NICE consultation on draft quality standards for Caesarean section - what are your thoughts/experiences?

Women who have had a CS are offered a discussion with a health professional about her CS and birth options for future pregnancies I have just signed the consent firms for CS4. They spent ages going over the risks but tbh I don't really have an option at 32 weeks! Information should ge given pre pregnancy.

Post natal care was v scant. They wouldn't let me get home early but weren't able to help me. I was also on crutches and with tubes in my arm I couldn't use them.

Also yes to having some choice over delivery & not being down to the cons.

TheSamling's post has reminded me: credit where credit is due. The antenatal and postnatal care, not to mention the team who delivered my baby at Birmingham Women's Hospital, were first class. I'd definitely choose there again for another pregnancy and birth.

Reading some of these I feel very grateful to the lovely team at Hull mother and baby unit where I had my emcs. From the moment I arrived in the ambulance the situation was turned from a panicky, stressful mess into a calm, controlled, peaceful and very happy experience.
I got the pain relief I needed straight away, they listened to everything we wanted as soon as DS was born. DH was in the operating theatre, he got skin to skin contact with DS straight away, he got to cut the cord, DS was breastfed by me within minutes. The C'S itself was amazing, upbeat happy, almost celebratory atmosphere that totally set DH and I at ease and made it a very special time for us. (hmmm I wonder if some of that was the drugs, but DH said it was fab too!)
post natal care was FAR superior to my Vaginal Birth experience with DD, (which was shockingly crap) in fact te whole experience was much better than first time round.
The only thing I would have changed was having a room to myself, but that's being VERY picky as I was in a room of two, compared to 8 in York, so minimal disturbance.
I honestly don't think they could have done anything better for us. We went home happy, rested and looked after, it was the most amazing start in life for DS and they saved him and my life into the bargain. it was the care that every woman and her baby should have. My introduction to motherhood and nod could have been avoided with DD if the team at York had been Half as good tbh. It really makes a HUGE difference to get good care from a respectful and understanding tem!

My EMCS was the only 'enjoyable' part of my entire labour. The rest - before and after - was was pretty bloody useless.

Picking up on one point in the consultation document...

Women who have had a CS are offered a discussion with a health professional about her CS and birth options for future pregnancies - I wasn't, and haven't been, offered any discussion about this. I am quite certain on my choices for a future pregancy, but this certainly wasn't part of my aftercare, and it would be useful if I was unsure what to do for another pregnancy.

However, as poppy puts it, "I never wanted a vbac, and I'd like that to be recognised as a valid choice". This, definitely. It's only finding out recently from friends that cs's are allowed for the next baby that has reassured me, I didn't realise quite how scared I was by the thought I might be pushed in to a vbac. Though I am worried about all the hoops I will have to jump through, and that they might schedule it so close to my due date in the hope I will go in to labour on my own. I am terrified of natural labour now. I appreciate that women should see a professional to discuss their choices, but I think the tendency to try and override the mother's natural feelings on an elcs v vbac is terrible; if a mum is already scared of natural labour, why make her pregnancy even more stressful by continally pushing her towards something she doesn't want to do?

A few other things that cross my mind:

My baby was poorly, hence the emcs, and was rushed off to NICU. I didn't even get to see her, let alone hold her, which still plays on my mind even a year later (and is part of the reason why I don't want a vbac). Now of course I know that if my baby needed medical care immediately that is far more important than seeing or holding her. But I suspect everyone in that room knew she would be that poorly when she was born, and I just wish someone had told me that. I wish someone had explained it to me, so I wasn't sitting there a day or two later, once the drugs and shock had worn off, thinking - hang on, what happened there?

Also, I had no explanation or instruction of how to get out of bed, how to look after my wound, that sort of basic care. Like several other posters have said, the postnatal care was absolutely shocking. I don't think one-on-one midwife care is anywhere near achievable, but just the sight of a midwife or nurse would be help. The women in my hospital were just left in bed on the ward with the baby, and no nurse or midwife even popped in to see if everyone is alright. I can't even begin to imagine how the new mum's three hours out of a cs coped with a newborn baby.

The NHS currently seems very happy to stress that it is major surgery if you are trying to get an ELCS - but then very happy to ignore that you've just had major surgery when you are on the postnatal ward.

Lastly, if a mum has had a cs because the baby is ill and the baby is then taken to NICU/SCBU, please try not to put her on a main ward with other mums and babies wherever humanly possible. I know beds in private rooms or small wards might not be available, but is it so hard to just have a piece of paper that says 'move Ms X to a more private bed when one is free'? The first night on a shared ward with newborn babies crying and mums chatting was living hell for me. I ended up at the nurses station at midnight in hysterics because I hadn't slept for three days and my baby was poorly, and I was treated as if I was overreacting and a completely pain in the arse to them. Yet they finally admitted there was a bed free in a side ward for mums with babies in SCBU! I even saw they'd written in my notes for that night that I was 'over-emotional'. A little bloody compassion, please. I honestly don't think that any of the medical staff on our postnatal ward for 30-odd women had any interest whatsoever in babies or in acknowledging what the women had been through.

I had a very positive ELCS in April 2012 with my second baby.

