamental, crucial issue of midwife and consultant shortages, and the worrying increase in the numbers of women with complex and threatening conditions being cared for in maternity units.

RedToothBrush Thu 15-Aug-13 20:09:06

Do you know how hard it is to get diagnosed as tokophobic...? Thats part of the point actually. A MASSIVE part. It was because there is so much disagreement about what constitutes an 'acceptable' level of anxiety. The NICE guidelines were written with this in mind because of the widespread inconsistances in care across the country in relation to this subject. I'm sure this has been stated explicitly in either the document or the press releases associated with it. I'll do my best to find it for you.

Sadly their aim to stop this has not progressed in any shape or form whatsoever. Especially since so many professionals refuse to even acknowledge its existence.

Good luck trying to get diagnosed if you have issues of this nature.

For women who are over 35 there are a great many hospitals that have rates of well over 30% ending up with a CS (thats a combination of EMCS and ELCS), about 30% ending up with an operative VB and only 30% achieving a birth without intervention of this nature. This is for all women and does not reflect the fact that first time mothers are even more likely to need intervention. I'll try and find this information sometimes for you too.

Now do you, or do you not acknowledge the evidence that EMCS and operative VBs are worse for both mothers and babies in terms of outcomes than ELCS?

So isn't that enough information alone to start asking questions about 'healthy' mothers? The main problem being that there is still a situation where they haven't the slightly clue who is low risk and high risk until after the birth. Nor do they have much of a clue why older women have a harder time really. Sure they are more likely to have other underlying medical conditions but that does not explain everything. As I've read so many times before "You are classed as low risk until you are classed as risk risk" and thats about as far as they have got in terms of identifying problems.

Perhaps however you'd like to do your own donkey work and read the NICE guidelines at length though instead of relying on me to regurgitate and repeat it back to you.

RedToothBrush Thu 15-Aug-13 20:39:56

BTW, you might want to start with a WHO report on the subject of women opting for a CS without clinical need as an interesting debating point.

This is a very interesting critic of their finding which is incredibly telling.

Please note that straightstatistics.org are not a website which has a political line on being pro-CS or pro-VB. Its a site about getting to the bottom of what figures are showing and how they are being manipulated to show a desired outcome by those presenting the statistics.

Minifingers Thu 15-Aug-13 23:02:15

Well lots of issues there, mostly stemming from women not being treated as individuals, and a lack of continuity of care. Many of these problems would be resolved with greater access to case loading midwifery care, which would empower women to obtain the births they want.

Re: rates of unplanned c/s - for healthy, low risk mothers this obviously varies hugely according to place of birth, age and parity. However,according to the Place of Birth study 2011, more than two thirds of healthy first time mums giving birth in low-tech settings (birth centres and home births) had normal births. When you look at both first time mums and mums having subsequent babies, over three quarters of healthy women who planned births in midwife led units had completely normal labours (ie, no episiotomy, no syntocinon, no forceps, no c/s etc)

Now do you, or do you not acknowledge the evidence that EMCS and operative VBs are worse for both mothers and babies in terms of outcomes than ELCS?

"Now do you, or do you not acknowledge the evidence that EMCS and operative VBs are worse for both mothers and babies in terms of outcomes than ELCS?"

Outcomes for ELCS are better for mothers than EMCS, not necessarily better for babies. Assisted deliveries it's difficult to make any sort of comparison as they cover a huge spectrum in terms of difficulty. Most women who have assisted deliveries in the UK have uncomplicated ventouse births and have no further problems following on. The majority of forceps births are low cavity and don't result in any ongoing problems . I'll grant that an uncomplicated EMCS is generally going to leave a mother and baby in much better shape than a complicated mid-cavity delivery involving rotational forceps, but then these are quite rare these days. And of course it also depends on whether you're willing to factor in complications in future pregnancies and births, which is always an issue with c/s for mothers who want more babies.

"The main problem being that there is still a situation where they haven't the slightly clue who is low risk and high risk until after the birth"

They know enough to identify a group of women who can plan a birth outside of an obstetric setting who can reasonably expect to have the majority chance of a normal delivery. They have been doing this for years and the outcomes for these women and their babies as a group are very good.

Minifingers Thu 15-Aug-13 23:15:16

And by the way - I agree that if you take women in obstetric settings, them the sort of care in labour which leads to high levels of failure to progress, have high induction and augmentation rates, high rates of CEFM on low risk mothers, heavy use of opioids and routine use of epidural (both linked to higher incidence of fetal distress in labour) you ARE going to have very high rates of emergency c/s. In a system where this is the only alternative to a planned c/s, then outcomes are never going to look good for planned v/b. Of course not - because women having v/b's in these settings are getting sub-optimal care leading to very high rates of birth complications and emergency surgery.

