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)

I had an ELCS with DS1, he was breech and well and truley stuck. The consultant wouldn't even consider trying to turn him as he was sure he wouldn't turn. It was not an experience I enjoyed, not one tiny little bit.

DS2, I was offered a ELCS but said no. I was eventually booked in for an ELCS if I didn't go into labour naturally. That would have been at term + 13. On term +11 I went into labour. I was contracting 2 in 10 for a minute each time. Extremely strong. Strong enough that I couldn't speak through them. Went in and put on a monitor. Baby not coping well, but let's see how we go. I was eventually given codeine as I was not in established labour as only 2cm dilated and still strapped to the monitor. I did make it out of the hospital to the supermarket for breakfast, this was very early on in the whole saga.

19 hours later I was still contracting, but now 3 in 10 and STILL 2cm dilated. The baby was still in distress and my hips were past useless now, (SPD from 24 weeks) I couldn't walk from one end of the corridor to the other without them giving out. I tried pethedine, HA! what a joke that was, didn't even touch the hip pain. G&A made me feel sick. The consultant was in and out every 20 mins and in the end sat down and said "look we can be here for another 10 hours with no more progress, its not safe for the baby and it's not safe for you, but it is your decision to carry on or we can get it over and done with and you have another section." He then ran through the risks again and I signed up. I was taken to theatre with my midwife, all the staff were very calm, reassuring and explained each step as they did it. It was the most relaxing, beautiful and calm way to give birth. For me.

Curlymama, Curlyquestion - personally, no absolutely not - the trouble is you don't know beforehand what you're going to get, do you?

I asked my consultant if I would be likely to have a vaginal birth without needing and episiotomy/emergency C-section etc etc, and the best he could tell me was that he didn't know & that I could try for a vaginal delivery. It's all finger in the air stuff - not even knowing a percentage likelihood of having a safe, relatively problem free delivery. I'm very petite, my husband is big, the baby never engaged etc etc, and I had the option of an elective C, so I took it.

But that's just my story. Other women may be totally against vaginal birth, regardless of how smoothly it could go.

Emmyloulou - it's all relative. It's as civilised as it gets.

True Emmyloulou, there is no completely dignified way of giving birth. Having a gown with a split up the back aint that dignified - having a catheter full stop, with a bag of piss beside you isn't really, though you can end up with that with a "natural" too.

Still reckon less indignity with a section.

Having said that you still bleed afterwards, so still lie there with a surfboard maternity pad between your legs, and getting checked by midwifes occasionally to make sure you are not haemorraging etc (possibly more so due to increased risk of doing so plus the fact you might not be able to feel a large volume of blood due to spinal block not worn off yet etc)

No, its not really a priority or shouldn't be with having children, the dignity thing. Its sort of nice to have some, but really its not the end of the world and you just sit there sniffing your baby's head afterwards anyway so who cares

I haven't read all the posts, but I had an emcs first time round which I found dreadfully hard tp recover from both physically and mentally. I had a successful vbac 2 weeks ago - I sustained a 2nd degree tear which needed stitching, but on balance, the vbac was so much better (I'd say I'm almost fully recovered now). Looking back at the photos taken after my first birth, I look terribly ill - this time I gave birth with the flu and looked miles better. However, I do agree with frgr 's point about the need for people to fully understand the risks of both. I was very aware that the decision I made about a vbac was potentially increasing the risk of harm to me and my baby and I was lucky that my DH was supportive of my choice.

Kudos for the vbac maxpower!! Seriously.

Tyler, babies don't die because of a normal delivery. they are more at risk or dying because of a caesarean deliovery.

"Cleofartra - so why not offer CS instead of induction to first timers, with full information on both?"

I can see a good argument for that. Particularly if you have a very unfavourable cervix for induction.

But I would have major wobbles about the idea of the c/s rate going up any higher overall than it is at present with the number of midwives and obstetricians we've currently got. I don't think you could safely increase the number of c/s we have at the moment without a major increase in midwife and doctor numbers.

tyler80, I'm not sure that speculation which isn't rooted in a good understanding of the risks and benefits of c/s is worthwhile.

No, more babies die in natural delivery than in c-section delivery.

More mothers die from c-section delivery though (deep vein thrombosis, haemorrage, infection, etc)

Its not to say its "safer" or "better" overall for babies to be delivered by section, BUT, it is not true that natural delivery is safer in terms of mortality for babies, technically it is not (but by a small percentage of what is a very low risk anyway)

"No, more babies die in natural delivery than in c-section delivery"

I wonder what would happen to those figures if you could factor in the possible additional risk of stillbirth in pregnancies after c/s?

Just to add that the mortality rates for women are slightly distorted due to the fact that some of those requiring c-sections may already have complicated health conditions, thus them requiring a c-section.

Also, the simple rate of mortality in natural vs section shouldn't really factor too much as there are complications arising from c-section that might manifest later, therefore not being seen as dying during birth, which might impact the overall figures.

For instance, a longer hospital stay may mean a baby contracts an infection they otherwise may not have got if they had been delivered naturally and left later that day. This wouldn't count as dying during labour/birth though, yet may be the "fault", in a roundabout way, of the c-section due to increased risk.

I'm getting tired, its hard to explain what I mean!

