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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:
VivaLeBeaver · 22/12/2019 15:56

The head midwife arrived and the button was pressed. I was hauled onto a birthing stool. The Dr arrived, ds was being strangled by the cord. The cord was cut with baby inside the vaginal canal. The Dr got ready the forceps and told me to have one more push.

Wow, that’s very scary. A cord should never be cut with the baby still inside. If you’d had a shoulder dystocia the baby would have been dead. So out of the midwife and the doctor it seems to me the doctor was the most negligent one out the pair, but you choose to blame everything on the midwife.

I’ve seen experienced consultants get it wrong when trying to work out whether a baby is posterior or anterior. One I remember in particular the consultant did a VE, felt the Fontanelles, proclaimed the baby to be posterior so rotated the baby and then delivered the baby (expected to now be anterior) by forceps but baby came out direct posterior. So she’d rotated an anterior baby to posterior! You can say that missing it on palpation is neglect but it really isn’t. With all the best will in the world it’s not an exact science. A midwife could get it right 99 times out a hundred but I do understand if you’re the one she gets wrong you’d consider it incompetence.....but nobody has 100% accuracy. It’s not a skill you can be 100% at.

StrawberryGoo · 22/12/2019 16:28

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

Also in the scheme of things, how long it takes to recover is surely less important than whether you actually recover fully at all.

Fraggling · 22/12/2019 16:36

Not rtft but got as far as the person pontificating that women who have cs have destroyed their baby's health...

'An elective CS is a major surgery performed on a body which is perfectly healthy.'

This is bollocks. It means planned. So a woman with eg placenta praevia would have an elective. On doctors advice. So as not to, you know, die.

With such a massive inaccuracy, maybe the whole YOUR CHILDREN WILL BE REALLY ILL selfish women thing can be taken with a pinch of salt.

Someone has an axe to grind.

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OhTheRoses · 22/12/2019 16:56

@VivaLeBeaver. It was the midwives who cut the cord not the Dr. It was the midwife who said the belt was faulty, twice, when the heart beat disappeared which is why the baby was too far down the birth canal to be pushed back. I still see it in technicolour. I assume when they cut the cord they knew it wasn't shoulder dystocia as they could feel the head.

I really don't think I'm chosing to blame midwives. It was a midwife who laughed at me when I was in desperate pain 1/2 cm dilated, a midwife who gave me pethidine without consent, a midwife who left me on a public ward when I wanted privacy, a midwife who ignored the disappearing heart beat, a midwife who shouted at me the following day because the mattress pad had moved and I bled onto the bed.

The Dr, his name was Zak, seemed altogether more caring and professional.

Perhaps if the dr had been called the first time the heart dipped the fiasco could have been avoided but it was a faulty belt in her opinion.

VivaLeBeaver · 22/12/2019 17:23

Sorry, I misread that and thought it was the doctor who cut the cord. Even if the head is out you can still get a shoulder dystocia so she should never have cut it, poor practice. And obviously laughing at someone in pain is terrible and the other things.

I do think in any profession you get good ones and bad ones. I’ve worked alongside some very ropey doctors and midwives and also excellent ones from both professions.

As a patient I’ve had some terrible doctors, ones who have laughed at me and told me I was imagining symptoms when actually it turned out I was really ill. Dd has had the same. I’m not afraid to tell someone when I think their practice is poor and insist on being referred elsewhere for a second or even third opinion. Took me 3 orthopedic consultants before I found one I was happy to let operate on me! I’m very fussy!

BoxedWine · 22/12/2019 17:43

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.

Yes, this is it. I've managed to get through two pregnancies without being told about the risks of VB, yet was given spurious information about CS interfering with bonding. Anecdotally I don't know anyone who received full and accurate counselling about both. And now that Montgomery v Lanarkshire is the case law, the onus is very clearly on the clinician to do it not the woman to ask. The reality is that there are risks and benefits to both methods and anyone only telling you about one is not to be trusted.

reginafelangee · 22/12/2019 17:48

A vaginal birth is safer for both baby and mum and the recovery for mum is much quicker.

