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 so is it right that risks on CS are not separated, ie ELCS stars lumped in with emergency stats?

@Thedevilspedicure in most research I have read, they separate ElCS from EmCS. The compound risks of EmCS is not due to the surgery irself, but to the fact that an emergency CS is called when they are already life risks for the mother and/or the baby. So of course outcomes will be worse. Emergency CSs are often done because a baby is compromised and stressed, or a mother is deteriorating, after the effort of labour. You don't need research to know the recovery is going to be much tougher both for mother and baby.

@christmasathome It's possible for some women to have a VB without any permanent damage, it's possible for some women to survive a VB with damage, some women will die without medical intervention. Not everyone is "made" to give birth vaginally.

Natural does not equal good.

Anyone saying about cost, how much does it cost to keep a woman in for a very long induction? I was in nearly 3 days before I was taken to theatre for emcs, if they had said emcs straight away I could have been done & ready to go home by then.

@Sunshinegirl82 agreed, but then you have to admit that "intervention" does not always equal good either. I have seen plenty of women undergoing elective CS have massive haemorrhages and need several units of blood, with a long, painful recovery. I have seen plenty of young first-time mothers needing a hysterectomy due to that same haemorrhage, with the devastation that causes long-term. I have seen a couple of mothers die as a result of a blood clot after an elective CS (google "pulmonary embolism", which is one of the risks increased by CS). I have seen a mother die after sepsis, and plenty others spend time in ICU for the same reason (some ending up with long term disability), after an elective CS. The last one was two weeks ago... a massive abdominal infection which is still being regularly drained. I have seen two mothers lose their uterus dur to placenta accreta and plenty others losing almost all of their blood and requiring multiple surgeries. Don't ask me to tell you how the mother with placenta percreta is doing. I have seen plenty of babies enduring difficult CS extractions requiring forceps (not every mother knows that some CS require forceps to extract the baby) and requiring long stays in NICU to recover (yes, also suffering from hypoxia during the process. This happens much more often with breech babies). Vaginal birth can have dside effects, but CS is hardly blameless. How many of these get mentioned when a woman asks for an elective CS "because vaginal birth is risky"?

@aurynne it's mentioned lots of times on these threads that the stats aren't separated out and aren't clear, and aren't taking into account age and other factors.

What about mental health of the mother? Do you think the risk to mental health with a traumatic vb with lasting complications for mother and baby is considered proportionately and consistently?

Mental health is very much considered here in NZ when discussing option, yes. The more I read the more I am convinced that the only problem I see is lack of information.

@aurynne this leaflet is from a leading hospital here. I'd be interested on your thoughts...

www.ouh.nhs.uk/patient-guide/leaflets/files/10405Pcaesarean.pdf

Actually, they really hammer home the risks of a section, that's sort of the point.

Both routes have risk, risk is innate to birth. I would never argue otherwise. However, the focus of the communicated risk is the risk of intervention, particularly the risk of sections.

There is a VB = natural = good mentality that perpetuates because the risks of VB are never discussed.

In my first pregnancy at no point was anything to do with the risks of labour really discussed with me. There was some discussion about epidurals increasing the risk of intervention and that was about it.

I ended up with an emergency section as DS was in distress (good job as turned out we both had an infection and we both spent over a week on IV antibiotics post birth). I opted for an elective second time round (for various reasons) at that point things like the accreta risk were moot for me personally as I had already had one section (thus incurring the risk) and I don't plan on more children.

What I'm saying is that the perception of risk is skewed (in my view) because if you only ever discuss the risks of one course of action and never mention the risks of the other it will seem, on the face of it at least, that there is an obvious "better" choice and, as we agree, that isn't the case.

Wow @TheDevilsPedicure, thank you for that resource. My thoughts after a first quick read is that Oxford Hospital is seriously trying to reduce their rate of CS. I had never read such a "pushy" guideline and to be honest, parts of it makes me feel uncomfortable as a maternity health professional. don't think it is reassuring on any way for women who are anxious about giving birth vaginally and are trying to make up their mind, and definitely paternalistic for women who have already decided to have a CS. It seems there is a new breed of "conscientious objectors" to CS as there are to abortions! I may actually print this and show it around in the hospital where I work after the Xmas holidays.