I delivered my first baby vaginally in February 2009, but developed coccydynia as a direct result of the 2 hours it took to push her out.

Therefore, I requested an ELCS second time in order to prevent further damage to my spine. My consultant was initially very dismissive ofthe reasons why I wanted the CS. My impression was that he was
inclined for me to deliver vaginally again because the coccydynia might not recur; despite me informing him of my independent consultations with a physiotherapist an chiropractor - who both said that I was at a much higher risk of worsening the coccydynia.

The individual merits for me were only given as: 'you'll know your baby's birth day'. Then the demerits were things like: 'you could need a hysterectomy'. All very frightening. All true, of course, but not given in a balanced context.

In the end, due to the NICE November 2011 guidelines, I was offered the CS because I had informed myself of the risks. I'm emboldening the last statement because, had I not independently consulted the NICE guidelines and consulted other relevant HCPs, then the risks that applied to me had been given way out of context.

I was also told by the OB that CS is a "violent" mode of birth for the baby. I didn't say anything, but I did think 'it couldn't be more violent than my poor DD1 who was eventually suctioned out of me because I was literally too physically exhausted to push anymore.'

So, in conclusion, if I were to see a consultat obstetrician again to request a CS, I would like to hear a more balanced, personally contextualised account of the risks and benefits of ELCS and a planned vaginal birth.

Ultimately, I would like ELCS to be regarded as another legitimate birth option. There is still stigma attached to CS; mostly because of the damaging 'too posh to push' mantra that has become normative within out society. No, its not due to being too posh. This attitude must change somehow. Through unbiased, clear information, I think.

And for what it's worth, my ELCS was calm, peaceful and extremely positive. Not "violent" at all, as far as I am concerned.

I hope this helps.

A CS can be a good experience, I "enjoyed" mine, but women who have CSs should have choices like women who have vaginal births, for example delayed cord claming IS possible with an uncomplicated CS, at my local hospital vaginal birth women have this choice but CS women do not, also slower removal from the womb to "squeeze" the lungs and whether or not to have the screen down and delivery onto mothers skin etc... there's no choice! its all down to the particular consultant's way of doing it! All of the above are possible and reasonable if a CS is going to plan, and noone would deny a vaginal birth women those choices, but once you are having a CS you are having the kind of CS the consultant likes doing! Imagine the same attitude applied to vaginal births!

I requested a cs after dc1 was born by emcs. The consultant was initially dismissive, then scheduled the op as close to my due date as she could. If I went into labour I was to try for a vbac.

I ended up with another emcs after 24 hours of back to back labour.

I never wanted a vbac, and I'd like that to be recognised as a valid choice.

Don't dismiss requests for a CS as being from women who are 'too posh to push' - after carefully considering my options, I asked for a ELCS - I was completely dismissed out of hand and told that a 'big' healthy woman like me would have no problems - I ended up with an EMCS - I didn't care but it must have cost the NHS much more money .

Having a CS can affect breast feeding and bonding, I only found this out thanks to Mumsnet - this should have been properly explained and when my DS was failing to put on weight it would have been nice if my DH hadn't had to almost make threats before my DS was 'allowed' to have a bottle.

Please be sensitive to the medical needs of the mother, I could have cried when I asked for some sanitary protection as I knew I was bleeding heavily, the very young nursing assistant just put it at the end of the bed ........ I couldn't reach it. Yes, I know I should have just asked her, but I was incredibly weepy, (DS diagnosed with serious health problems after birth - nothing to do with the CS), dosed up with GA etc etc - a little kindness and thoughtfulness would have been nice.

This was all 12 years ago, no lasting problems for either my DS or I so we did have a happy ending, but hope comments may be useful .

I had an emcs so I can't comment on many of the points as they are geared to elcs/ planned cs.

However, I absolutely agree post natal care is dire. I was ill, ds was suspected to be ill but I felt pressured into doing far more than I should have on less painkillers than I needed (dh had to keep asking for them otherwise I'd be forgotten). I would have loved a debrief as detailed in the guidelines, I had a very short consultation with a healthcare assistant who didn't know many things as she had just joined.

Nearly 14 months later I'm still not sure things are right but I find gps are dismissive of anything to do with gynaecology after childbirth, covering themselves with the catch all that things are just different after it. Proper follow up care with an expert would be brilliant, perhaps an out patient appointment?

Post-natal care should be covered by any new guidelines.

The info and help before the op was fine, the op itself was wonderful, but from the recovery room onwards I was on my own.

It was the most horrendous experience and really ruined any chance of breastfeeding and bonding properly with my gorgeous newborn. I was in so much pain and it was only 'healthcare assistants' who came when I pressed my buzzer, I thought they were midwives and their advice and help varied from crap to downright damaging. I cried and cried, as did baby, and received no help. I was referred for 'enhanced postnatal support' by the midwife doing the release form 2 days later, which consisted of a couple of judgy and useless HVs turning up a few days later, by which time the damage had been done.

One to one midwife care for every woman postnatally until she leaves hospital. Not just helpful but essential.

Everything before the birth was professional, caring and great - I struggle to understand why postnatal care is not seen as important. It is the most important bit!