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!

Because we're women.

If men gave birth C section would have been the preferred option decades if not centuries ago.

Everything else is just lip service.

I've had five C sections and am extremely pleased with my choice, so is my pelvic floor.

The duty set out in Montgomery v Lanarkshire isn't a matter of opinion aurynne. You seem to be confusing what the law in the UK says with what you think it should be.

I appreciate that you're not in the UK, though your opinion is grotesquely paternalistic even if it corresponds to the law and practice of the country where you are. But if you tried taking that attitude here, you'd be failing in your legal duty. That simply wouldn't be acceptable.

I don't think aurynne knows much of anything about UK healthcare system, they've said as much up thread.

And said that elcs means choice when that's not what it means here at all.

If aurynne or anyone else doesn't know much about the UK healthcare system and presumably also relevant law, they shouldn't then be disagreeing with people who point out that their ideology would conflict with the legal duties.

"The duty set out in Montgomery v Lanarkshire"... and I am the one who is accused of sounding authoritative? I have no idea what Montgomery v Lanarkshire was about but my "attitude" towards healthcare was learned in the country I studied and currently practice, so it is very relevant for my practice here. If in the UK you can turn up at a public hospital and request that your perfectly healthy appendix is taken out to prevent future emergency apoendicectomies then perhaps it is not that strange that your health care system is in crisis? (and before you jump at my neck, this is said in jest).

@BoxedWine, women in the UK have the same anatomy and physiology as women anywhere else. The particular law of your country does not affect the research findings about VB and CSs, which you can easily see have been put together with data from women from all over the World. Now, how your midwives and obstetricians practice in your country, that's entirely up to you. However, considering the number of midwives and obstetricians we have had moving to New Zealand in the latest years, and the horror stories they tell about the healthcare system where they come from, I think I will stay here and continue to practice the way I do, thank you very much.

If you don't like what I say, you're very free to ignore it. However, sometimes it can be interesting to analyse the reasons why some people have such strong visceral reactions to what other unknown people say on the internet.

aurynne

Montgomery was a very sad case in which an obstetrician did not warn a very small Of stature diabetic mother of the risk of her baby getting stuck. She said she did not do so because had she warned the mother of this, the mother would have asked for a caesarean, and caesareans are “not in the maternal interest”.

The baby got stuck, suffered a terrible brain injury and now needs round the clock care. Not to mention they had to saw through the poor mother’s pelvis to get the baby out.

The upshot is in the UK you have to warn patients of the risks that are likely to matter to the patient, not simply what you as a medical professional think is relevant.

And I personally had only positive experiences with midwives - I don’t blame anyone for my poor outcome. It’s an inherent risk of vaginal birth.

That said I’m not here to stick up for everything the NHS does. Apparently our forceps rates are pretty high compared with other countries, whereas as far as I’m concerned they are barbaric and to be avoided wherever remotely possible.

@StraberryGoo was that really the only risk that was discussed with you? They did not discuss that inductions of labour, especially when using IV oxytocin, are the number one cause of fetal distress leading to instrumental/cesarean section on an otherwise healthy baby? (obstetricians discuss that with our women here, before someone starts attacking "useless midwives" for mentioning this).

By the way, the second cause of fetal distress is hypotension caused by epidurals.

Do your anaesthetists and obstetricians warn you of this in the UK, or do the obstetricians tell you "thank God we were here to save your baby's life" afterwards, as if your baby getting distressed was "just bad luck"? Kill me now.

Yes, I’m afraid it was all they said. I didn’t have an epidural because I knew they could generally increase the risk of forceps, and avoiding those was my main priority - but I ended up with forceps anyway due to decelerations. I never knew till you just said that this could have been because of the syntocinon.

A very short mother with diabetes is very far from "a healthy mother with a healthy baby". Of couse she should have been warned of the risks of any type of birth. Macrosomia, shoulder dystocia, obstructed labour are just the top ones which come to mind when thinking of VB. A CS would also be risky for her due to a higher than normal risk of DVT and bleeding. Her baby would be at risk of developing low blood sugar levels regardless of mode of birth. That particular court case sounds much more complex to me than simply requesting an unneccessary intervention.

Your appendix example is batshit aurynne. I hope you were just trying to be clever, but if you genuinely think having a healthy organ removed is comparable to choosing one of two ways to give birth, each a mixture of risks and benefits, I feel sorry for the women in your care. I'm glad you're on the other side of the world to me and everyone I love, but poor Kiwis. Their bodies are the same as ours which means your ideology is wrong there too.

As for sounding authoritative, that's just what the case law says. I'm a solicitor but you don't have to be to understand it.

@strawberrygoo I am very sorry to hear that. How did they explain the baby getting the decelerations then? Also, when the choice is between forceps and CS, I agree it is not black and white. Forceps can destroy a mother and probably I would choose CS over Kiellands forceps, or a theatre trial of Neville-Barnes after a long econd stage.

