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!

And yes I am aware that my sister isn't the subject of a medical study but looking at people I know (which isn't the biggest sample size but it's all I've got, I don't know everyone) I don't see that link. And right now, that's the best I have to go on. Will your comments echo in my head months/years down the line, possibly but hopefully not. If these risks are so huge then why are they not discussed, why are we not pushed towards vaginal delivery? I chose a c-section based on possible risks as opposed to apparently very real ones that nobody mentioned?

I am not sure in your case, as I live and work outside the UK and the maternity system here is different, and we are not in a dire situation in maternity care as the NHS seems to be according to the news and statements of many NHS midwives and obstetricians.

When I worked as a community midwife I provided this information to all my clients, however a continuity midwife sees her clients dozens of times during their whole pregnancy, which makes it easier to talk about these issues in small, easy-to-digest chunks. A consultation with an obstetrician, however, is quite short and often only the most obvious - and short-term - side effects of particular interventions are discussed. Families, in my expoerience, often do notn ask specific questions. Plenty of health professionals, especially those who have been working in a similar way for many years, are a bit slack in keeping up with the latest research, so often are not aware of the latest findings (the importance of delayed cord clamping or the benefits of microbiome seedings, both now performed routinely in New Zealand, took years to be accepted by a lot of obstetricians and neonatologists, even though the former resulted in a reduction of mortality in compromised babies of about 25%, which is massive). Others may have personal interests in a particular intervention (obstetricians sometimes favour CSs because they are planned, are finished in less than 1 hour, fit in with their personal agenda and the fact that they perform many and often gives them a sense of control which minimises risk in their mind). Also, obstetricians do not see the hundreds of women who have uncomplicated, normal births so they are often biased towards interventions they perform and consider "safe".

Sorry OP I've derailed your thread.

well put aurynne as a retired l&d nurse your perspective is spot on.

@goingtoneedabiggercar you, as a woman and as a mother, made the decisions you made with the information you had available and with the best intentions in your mind. No one, regardless of knowledge or background, can consider 100% of evidence, because no one knows all the data, and even if some super hero of the mind could read and remember every bit of evidence, what we know changes constantly, ther are new developments and discoveries, and knowledge changes and evolves. You made your decisions based on your own knowledge and there are hundreds of other factors which will affect the life of your children and family members in multiple ways. Mode of birth is only one.

As a midwife I work with families who had a normal birth without complications. But then they live in situations of domestic violence. They do not provide their children with a safe, nurturing environment. They neglect their children and put them in extremely dangerous situations. believe me, i'd much rather these children were born by elective cesarean section but lived in an envirunment full of love and nurturing. Their lives would be much better.

I recommend you to read "the First 1000 days" (google it, there are plenty of amazing videos by one of my favorite researchers and science communicator, Nathan Mikaere-Willis). He takes the latest evidence and explains it in ways everyone can understand and use every day. He talks about many, many ways you can help your children and family have an advantage in life, and avoid other circumstances that pout them at a disadvantage. Life is about making the best you can, and by your words you seem to me like someone who wants to achieve the best for her family. Just by having someone like you, your family already has a massive advantage.

I am sorry if my scienc-y language made you anxious. it was not my intention. The data is useful just when you put it in context. Your sister will be fine. your children will be fine. if you had a CS and read this information, perhaps things you could consider is to make sure your children nutrition includes plenty of pre and probiotic foods which will help develop gut flora. Or you may focus on the most important advantage of all: give them love and security :)

Does anyone (@aurynne?) know of any studies (especially for the risk of still birth and complications for baby and mother at birth), where the stats separate out ELCS from EMCS? If so, could you please link to these stats. I have been trying to research but almost everything I've found conflates the two. Thanks.

