That's fine. Now list the number of hospitals that perform ELCS....
...cos it's massively relevant to this conversation.
When I was going through the process, I'd have happily paid that. The problem was that logistically I live in the NW and the only privately available maternity units were in the SE.
We could just about afford the operation. What we couldn't manage was the rest - it just wasn't viable.
Fortunately I was put in touch with a consultant midwife who was a specialist. And I was able to get an ELCS.
My notes are covered in big handwriting 'ELCS for mental health reasons'. I was so bad, I had issues with going mute in fear and got a request granted before getting pregnant. I'm still to hear of a similar case tbh.
But what pisses me off is the coding system doesn't actually have a category to reflect this and insist it's recorded as maternal request. It's wholly inaccurate and misleading. It's a loss of huge amounts of important data to have done this. We simply have no idea who many requests have been granted on the basis of mental health or genuine material request or some other classification because some pricks don't seem this worthwhile to explore.
It's appalling.
As for risk - I was 37. Women who tend to suffer from extreme birth fear, statistically have worse outcomes - anxiety is directly related to risk levels and this has shown up in multiple studies. Women who request CS tend to older, plan few children, have anxiety disorders, have a history of trauma / sexual abuse or fertility problems. Thus they largely tend to be much higher risk for a number of reasons than the general population anyway. So would be more likely to cost the NHS more regardless of whether they were 'allowed' a CS or not.
With this self selecting group being naturally higher risk of complications - which isn't reflected in the NICE guidelines explicitly - but there is considerable supporting research for, it really does put an argument for individualised risk assessments and care on the table. The NICE guidelines can only do a more generalised risk which effectively understates the risks of an ELCS and overstates the risks of an attempted VB for younger women and conversely overstates the risks of an ELCS and understates the risks of an attempted VB for older women!
The NICE guidelines also doesn't reflect something else - women who previously had a traumatic birth behave differently to women who have never had children and have birth fear. Women who previously attempted a VB and request a CS, if given adequate support and a flexible birth plan tend to change their minds after being told they can have a CS if they wish and end up having a VB - and are happy with this decision and have better experiences. Whereas women with birth fear who have not had children may change their minds but are more likely to stick with their initial choice.
Basically it suggests that actually poor care and treatment for previous births is more likely to encourage women to request a CS but this changes if they are given staff support. Think about that - especially with the 'a CS is too expensive and women should pay for them'. It's fairly clear that under staffing and poor support is leading to a huge number of requests but no one wants to address this. Again this is where not collecting data on reasons ELCS are granted is important. I would suggest that the lack of collection of this type of data is precisely to supress the link between poor care and under resources maternity wards and birth trauma and subsequent requests for CS.
Women are less likely to need interventions full stop if labour is better managed and women feel supported and prepared throughout their pregnancy. It doesn't help that most babies are born outside 9 to 5 weekdays when senior staff are less likely to be around:
The study, published in PLOS ONE, analysed over five million births over a ten year period in England and found that 28.5 per cent of births occurred within between 9.00am and 4.59pm on weekdays while 71.5 per cent of births occurred outside these hours at weekends, on public holidays or between 5.00pm and 8:59am on non-holiday week days
Undoubtedly the rise in requests for CS owes a great deal to the state of maternity care in this country which has seen multiple scandals in recent years will little sign of a prospect of this changing.
It's not just the cost of compensation either if things do go very badly wrong - if you have a pile of incidents the cost of insurance goes up. Which means more budget is dedicated to that and not services, at a time when you should be directing more money to services to improve them! It's nuts.
Instead women are blamed and vilified for requesting an ELCS with crap like 'too posh too posh' still being far more prevalent than it should be.
The point I make on these threads is that a request for a CS shouldnt be seen as anything but a red flag, for additional support and access to maternal mental health services if appropriate - because they are still notoriously difficult to access. There was a survey on this, which found most hospitals didn't have any provision whatsoever.
I was lucky. I did a lot of research and went out of my local area to somewhere I had found did have this. But that was off my own back. My GP knew nothing of it but was happy to refer me because it was appropriate.
It shouldn't be like this.
We shouldnt be treating pregnancy and childbirth purely as a physical thing, nor should we be trying to do them for the cheapest knock off rate possible - because when it does go wrong the consequences are much more significant. Indeed the mental health costs of women having a poor birth experience were not even considered in the NICE guidelines - it's a huge oversight.