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Why are some professionals so against ELCS??

(42 Posts)
Writerwannabe83 Fri 14-Mar-14 20:06:08

I've got an ELCS next week which was decided upon when I was about 20 weeks gestation.

Since that decision was made I had a routine check-up appointment with my Cardiologist and when I said I was having a CS she was very judgemental, told me she didn't think it was necessary and used quite accusatory language towards me and spoke in a tone that implied she thought I was just opting for the 'easy route'. She even wrote to my Obstetrician and said she didn't agree with the decision. I left the appointment quite upset. Thankfully my Obstetrician put me at ease and said the Cardiologist's opinion and her letter had no bearing on anything.

I had my pre-op anaesthetic appointment today and when he asked why I was having a CS (I have epilepsy and a heart condition) he clearly wasn't impressed. He kept probing and basically made me justify myself and the decision - he made me feel like I was a naughty child being 'spoken to' by my parents - it was awful. He didn't try and hide the fact that he didn't think it was a 'good enough reason' and he made me feel very uncomfortable.

I don't understand it??
Why are they so concerned and obviously against me having one?
What's it got to do with them??

Has anyone else came across this kind of attitude from other members of the medical team??

ReallyTired Fri 14-Mar-14 20:13:07

Your obstetrician has decided that you need a c-section and that should be enough. Its not really anyone's business. Does it matter whether you are opting for easiest route? What is the easiest route depends on your circumstances. You are opting for the obstetrician considers to be the most appriopate route for you. (Ie. the safest route)

StarsInTheNightSky Fri 14-Mar-14 20:29:35

That's awful! Have you complained? I don't know why some HCPs have such a bad attitude to ELCS, but I fail to see why it's any of their damn business - it's between you and your consultant.If I were you I'd smartly tell the next person who asks why that it's between you and your consultant. Grrrr, this kind of nonsense makes me so angry - why do they automatically assume that it's because you don't feel like pushing, or you're too vain to want to risk your bits getting messed up!?

I'm having an ELCS and so far everyone has been very supportive of that, except one midwife at the hospital today when I was being monitored who took it upon herself to try to lecture me about ELCS not being the easy way. hmm She hadn't even read my notes which explain why I'm having an ELCS, so I calmly told her to read them. She did, went a bit white and apologised profusely for being so insensitive.

It made me really angry though, I'm having an ELCS due to previous severe trauma, our consultant 100% agrees that it is the right decision and anyone else can go whistle.I've had major abdominal surgery recently, so I know surgery is no picnic, but it is the best option for me and our baby.

<<Steps off soapbox blush>>

Jollyb Fri 14-Mar-14 20:31:45

Speaking as a HCP (and someone who had an ELCS) I suppose the main reason is because it is still considered as major abdominal surgery. In most situations in medicine surgery is considered 'last resort' with preference to try less invasive options first ie medication. I suspect this thinking is being transferred to childbirth, despite the potential risks from vaginal delivery.

The other option is that they are not really thinking that and you might be projecting? Good luck

Jollyb Fri 14-Mar-14 20:34:06

Sorry just read the bit about your cardiologists letter - you might not be projecting!

Tea1Sugar Fri 14-Mar-14 20:46:22

Op just seen another of your threads which says how nice the anaesthetist was?!

RedToothBrush Fri 14-Mar-14 21:18:32

Answer: Because they haven't got a fucking clue why you want a CS and why your consultant is supporting you.

Its made up of lots of different bits of information they are ignorant of.

And to be honest for a lot of the same reasons that someone who was not a HCP might judge you.

They don't have the full information on your personal medical history - only bits of it.

So they only focus on their specialistic knowledge. I'm noting here their lack of understanding of mental health (hence their judgmental twattiness as much as anything else. If they had a fucking clue, they would be a lot more careful about what they said to women wanting a CS).

Knowledge about why women choose to an ELCS is still shit at best - even within the profession - its only just beginning to get the recognition it deserves.

The media perception of 'too posh to push' has had more effect even on professionals than they would like to admit. Stick a few research papers under their noses and they might take notice, but they are more likely to read the Daily Fail instead if its not of special interest to them.

Very few people in this country regard women who ask for an ELCS as potentially vulnerable. Instead they like to attack them with the verbal equivalent and sensitivity of a sledge hammer.

Basically, ignorance needs to be tackled.

If you felt like they were judging you and that you felt the need to justify yourself, COMPLAIN. You are not being difficult. They are being unprofessional. If they disagree with the decision your consultant has made, then they should be raising those concerns with the consultant rather than making you feel like a pile of shit with their attitudes.