For me the logical response to this is not: well lets tell women that planned v/b is dangerous and give everyone the option of planned c/s instead. The response is to change the way maternity care is delivered in order to reduce the number of women experiencing complications in birth leading to emergency surgery. And luckily for us in our cash strapped NHS the patterns of care associated with lower rates of complications in labour namely giving birth outside of obstetric settings, also happen to be quite cheap.

VinegarDrinker Fri 16-Aug-13 05:41:54

I don't think it's helpful to conflate the issues of resource management (FWIW I'm not aware of a national Consultant shortage, the opposite if anything, though I've certainly come across units which are very understaffed from a midwifery POV) with the fundamental (feminist?) question of whether an individual woman should be able to make an informed choice about her mode of delivery.

Yes, all the things you have mentioned are hugely important, and reducing em CS rates is an admirable goal, but it is patronising in the extreme to assume that all women strive for a VB - even if they could be assured it would be complication-free.

Bowednotbroken Fri 16-Aug-13 06:00:00

In an ideal world, if everything else was equal, a vaginal birth is much better for the baby than a planned caesarean birth. The contractions stimulate the baby's central nervous system so that s/he is much readier to breathe, the squeezing through the vagina encourages some fluid from the top bit of the lungs and vaginal bacteria help to prep the baby for healthy living too. That is NOT to say that this means anyone planning a caesarean birth is clearly not caring about their baby - but surely it does mean that if there was anything that could be done to reassure women so they felt happy and confident to birth vaginally it should be tried at least?

VinegarDrinker Fri 16-Aug-13 07:34:45

I'd refute "much". Anyway, absolutely women who want a VB should be supported to have one (in the ways discussed upthread). But we don't coerce/force women to do other things that are good for their baby either before or after birth (eg losing weight or stopping smoking before TTC), we allow them the autonomy to make informed decisions and trust them to do so. And importantly, the fetus has no rights in law until born.

VinegarDrinker Fri 16-Aug-13 07:36:24

Some women, despite reassurance and support, still don't want to try for a VB. The question is whether they should be forced to try for one, or allowed an informed choice.

LaVolcan Fri 16-Aug-13 10:05:12

But we don't coerce/force women to do other things that are good for their baby

I get the impression that a lot of coercion is going on e.g routine bookings for induction - justified on the grounds that they are only thinking of the baby.

I think coercion and inductions is right - I really didn't get given the option to refuse but on the other hand they'd just diagnosed me with pre-eclampsia and I was 40 weeks.

DD was EMCS following failed forceps and ventouse but I have to say, the recovery was fantastic and I was properly up and about before a friend whose daughter was born vaginally 4 weeks before mine.

Do I think the induction led to the EMCS? Absolutely. Do I wish I'd had a vaginal birth? Absolutely not (though I would go for a VBAC next time, all being well). I was fine and DD's APGARs were 10, 10, 10. She may not have been as healthy had I not had a c-section.

C-sections are not, in any way, an easy option but neither are they the work of the devil. DH wouldn't be alive if they didn't exist, for example. There's a balance and the NCT haven't achieved it yet, although we did have a c-section role play with playmobil in our class and that was tremendously helpful, complete with suggestions of how you can take some control.

Kirstie Allsopp, meanwhile, does no-one any favours. I've completely lost track of what she actually thinks other than 'DOWN WITH NCT'.

LaVolcan Fri 16-Aug-13 18:11:20

I wasn't thinking of inductions for pre-eclampsia, but more of the routine inductions because a date has been reached on the calendar 40 +10,12,14 depending on where you live. Personally I think 'we'll book you in for induction on....' could be seen as coercion, whereas, 'you are 40 + [some days], your choices are induction or monitoring, what do you think?' isn't.

I think that's fair. There's still a question mark over whether I did have pre-eclampsia (one high BP reading only but consistent ++ on PCR test) and if it happened again I might question a little further but I definitely wouldn't have been happy with automatic induction at 40+x because of policy and wouldn't consent to a sweep in a month of Sundays.

Minifingers Fri 16-Aug-13 20:17:45

"but it is patronising in the extreme to assume that all women strive for a VB"

I don't think I've implied that all women want a vaginal birth have I? confused

"FWIW I'm not aware of a national Consultant shortage"

here

"A shortage of obstetricians and gynaecologists is putting women and babies' health at risk, a report says.
The Royal College of Obstetricians and Gynaecologists called for another 1,000 consultants on top of the 1,500 working currently to provide a safe service."

