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!

Just to answer the OP's question though, medics seem to push for natural birth as statistically it is safer / better option if uncomplicated. I think by default a lot 0f women seem to actively want it, as it tends to make recovery and breastfeeding easier statostically, and they are trying to support women with these aims.
As others have pointed out its not really that simple though and as a woman giving birth, particularly for the first time, you can be left very vulnerable if things take a turn for the worst and be asked to make very difficult clinical choices when you're not fit to do so.
I think it's so important to research your birth options and to have a good advocate with you.

I can share my CS horror story if you want some evidence that not everyone on MN thinks they're positive experiences

Who said everyone thinks they’re positive experiences?

The point people are making is it is simplistic to say VB is necessarily better.

@Aurynne as you will know, coincidence does not indicate causality. You would have to look also at why the mother ended up with a CS. What was her state of health before and after the birth. Was she supported properly post surgery to allow her to recover well? A poorly supported mother is less likely to make good nutritional decisions for herself and possibly for her child.

Do studies also look at long-term consequences for mother and child after all births with VBs broken down between those where intervention was required and those where it wasn't? Or are all VBs lumped together, the good and the bad, with all CS also lumped together?

aurynne

Thank you for the clear information.

I think the hardest part is not being able to know how a vaginal birth will go. Elective c section risks cons and benefits are there. That is what they are.

Vaginal births are not predictable. It might be textbook. It might end in an intervention or series of interventions and the woman giving birth can’t know until it’s happening.

I had a badly managed hospital birth for a back to back baby. Grim. And 6 months to heal episiotomy and permanent damage to my pelvic floor.
I then had a home birth, also back to back baby which was amazing. Actually got the rush of I am woman after. The difference was I had read up like crazy on back to back birthing techniques, I was less anxious it wasn’t my first time, I was much more relaxed and comfortable at home with a midwife I’d known for 6 months.

In hindsight, midwifes who are able to say look do this, this is why could mitigate the risk of interventions. It probably should happen. Maternity care is stretched thin. I don’t know how a midwife is supposed to balance respecting her patient and being able to say look you have to do this. The way you are lying/sitting/whatever is not helping. Women are very vulnerable in birth.

Nothing helps any woman pre birth to know what her individual risk is of a bad birth.

Statistics of births as a whole are useful. But when it’s your body and baby a vaginal birth is an unpredictable risk.

My friend who had the unhappy EL CS would say it was anything BUT predictable.

It's the lack of control and the fact it's a crapshoot that's the issue. If everyone was guaranteed a smooth vaginal birth, then I think most people would go for that. But that's not the case.

And as for the human body being made to give birth, sure, tell that to all the women who have died in childbirth throughout history. Also my body didn't get the memo about that either and I'd have had a dead baby without an emergency section!

I was really anti-section during pregnancy and terrified of having to have one, but actually mine was a walk in the park. My poor friend with a third degree tear is still having issues with continence 10 months on Regardless of whether it's a normal consequence of childbirth not, it's a shit thing (literally) to have to live with.

I'm not having any more kids but if I was I would request a section instead of trying a VBAC. I don't fancy rolling the dice knowing what I know now.

I had a complicated vbac with my first and recovery was around 5/6 weeks. I've now been advised to go for an elective c sec with my second, which I am going to do. It'll be a different recovery but after the trauma endured first time round, it's the right thing for me and recovery time will roughly be the same length of time. I'm most looking forward to a more controlled environment.

Perhaps antenatal care needs to get enormpusly better at predicting higher risk births. Position of baby and cord is a principle indicator. Please can you answer this question @Aurynne?

I've had 2 vaginal deliveries, both inductions for medical reasons.

First had complications - forceps, injuries to baby.
Second was a walk in the park.

I'm pregnant again (after 2 lossrs, so nothing is certain). I will absolutely favour vaginal delivery unless my obstetrician recommends otherwise. Why have major surgery if you don't need it? Plus all the other reasons @aurynne listed earlier.

Im not sure why someone would willingly choose major abdominal surgery if they didnt have to, when there is already a hole/organ there for the baby to come out of that is designed for that purpose.

Thank science we have the option of C section for those that need it, but its hardly an easier option. The recovery time is higher.

Although saying that, I always said id want a C section over an episiotomy

VB is nature's compromise. If humans want to walk upright and have babies with big brains then there is risk involved. If we spent more time on all fours then there would be less strain placed on the pelvic floor (which would be less of a floor anyway). If our babies had smaller brains we would give birth when they were more developed but with smaller heads.

