Does anybody actually know anyone who had an ELCS just because they thought they were "too posh to push"?

[InAStateOfReflux]

Just watching the Wright stuff. One of the hot topics is that apparently ELCS rates being performed by the NHS are rising because people are deciding they are "too posh to push" and it's costing the NHS lots of money.

They are suggesting that these women should be offered psychiatric counselling to bring them round to the idea of having a vaginal birth.

Now correct me if I'm wrong, but I was given an ELCS because my dd was breech and was in fact strongly advised to (not given much choice in fact) and anyone else I know who's had one has been offered it because of significant trauma or complications in a previous birth.

I have never however met a woman who insisted on one on the NHS just cause she didn't fancy pushing it out of her fanny, and I doubt the NHS would go with this anyway tbh...

And if they're talking about women who have real fears and emotional distress regarding child-birth, then yes of course lets force the hysterical wench to push it out, does she not know how much money she's costing the NHS?

Oh how I love the way the media portray these issues...[sigh] Yes perhaps ELCS rates are rising and perhaps this should be addressed in some way, but to suggest it is for such fickle reasons is so juvenile. Perhaps it is the HCPs fault and not the whole female population who are apparently too cowardly to push their babies out?

Thank you so much for saying that. I'm actually onto my second consultant, who is still virulently pro-VBAC, but has at least recommended that I have this counselling (which I'm happy to give a go as I want to do the right thing, and I want to be helped to feel better). Although I am concerned that she's implied I have wider mental health issues because I am so upset about this - I don't, it's just this. The first consultant didn't even offer any support and completely dismissed me.

I do really want to complain and will do after the birth because I don't want this happening to anyone else, but at the moment I just want to get my head down, follow their processes and pray that this will get resolved in time for me to start focussing on my baby.

Christ Schmee. Can you ask to be referred to another hospital? Is going private at all an option for you?

I think you need to get away from this hospital, I really do. They can refer you elsewhere, I'm sure. Then after the dust has settled you should complain.

I have been raped. I really don't want to have to drag that all up in some counselling room to swing the choice for ELCS my way weeks before I give birth, when I should be concentrating on the happy event. And I also don't want 'mental health issues' plastered over my notes. Already had to downplay my depression/suicide attempt (after the rape in my early twenties) to the midwife. Shouldn't have mentioned it at all.

Very good luck.

Schmee. That's awful.

If your consultant says "no" you are within your rights to ask them to refer you to a consultant or a hospital that is willing to perform a c-section on you. Tell them that you would like to exercise "Informed Refusal" of their suggestion that you attempt a VBAC, that you have studied the risks and benefits and that you are in no way comfortable with the risks. Their word does not have to be final - they are within their rights to refuse you but you are within your rights to insist that they refer you to a hospital/consultant that will be willing to discuss this further and do a c-section.

From the website www.csections.org:

UK hospitals have the right to refuse a caesarean at the mother's request if there are no recognised medical grounds. However the National Institute for Health and Clinical Excellence (NICE) 27 also state that "the woman's decision should be respected, and she should be offered referral for a second opinion". Though "under British law?the medical profession has historically favoured the life of an unborn child and/or saving the mother's life over maternal autonomy."

It is possible to negotiate a caesarean for reasons of 'psychological fear of child birth' or Tokophobia. In some hospitals such an explanation would be accepted and your request followed. In other hospitals you would be asked to undertake counselling to address this fear, following which you may be able to have a caesarean or be referred to another hospital that would perform the caesarean (your hospital is obliged to offer this referral).

The difficulty facing a mother in requesting a caesarean is being able to stand up to those health professionals presenting the story of caesarean doom and gloom. If you are in this situation it may be helpful to be fully informed about the benefits, risks and options available to you.

Putting your case when you have no recognised medical indications requires more planning on your part to reduce the amount of discussion and possible confrontation. The hospital may require you to undergo counselling and ultimately they may still refer you to another hospital rather than carry out the surgery themselves. They are obliged to refer you to somewhere that will carry out your caesarean.

A recent study commented: "The risks of CS [caesarean section] and labour are real but different, and if fully explained to the woman, she should be allowed to accept one set of risks over the other - after all she is the person who has to live with the consequences. An elective CS in a fit healthy woman is neither unsafe nor bad practice if she truly understands the risks involved and is adamant that she cannot accept the risks of labour or vaginal delivery".