"Why is it commonplace to compare the worst case scenario of CS complications with the best of VB?"

Well I don't think it is. All sensible people acknowledge that the very high rate of interventions in attempted vaginal deliveries in the UK results in the picture not being straightforward. But there is still no doubt at all of this: that the majority of vaginal deliveries to healthy women are NOT complicated by serious perineal damage, and result in shorter recovery times than for c/s. This is massively the case for healthy mums who are having a second and subsequent baby. Less so for first time mums who are more likely to have complications.

"The question is whether they should be forced to try for one, or allowed an informed choice."

That's a bit of a distorted way of looking at it. It's not the NHS which will force the mother to try for a normal birth. It's her own body! The question is whether the NHS should offer the option of an operative birth. For me this is the nub of the problem. Across the NHS there are many cases where people are not able to have their preferred pattern of care - not just in relation to surgery, but in relation to drug treatments and other therapies. For example, some very overweight people may feel very strongly that they need to have gastric band surgery in order to have an acceptable quality of life. But perhaps their trust is limiting this type of surgery to overweight people with diabetes, as there is a financial imperative to ration surgery and the commissioners of services in this particular trust feel that they need to focus on ensuring the best health outcomes for the largest number of patients, and in this instance it's offering a treatment which will reduce the likelihood of severe complications further down the line with diabetes. They are doing the same with c-sections for healthy women - rationing to get the best bang for their buck in obstetrics.

I don't know what the answer is but I don't want to see high risk women dying while waiting to get into theatre because there has been a big increase in planned c/s with no consequent increase in surgical staffing. I don't want postnatal wards to be any worse places to be than they already are, and they will be if there is a significant increase in women having operative births. Because who are the women who get fucked over when resources are short? I can tell you (and I have seen this for myself in hospital) - it'll be the young ones, the poor ones, the ones who don't speak English and are unlikely to make a complaint. No - I don't believe in choice at any price - not if it ends up putting vulnerable women and babies at increased risk of neglect in hospital.

RedToothBrush Sat 17-Aug-13 18:34:18

VinegarDrinker Fri 16-Aug-13 05:41:54
I don't think it's helpful to conflate the issues of resource management (FWIW I'm not aware of a national Consultant shortage, the opposite if anything, though I've certainly come across units which are very understaffed from a midwifery POV) with the fundamental (feminist?) question of whether an individual woman should be able to make an informed choice about her mode of delivery.

Yes, all the things you have mentioned are hugely important, and reducing em CS rates is an admirable goal, but it is patronising in the extreme to assume that all women strive for a VB - even if they could be assured it would be complication-free.

BINGO!

As for coercion of women. Really?

Lets coerce women to stay home, do all the housework etc etc etc. Lets ignore the implications of coercing women who do not want to do what they are being coerced into doing...

Fuck that!

Am I living in some parallel dimension were it is unacceptable to make the suggestion of coercing women is bad, in all things but healthcare because of this utterly misguided and disgusting view that women are incapable of making an educated decision for themselves and someone else has to somehow tell them what to do.

I am utterly horrified by that comment and the implications of it.

Minifingers Sat 17-Aug-13 19:59:09

Red toothbrush - I absolutely agree that women should have the choice of a planned c/s, just as they should have the choice to have gastric band surgery if they feel they need it for a decent quality of life. The question is whether this choice should be provided by the NHS where women and babies are already being put at risk because of an over-stretched surgical service and a lack of midwives.

Minifingers Sat 17-Aug-13 20:20:46

"to make the suggestion of coercing women is bad, in all things but healthcare"

Sadly we are all 'coerced' into choices we'd not usually make by a lack of funding in the NHS and across public services.

My elderly disabled FIL is bedridden and is currently being 'coerced' into staying in bed by a lack of funding for physiotherapy which would help him regain some of his mobility, for example.

Not offering surgical birth on demand across the NHS isn't misogynistic, really it isn't. It IS about the fact that hospitals can't safely accommodate higher levels of surgical birth than they are currently doing without an increase in funding. And it's hard to argue that any increase in funding should go towards expanding elective surgery for healthy women when women with complex health conditions (including tokophobia) are experiencing higher levels of mortality and severe morbidity because of a lack of consultant cover and postnatal care.

Women who have significant mental health problems relating to childbirth should already have access to surgical birth if this is what they need. If they are not being diagnosed and put on the right care pathway then this issue needs addressing, but that is not what's being discussed here is it?

RedToothBrush Sat 17-Aug-13 21:17:44

And you are saying coercision is good? And making excuses for it on the basis of cost?