StarsInTheNightSky Fri 14-Mar-14 21:37:40

I agree 1000% with what RedToothBrush said, great post.

gamerchick Fri 14-Mar-14 21:44:12

because it costs the nhs a lot more than a natural birth.

SpinningFates Fri 14-Mar-14 21:44:13

Terrific post RedToothBrush (as always).

RedToothBrush Fri 14-Mar-14 23:46:16

gamerchick Fri 14-Mar-14 21:44:12
because it costs the nhs a lot more than a natural birth.

Except (and this is only a minor criticism of your post) it doesn't.

Writerwannabe83 Sat 15-Mar-14 08:39:09

Tea - he was really nice apart from this. I'm just so glad my DH was with me for that little bit of moral support when I was being questioned about my reasonings.

redtoothbrush - I think you're right about the aspect of them only having limited information on our medical status and making their judgements based on that. After our initial talk about the reasons for my CS he opened my notes and read through some of my clinic letters with me and realised my cardiac issues weren't quite so straight forward as he had assumed them to be which seemed to change his outlook thankfully.

As I said, he was otherwise very nice, very thorough and I have complete faith in him as an anaesthetist etc - I was just very surprised by the attitudes I have come across. Like someone said, CS is not their Speciality and if it has been decided to be the best option why don't they just accept that?

When I had told my Cardiologist about the CS she said quite harshly, "And who actually made that decision?" I told her it was made between me. my DH and my Obstetrician - i.e the people whose decision it is, not hers!

gamerchick Sat 15-Mar-14 08:57:02

A Normal birth costs around or just under 2 grand.. A planned cs costs just under 3 grand.. then there's the cost of a longer stay in hospital...potential intensive care treatment and potential further treatment for infections.

So please explain to me how It doesnt?

StarsInTheNightSky Sat 15-Mar-14 10:41:39

I never understand the cost argument. For a start I've had three consultants, a doctor and a midwife tell me that when you factor absolutely everything in, an ELCS doesn't cost anymore than a vaginal birth. I don't have the exact figures, but I doubt they'd say that if it was a lie.

More importantly though, I didn't choose to go through the abuse and trauma that I have been through in my life, so I fail to see why I should be forced to give birth vaginally. It would traumatise me further and do massive damage to my mental health, which I have spent years rebuilding.
There are many people out there who make lifestyle choices which mean they end up with self inflicted injuries or conditions, but there don't seem to be the bad attitudes/judgement in HCPs surrounding their treatment that are so prevalent with ELCS.

It is about time that people, not just HCPs, started realising that a lot of women who request ELCS do so because of trauma, and personally I would support anyone if their care decisions meant they didn't have to endure further trauma.
HCPs have a responsibility to take care of patients, and trying to force or guilt trip them into something which causes them distress/trauma is morally and professionally very wrong.

RedToothBrush Sat 15-Mar-14 12:23:28

There are three problems with what people do when they compare the cost of a VB and an ELCS.

The first is they don't consider the costs of a planned VB include the most costly EMCS and instrumental deliveries. You have to add these costs together and compare to a planned ELCS otherwise your methodology is fundamentally flawed and not a fair comparison. (Incidentally, it is worth pointing out that most medical literature and research is actually pretty worthless as even those doing the research have failed to acknowledge this. More often than not EMCS and ELCS are lumped together in data, creating a very misleading picture where the risks of emergency surgery are down played and the risks of planned surgery are exaggerated. This is not good for women as they are being misinformed about the safety of each).

The second thing they do is assume that all women who request an ELCS would have had a problem free VB. This is very much not the case.

Women who choose to have an ELCS rarely do so without some other medical reason - though this alone my not be enough to merit an ELCS - but in some cases it provides a very strong case. It is a myth that there are thousands of women making the decision based on fitting in a date and without regard to their health and the health of their baby.

Indeed there is an argument that these women attempted a VB a sizeable percentage would end up with an EMCS anyway. There is an argument to say in these cases that an ELCS is cost saving rather than more costly.

Bare in mind for example that there is a disproportionate number of older women who ask for an ELCS. Bare in mind that mental health reasons ARE health reasons but are often dismissed and belittled as not 'proper' health reasons. Bare in mind that many women who ask for an ELCS have previously had a very bad tear, and though technically could have a VB could end up with very nasty injuries that end up having to be repaired - something that is not recorded in national data.

