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Why do medics argue for VB over CS?

281 replies

EmeraldIsle81 · 22/12/2019 00:29

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!

OP posts:
SexlessBoulderBelly · 22/12/2019 23:46

@aurynne

Oooh let me pick your brains.
I’m 36+4 and I’ve been having multiple growth scans, baby is 3rd percentile. I’ve been told I’ll need a c section and they will arrange this ‘as close to 37 weeks as possible’

At 33 weeks I was told due to blood flow from the placenta I would need baby delivered in 7-10 days by c section as it’s safest. It never happened because the fetal medicine scan lady said everything was fine.. then had another scan which showed issues with placenta again and was told to prepare for c section Thursday just gone if not Monday (tomorrow) Had another scan on Thursday and was told to go home. I have another scan and review tomorrow and have been told to expect c section tomorrow. But after it being put off twice before I’m hesitate to believe it’s going to happen. They had an original date of 31st December that I was booked in for.

My scan report says I need a c section as baby will likely not tolerate labour and the risk of a emergency section is high... why is this? Just because she small? Obviously I will do whatever a professional tells me because they’re professional and telling me it’s the safest option. But I am terrified of the surgery, and I don’t exactly understand why I can’t be induced at 37 weeks, unless it’s genuinely just because she small.

My hospital has been pretty shoddy at telling me anything tbh. I had no idea my c section had even been booked until last week. But they continue to tel me to prepare for c section every time I go.

What is happening?!:(

aurynne · 23/12/2019 00:19

@SexlessBoulderBelly without actually having seen the scans and listened to your health care professionals have their discussions, I can only give you general information. By what you describe, it appears you have a small for gestational age baby (SGA) which is likely IUGR (intra-uterine growth restricted). This seems to have been caused by abnormal flow of blood from the placenta: for some reason not enough blood is reaching the baby, which is resulting in slower growth and a baby who may be experiencing a degree of oxygen deprivation already.

The degree of stress your baby has been through is hard to determine. I assume you're having frequent ultrasound scans and that they are regularly measuring estimated fetal weight, abdominal circunference, head circumference, femur length and dopplers in several vessels, which indicate the flow of blood the baby is receiving. In these cases it is very, very difficult to decide at which point to deliver the baby, and CS is often the chosen method because it avoids the distress of labour on a baby who is already compromised. Risk of damage and stillbirth increases the longer the pregnancy goes on, however the more premature the baby is at birth, the more difficulties he/she will have too, so choosing a delivery date is very difficult and the best professionals to do that are the ones who have been seeing you and measuring the baby's wellbeing.

Now, talking about mode of birth. During a normal vaginal birth, the pattern of contractions means that every time a baby and cord get compressed, there is a brief period where the flow of oxygen to the baby is reduced. This happens for many hours, and is heightened during the pushing stage. Healthy normal-weight babies are made to deal with this process easily, control the blood flow so their brain and heart are the priority, and return blood flow to non-essential organs as soon as the contraction is over. Babies who have been compromised in utero, are of smaller size and have received less oxygen may not deal with a normal labour easily though, and lack of oxygen during contractions may bring on stress and deprive them of oxygen much quicker.

By what you have told me, it appears that a CS is much safer method to deliver your baby, not because the baby is small (some small babies are perfectly healthy, just smaller; however there seem to be placental issues with yours, which would put him/her into the "growth restricted" category) but at the same time the obstetric team seems to be making a great effort to give your baby time in utero to develop, to the point that you are now almost full term (37 weeks). That is fantastic! Delivering your baby before 36 weeks would mean a long stay in NICU for your baby and you and your DH/DP having to spend weeks visiting your baby in hospital. At 37 plus, and depending on baby's condition at birth, you may be able to take your baby home very soon.

I am sorry you seem to be kept in the dark about so many aspects of what seems a stressful pregnancy. I wish they were taking you into account when making decisions and asking for your input. This is your baby! It is horrible for a mum to hear that not everything is right with your pregnancy but not being informed properly and have a chance to have your questions and concerns addressed.