BoxedWine · 22/12/2019 17:52

Useless generalisation.

StrawberryGoo · 22/12/2019 17:53

A VB safer for baby? Really? How many babies born by section need lifelong round the clock care due to hypoxic brain injury vs those born by VB?

I’m pleased you mentioned Montgomery boxedwine. I’m a lawyer and the facts of that case make my blood boil, and is another tragic example of it being actively dangerous to go too far down the route of VB being better.

Branleuse · 22/12/2019 17:58

If a woman is properly cared for and monitired during a vaginal birth and not just left occasionly checked up on, then a lot of trauma would undoubtedly be avoided and VBs would be safer.

Willow4987 · 22/12/2019 18:27

But I was continuously monitored during labour...the midwife didn’t leave my side however the fact remains that I’ve been damaged by it. Luckily my DS wasn’t

OhTheRoses · 22/12/2019 19:07

May I venture to suggest @reginafelangee that you mean the mum or the mother or the woman. To refer to baby and mum is both reductive and demonstrates a spectacularly poor grasp of English grammar.

aurynne · 22/12/2019 19:11

@OntheRoses no, position of baby and cord are not determinant in birth modes. About 1/4 to 1/3 of all babies have the cord around the neck and have no difficulties being born vaginally. The cord is elastic and it is quite common that, during pregnancy, it gets tangled around different parts of the body, so it is prepared for that and grows and stretches accordingly. In 5 years as a midwife, I have delivered hundreds of babies with the cord around the neck, and still have not needed to cut a cord before the baby is delivered. Very occassionally, the cord is too short (and this happens whether or not it is around the neck) and can pull on the placenta during the pushing phase. This is what is risky and results in deep decelerations which inform us that the baby is running out of oxygen. Whether the cord "strangles" the baby is not that determinant, as the baby does not need to breath until they are out. It is the pulling of the cord on the placenta, and the interruption of the blood flow to the baby, that means intervention to get that baby out is crucial. This would not be seen on US scan, as the length pof the cord is impossible to determine.

You are right that babies whose position is persistent posterior often cause longer, more painful labours. However, persistent posterior all the way through labour happens in a minority of labours. Most babies turn to anterior before birth (sometimes right before pushing). There are factors that make a baby more likely to remain posterior, such as having an epidural (as the mother loses the ability to mobilise and help baby turn). In your case, having had an epidural likely contributed to your baby being posterior all the way through labour and pushing. An epidural in itself already increases the chance of needing an instrumental birth, but if the epidural happens when the baby is posterior, the chances of emergency CS also increase significantly. When a baby is posterior, it is even more important for the mother to be mobile.

No obstetrician or midwife would offer a CS for a baby with the cord around the neck or posterior on US scan, so doing a debside scan on every labouring woman just because of this would be a waste of resources.

In the gentlest way possible, your experience has tainted your judgement of birth. You have gone through a huge amount of trauma, due both to lack of skill of your midwife and a number of circumstances which were out of anyone's control. Your brain is trying to make sense of what happened. That is probably why you're arguing so passionately in a thread that has nothing to do with what you're arguing about. This thread is about the advantages of VB vs. elective cesarean section, and your experience, while very traumatic, has nothing to do with this debate. You have said very clearly that you don't trust midwives, so I believe you will oppose anything a midwife says here, which is your issue, not mine. Unlike many other midwives, I have a background in research, molecular biology and genetics, and if there is something I can argue, is past and current evidence.

Which is not the same as arguing what is better for any specific woman and her birth. For a specific woman, in my opinion, the best way to have her baby is the way she decides once she has been given unbiased information and allowed to contrast it herself and clump it together with her own experience and background.

StrawberryGoo · 22/12/2019 19:17

aurynne

I don’t agree that ohtheroses experience is irrelevant to this debate. Clearly she has had a horrific experience, as sadly is not all that uncommon in those giving birth vaginally. Her point, as I understand it, is that saying VB is better than CS isn’t giving due regard to the risks of VB and how badly wrong it can go.

