to think that so many women have traumatic damage during childbirth, and why can you not have a CS on demand?

[GetOrfMoiLand]

No I know this is probably a contentious point, and financially there would be a hell of a burden, but it seems that a woman's body is not brilliantly well designed for childbirth, and so many women have had terrible vaginal damage caused by birth, you only have to look at the threads on here.

I was only thinking this because SIL went to A&E on christmas day due to severe rectal damage, she was in utter agony and couldn't go to the loo. And one of her friends who gae birth at the same time had terriblt third degree tears also.

Disclaimer - I know bugger all about anything, but childbirth can cause such trauma, there is a perfectly good alternative which would reduce these incidents of damage (yes, I do know that a CS is major abdominal surgery, I have had abdominal surgery myself and although painful, I wouldn't say it was as painful as my poor SIL's injuries, not by a long shot)

Large heads cause a problem for the baby - gets stuck and suffers. It's bleeding and infection caused by this trauma that does for the mother in countries where treatment for these complications is not as readily available - and historically of course, in this society too.

Why would it be unethical peering?

I totally agree re the cost to the NHS, but if you are paying for it, it is not unethical is it?

This is very interesting heating the different opinions, anyway.

I think there would be a knock-on effect of more c-sections for babies - okay so actual death rates might be lower, but its not a bad thing to consider the impact of more c-sections on the babies.

I think breastfeeding rates would suffer - I think c-section is a common delayer of milk coming in (I think it can come in up to 2 days later or something) which would definitely increase the liklihood of midwives and mothers offering fomula when they otherwise might not have. I think a baby is more likely to end up in SCBU from a natural birth gone wrong than c-section, my midwife said that the liklihood of an elective section baby ending up in SCBU is very rare, so whilst the lungs dont get squeezed, I'm not certain this is a big factor - I know my daughter was coughing up some liquidy phlemgh stuff for the first 12 hours or so that was probably due to this but it didn't actually cause her any problems, it was less than ideal but not a problem ...

We are just starting to hear women talk on mn's grislier threads about how wrong vaginal birth can go, but the women for whom CS has gone horribly wrong are not talking about it, because they are dead. Now there's not very many of them, I grant you, but they are much deader than the women with fistula and third degree tears (however horrible that may be). And some subsequent babies do die or have brain damage as a result of post-CS uterine tear. And many babies will be born prematurely as a result of the choice of ELCS, most only slightly, but some, due to faulty maths, a matter of weeks before their natural due date, which has lifelong consequences.

However YANBU to wonder, and I'm not saying you're wrong. I think that the risks require constant review and I suspect that the risks of incontinence, sexual damage and other permanent trauma from vaginal births should be given more weight in the official balance than they currently are.

It's unethical because the best longterm outcomes for mum and baby are from well managed vaginal birth. The mediical profession cannot morally justify offering second best and claiming it's as good.

Christ.

Well I had no idea re the impact on babies. In my dim head i would have thought a CS would have been less traumatic.

Just be thankful i am not a nurse, then.

I think in Brazil or Chile or somewhere, everyone (just about) has c-sections. I wonder at what point this became the norm and if anything has been published on how this changed things both for the worse and for the better, if applicable, in terms of public health...

Some women are NOT perfectly designed for childbirth. Also, as our diets are improving, babies are getting bigger. Your SIL should have been given a c section anyway if the baby was really big. I think there is often a distinct lack of caring in maternity services, and if you're not going to die they don't really care what else happens.

But of course we can't afford for everyone to have c sections.

"Very few women die - have ever died - because a baby is actually stuck"

I don't agree with this at all - I think that we tend to forget, with the access we have to medical facilites, that childbirth is actually a risky business, and you are lucky to come through it totally unscathed, and with a totally healthy baby. There are many places in the world where this is a far less likely outcome than in the UK.

Getorf I mean that it would be unethical of the NHS doctors to offer an operative procedure to healthy women with healthy foetuses and uncomplicated pregnancies as a matter of course, because the research base currently shows that a section carries a higher risk of complications/adverse outcomes than a staightforward vaginal delivery. In the private healthcare sector, I think you pays your money, you takes your choice...