Would also be interested to know what would happen to the neonatal mortality figures if the same amount of money was spent caring for women having v/b as is spent on those having a c/s.

Does c-section increase you chances of a stillbirth then? I didn't know that.

True, Cleofartra, re increased risk of stillbirth and that would be hard to factor in but should be a consideration.

All part of informed consent to know these things before making a decision.

When I signed the consent form for my elective (I had placenta praevia) they were pretty clear about risk of adhesions and my increased risk of death etc (ironic considering the only way not to die was to have a section! And even then no guarantees!) but I dont remember them mentioning increased risk of having a still birth in future though I think they mentioned sub-fertility (not that I was worried at that point, I was so over being pregnant and had decided NEVER AGAIN!)...

Is the increased risk of stillbirth due to the risk of scar rupture or separate again?

Is it not more a case against VBAC than a section per se?

Or is it something else?

Tatty - I think I understand what you're saying. But it's getting late for me too! [yawning emoticon]

I'm off to beddy byes in a sec but will check this in the morning, its a very interesting topic for me having had sections and having known so many people with butchered vaginas

I think it's complicated but some of it's down to placental issues.

On a personal note I have a friend who lost her womb and nearly lost her baby and her life after her placenta grew through her c/s scar and adhered to her bowel during her third pregnancy. Eek!

Oh hell. Did she have closely spaced pregnancies or was she just unlucky?

At one point they thought my placenta was attached to my scar and didnt' know where they could cut me. They were talking classical incision (i.e vertical). Whilst I think my bikini wearing days are over, I wasn't loving that idea but being alive is soo cool.

It was fine in the end, it was more posterior than they thought so they did a dildo cam and realised they could cut me after all

That's placenta accreta, which I mentioned earlier -- overall rate about 1 in 2500 deliveries but much much more common where there has been a previous c-section.

I agree that my memory of the c-section consent form is that it covered immediate risks but didn't mention increased risks in subsequent pregnancies. I do remember that it was yellow, oddly enough, but that's not massively helpful.

I've had both and would take the vb every time. DS1 was ELCS due to PE and IUGR at 33+5 as the consultant didn't think he'd cope with an induction. I got 3 different infections post surgery, weeks of antibiotics, and it was still painful months later. Plus i couldn't drive for 6 weeks and he was in SCBU for a month.

DS2 was vbac with ventuous because his head engaged sideways and he had to be manually repositioned by a reg. I had an epi which didn't work and finally a spinal anesthetic. If she hadn't been able to unwedge him they'd have gone to emcs. Post birth i had nothing stronger than paracetamol despite tearing and was fine (apart from a shockingly high bp) by the next day.

Not having any more!

The thing is, is that damage happens with c sections too! Cutting the uterus makes it weaker & susceptible to rupture in subsequent pregnancies/births. It can also develop scar tissue, which causes problems.

I have had 2, I have no feeling in parts of my stomach, ok so it doesn't cause me pain, but the nerves in my legs that were affected by the incision, do. I have to wear thick trousers in winter, otherwise the cold hurts it. My feet get painful if they get too cold & I am talking about walking on a cold tiled floor. I get very achy legs if I walk too much, couple with tingling & nerve pain.

I now have constant numbness, in one patch, in one leg due to nerve damage.

I know that women suffer in child birth, but unless you have had a section, I don't think you can say that you would rather have one over a vaginal birth. Because neither are without risk.

I would also point out that it was weeks before I could sleep any way except on my back. It took me a while to get in & out of bed. Sections are no walk in the park!

I don't think you can/should opt for a section to avoid piles!

I know that women get piles through pregnancy/childbirth, but people also get them other ways too. My uncle has them, and as far as I know, he has never given birth!

The ESC was a walk in the park - I was out of hospital and off painkillers within 3 days

My first section (crash, GA), I was home after 5 days. wasn't given painkillers, didn't seem to need much more than ibuprofen at home.

My second (elective), I was in hosp for 6 days, severely constipated (painkillers) sent home with painkillers, needed repeat script after 2 weeks, still severely constipated. Caused some kind of internal pain through straining too much (more painkillers), but in too much agony with the constipation to not at least to get something moving.

So while some are a walk in the park, one in two of mine certainly wasn't. And it is a huge factor in deciding not to have any more babies.

I had a crash CS under GA for foetal distress with my first DC, after a very long and protracted labour. She was very sick for a short time afterwards as was I (to a lesser extent) I had had a very difficult pregnancy with a fair few problems. I was induced after my waters broke and nothing happened. I consider myself to have had excellent care and my DD would most certainly
have died had I not had such an experienced midwife looking after me-I have vivid memories of her really giving it to the on call Dr and eventually going above his head and getting the consultant in from home.
I chose to have an elective cs next time around after much discussion with my Dr-that pregnancy had again been difficult and I was scared of a repeat.
My recovery after both was fine-in bed for 24 hours after the first but I think that was mostly due to me being rubbish after anaesthetic but was up 6 hours after the second one, catheter out, breastfeeding an hour after birth and home 24 hours later.
My elective cs was a very positive experience for me compared to my experience of labour albeit that I have never actually delivered a baby vaginally.

Swings & roundabouts. For every one who would prefer a CS there's one bleating on about her "natural birth experience".