Why do medics argue for VB over CS?

[EmeraldIsle81]

Just reading so many threads where medical teams really argue with patients to do vaginal birth over Caesarean section when the patient wants a CS. Can anyone tell us why that is?

The uncertainty of vb, the risk of distress and damage to baby if vb doesn't go well, damage to mother, length of time in delivery, pain management. Midwives having to go to find a specialist if complications arise.

I just don't understand why all of that is so preferable to a patient wanting a CS where everything is prepped, planned, no surprises, quick procedure with the right people there in the room just in case, recovery is monitored and managed.

Thanks all!

@aurynne I'm not being snippy (honest!) but I find some of your posts a bit contradictory in the way they come across.

On the one hand you seem to be saying that women should be informed and then should make their own choice (I completely agree with that perspective!) on the other hand I get the impression that you think a woman who chooses a section without a medical "reason" is making the wrong choice? Apologies if I've misunderstood your thinking but that's how it comes across to me.

I think the issue I have with that is that all the statistics in the world can't account for individual feelings and preference. I have a friend who had an uncomplicated pregnancy, early 30s, normal BMI, fit and active with no underlying health conditions, spontaneous labour at 1 day post due date, hypnobirthing, MLU with midwife support, so ticking all the boxes for an uncomplicated VB. Instead she had a 36 hour nightmare that culminated in forceps and permanent injuries which have required corrective treatment and from which she will never fully recover.

I know it's only anecdotal but I just don't think it's unreasonable to say, actually I'll take the risks of a section over the risk of an outcome like my friend even if there is no medical "reason" for that choice.

I have had two sections (1 emergency and 1 elective) and I've recovered pretty well. DC seem unaffected although are still very young so I guess time will tell!

Yes the information on forceps in this country is terrible!

My NHS booklets given to me by my midwife described them as smooth tongs that ‘gently’ help the baby out. No mention of different types of forceps. Just making them sound really gentle and safe and nice. And also along the lines of ‘your midwife/doctor will decide if they will be the best option for you’- no mention of different scenarios where a c-section could also be a choice.

@IrishmMamaMia in a way, if we explained in detail every possible side effect and risk of any procedure, natural or not... everyone would be so terrified that nothing would get done. One of the problems with our human brain is, we are not very good at analysing risk/probabilities/chance. When you work as a health professional you are faced with this dilemma in everything you do or say. How much information is too much information? How much should I focus on this risk, or on that advantage, so I am not actually scaring that person so she believes she needs to do it? If I explaind to every single women every single thing that can go wrong with pregnancy and birth then nobody would ever have sex again.

I have seen forceps used in such a careful, delicate way, that an episiotomy was not even necessary, the baby did not have any marks, and the mother's perineum was intact. I have seen obstetricians pull the forceps so brutally that they had their foot on the operating table, just to give them more force to pull harder. I have seen mother's vaginas destroyed by an unneccessary episiotomy, and another mum whose vagina had horrific, quick, unexpected tearing after birthing quite a small baby... no one would have thought it could have happened, and there was no time to do anything to prevent it. I have had clients who were elated after an elective CS, others who absolutely hated it and did everything they could to have a normal birth afterwards. I have cared for mothers who had a completely natural waterbirth but ended up requiring therapy down the line to deal with specific comments from a midwife made during the birth. i have had a mum who had a home birth and had a horrific PPH (post-partum haemorrhage) afterwards, lost 2 litres of water, got taken to the hospital, and when she came back the first thing she did was phone all her friends to tell them about her wonderful homebirth, she was so proud of herself and felt so fortunate she had that choice, that the PPH was considered by her just bad luck, and did not affact how she viewed her experience at all.

The issue with birth trauma is, plenty of times times it is not caused by an actual thing that happened or did not happen, but by the perception of how the person was treated, what information they received and how her support people and environment helped her heal.

