Why vaginal birth?

[SantaSusan]

Inspired by another thread. I'm really interested to understand the reasons for most women opting for a vaginal birth.

Disclaimer: I really, really want this thread to be a nice discussion to share views. I'd hate for this to descend into a judgy or unkind thread! Obviously, however anyone chooses to give birth is their choice alone. And as long as your precious little bundle arrives safely at the end, then who cares how they got there!?

I ended up with an elective. I never in my wildest dreams thought I'd have anything but a vaginal birth. However, for reasons I won't go into, it was decided during my pregnancy that a c section would probably be the best option for me. Everyone I spoke to absolutely loved their c section experience, and 99% of the comments online were so positive, so I wasn't worried about it at all once it was decided upon.

I had absolutely no pain during my c section or during recovery. I breastfed right away. I was up and about pretty much immediately. This seems to be the experience of most women who've had elcs. I would have an elective section again and again. If I'm lucky enough to have another baby, it'll be another section.

As such, I often wonder why more women don't choose to have their babies this way. It's so common in other countries. I think there's a lot of misinformation around c sections. The risks are also lumped in with those of emergency c sections, so electives are often painted to be riskler than they actually are.

You often hear people saying it's major abdominal surgery' in quite a judgemental way, which of course it is. But as far as surgical procedures go, it's generally very straightforward and in most cases, is easy to recover from.

I also repeatedly hear that vaginal is best as it's the most natural. But just because something is the 'natural' way to do something, doesn't necessarily mean it's the best. There's lots of things we do now with technology and with medicine that isn't the 'natural' way, and nobody bats an eyelid.

I can't quite put my finger on why I was so opposed to c sections previously. It's like it was subconsciously ingrained in me for no reason other than popular rhetoric. Which is why I'd be interested to hear why others decided a vaginal birth was best for them? Or why others knew they wanted an elcs? Has your subsequent birthing experience changed your minds at all?

are you sure? I had vaginal birth at birth center, the only staff who attended me was a midwife and minimal intervention from her. I do think vaginal birth is much more cheaper than a c section.

I wanted a vaginal birth. Unfortunately my waters broke but labour failed to progress, despite induction, and the syntocinon drip caused DS' heart rate to drop dangerously, so I had to have an EMCS 24 hours after my waters had broken.

I was fit and healthy and found the recovery straightforward, thankfully - I was on my feet pretty much as soon as the spinal block had worn off, and could walk into town for a coffee on day 3 (and to the pub on day 4!). Sitting up was painful for a week or so, and I couldn't lift anything heavier than DS for the first three weeks, but after that I was basically back to normal: I was exercising after six weeks, swimming in eight and running in 11.

I have a slight indentation on the side when my incision began, but it healed smoothly and I don't have an overhang. I was also able to breastfeed DS without too much trouble (it took a week or two to sort his latch but he's still a boob monster at nearly 20 months!).

I do wish I'd been able to experience VB, especially as I’m not sure I'll have another child, but it wouldn't have been safe to carry on trying and after hours of labour I just wanted him out!

Yes, very.

Because attempting vaginal birth means we get some outcomes that are much more complicated and expensive than yours. As an example, I too attempted vaginal birth, and each time ended up costing the NHS more than an ELCS would've. There are enough like me, plus the additional litigation and downstream costs, to mean NICE are clear there isn't enough evidence to make a costs recommendation that attempted VB is cheaper than ELCS.

That is not what it says. Risks and benefits to both does not mean that the risks and benefits are equal.

Again, the whole principle underpinning it is that it isn't possible to make an overall recommendation as to one being safer, because there are risks and benefits to both approaches. NICE thus disagree with your claim. They reject your entire approach. If NICE concurred with you that attempting vaginal birth was safer overall, the guidance would say so. It very clearly says something quite different.

Exactly - only 30% of vaginal deliveries with no intervention, given that as an over 40 FTM I'm always going to be under pressure to have an induction (at least) at 40 weeks, didn't feel like good odds for me, even if my baby was no longer breech.

Yes, and obviously with c- sections you have the standard risks that come with major surgery, bleeds, womb- and wound infections, adhesions etc.
Not all risks/ side effects are obvious in the days or weeks following a C-section.

@Whataretheodds

I didn't have the shelf after first one. Have a little one after no 2, but it is receding and might disappear with more core exercise. If not, I might tidy it up!

Honestly, it's not too bad and I had big babies. My husband still thinks I am fab!

I disagree with your reading of the guidance.

@Acornsplop

Agreed that c section risks are not always evident on day one.

However, I just want to emphasise that annually the NHS spends the same as its entire maternity budget on compensation for those babies who are harmed by birth, predominantly VB. brain damage is seriously expensive. If the NHS were better at assessing and triaging individual cases and did less scaremongering over c sections (which are a useful risk management tool), they could spend more money looking after all women.

Which doesn't matter in the slightest, really. If the NICE guidance concurred with you that attempting vaginal birth is safer, you'd be able to show us where. If it stated that it was possible to identify one mode as safer per se at all, you'd be able to show us where. The guidance disagrees with your claim, there is no getting round that.