One thing you can do to participate and monitor the wellbeing of your baby is, keeping an eye on your baby's movements. By now at 36 weeks you know what the normal pattern of movements for your baby is. If you notice at any time a change on this pattern, especially at night (babies normally are more active at night, and fewer movements during the evening are very significant), please call the maternity ward and go to be checked (your baby will have a CTG and have their heart mnitored). Not only with fewer/no movements, but also if suddenly your baby seems to go crazy and move non-stop, if this did not normally happen before. Do not wait hours for this, get checked as soon as you notice. Your baby's normal movements tell you that your baby is happy. A sudden change in the pattern of movements tell you that your baby is not him/herself and needs to be checked asap. A baby who moves little or not at all is a seriously compromised baby who needs immediate care. If you're worried, present yourself at the ward and demand a CTG. It is a simple procedure which can be started in 5 minutes and you should never be denied one, especially having a IUGR baby.

Would you please come back to this thread and let us know how things go? I would love to know when your gorgeous baby is born and how you guys are doing.

aurynne · 23/12/2019 00:30

Other things you could do to help you feel more involved about your pregnancy: has anybody suggested colostrum harvesting before birth? You can start expressing colostrum from now, so it is ready for the time your baby is born. Babies who are born a bit on the small size, like yours, can have low blood sugar levels at birth (be ready for midwives checking this regularly), and need to be fed regularly to prevent hypoglycemia.

Is this your first baby? If so, you may have the extra stress of learning to breastfeed with the pressure that "your baby needs milk NOW!". Expressing colostrum can give you that peace of mind of having some milk for your baby in case you find it hard to latch and feed, or if baby has some difficulty latching due to size/muscle development. It also teaches you a wonderful skill, helps you know your body better, stimulates milk production, and can make latching easier when the baby is here. Your DP/DH can learn too and be more involved with this pregnancy, and feed the baby the milk from the syringes after birth. Even if you cannot extract any colostrum (not every mum produces it antenatally in amounts sufficient forn extraction), the massage and stimulation can help the colostrum come earlier and increase the total volume.

Do you have any midwife/lactation consultant avauilable who can give you some syringes to collect colostrum and teach you the expressing technique?

Interested in this thread?

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SexlessBoulderBelly · 23/12/2019 01:30

@aurynne
Thank you for the information, that definitely sounds familiar and I feel a bit more reassured now. It is my first baby and I have just about started to thinking about trying to harvest as much colostrum as possible before any possible c section. We’re pretty pro breastfeeding in my family so I’ve tried to read up as much as possible. I will definitely ask at tomorrow appointments who could point me in the direction of getting some syringes to start actually collected. I’ve been massaging and trying to stimulate and currently just have a watery/cloudy substance coming through in tiny amount but it’s getting more by the day nearly.

I will let you know how we get on, you’ve given me some fab info so thank you for that! Flowers

GnomeDePlume · 23/12/2019 07:49

It is very difficult for women to get unbiased information. If you get given the leaflet TheDevilsPedicure linked to then most women will see that as the official view. When I had my DCs (20+ years ago) this was how I got most of my information apart from a 'giving birth' book.

My experience of maternity care was that it was very formulaic. This happens, then this happens, then this happens, bingo you have a baby!

Nothing prepared me for the reality of stop/start labour which went on for several days. Once in the hospital a midwife sat in the room singing to herself and knitting not noticing that I didnt know how to use the gas & air machine so that it would actually be some use.

The oxytoxypoxy drip machine was faulty so wasnt delivering properly (some staff already knew the machine was faulty). The heart monitor thing didnt work properly so they tried a scalp monitor but that wouldnt stay put because DC1's head wasnt actually engaged (which also hadnt been noticed). By this time many hours and shift changes had taken place.

Eventually they realised that DC1 was in distress and flapping started. Thankfully the obstetrician was called. He took one look at the whole situation and said CS now.

Perhaps a VB could have worked, who knows? I was left with the feeling that I was being looked after by a bunch of disinterested amateurs who couldnt see that the VB formula wasnt working.

3 years later I had DC2 by ELCS, it was suggested I didnt need to push for it. The experience was totally different. As it was a planned CS it was all very calm. Nobody was flapping. A far more positive experience all round.

Perhaps care is better now, I dont know.

OhTheRoses · 23/12/2019 10:15

Off thread but how's your dd doing @GnomeDePlume?

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