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?

@Acornsplop that was the OP quoted, I only mentioned afterwards.

That is not what they’ve stated.

Yes it is. NICE don't agree with your claim that attempted vaginal birth is safer, and if they did you'd be able to show where. You can't.

No it is not. They’ve stated that the risks and benefits of both should be discussed. In the context of the advice you’ve shared they cannot state the absolute statement that one is safer because it depends on the mother’s circumstances. NICE guidance is supposed to give steps for what to do when individualising treatment plans. It there does not state they are of equal risk. Or equally safe. Because for that advice it would not be appropriate.

What you need to do is look at observational studies that look at overall trends.

I shared one elsewhere. There are many. Go to google scholar.

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.14408#:~:text=Conclusions,than%20with%20planned%20vaginal%20delivery.

If you’re going to tell me again that NICE says they’re the same I will not be replying. It’s irrelevant.

NICE disagrees with you. It just does. There aren't two opinions on this, you can accept it or be wrong. There is no requirement to take a view about whether it's possible to say either approach is safer than the other in order to disagree with you. It's perfectly compatible with you being wrong, and no other text that you happen to link to will refute the fact that NICE guidance disagrees with you.

You won't be replying because you can't....

I had the same views as OP when I got pregnant and was totally ready to insist on a C section. However, after speaking to a friend who’s a paramedic who had 2 c sections and had said she wished she had a vaginal birth. I decided to just be guided by the midwives.
I gave birth vaginally in the end but really should have had a c section due to issues noted during pregnancy that were downplayed by the midwives, I ended up in theatre after birth for something which could totally have been prevented. Despite all this I’m glad I had a vaginal birth, I was up and walking round with my baby immediately and I could hear a few c section ladies in nearby bays needing to call for assistance for getting out of bed. My body is back to how it was pre-pregnancy without a scar in sight. Not everyone’s experience I know, but birth is a personal thing and everyone is different.

NICE doesn’t disagree with me. That isn’t what it says.

Oh look, you did reply. NICE disagree with you.

I disagree with your interpretation of what they’ve said.

You want me to keep repeating that?

@AnneValentine

I have - if you look at p59 of the document I pointed you to, there is a graph showing that £3.5bn was spent on maternity claims relating to cerebral palsy and brain injury. I really don't know what more I can do to convince you - it's from the NHS' own litigation service!

It's this one @AnneValentine

go.skimresources.com?id=470X1716091&xs=1&url=https%3A%2F%2Fresolution.nhs.uk%2Fwp-content%2Fuploads%2F2021%2F07%2FAnnual-report-and-accounts-2020-21-web.pdf%23page%3D59&sref=https%3A%2F%2Fwww.mumsnet.com%2Ftalk%2F_chat%2F4986656-why-vaginal-birth%3Freply%3D132305135

And sorry if you actually do support choice. Your skepticism as to the costs of c sections and the NICE guidance presents as very anti section.

That's easy on the back of an envelope from well known figures.
c. 600,000 births a year
c 20% ELCS
c. 15% EMCS most of which will be attempted VB
c. 65% actual VB
Cost of a level 1 birth c £1,800
Cost of a level 3 ELCS birth c £2,900
(these came from this source so can any NHS admin gurus correct me if it's hopelessly inappropriate for the task but the differential seems reasonable)
https://www.england.nhs.uk/wp-content/uploads/2021/02/20-21NT_Non-mandatory_prices.xlsx

Up front savings to the NHS £1,100 on each of 390,000 births =4.29 billion.
Less the cost of double catering for the up to 90,000 attempted VB which end up as EMCS it's pretty much evens. We pay our money and we take our choice.

And apologies, I should say that this is the amount claimed against the NhS in 2020/2021 - some may not be paid. £3.5bn is still a shocking figure though

@IlsSortLaPlupartAuNuitMostly

Agree with this, save that my first attempted vaginal birth was an induction, so I would have cost the NHS substantially more with induction, then EMCS than if I had gone straight to ELCS.

If statisticians and clinicians could work together on the difficult cases - predicted big babies, inductions, presentation and positioning of baby etc and work out what the success rates are, they could give better guidance to women. Women should still have a choice of course, but we might prevent birth injury and brain damage in at least some cases.

I have skimmed it. I can see nothing in there that attributes 4.8 billion to vaginal delivery but it’s a long report, which page?

With DC2 I was at a playgroup the next day with baby & toddler. He was a very quick birth. I had friends who struggled post C sections for 3-4 weeks. I had no reason to go C

OP I’m surprised you saw “judgement” in this post and also that you say people say “it’s major abdominal surgery” somehow in a judgemental way…surely these are just statements??

anyway, people love banging on about “judgement” as though it’s the biggest sin ever, but we have to judge things to make a decision about anything. We don’t have to judge people as good, bad, stupid, lazy or whatever for their choices. Some people do the latter which is unfair. However, lots of people accuse people who are doing the former of doing the latter which is unhelpful.

e.g. I wanted a vaginal birth because I believe a birth as nature intended with as little intervention as possible is better for mother and baby. This is a judgement I am making, yes. But it doesn’t mean I’m better than anyone else who made different choices.

