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!

I also think there is a big discrepancy between trusts & what they "allow".
I was offered a CS for dc2 straight away & I persuaded them to let me try naturally. My friends who had first babies in their late 30s had CSs just because of their age on the advice of the consultants.

I think many are not aware that CS is major surgery. I had EMCS the pain for about 10 days after was horrendous. To get up form lying down would often make me cry it was so painful. Thankfully ds was a chilled baby

I was given no advice and was given no painkillers when leaving and that was after I also had an infection (had my antibiotics)

I used to work with someone who was a midwife in Brazil I remember her telling me that women routinely had planned CS and were out very quickly so the hospitals could run a well managed timetable - I was quite shocked by this and I guess that would help keeping costs down

I had an emergency c-section with my first and a Vbac with my second. Vbac was much easier in my opinion in terms of pain overall and being able to mobilise to quickly. I got a horrid infection after my c-section which left me struggling with post-natal depression. I know not everyone's vaginal birth is easy but I don't think we should treat c-section like a minor issue. 12 years on I still have no feeling in part of my stomach. You could argue that if I had had a planned section then some of the issues would not have occurred (risk of infection is higher with emergency sections and the speed they needed to get DD out to save her life might have meant less careful ripping apart of my stomach muscles) but the stats tell us that this can happen even with planned c-section. My friend had a planned section and got one of those hideous headaches you can get after an epidural and had to be re-admitted. There are problems with both types of birth so that's why we need population level stats. And of course the NHS will try and 'save money' if there is data to suggest it's being spent unnecessarily. That is not the same as saying that it will save money at all costs.

@Willow4987 I know its not as simple as all that, and I would never be someone that would push VB at all costs, but the reason that VB is promoted first is because in most cases, its the best option for the health of both, if no other complications.

I dont think people who are terrified or who have complications should be pushed into trying a VB if they really dont want one, but I thought it was pretty clear why CS is not the simplest option or a neutral choice. Its an expensive, invasive procedure where the abdominal muscles are cut and takes a great deal of recovery. Thats not to be sniffed at.

@LizB62A

I call mine a c-section shelf too! My daughter is 12 so I guess it's here for life.

@Branleuse I completely agree with you, CS is major surgery and risks shouldn’t be ignored

But what I’m also saying is that a VB isnt right for every woman and I personally don’t believe that the pushing for a VB from certain health professionals is always in the woman’s interesT

Which is why I believe we should be given the facts around all options available to us freely by the midwives/Dr’s

Every woman will weigh risks differently. As I said before, a VB is technically overall lower risk for me but the risk around permanent damage to pelvic floor especially after last time, I personally weigh those higher than associated CS risks

@Branleuse and I don’t mean you are pushing VB over everything at all! I was just talking generally in what I’ve seen from some people in real life/medical professionals/various threads on MN with woman having to fight to be heard

Of course a CS is major surgery. But so too are repairing prolapsed bladders, serious rectoceles and repairing anal sphincters arising from botched or difficult vaginal births. What are the figures? Notwithstanding the humiliation and upset of years of incontinence, of always having spare pants and tights, needing tena pads, worrying about making sure all trousers are washable. But we are only women and it's all to be expected.

@BoxedWine, there is plenty of research about CS and increased childhood obesity and a majority of them have found a correlation. Here are some examples I found in about 30 seconds of searching

I can only read the abstracts for most of these, but you miss the point. It's quite clear that research has shown an association, but the point is that we don't know whether this is the section or the things that led to it and what you posted does not refute that. They all mention adjusting for at least some covariates, I can't read them to see whether they did a decent job at this or not, but there are so many health reasons why a woman might choose a section (this is even in the ones that do actually split EMCS and ELCS). You don't cover them by going income, BMI, age.

That you choose to cite the second link is particularly concerning, because they said that section rates in many countries exceed the recommended 15% level. That isn't a thing and hadn't been for around 3 years when this research was published. They've either put that in because of inherent bias or because they didn't know, both of which would be a problem.

Well with the amount of OBs that opt for ELCS it makes me think it's to do with cost

It's a particular view of costs too. The NHS isn't well set up for looking at long term costs. The NICE guidance does with some stuff, like prolapses, but some of it is time limited, and of course it isn't necessarily followed either.

aurynne - well said.

Why do we always have to muddle with nature, especially in the case of elective c section? Just because we can does not mean we should!!