That's what I mean about hammering home the risk of a section! The information is just so unbalanced that it really isn't possible to make an informed choice.

I would summarise that guideline as: "If you don't want a vaginal birth, we will do our absolute best to convince you to have one, and if we fail, we will send you somewhere else"

TheDevil'sPedicure risks of vaginal birth somewhat understated I'd say.

@aurynne thanks for reading and sharing your thoughts, I agree with you. I find that leaflet appalling on so many levels. The main thing being that they will not 'allow' you to have a c-section to the point where you have to go to another hospital. Shameful. I also don't think the risks of vb are accurately presented.

By all means of course there are risks to c-sections but vb comes with risks as well. Neither is 'better' than the other, we are in 2019- women should be given the facts and have autonomy over their own bodies.

@OhTheRoses it's hideous isn't it. Completely minimising the risks of vb

That's fairly accurate.

To me reading that it reads like:

CS = possibility of death, hysterectomy, poorly baby, compromised future pregnancies, long stay in hospital all really quite likely.

VB = bit sore, little bit of weeing which we can sort with a few exercises.

I just do not feel that is in any way representative of reality. I think this is why so many women feel strongly about the right to a section because it feels as though everything is set up to bully you into a VB regardless of how you feel.

@thedevilspedicure the irony is that, in my opinion, with leaflets and attitudes like that they will achieve exactly the opposite to what they are intending. Women who want a VB will attempt it. Anxious women will be more anxious. Women who want a CS will get more set in their ways, more vocal and feel more discriminated against; they will not even listen or process the message.

I had two ELCS due to extreme (I mean extreme) tokophobia. I dread to think the state of my mental health if I hadn't been 'allowed' ELCS.

When presented with the risks of vb vs c-section given I was young, slim and in very good health, the risks of c-section were low. Given the risk of death was so slightly increased (and to me not baby) I was prepared to take that choice. Given they had a reduced risk of brain damage I actually saw it as a good thing for them.

FWIW I had great experiences with textbook recoveries. Hardly pain free but it was manageable and I was back to normal quickly. Or certainly able to do things as usual very soon. It didn't affect breastfeeding either (my DS having a tongue tie that they don't bother to check for did but I still succeeded in breastfeeding him- despite the NHS doing nothing to support it, not because of them).

I wasn't aware of the microbiome thing at the time but it wouldn't have affected my choices. The fact is so many people born naturally have allergies- if everyone born naturally was allergy free it would be different but that's not the case.

What makes me really sad is that I have lived with the after effects of DS1's birth for 25 years and actually I thought I got off lightly with a xmall tear and no episiotomy. But my bladder is shot and it has taken alot of physio not to pee with every brisk step. I have a severe rectocele and a weak anal sphincter (hideous).

The saddest thing is that I will need surgery in the next 5 years. I have great consultants - because I pay. I have already spent about 1500 on physio; 1500 on colonoscopy to make sure no nasties. A couple of ops when I retire ahead privately.

GP has been very dismissive until I have said "happy to pay - insured". I am quite sure my treatment and potential treatment would not be available if I were reliant on the NHS.

They used a ventouse during my CS, no one told me before that there was a chance of that.

@OhTheRoses that is hideous. So sorry that you are dealing with the consequences of a mismanaged birth and that the NHS is such a shower at dealing with this.

I'm happy to admit as well that the greatly reduced risk of pelvic floor damage and the eliminated risk of 3rd and 4th degree tears would have been enough reason itself to request a c-section, tokophobia aside. I was honestly happier knowing I had an absolutely tiny increased risk of death, but knowing I wouldn't suffer tears or damage like that.

That leaflet is awful. Patronising, unbalanced and inaccurate.

I have seen that hospital mentioned before by the birth rights charity- their c-section policy seemed be causing a lot of distress to women who had real genuine needs for a c-section. I know their guidelines also made a lot of women have no choice but vbac.

Is that leaflet still produced and distributed to women?

@neonglow I got that leaflet straight from their website tonight

I do feel CS risks, pain are downplayed on MNs & that birthing options are often presented as VB = bad tearing, incontinence or CS = absolute breeze. Giving birth is hard whichever way you do it & no way is 100% risk free for mother & baby. I felt awful & guilty after my CS because I find it really painful the first few days but thought I was abnormal because loads of posters on here are shopping on day 2 & driving on day 5.