I totally think the risks of VB are downplayed.

When discussing CS v VB, you have to make the comparison looking at the full range of potential outcomes, not just compare uncomplicated with uncomplicated.

neonglow · 22/12/2019 19:23

@BoxedWine also glad to see the Montgomery case mentioned.

So frustrating that despite this so many women are still routinely getting given totally one-sided information to inform their ‘consent’. Hopefully things will improve in the future.

OhTheRoses · 22/12/2019 19:24

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OhTheRoses · 22/12/2019 19:33

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aurynne · 22/12/2019 19:40

@Ontheroses whatI discuss here is not based on my experience (which is statistically irrelevant), but on research readily available to you or anyone else here.

I have so far been respectful to you. Your last post was incredibly rude, unfair and nasty, so that is the end of my discussion with you. Your "60 years as a mother" do not give you any deep academic understanding of how the human body works or make you any more knowledgeable about any of the matters you are discussing. If you despise midwives, at least recognise that is your own weakness and/or the mechanism your brain has used to try to overcome your personal trauma, which has nothing to do with me or any other midwife.

Right now you're just behaving as a rude, angry disrespectful woman who sems to be offended because I am not automatically agreeing with you (how dare I, lowly midwife!), so you have decided to turn personal and attack someone you do not know. I am very proud of being a midwife and a researcher and I happen to live in a country where 92% of women choose a midwife as their maternity carer, and we have one of the lowest perinatal mortality and morbidity rates in the World. Oh, and I work with wonderful obstetricians every day. Neither of us are better or worse professionals, we all work together within our scope of practice. Having had a traumatic experience does not put you up on the pedestal of "those who cannot be argued against"... "dear". You can "DFOD" yourself, or perhaps you could have been braver and not bothered to use acronyms.

I am very sorry for what you have been through, but you have the choice of not becoming a bitter nasty person over it.

FruitcakeOfHate · 22/12/2019 19:40

Money. Money. Money. I felt so sorry for the CS mums in the postnatal units, the 'care' was appalling. I'm amazed more women don't die from such awful treatment.

OhTheRoses · 22/12/2019 19:46

Please go and exercise a bit of reflective practice and stop being so patronising. Many many women are better educated than the average midwife. I will debate with properly qualified doctors.

reginafelangee · 22/12/2019 19:46

@OhTheRoses

May I venture to suggest @reginafelangee that you mean the mum or the mother or the woman. To refer to baby and mum is both reductive and demonstrates a spectacularly poor grasp of English grammar.

May I venture to suggest @OhTheRoses that you must be rather bored this evening. 

olivehater · 22/12/2019 19:47

Had 2 electives sections after 1st was Forceps and third degree tears. Sections were far easier to recover from for me.

The way I see it is:
The order of preference is: 1 normal easy delivery with minimal tearing. 2 elective section. 3 forceps/vontouse/more significant tearing. 4 emergency section. 5 crash section.
If you go for number 1 you could get 3,4 or 5. If you go for number 2 you won’t. No brainer after one bad delivery.

Also sections cost more on paper but they don’t take into account the costs down the line. They don’t take into account issues with prolapses once women hit the menopause. They don’t take into account the extensive cost of ( not to mention the loss of who they might have been) looking after babies with brain damage for the rest of their lives because they were deprived of oxygen from a bad delivery.

In most of the world sections are not seen as a bad thing.

aurynne · 22/12/2019 19:50

@OntheRoses you are unable to debate. I have just reported your posts.

OhTheRoses · 22/12/2019 19:51

I don't think I said I'd been a mother for 60 years. I think I have said my first childcwas born 25 years ago. Is it so impossible to kerp up with the simplest facts.

I don't think I was any ruder than the poster who reported me and insinuated my pain was because I had had an epidural.

LilQueenie · 22/12/2019 19:54

vb is natural. cs is an operation with serious consequences. Infection being one. Its supposed to be for complications only.

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