A c-section is better for some babies - like my nephew - big baby, back to back and sort of sideways too, days of labour (poor sil) without much progress. But they only knew that it would better for him when they'd done all that. For my three vaginal birth was much the best option.

The risks of c-section don't only apply to that pregnancy though. The risks also continue into future pregnancies.

The name "elective" section can also be misleading as it does not necessarily mean that the woman is having a section by choice, but that the section is planned prior to the onset of labour (but is often still medically necessary e.g. placenta previa, transverse lie and other reasons).

I did ask SIL (because she was huge) did they offer a CS?

Apparently not, as she was fine and dandy in her other births, despite being smaller babies.

She was completly expecting teh birth to be fine. She was in a state of shock I think after the birth, really traumatised.

Also, one of the more deadly complications of pregnancy, Placenta Praevia, is a risk factor itself in previous c-section. So the more c-sections performed the more of this condition, which is one of those ones that can kill you both, would happen, no doubt.

Trying to think of some definite negatives of routine section because I'm coming across a bit pro-section, which I'm not necessarily, but I am well schooled on the positives of c-section, because having had 2, that's what I needed to focus on at the time!

Peering - if you read my post you will see I was talking about the causes of maternal mortality - infection and bleeding are the major causes not the baby being stuck - although the latter may lead to the former.

Thanks peering and notrhern re explaining re ethical reasons.

I think secondary infertility or sub-fertility is more common in women who had a c-section - less places for a fertilised embryo to implant, or something? There's another negative.

Very interesting thread, forgot to say that earlier

Well, it's nice to have a thread which hasn't descended into a great big row by this stage

Not that I don't like MN rows, but still.

C-sections raise the risks for subsequent pregnancies and births, also -- your chances of developing placenta accreta (which is difficult to diagnose before birth but can lead to emergency hysterectomy or be fatal) in a subsequent pregnancy are much higher if you've had a previous c-section than if you've had vaginal birth(s), for example [arse, why did I just remind myself of that at 32 weeks pregnant after previous cs? emoticon]. That tends not to be factored in when weighing up the various odds relating to cs or vb for a first birth considered in isolation.

However YANBU to wonder, and I'm not saying you're wrong. I think that the risks require constant review and I suspect that the risks of incontinence, sexual damage and other permanent trauma from vaginal births should be given more weight in the official balance than they currently are.

This pretty much sums up exactly how I feel. Thank you for articulating it so concisely :)

IIRC they sort of offered me an elective c-section with huge DS (eventually wound up with emergency c-section but not because of his size and DD had same size head and came out by VBAC with no problem) because of his predicted size even though I have a huge arse-- childbearing hips. Or at least, they sort of floated the possibility to see what I thought of it.

Somethiong frightened me on a a thread not long back, about forceps. It said (I don't know if this is true) that in some cases the baby is too far descended to have a CS, even though a labout may be classed as very difficlt, and in those cases high forceps are the only option (with episiotomy and associated damage etc).

Bother.

IIRC they sort of offered me an elective c-section with huge DS (eventually wound up with emergency c-section but not because of his size, and DD had same size head and came out by VBAC with no problem) because of his predicted size even though I have a huge arse childbearing hips. Or at least, they sort of floated the possibility to see what I thought of it.

That's better.

I have had 4 c-sections and YABU.......I'd rather I hadn't I nearly died after my first PPH.

PPH's are more common after c-sectons but still incredibly rare on that scale. SO that's why I had more. Heavy bleeding is more common. Also bowel and bladder damage and permanent uterine damage is also a risk.

The risk of death is higher in the mother too. So I know people have problems and even need surgery down there, but compared to permanent organ damage and surgery scars, it kind of puts it into perspective for me.

Also after a c-section depending how you heal you form internal scar tissue or adhesions, these can cause lots of pain, resulting in more ops, they can also cause your organs to stick together. The biggest risks for mutiple sections are PA or adhesions and sticky organs.

Stick organs and adhesions make any future surgery you may need more complicated and risky. Key hole can be a no-no and it can cause complications in surgery you may need in that area.

I think for those reasons it should be left for a dr to decide as it can have long term implications for your future health way after your children have left home.