How did they explain the baby getting the decelerations then?

They didn’t! I accept I was out of it and may not remember, my husband is a doctor so he was calm and I’m confident he would have remembered/understood if they had given an explanation. it was Neville- Barnes forceps, I know that from my notes, but no idea what that means. Not in theatre, done PDQ on labour ward.

@BoxedWine, you can stop feeling sorry for the women in my care (how lovely of you!), I haven't had a single complaint so far in my career and all the feedback I have received has been positive so far. Go figure. Reading what I read here, I am also very happy I am working on the other side of the World, so thank you for your sincere concern for my wellbeing :)

There happen to be plenty of professionals who consider that extracting a healthy baby surgically out of a healthy woman with no other indication is, indeed, very comparable with an unneccessary appendicectomy. in fact quite worse... have you ever seen how the CS cuts are done and compared the size of the surgical scar, as well as the recovery in terms of tissue healing?

@aurynne and I think that’s just the issue...in the UK we generally aren’t told any of the risks around VB/intervention/CS unless we specifically ask for it

And even then information is severely lacking...

I asked my midwife for CS risks - she effectively told me to google it...is obviously already been looking but wanted the NHS official info in more specific detail

It can be hard to simply say what is a ‘necessary’ intervention and what is not though.

Even in this country- some hospitals will say that a previous c-section is a good enough medical reason to have an ELCS for the next pregnancy, other hospitals will disagree. One hospital will routinely book women in for induction at 7 days overdue, a hospital half an hour down the road will not offer it until 12 days overdue.

I think this is one of the reasons it’s so important INDIVIDUALS are informed to make their own decisions.

@strawberrygoo the type of forceps is mainly related with the length of the blades, how deep into the vagina they go and at which height the baby's head is when they are used. Neville-Barnes are the middle size. I really cannot comment about your particular case because I wasn't there. If your baby's decelerations were severe and the health professionals with you at the time felt the baby's life was at risk, then forceps would have been faster than an emergency CS. However, if you had received all the relevant information, you would feel better about your choices and the decissions that were made at the time, instead of feeling "why didn't I know that?" afterwards. This is the only reason i am posting about this today, so women know about this. Not to convince them to have one or other type of birth. Knowledge is power, and women have been disempowered in healthcare since the inception of Medicine.

That there are quite a few professionals who also hold your paternalistic and arrogant beliefs isn't in doubt aurynne, many of us have suffered at their hands. That's part of the reason there are so many issues with childbirth in the UK, so this isn't the gotcha you clearly think it is. I shall continue to feel sorry for those in the care of those ideologues, because I know all too well what that means.

I've got both a section scar and an appendix scar as it so happens, but even if I didn't your argument would be nonsensical. You're essentially saying they must be comparable because they both leave a scar. Being pregnant and preferring the risks and benefits of ELCS to attempted VB is an indication for a section.

Thank you aurynne. As I say, I have nothing but praise for the midwives and doctors who delivered my baby (save possibly the consent issue but it probably wouldn’t at that stage have altered my decision). I think the issue with risks etc Not being explained goes wider than just in the immediate run up to birth. There’s a culture of VB being better in the nhs, and people don’t really talk about birth injuries. It is a bit taboo.

I have no reason to doubt the intervention in my case was necessary, and faster than an emergency CS. Possibly baby was too far down by then for EMCS as well. I’m pregnant again and have asked for a birth debrief so I’m sure I will get some explanation at that stage. I’m interested in this issue as I am very conflicted about what is best for the next birth.

I should say my midwife this time has been very sympathetic and interested in my ongoing issues from the birth which means a lot to me.

@aurynne as far as I'm aware the risks and physical and emotional damage of forceps aren't clearly explained in the UK health system. Would anyone consent to it otherwise? Speaking from personal experience of emergency forceps.

I am sorry that you consider that offering women all the available information, in a language they can understand, giving them the chance to discuss and think about it, and then listening to what they want to do and advocate for them, which is what I do in my practice, is paternalistic. I am curious, what type of care do you prefer for yourself @BoxedWine?

Our forceps rates are higher than in quite a few countries too.

@BoxedWine I was going to mention this. I was pretty much forced into it and I had a great birthing partner and a close friend who's a doctor advised us. Wouldn't have considered anything other than ELCS for my second and it was a comparative walk in the park recovery-wise.

I suspect that some of the negatives of a VB are endured entirely by the mother in private and therefore not factored in as a cost (how much should we value a woman’s lifetime of incontinence at?) whereas the costs of an ELCS gone wrong will come straight back to the NHS in surgery, hospital treatment, SCBU time and even post surgery legal action so it’s costed fully.