@aurynne that’s really interesting thanks
Shortly to have my 3rd induced labour. I’ve had complications with my pregnancies and this time for the first time I’m going to be induced early, but I’m hopeful for another successful vb.
Ime recovery time (even with surgery for 3rd degree tear first time) is much quicker. With my second delivery I was very well physically. Your info helps me to get in the mindset to deliver my baby vaginally as well, all being well 😀

Can I just point out that we have preventative surgery all the time and not just to ‘fix a problem’ that already exists? For example my husbands wisdom teeth were removed before they caused issues as it was felt there was a strong possibility of there not being enough room in his jaw. I had some growths removed from my back as there was a small chance (like less than 1 in 10) that over time these may change to become a usually non-lethal from of skin cancer.
Elective CS are rarely done just because the mother fancies it - there is usually some risk (maybe small) that she is seeking to avoid, even if this is simply mental trauma of a bad VB.
Having had a bad VB myself (retained placenta, pph, then pre-eclampsia after delivery) I was told that I still wouldn’t qualify for an ELCS - I chose not to have any more children rather than go through the risk of having all that again.

I am always bemused that, in all other healthcare treatment patient choice is enshrined and it’s drummed into us that patients have the right to choose treatment options and even make poor choices provided they have capacity to do so.
But with birth and neonatal there is only one ‘choice’ that is acceptable- natural VB without pain relief followed by ebf. Why is this ‘natural’ narrative so strong?

I had a huge life threatening pph, and vividly remember being told afterwards that a natural birth was much safer than a cs for pph if I were to have another child (I didn't, was fairly traumatised after this one!)

Quicker recovery, less time in hospital so cheaper for the NHS, better for you and your baby in terms of various things eg baby risk of allergies and asthma etc.
They only recommend a CS if on balance it will be safer for you both.

It's the unpredictability of a vaginal birth and that the statistics are not the same for every person. I had an EMCS with my first and by the time I delivered was exhausted. I'd been in 'labour' for what felt like days. I was given the option for my second of either a cs or vb but I had to do my own research. I was told everything above about it being better to have a vb etc. But on carrying out my research I found that given my first baby was over 9 pounds the chance of my successfully having a vb with my second was really unlikely. Especially given I would have had continual fetal monitoring. I am very glad I made that decision because at 39 weeks of pregnancy that second baby was well over 9 pounds. I'm sure if I'd attempted a vb I'd have ended up with an EMCS. So you have to look at the statistics and use them with an eye on your personal situation.

Vaccines are a human invention created to prevent disease. Surgery was created to correct something gone wrong, not to prevent disease from happening. An elective CS is a major surgery performed on a body which is perfectly healthy.

I wasn't perfectly healthy, I was dying of HELLP syndrome. My C Section saved my life

Because an uncomplicated vaginal delivery is really really easy to recover from. I went home 6 hours after mine with DC2, and was physically And mentally well straight after. I had a complicated instrumental VB with DC1 and that was horrific to recover from physically and mentally, but probably no worse than some EMCS. Birth education is an important factor in managing natural labour and delivery, and that was a big issue with my first birth. I didn’t understand my body or how to help it do it’s thing (positioning etc). Given the chance of a natural delivery I’d always try for that, but based on my experience I would think twice about induction as I think that is implicated in many difficult deliveries

Women are built to give birth. It's the most natural wonderful thing.

FWIW my DH is a hospital Dr who routinely performs CS’s.
I’m currently 7 months and my GP offered to request a CS for me at 38 weeks due to how sick I’ve been.
DH strongly thinks bad idea and has encouraged me to ignore this and try to have a VB.

CS is major surgery. People like to forget that. It takes significantly more time to heal and whilst it may be ‘less common’ to have complications they’re much more severe when they do occur. You can’t drive or do anything physically strenuous for 6 weeks, so unless you have someone at home to assist you 24/7 during that time it’s pretty tough. It’s common for women to not heal well/get wound infections/pull stitches as they ‘have a baby to look after’ and their DH went back to work after 2 weeks.

My DM had an ECS with me almost 30 years ago and still has mild nerve damage and a noticeable scar 👍🏻

NoArmaniNoPunani

I wasn't perfectly healthy, I was dying of HELLP syndrome. My C Section saved my life

That's because your CS was not an elective procedure (which is what we have been talking about all the time) so everything I said does not apply to you. Your surgery was life-saving, both for you and your baby, so whether it increases your baby's chances of having eczema in the future was probably in nodoby's mind at the time.