I prefer to be cared for by someone who doesn't think it's their job to protect me from unnecessary intervention and thinks an ELCS without medical indication constitutes such aurynne. And who doesn't think there's a global research consensus that attempted VB in low risk women is definitely safer than ELCS when actually, given that the research shows various risks and benefits, the answer to that question also depends on how I weigh them. It would not be for any midwife or obstetrician to decide whether eg decreased prolapse risk matters more or less than increased future stillbirth risk. I particularly wouldn't want care from someone who thinks chosen ELCS is akin to having a healthy organ removed because hey, the scar tissue can be quite similar. None of this would inspire me to trust that they would appropriately counsel me about risks and benefits of ELCS and attempted VB simply because none of it suggests they fully understand and accept them.

In summary: Accurate information, leave your ideology at the door, and I'll be the one to decide which risks are more significant. Basically as the case law and NICE guidance says. The UK does not always do an adequate job at this.

@Binterested I’m sure on one of the past similar threads somebody mentioned that a lot of calculating the cost of deliveries of the NHS only looked at the immediate cost of the birth and didn’t factor in that attempted VB have a lot of associated cost in the long term- lifelong incontinence problems for women, prolapses and repairs, much higher rate of birth trauma/PND/mental health problems for women who have attempted VB and end up with EMCS or instrumental, more chance of claims for poor outcomes eg brain damaged children. Once you add up the longer term costs there really isn’t much difference..

@Sunshinegirl82 I actually agree with all you say in your post. Choosing a CS is not "right" or "wrong", it can only be "right" or "wrong" for the mother who chooses according to her own experience. I think the most important part of the discussion is that the woman needs to have access to information which is as unbiased and easy to understand as possible.

I think the contradiction may come from discussing "adverse outcomes" and "positive outcomes" of different interventions. Research can tell us what happens in a population that does "X", but can rarely tell us what the real people involved thought about it, or felt about it, or how happy they were with their decisions. There is research that addresses this, however as it is quite onerous to collect personal opinions, it is usually done with a small number of participants and very, very biased by their personal beliefs, lifestyle and experiences.

Also, when we talk about "healthy mothers and babies"... what does that really mean? There is no "standard" woman whose health is 100% perfect. We can never know when a baby is 100% healthy. The only time we know whether another option would have been better is when the option we chose tiurns to custard. And even so, we still cannot be sure that choosing the other option would have been any better.

In summary, i never intended to say that one option is "better" or "more right" than the other. I tried to argue the initial question in the thread, which was "why do medics argue for VB over CS". Which, admittedly, can look like I am defending one versus the other.

I hate these threads as they always put sections in such an awful light by making everyone jump to the defence of natural birth 😔

' I have no idea what Montgomery v Lanarkshire was about'

And yet on you go.
You have no idea of what the situation is in the UK and yet still on you go.

I had no discussion of risks of induction. Ended up with emcs. Maybe, if I had known, and been offered a CS instead, I would have taken it.

Yes also re forceps.

You cannot go on at women in a different country for wanting certain choices when you clearly have no idea what the actual situation is.

And again, in UK elcs simply means planned. Vast vast majority are for medical reasons (Inc psychological eg traumatic first VB).

'Choosing a CS is not "right" or "wrong", '

Your very first post on this thread that got so many people's backs up very much indicated that in your view a CS is a terrible choice.

Choosing a CS is not "right" or "wrong", it can only be "right" or "wrong" for the mother who chooses according to her own experience

Absolutely this. I think the problem with maternity care is that it’s pretty paternalistic and it’s seen that women should be told what is ‘right’ or ‘wrong’ for them by others and go along with it.

' A baby been born by CS does no acquire the mother's vaginal microbiome, and this has life-long consequences (regardless of how much skin flora the baby acquires through skin-to-skin). Babies born by CS show abnormal skin and gut flora, and longitudinal studies are now showing significant increases in these babies having allergies, eczema, IBS, Chron's disease, and all sorts of immunological problems when they grow up.

Being born by major surgery is not how our birth was intended, and no amount of reasoning based in pain and inconvenience will change our physiology to make CSs good for us.'