Same with breastfeeding - I wanted to breastfeed because I believe that feeding baby as nature intended is better for the baby. This is a judgement - but again I don’t judge anyone who chose otherwise as inferior to me.

but the minute you say “well, it is better to give babies human milk rather than formula” everyone gets all upset that you’re being judgemental even though you definitely haven’t said “and if you don’t you are a piece of shit”.

@AnneValentine

Again, it's page 58/59 (depending on if you are looking at the pdf or the page number) - there are the statistics from maternity claims for brain injury and CP. these claims will necessarily relate to failed vaginal birth - it is almost impossible to get CP or brain injury from an elective c section. That's just a fact (and I am really concerned if you have any medical training and cannot infer this!).

(I am not medically trained, but I am legally trained and can tell you that brain damaged baby is basically as expensive as medical negligence gets - it is more expensive than killing someone, because it requires life long care. Claims will often be 10s of millions of £

this is in reply to ‘how much is a private c section in the uk question, I messed up the “quotes”
It depends on which hospital you deliver in. I believe it’s about £7,000. But that is for a package that would include anti natal appointments, private room etc.

@FoxtrotOscarFoxtrotOscar how it should be! Seems to be a new craze to be able to just ask for a csection. My youngest is 9 years old and it definitely wasn't a choice. It was a medical emergency.
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I see where it says it relates to maternity but not where it says it relates to births (which you assume automatically relates to vaginal delivery) - are you saying that maternity automatically means harm to infant and doesn’t include anything that might happen to mum?

I have also shared a link elsewhere outlining risks of ELCS. Let’s not discount those.

There are a lot of posters here discussing two completely diferent issues.

One of them are the risk factors found by research in vaginal birth/cesarean sections, which are studies done on many women in very different circumstances (the post I added before listed some of the risks, to be used as a reference).

And a completely different issue is women making a personal decision about their own birth. Women's decisions often have nothing to do with research evidence, because women have other non-medical factors in their life that are often more important, or higher in their list of priorities, than the research evidence.

An "empowered woman" is not one who has a vaginal birth, or one who chooses an elective cesarean. An empowered woman is one who has been well informed by health professionals, who has had time to understand and reflect on this advice, who has been listened and respected, who has made choices, and who, in the end, whether or not those choices were possible (circumstances do change often in pregnancy and birth), has been respected during the process, has received timely updates and explanations about the situation and has had the choice to make more decisions, either to continue with her initial plan or to change it, without undue pressure or coercement.

I have supported many, many women. And in the end, what matters is not how the baby came out. What matters is that the woman has felt respected and listened to. And the only person who can confirm that is the woman herself.

Not one individual woman (and not one individual midwife or obstetrician) knows how her birth is going to pan out, regardless which method of birth she chooses.

What we, health professionals, have the obligation and responsibility to ensure is not her choice. It is her information and her advocacy, and support to be sure both are delivered (excuse the pun).

If a woman feels supported and respected, she will be satisfied with the birth experience, even if circumstances meant her planned home waterbirth ended up being an emergency transfer and cesarean section.

If a woman does not feel respected, even an uneventful home waterbirth can end up being a traumatic experience the woman is not happy with.

Evidence guides us, women and health professionals alike. But the experience is entirely individual.

@aurynne

Whilst I agree with the sentiment, they are not entirely different issues - after all, how can women be well informed, if they don't actually get told the risks, or rather (as is the case for the NhS), they are told the risks of one type of birth over the other. Surely good information is due to all women who want it?

They are different issues because women categorise them very differently in their mind. Obviously they consider both, but there is no point having a heated discussion where each part is talking about a different issue.

Most decisions about birth are made with feelings, not with evidence. Evidence may influence, and when I started my career I was pretty sure evidence would weigh heavily both on women's minds and especially on practitioners' minds.

After years of practice I have found that feelings of relative safety and personal experience (not only about birth, but about many other things) weigh much more heavily on people's minds that research when making decisions. Women will decide what feels better for themselves, and then use specific evidence to justify that decision or belief. Health professionals tend to advice what they feel safer with themselves, not necessarily what is medically safer for the woman who is in front of them. And what feels safer for themselves is heavily influence by their training experience, and their individual experience (for example, an obstetrician who has experienced a severe PPH recently will tend to choose interventions that are not justified by the individual woman in front of them, but by that last adverse event which scared them and made them more cautious, and made them feel tht another severe PPH is much more likely than the reality).

This is not a conscious process, it's a mental process that happens in the background every time we make a supposedly free choice. We all believe we make rational decisions. But barely any of us, regardless of education and experience, actually does.