I was strongly advised by both midwife and doctors to have a CS for my second one after severe birth injury which needed surgery after by first (VB)

The cost and recovery time of major surgery?

I've had one VB and one ELCS (chosen due to a risk to baby I wasn't prepared to take).

My DS delivered through VB had nerve damage from his forceps delivery and was a very traumatic birth. The ELCS in contrast was a lovely experience. I was able to bond so much easier with DS2 and the recovery although longer was much calmer.

I suffer from IBS and eczema and I was a VB.

It's all anecdotal, I know that. But I strongly believe that VB is a great option if it's straightforward...but you just can't guarantee this.

Money is certainly a factor in this. It would be crazy to think otherwise.

@CatintheFireplace it is well known that both maternal and fetal outcomes are worse in emergency CS compared with elective CS, which makes sense, as emergency CS are performed precisely because there is a risk or emergency that outs the life of the mother or the baby under threat.

Here are some articles, unfortunately some are pay-per-view:

link.springer.com/article/10.1007/s00404-017-4445-2

pdfs.semanticscholar.org/1367/55b06ed814ae74a68548c356a91d17941838.pdf

pdfs.semanticscholar.org/e235/9f271376c6f7897f2caae318ac29c599f020.pdf

www.sciencedirect.com/science/article/pii/S0140673618319305

www.sciencedirect.com/science/article/abs/pii/S0378378215301249

bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1028-3

Plenty of great sources also in the references.

*puts, not "outs"

CS’s are not ‘bad’ or ‘dangerous’ and if there is a valid reason why it’s better/safer for you to have an ELCS then yes that’s no doubt a good option.

BUT if you’re a healthy woman with no known complications/issues then an ELCS is silly. It’s choosing major surgery over a natural process. I think that’s what most medical professionals believe and try to promote!

A CS is not by nature an ‘easier’ way of giving birth. Recovery from a CS compared to a normal VB is much harder and longer.

@aurynne I've read your posts with interest - I had no idea of the additional risks associated with CS. I had an EMCS with my DD and then a VBAC with my DS. I'm one of the bloody-minded folks that wouldn't accept being beaten by something my body should be able to do itself. Thankfully for my own sanity, DS came vaginally. The births were so completely different. 4 years on and I still struggle with the effects of my EMCS. I haven't noticed much difference between my children other than DS born vaginally has never once been ill in nearly 2 years and DD has had most things. Perhaps a little more time on the planet and DS will catch up!

I'm interested to know more about microbiome seedings please! I'm concerned for what my DD is lacking.

Money. There’s a good reason why so many private patients choose ELCS. Because it’s tougher than a straightforward vaginal delivery, but way more straightforward than a complex one. And a lot of vaginal deliveries end up complex...

I’ve had all three (complex vaginal, straightforward vaginal, ELCS). ELCS every time, please.

It is difficult if not impossible to make true comparison. The population which opts for ELCS will tend to be skewed towards higher risk births compared to the population which opts for VB. So, straightaway, the children and mothers of ELCS births are going to tend towards having more post natal problems.

A succesful VB with no intervention and just needing a trebor mint to suck on to deal with pain is an ideal. If you compare an ELCS to this then of course an ELCS will look like the worse option. But this isnt the choice being made.

Giving birth whether by VB or CS is a huge physiological, mental and hormonal event in a woman's life. For most women it happens a very small number of times. Each birth is different even for the same woman.

The mother will have far more intimate knowledge of her own general and reproductive health than any medical professional can have. She will have a far better understanding of her own ability to cope with stress and pain in general life. This will impact on the choices she will make around giving birth.

The risks of a CS get quantified and ascribed to CS. The risks of VB tend to be less quantified and less clearly ascribed to VB. Problems with continence tend to be under reported and minimised, the same for having sex after VB.