Utterly appalling. Lets let old people sit in their shit because we can't manage our resources. We are a wealthy nation. We CAN afford this.

Stop justifying the unjustifable.

You are the reason why healthcare is in the state its in. Because you are accepting it instead of saying this isn't acceptable. You allow those running the services to get away with it and carry on, rather than tackle the issues.

LaVolcan Sat 17-Aug-13 22:17:47

That's very harsh RedToothBrush - trying to lay the blame for the problems of the NHS at minifingers door.

No one was saying coercion was good and I doubt if anyone thinks it.

I think that anyone who wants to deviate from the standard package that their hospital offers runs the risk of meeting with some sort of 'coercion'.

Minifingers Sun 18-Aug-13 08:26:18

Redtoothbrush - I would LOVE for the NHS to be given enough money so we could all have optimal care. But you know what? IT'S NOT GOING TO HAPPEN.

In fact not only is it not going to happen, but there is going to be more and more rationing - it's inevitable as we have an ageing population affected by very high levels of obesity, and a huge host of sophisticated and expensive new treatments for cancers and complex conditions which the public will expect the NHS to provide.

There will be more and more 'trimming' of services.

Please don't think by saying this I'm in favour of it. I'm frightened for the future of healthcare in the UK.

Minifingers Sun 18-Aug-13 08:33:05

And I'm wondering what YOU are doing about the situation?

Are you part of any activist groups arguing for a massive increase in funding for the NHS?

RedToothBrush Sun 18-Aug-13 12:24:44

Sorry, but anyone who justifies coercion should get that treatment.

You can not cut corners in care without it doing damage and harming people. The idea that you can is utterly absurd. And the truth is you end up paying for it elsewhere further down the line anyway. You don't get something cheaper because you cut corners. The greatest efficiency saving is to treat properly in the first fucking place.

If we can not afford things, then thats what should people should be told. They should not be coerced into anything. The idea that we should coercise because of cost is an appalling thing to suggest and say that we should be happy with.

At least that way it creates a situation of transparency and people can actually then be held accountable for, rather than this things of lying and saying this is the best treatment for you, you just have to wise up and agree to it and consent to something you are not at all happy with. This attitude of coercision destroys all confidence and trust in the system that you will be able to make an informed choice that is in your best interests and properly considers your needs.

If you don't actually get that, and you work in healthcare, then we really are already so fucked that the NHS is beyond all repair anyway. We might as well all sling women under the bus along with the elderly and save some precious money that way. Afterall its in their best interest to save their pain and dignity later one.

Minifingers Sun 18-Aug-13 13:08:23

Red - you need to learn the difference between the words 'explaining' and 'justifying'.

The NHS is in a state of financial crisis, and this is set to continue.

Even a change of government won't make a difference in terms of future priorities for the NHS.

LaVolcan Sun 18-Aug-13 14:03:22

RedToothBrush: You should be addressing your complaints to your MP for a starter, but maybe you have done?
Or join a pressure group to support the NHS.

Remember that Cameron promised 3000 more midwives
blogs.channel4.com/factcheck/painful-contractions-cameron-breaks-his-promise-on-midwives - a promise which he has quietly reneged on since becoming PM.

Ushy Tue 20-Aug-13 23:43:12

But midwives don't do caesarean sections, la volcan

Whether elective caesareans are better for the mother depends on what she wants. Red is right - coercing people will never result in better outcomes and women are regularly coerced into vaginal births they do not want. (Read the thread about the Mner blowing her £13000 life savings on private care to avoid another vaginal birth).

However, caesareans pose fewer serious risks for babies ; Slightly more minor respiratory distress with electives but much less serious morbidity and mortality. There was a good study that actually quantified the risks here:

http://www.ncbi.nlm.nih.gov/pubmed/17011400

What is wrong with a woman wanting to choose the safest mode of delivery for her baby? Why should it not be her choice?

Resources don't come into it. The difference between caesarean and vaginal - taking into account the long term costs was estimated by NICE as only £84.00 BUT that excludes litigation costs. Since you almost never get brain damage or cerebral palsy caused by elective caesarean, the legal claims more than wipe out that small difference.

So basically, we should just be letting women make their own choice once they understand the risks of both modes of delivery.

LaVolcan Wed 21-Aug-13 00:06:04

But midwives don't do caesarean sections, la volcan

Did I say they did? I was commenting on Cameron reneging on a promise to improve staffing of maternity units. As far as I am aware he didn't make any promises to improve consultant cover, but that is also a problem in some units, where it would be best to avoid an EMCS in the evening or at the weekend.

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