Perhaps the hardest lesson many midwives need to learn is kindness, with honesty a close second, with well mannered snapping at its heels. It was not well mannered to describe my vagina and tucked away cervix when there is a thin curtain separating me from the next bed where a random womans bloke is sitting and two male children are playing. How cleved and well qualified does a midwife have to be to know that is inappropriate and undignified especially at a really quiet time. Like Christmas Eve, oh but to have sent me to a labour room would have meant accompanying me and missing the shits and giggles at the nurses station on Christmas Eve.

Actually I am going to ask for a debrief even if it is 25 years on. Do you thinknthey would do that?

I actually felt less in control during my CS due to the epidural & I really didn't enjoy that aspect.

CS is major surgery - I had a CS as my son was very big (there's no way he'd have got out, he had massive shoulders and weighed over 11lbs)

Post-CS I couldn't drive for 6 weeks, couldn't walk up the hill to the village pushing him in his pram either as the midwives told me not to.
And I still have that unattractive overhang I call my caesarean shelf !

Although saying that, I always said id want a C section over an episiotomy

Well, you can’t really make that choice - you have to either have a section or risk an episiotomy.

I had an episiotomy and it hasn’t healed. Nearly 2 years later I am in pain from it. that is the least of my worries from giving birth vaginally. I’m grateful for a healthy baby but I don’t think I will ever feel human or happy again because of the damage from it, which is permanent.

of course discuss the benefits of Vaginal birth. however I really resent comments like ”why would you have major surgery?” - well because a not insignificant number of people have dreadful outcomes form vaginal birth, which funnily enough is a fairly fucking major thing to undergo as well.

Well said strawberrygoo. I wonder if there would be as many vaginal injuries and botched births if men had vaginas?

Everybody is different though which is what makes it so difficult, birth is so unpredictable. One of my friends had an episiotomy & infection after DC1 but recovered well with no issues. Then had an elective for DC2. She found the CS much harder to recover from. I had a 9 stitches with DC1 but didn't feel anything, no issue with sitting etc from day 1.

One thing I will be dping for dd and any future dil is offering to pay for private maternity and post natal care for them. I would not let my daughter suffer what I had to suffer.

@Branleuse I think people choose it because it’s not as simple as because nature made us able to have babies naturally that all women should. There are multiple factors that make women chose major surgery and all the risks that come with it

My first DS was an horrific labour of which I’m still recovering from over a year later.

However despite this, yes I would choose another vaginal birth IF it could be a guaranteed straightforward birth with no complications or further worsening of my current birth traumas

Sadly VB isn’t always straightforward and I think every woman will weigh risks vs positives for all birthing choices differently

For me....I just can’t risk another 5 hour pushing stage with forceps and the resulting incontinence again. I know it’s not guaranteed to happen but the risk is there

Every medical professional I’ve seen has supported me to make this decision. However if I’d have wanted a VB again they would have supported this too.

And I think that’s the crux of the matter...women need to be given all the information around VB (complicated and uncomplicated) vs EMCS vs ELCS in advance of labour to make that choice with the support of their medical team

There is no answer here.

My VB was horrendous. Lost 2L of blood. Didn't bond etc. Recovery time was months physically and years physcologicaly.

My CS was amazing. Felt that bond straight away. Was so happy with it.

I also know 10+ women who had a VB and they went perfectly.

Also know someone who had a CS and almost died. She is in a wheelchair now. So many health issues because of it.

There really isn't a more safe option in my opinion. It's all a risk regardless.

I wonder if there would be as many vaginal injuries and botched births if men had vaginas?

I think this is the issue, women just aren't listened too & their pain & discomfort is always downplayed.

I was scanned in labour due to being overdue and they wanted the cord checking and I’d been in labour a quite few days bythen. It did not show that ds was too big and I was too small for a vb so we had to try for another day
They could have done my elective cs because they didn’t think it was necessary without anaesthetic and I wouldn’t have cared because at least it would be over.
Maybe sections without labour before hand are found more painful because you haven’t experienced the horrific pain of labour for days first

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

This woman isn't. My giant headed babies can't fit through my sub optimal pelvis.

Luckily my emcs recoveries have been literally a walk in the park. No need for pain killers, up and dressing myself within 6 hours of surgery. Perfectly capable of looking after my babies by myself which was handy really given the midwives just left me to it.

So far I haven't made it beyond 39 weeks before labour starting though so have been told if I get pregnant again, I'll be getting my 3rd shot at a vaginal delivery...the "threat" of which is almost the best birth control going.

Wonder what the chances of the Duchesses of Cambridge and Sussex were of being shouted at for bleedimg on the sheets were or for having a retroverted cervix. On that note no oractice nurse hss ever managed a smear test without really hurting, really moaning or making me bleed. My lovely lady GP or obstetricians have had no difficulty whatsoever. I can only assume Drs are better trained and better skilled than nurses.