Probably @Ylvamoon because turn the clock back 150 years and maternal and infant death was very very high. With DS1 I'd have died from puerperal fever arising from mastitis and a breast abscess. DS1 without a wet nurse would have died. Had I survived, after DS2 died, I'd probably have developed puerperal fever due to some retained placenta and would have died then.

Are suggestimg that wpuld have been preferable. Possibly yes in a Darwinian context but not in a first world civilised society.

Interesting article from the NHS re vaginal seeding here
www.nhs.uk/news/pregnancy-and-child/c-section-mums-warned-about-dangers-vaginal-seeding/

That perspective is so perplexing to me YIvamoon, because the way in which we live our reproductive lives now is already muddling with nature however we deliver.

We evolved to begin having babies shortly after puberty and to do so throughout our reproductive lives. We don't have nearly as many now and we start to have them much later. The average age for first birth now in the UK is 30 years old. The average age of first period is about 12, so we're going into our first pregnancies with nearly two decades of fertility behind us. That's meddling with how nature set things up before we even start thinking about how we'll deliver!

People make assumptions that a process we evolved for a massively different reproductive life is automatically going to suit best for conditions that bear very little resemblance to it.

27 years of pain, loss of sensation, severe back pain for most of it, severe adhesions - and the terror of doctors instilled from being cut into when the anaesthesia hadn't properly taken, then having the infected wound burst open on day 4 and being told it was in my mind as blood dripped onto the floor - I fucking wish a planned section wasn't still seen as an easy, always safe, pain and problem free option.

@StrawberryGoo what you said.

I understood that RGOG(?) had advised that women should be told the risks of both VB and section and allowed to choose. It's not happening though and it's really frustrating.

My issue is that the risks of VB are never discussed. When I had a section with DS2 I had to sign a consent form and had all the risks explained to me by the obstetrician. No one sat my friend down to explain to her the risk that she could be left doubly incontinent as a result of her VB.

Mitzik I am so sorry. I hope you sued.

Much of the problem is that we have been far too grateful for inadequate care for far too long. Why?

In the uk the nhs are under pressure to keep c section numbers down.

I had both dc abroad, by ELCS and thankfully didn't have any of the issues that are listed as risks and DC are probably the healthiest children I know, with the most robust skin. C sections even in the public hospitals are far far more common, almost encouraged. The Dr's train mostly in the UK or another EU country secondly so I wonder why they aren't advising against them in the same way?!

FWIW my good friend is a consultant in surgery at a maternity hospital (uk) and chose ELCS for both her dc too. Must ask why she chose that as presumably she'd know all this more than most - I guess she knows other stuff too that they don't tell us.

@OhTheRoses. Nope. I got a live baby out of it - one who turned out to be so badly positioned and tangled up in the cord, had I gone into labour, the pair of us would have died very quickly (and very horribly). PTSD from the actual procedure/aftermath was small fry compared to that.

The anger of the ex at depriving him of the natural birthing experience and the attitudes of everybody else that I was making fuss about something that was easy, safe and painless, compared to a natural birth (their phrase, meaning vaginal) was more of a fucking problem.

Bloody Sheila Kitzinger Fan Club members. No better than the 'Get all the intervention you can and it's a doddle' crew.

Bloody Sheila Kitzinger Fan Club members.

My family subscribe to that. Of course it's just a coincidence that the rest of them just sneeze babies out, completely pain free apart from the one of my gran's which was back to back. Whereas I was told that dc1 was an abomination because I couldn't give birth to him. The fact that I endured 75 hours of back to back labour, had virtually no pain relief, was at home for 80 percent of it (hospital didn't want me because I had a best chance of a vaginal birth labouring at home) and they tried everything short of hanging me from the ceiling to get him out made zero difference. According to my family "coven" I failed. I swear my mum is disappointed that neither of my emcs babies have any allergies, obesity or anything else which could be blamed on their entry into the world. She sends me every single negative section study she can find, every single bit of newspaper coverage and is hopefully that if there is a number 3, I'll try a bit harder "to do it right".

@73Sunglasslover

My son is 21 !!

On problem with obese mums, is they have bigger bbies which can lead to birth problems so increase the rate of c sections. Also csection risk goes up the more you have. Everyone can tell a good or bad story about either way. But the bottom line is the average vaginal birth takes less recovery then the average C section.

Dinosaur your family sound utterly hideous. I am sorry

**But the bottom line is the average vaginal birth takes less recovery then the average C section

But this is the thing...you’ve no guarantee of an average vaginal birth so I understand why people
choose ELCS especially if a first VB was traumatic for various reasons