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)

The only way I'd ever have another child would be he i could have a CS. The trauma i had with DD is with me still.

For 'he' read if

This might sound awful and is more a slight on other people, but it is civilised "after" the birth too - when I told people the size of my babies, they all did the sucky-in-breath thing but most then said "ah thank god for c-sections".

I have heard so many lewd comments made about women who have given birth to big babies, from "it'll be like throwing a sausage up Oxford street" to screwed up faces and "makes me want to cross my legs" etc type comments. I know that's no slight on the women and not even necessarily a relevent comment, but it sort of spares you a bit of dignity afterwards as well if your child was large.

Yes some people can give birth naturally but not all. I was hoping for a home waterbirth, did 12 hours contracting every 20 mins and then a further 17 hours contracting every 5 with a baby back to back the whole time on a couple of paracetomol. I remained 3-4cms dilated. Shattered and decided to go in...offered pethidine..I thought bugger that I have been doing this too long and went straight for epidural. The joy of medicine oh how delightful seeing those contractions and not feeling them . Did another 12 hours on syntocin and still only 3-4cms. I knew he wasn't going to progress any further and so decided not to wait another 3 hours when my baby could have started to get distressed. Went for c-section. Should have waited though as Registrar was incompetent and nearly killed me. He is no longer a Reg and I am suing his arse off for everything that happened then and after. Anyway if I can ever get pregnant again (I had lots of complications was in hospital a long time and a fallopian tube was removed to save my life) I will be having another c-section. My husband is 6'2 and I am 5'with size 3 feet..classic indication that I was never going to give birth to my son naturally! No way am I going to risk having anyone lower than a consultant, that doesn't work for the trust cut me open so I will demand a c-section by a consultant although it is written in my notes next time it is to be carried out by a consultant. We have medicalised it but sometimes people like me are never going to give birth naturally when they have a child with someone much taller. Pity the poor team looking after me next time though I'll be checking their creditials (can't spell it)

"people like me are never going to give birth naturally when they have a child with someone much taller"

But small women with tall partners can and do have vaginal deliveries every day of the week. Not saying that you can, but it's not a given.

Re: maternal mortality rates in developing countries....

Maternal mortality rates in the UK were less than 1 in a 1000 back in the late 1940's when we had a c/s rate of less than 4%. And that's prior to screening women for placenta praevia, effective treatment for pre-eclampsia, before widespread use of regional anaesthesia during c/s, and when c/s techniques were vastly less safe than they are today.

You really can't draw conclusions about birth in the UK from looking at outcomes for women in developing countries. The factor that caused the largest fall in maternal mortality in women in the UK was access to antibiotics, good antenatal care, good nutrition, and basic midwifery care in childbirth. In developing countries today just providing local women with access to antenatal screening and good midwifery care results in a large drop in the maternal and infant death rates.

Women in developing countries die in childbirth for the saddest of reasons - from rampant anaemia caused by malaria and malnutrition, from obstructed labour caused by malformed pelves, which is generally down to poor nutrition in childhood, from uncontrolled eclampsia, infections and diabetic complications. It's very tragic.

I don't really know the answer to this one.

A friend of mine and I had very, very similar births with different outcomes. Back to back babies that were induced, long labours, failure to progress, no luck with pushing, trial of forceps with consent signed for CS.

I had the forceps (high, Kielland's) and she had an emergency CS. We have similar memories of being pushed and pulled and our bodies being pushed from one side of the gurney to the other.

Both babies required some resuscitation with low-ish Apgars, both of us had tremendous difficulty with bfing.

I don't know much about the nitty gritty of her post-birth experiences, though I know that we were both traumatised. I have severe piles and didn't really recover enough to walk for more than a mile for about six months. I still experience pain in my pelvis if pressure is applied on it. Will never forget the pain of those first poos ((shudders))

I just don't know that CS would be better. I don't even know if I would take one if it were offered to me, despite feeling pretty squeamish about birth. Better the devil you know.. I guess..

I've had pretty horrible births - forceps with 9lbs 6oz first baby, shoulder dystocia with 11lb second baby and 3 days in active labour with third. My pelvic floor is a disaster and I won't be going on a trampoline without wearing a tena lady any time soon.

But I'd still rather have had them vaginally than by c/s. I'm glad I wasn't offered the choice.

I'd only be for c/s on demand if the government tripled the number of midwives in the NHS, otherwise it would be a disaster.

I think elective caesarians need to be offered sooner, after taking some things into consideration. When I was pregnant a women who had just given birth came and gave a short talk at a antenatel class I'd been at. She'd gone through a 36 hour labour and I thought then someone should have stopped that earlier and offered her a caesarian. In my case I think it should have been offered as they knew the baby was back to back, I'm relatively small, the father taller/bigger than average and the baby was two weeks late and had never engaged. I had said that I thought it was because he was going to be big (9lb). I ended up with ventouse, forceps, episiotomy and emergency CS after DS's heart beat went down to 20bpm. It could have been avoided I think. Natural child birth should be the norm but I also think sometimes decisions should be made to offer an elective CS.