I have no say in what other people choose to do with their backs when they read my posts :)

Indeed neonglow

I analyse and assess risk daily in my professional role. I also did it 25 years ago in my first career. I just needed the facts to make my own decisions. As I did with DS2 and DD. DD was a vaginal birth; she was also large. The difference was that I was better experienced, asked better questions and ensured I was cared for by very very experienced midwives. My care was therefore optimised. It makes an enormous difference.

Reading again this is an appalling thing to say

'no amount of reasoning based in pain '

I mean FFS.

And yet now you are all, oh forceps are bad, man.

...and I stand completely by your quote of what I said. Where in it does it say a CS is "wrong"? I am just listing a number of conditions babies who are born by CS are more likely to suffer in the future, so mothers can take it into consideration when making their decisions. Would you prefer that risks and side effects were not told? How would that make decisions any fairer or even easier?

No amount of pain will change our physiology to make a surgery good. How exactly is that invalidating that pain main be an important factor in a woman making a decision? She may choose the surgery, and be elated with her decision. And at the same time she will be informed of possible effects that surgery may have on her baby, which will help her take care to minimise that risk for her baby in her future. How is that bad in any way? Would you prefer the risks be hidden from her?

I still cannot see the contradiction.

So no amount of pain to the woman makes a CS worthwhile.

Jesus.

Your pontificating about the situation in a country where you don't know anything about how the health service operates around pregnancy and birth

Your dismissal of women's accounts of birth trauma

Your statement about women's pain being pretty irrelevant

All awful

You would think by the fact the majority of posters who have read your posts have responded to say they make them uncomfortable/disagree would tell you something.

@Fraggling absolutely agree with what you say regarding how risk of induction is not explained. I don't personally have experience if it but have heard lots from friends and read on here and while it can be fine it often leads to difficulties that are definitely not explained to first time mums here.
@aurynne you're not getting my back up so don't worry just the same old inconsistent info I expect from midwives. Sorry!

@aurynne can I ask do you honestly believe the risks of vb and c-section are both clearly and accurately presented to women? Are the risks presented equally in your opinion?

Not many, if any babies born via CS suffer the often devastating results of hypoxia.
My Aunt was a GP and talked me in to having an ELCS for my first birth, subsequent births then followed suit.

Birth is such an unpredictably risky business, I'd rather have a medical surgeon overseeing it than a midwife and I say this as a nurse practitioner. I have the utmost respect for nursing staff, their professionalism, experience, knowledge and level of education.

Also if a woman doesn't want to risk damage to her pelvic floor/sexual function when she doesn't necessarily have to, why should she?

If you would stick to commenting on how things work where you are and not generalising that would help.

For instance you obviously assumed that women who are induced here are told of the risks, and have real choices. You had no idea about our rate of instrumental deliveries.

If you are in NZ as you seem to indicate, can't you see that maybe just maybe, things might be a bit different? They are completely different countries. The population size and density are totally different. I imagine our health services are funded differently.

Start listening to what uk women are telling you.

UK women are telling me that they are not being informed about the pros and cons of the interventions they are having. I am saying I wish they were. @Thedevilspedicure I have no idea if women are explained those risks, I can only hope they are and make sure the women under my care do get those explanations, and the opportunity to make their own choices without coercion in either way.

I am not commenting about how things work in practice in my country or in the UK. I am talking about side effects and risks of procedures and interventions which work exactly the same anywhere they are done. As far as I know, the guidelines in UK in CS, induction of labour, epidurals, etc are identical to NZ ones (that's why UK midwives can come and basically start working in hospitals here straight away, although they need extra qualifications in Pharmacology and Cultural Competence if they want to work in the community). informed consent and choice, at least in principle, work the same too. i have accessed NICE guidelines and they are basically identical to RANZCOG ones. So yes, I can comment about procedures as much as I want and they will be relevant in any country with Western medicine.

@Fraggling I often use UK stats in my reports and we often use them to review guidelines in NZ. So yes, i am informed of the intervention rates in yours and other countries. Why don't you just stick to debating instead of trying to silence me?

I had an emergency section then vbac and i would choose the vb over cs any day. They recovery is much faster plus its what our body's are meant to do!