And lastly, as mentioned above, they think the costs of birth end in a delivery suite, which is utter bullshit. The NHS bares the cost of any complication and any resulting mental health related issues.

There have been very few comparisons, which take into account any of these three issues.

NICE did look at this briefly, when they considered the costs of allowing women to request ELCS did a cost analysis based on the cost to the NHS of incontinence alone. Based on this there was an £80 difference. They concluded it was impossible to go through every possible scenario (which may indeed have included complications where an ELCS came out worse) and decided that evidence they saw with regard to one of the most common complications, that that there was no justification whatsoever to reject requests for an ELCS on cost alone as they were cost effective and affordable, especially as they also thought that the financial cost of forcing women to have a VB was also likely to be high in terms of mental health finances.

However they didn't consider whether women who asked for an ELCS were more likely to have complications of some sort because the data really doesn't exist in a force that can be used accurately.

HolidayCriminal Sat 15-Mar-14 13:21:11

Did OP actually say that obstetrician said CS would be best for OP? And honestly, I don't know if I'd trust obstetrician's opinion on what's best.

Acquaintance is expecting her first baby. She's entirely low risk but her husband is very keen for her to have an elective CS and not consider any other way of giving birth. They had a bit of a heated argument when she said she wanted the midwifery led unit at the hospital. Why? Because he's an obstetrician. All he can imagine are nightmare scenarios.

RedToothBrush Sat 15-Mar-14 13:23:59

But you can't trust either a midwifes opinion either - for much the same reason.

There isn't much independently done to help women...

Writerwannabe83 Sat 15-Mar-14 13:53:22

My Obstetrician gave me two options for my birth:

1) Have an ELCS

2) Be booked in for a set date to attend the hospital where they would induce me with an epidural already in place and see how things progress. She said she would put a time limit on the labour and that if I hadn't given birth in 'X' amount of hours they'd take me for a CS anyway.

Mr and DH spoke about it quite a lot and researched into the success rates of vaginal birth occurring with Option 2 and decided that Option 1 was best for us.

Only1scoop Sat 15-Mar-14 13:58:01

Writer....sorry to hear you have experienced this.

I had an elcs based on far lesser reasons and was never ever made to feel like I had to justify my choice to any of the medical staff I was saw.

Best of look for next week smile

Only1scoop Sat 15-Mar-14 13:59:40

That Would be luck....

Writerwannabe83 Sat 15-Mar-14 14:07:30

He said to me that it was very rare he saw First time Mothers in his clinic as usually it is women who have had previous traumatic births that have an ELCS...

I just looked at him and said nothing.

He probably just thought I was being a wimp and trying to avoid labour.

The problem is that then you start questioning yourself..... sad

justtellthemthis Sat 15-Mar-14 14:20:25

I've been denied cs and believe me you would not wish the worst enemy what I'd went trugh
damaged vagina damaged back, bladder
Years of hell just because my "lovely obstetrician" could not be bothered to make a proper decision!

So writer just ignore those comments

Writerwannabe83 Sat 15-Mar-14 14:24:45

That sounds awful justtell - I didn't realise that hospitals were allowed to say no? That's really shocking you were treated like that and then had all your problems thanks

When I'd had my Cardiology appointment I got home and the first thing I said to my husband about it was, "I have a feeling she's going to try and stir trouble up about my CS....."

I'm very lucky that my Consultant is a lovely lady, she's been so brilliant and supportive from the very first time I met her. If I didn't have her on my side I think I'd probably feel very vulnerable.

MummyBeerest Sat 15-Mar-14 14:27:39

Writer, I've seen a few of your posts and had read about your circumstances before. Best of luck!

It's no one's business "how" a baby is born anymore than how a baby is conceived. A successful birth is a healthy baby at the end.

You're going to be a great mother flowers

learnasyougo Sat 15-Mar-14 15:32:40

I had a 'cheaper' vb, but it wasn't cheaper. The damage caused by my vb had meant physiotherapy, setting a consultant urogynaecoloist, future surgery to fix it, bladder scans, x rays, a 7 night stay in post natal. it would have been cheaper to have had an elcs. I've been on the fence about vb or elcs due months now (I'm 37w) and have opted for a vb, but only just. I'd have no qualms in requesting an elcs this time around. my vb last time was more interventions and more surgery intensive than a cs, as it turned out.

it's none of your cardiologist's business. She is not an obstetrician, after all and will never have witnessed a difficult birth.

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