That’s going to depend a lot on the reason for having the section isn’t it? I had vasa praevia, and was given a 99% chance of DS bleeding to death if my waters broke. Versus essentially 100% chance of survival if I had a section at 32-36 weeks. So, I had a section.

@AnneValentine

The issue is that the NHS spends £4bn a year on babies with brain damage from poor maternity care and other maternity negligence claims - these are effectively the consequences of vaginal birth gone badly wrong. This is one reason why NICE do not promote VB over CS - it should be about clinical risk management and individual choice - once you add the costs of vaginal birth gone wrong to VB, then VB and CS cost similar.

ChatBFP yes but if I have a c-,section and 30 years later I need abdominal surgery which is made more difficult because if adhesions caused by the c-section the potential cost of those complications 30 years later won"t come out of the maternity budget. So it's difficult to measure some of the consequences and costs

@Acornsplop

I don't disagree, but you can say that about prolapse as well and that is more likely with a VB (not impossible with CS, but Swedish studies have shown that having only CS is protective) and, as I understand it, much more common to have to have extensive physio or surgery for prolapse than having abdo surgery for adhesions.

@Acornsplop

(I don't dislike VB - wish I had had a straightforward one personally, but I do disagree with the way in which CS is presented in the NHS. I complained to my trust and got a personal response from a consultant who agreed with me and thanked me for complaining - clearly those who have concerns are shouted down...)

Equally you cannot show where it says the are equally safe or carry equal risk.

And the cost “saved” by all those who don’t have a c section?

Also can you source that figure. Thanks.

I had two vaginal births and they were the right options for me. I also respect anyone's decision to have an elective c-section and realise it could be equally the right choice for them.

I think the question OP asks is unhelpful as it seems to pit one type of birth against another. Childbirth choices do not need to be justified here.

@AnneValentine

I do find it a bit problematic that your first instinct is to query if brain damaging infants might be inevitable and "worth it" for the greater good, rather than engaging with my point that if the NHS could work out who is most at risk of brain damage and triage effectively it could both save money AND also spare children brain damage.

As to costs, try this one

lordslibrary.parliament.uk/negligence-in-the-nhs-liability-costs/

Which says:

The cost of CNST clinical negligence claimss incurred as a result of incidents in 2020/21 was £7.9 billion. NHS Resolution has said that 60% of this cost related to maternity servicess (£4.8 billion as at 31 March 2021).

Unfortunately, much of this is about brain damage - see p59. This is because actually killing a baby (or even a mother) is less expensive than paying for round the clock care etc.

resolution.nhs.uk/wp-content/uploads/2021/07/Annual-report-and-accounts-2020-21-web.pdf#page=59

This is similar to the maternity budget from a quick google search, but happy to be corrected on this if someone has a more precise number than £3-4bn.

I can't recall where I found the NICE figures on costs other than this daily mail link, but it does reference a proper study and I will have a look later - basically, they seemed to indicate that once you price in the full costs, the cost differential is pretty dramatically reduced, perhaps in favour of an elective section. Obviously, you wouldn't pursue a policy of having all c sections in the NhS as there is a benefit of choice and some possible long term benefits that are hard to quantify for vaginal birth BUT this is the reason why in countries such as South Africa where people opt for private care there is a high c section rate - obstetricians find it much easier to manage the liability risks with a c section than a vaginal birth and once you price that in, an elective section becomes the default choice.

www.dailymail.co.uk/health/article-6935517/amp/Planned-C-sections-400-cheaper-vaginal-births-NHS-finds-study.html

I didn't say either of those things, though. You were the one that made a claim about attempted VB being safer. It's quite possible to disagree with your stance whilst not stating there's evidence to go as far as to say the risk is equal either. Which is what NICE do.

I had absolutely no pain during my c section or during recovery. I breastfed right away. I was up and about pretty much immediately. This seems to be the experience of most women who've had elcs. I would have an elective section again and again. If I'm lucky enough to have another baby, it'll be another section.

not my experience of a CS in terms of up & about immediately with zero pain or for anyone I know. I thinks it’s a bit odd that how quick a women returns to her normal routine regardless of type of birth is almost seen as a badge of honour.

And I thought there was something wrong with me after my CS as I genuinely expected no pain. I remember phoning my cousin who is a surgeon & saying “why does it hurt” & she thought I was nuts.

bessytedsy · Today 18:31

I had absolutely no pain during my c section or during recovery. I breastfed right away. I was up and about pretty much immediately. This seems to be the experience of most women who've had elcs. I would have an elective section again and again. If I'm lucky enough to have another baby, it'll be another section.
You shouldn't have any pain during your C-section, but it's perfectly normal to be in pain afterwards!

You’re supposed to be sourcing figures to show that vaginal deliveries gone wrong is causing brain damage to children to the amount of £4billion.

Please don’t assume my “instinct”. My position is that women should be permitted to choose and shaming women for opting for an elective c section is no more disgusting than scaremongering vaginal deliveries.