I think that the intervention rate when birth is induced is so high that CS should be offered as an alternative. I was induced, none of the gels worked, but the drip did. I never thought I was very stretchy and one of the consultants I saw during the aftermath described my delivery as using a "semtex suppository" and referred me to the "designer vagina consultant". I couldn't sit down for 2 months, not to mention the pain and difficulty moving. Any further babies will be coming out of the sunroof.

breatheslowly, I do agree with that. I had a birth much like Bluecollie (although I was told straight after that although I am little, with a 6'2" husband, I should be able to have a VBAC next time, as it was DS position, not size -he was trying to come out ear first I think)

Anyhow, I want a vbac unless I end up being offered syntocinon again (horrible stuff) in which case I would rather have the op straight off than go through hell just to end up with a cascade of intervention and a section in the end anyway.

"She'd gone through a 36 hour labour and I thought then someone should have stopped that earlier and offered her a caesarian"

I've had 2 labours this long which ended in vaginal births. It's not THAT unusual. If a mum is ok and if a baby is coping well with the labour I don't see why a c/s should be offered. Most women who're in labour this long would have an epidural anyway, so wouldn't be in significant pain.

"I think that the intervention rate when birth is induced is so high that CS should be offered as an alternative"

But over all induction for post-dates appears to REDUCE the likelihood of c/s (compared to expectant management) , not increase it. I know things look different if you just consider first time mums, but even so.

"I think elective caesarians need to be offered sooner, after taking some things into consideration"

At the moment nearly 1 in 3 births in some hospitals is by c/s. Do you honestly think the rate should be higher than this?

Oh please. I have delivered hundreds of babies with very little damage to the woman. What is lacking is the time for midwives to spend with labouring women. I Have spent many hours with two women labouring and a student midwife.We are pushed to the limit.
Women give birth thousands of times a day and with proper support their is very little damage, honestly you are all capable, in the majority of circumstances. Please don't be put off. I have had 2 emergency cs and it is not what i would have chosen and definately not an easy option.

Would be curious to know what if any factors influence a good vs bad vaginal birth. How fit and active was the women during pregnancy, what position did she give birth in, was she required to be monitored and still vs up and moving about, did she have access to a pool or any other things that she might have wanted, etc.

It seems to me that the medicalisation of childbirth has brought, along with lower mortality rates, more medical intervention (possibly unnecessarily), more decisions that are made to the medical professionals' convenience (as opposed to the mothers') and more deferral to consultants as the professionals in childbirth (as opposed to midwives).

I guess I'm just wondering if there's any cause and effect betweeen near perfect circumstances in which to have a vaginal birth, and the actual success rate (defined by not horrible after effects) of said birth.

(I haven't had either kind of childbirth so I really don't know, but the scientist in me can't help but think we've made things worse as well as better with our all supposed great medical advances. E.g., epidurals contribute to tearing because they require you to lie on your back in bed and delivery "against" gravity?)

Some women just aren't designed for giving birth and I think it's quite damaging for some to imply that it's a natural process and anyone can do it if you do x, y, z. That's not to say that c-sections aren't higher than they need to be but my own personal view is it's better to carry out some 'unnecessary' c-sections than to fail to carry out one necessary section.

My sister was in labour for 40 hours, back to back presentation and instead of dilating her cervix was swelling. Even when they opened her up they had to use forceps to extract my niece as she was wedged fairly well.

It's a good vaginal birth if you wanted a vaginal birth and got one. It's a bad vaginal birth if you actually wanted a C-section and didn't get one.

Got it?

Cleofartra - I don't just mean the CS rate when I say intervention - I had forceps and complications following forceps. The 3 nights I spent being induced and subsequent surgery means that an ELCS would have been substantially cheaper. A number of the people I know who have experienced forceps would choose a CS next time if they could (apparently I will be given the choice).

"it's better to carry out some 'unnecessary' c-sections than to fail to carry out one necessary section."

Even knowing that there may be women who die, or who lose their womb or suffer a stillbirth in a subsequent pregnancy BECAUSE they've had an unnecessary c/s?

"A number of the people I know who have experienced forceps would choose a CS next time if they could"

I can understand that.

Induction can be very tough.

That would depend on your reasons for wanting the C section Casseopia.

Would you still think it was a bad vaginal birth if you had wanted a c section but didn't get one, then ended up with a heathy baby and no abnormal complications?

I have had both, and the elective cs was a (relative) doddle. Compared to incontinence, agony, and immobility for several weeks after the worst imaginable vaginal birth, anything would feel like the proverbial walk in the park.

Very simplistically

If you have 10 pregnant ladies

All of them give birth naturally, and one baby dies in childbirth so 9 healthy babies

v

4 C-sections (so 3 unnecessary) resulting in 10 healthy babies and say one emergency hysterectomy

Yes, I'd take the latter scenario

Cleofartra - so why not offer CS instead of induction to first timers, with full information on both? When I asked about alternatives, only monitoring was mentioned. The rates of various interventions with induction weren't mentioned. When I had an epidural I was told all of the facts, "1 in 2000 gets this, 1 in 200,000 gets that". Yet when I was induced none of the information I have since discovered was mentioned and no one gave any statistics. I assume that this is to prevent you from realising that a CS might be a better bet and damaging their precious statistics. After all I am down as a "success" and did not add to the CS rates. Every woman who has a VB and is left incontinent, with a birth induced prolapse or requiring scar revision is a "success" as the stats only measure the type of birth and never the subsequent damage.

C-section is not that civilised, not when you think about it.

They shave you, they do part your legs for the necessary catheter, oh and the shove their fingers up your bum for the pessary after they have sewn up. :)