I suggest you start a major campaign. Go to your GP and tell him/her that you have been up crying and that you need help, now. Tell them why. Tell them you need treatment for this depression and anxiety. I think they are pretty limited in what they can "give you" for anxiety and therefore will possibly be keen to get to the root of your anxiety and possibly help you campaign with your Consultant to agree to a c-section. If you have been promised counselling and it hasn't happened, start putting your concerns in writing stating that they don't seem to be delivering their end of the bargain and that you will not be fobbed off. Take any possible action you can, make a note of phone conversations, meetings, take copies of letters you send.

I do love a personal crusade. PM me if you need any help or support.

Back to the OP - was just browsing around csections.org and I found this:

"Myth: An elective caesarean is the sole choice of the mother and is requested for cosmetic reasons

Most elective caesareans are carried out for medical reasons i.e. breech presentation, multiple births etc. If the recent phenomenon of women being "too posh to push" were solely responsible for this you would expect the number of elective caesareans to have risen significantly in comparison to the number of emergency caesareans over the last 25 years. In fact figures 3 and 4 below 26 show that if anything the reverse is true: the number of emergency caesareans has grown more than the number of electives.

"Too posh to push" is a media hyped term that has sadly caught on and stigmatised those women who either have a caesarean recommended to them by their obstetrician in advance of labour or those who opt for a modern, controlled alternative to vaginal birth. Researchers conducting the Nuffield Study stated that "Despite strong rhetoric around the topic, existing research fails to support the notion that large numbers of women are demanding caesareans in the absence of any clinical indication. [The Nuffield study] has also been unable to find evidence for women asking for the operation for social/trivial reasons eg because they are 'too posh to push' or solely to time the birth."

Wish I had that open in front of me during Matthew Wright's poxy show yesterday...and got through on the phones. He's a tosser.

Oh Schmee you poor thing. Is it within your means to go private? I know you shouldn't have to, but on the other hand it would give you endless peace of mind knowing you are booked in for the birth you want and allow you to enjoy the rest of your pregnancy. x

Tatty - funnily enough I didn't see the topic being opened up for public discussion on the phone lines - funny that. Just a bullshit-filled, cliche-laden convo between the "panel", who clearly didn't have much of a clue of what they were talking about.

" CSs are more dangerous for both mother and baby."

CS at 39 weeks is safer for baby than VB.

CS is slightly more dangerous for mother than VB.

Shmee that's awful.

I know it's getting late, but it's not too late. It sounds like your hospital is more clinically disposed to VBAC than ELCS.

Before I got my C-S I looked at the stats for all of my local hospitals and chose the one with the highest rates of ELCS. Then I posted on MN asking if anyone had any experiences of any of the consultants there. I was very lucky as a MNer gave me the name of her consultant who was very pro ELCS after previous C-S. I asked to see him and had no trouble getting my ELCS.

If you are able to change hospitals then have a look at this it allows you to find the ELCS rates of hospitals by postcode.

I guess I would fall into that category. With DS I had a choice of a VBAC after inducement (which failed first time) or a repeat CS. I chose the CS because I didn't want to be put into the same situation again and end up with an EMCS. So I opted for a CS.

But frankly I was given no counselling other than signing the consent form. Perhaps if the consultant had been in any way keen on a VBAC I would have had that instead.

"CS at 39 weeks is safer for baby than VB"

But of course, unless you're not planning on having any more babies, you might want to factor in increased risks of placenta praevia and placenta acreta and percreta.

There've been quite a few studies over the past few years which have linked c-section with higher risk of stillbirth in subsequent pregnancies. The argument is that abnormal placentation is more of a risk after c-section.

Would also want to point out that the main risks with v/b that stop it from being vastly safer than a planned c/s is the chance of it ending in an emergency c/s, which is much riskier than a planned c/s. So successful vaginal births are significantly safer than planned c/s.

So I reckon you to maximise chances of a safe birth you EITHER plan a c/s, or you opt for a vaginal birth, but you do EVERYTHING you can think of to reduce the likelihood of a c/s (ie, choose a hospital with a low c/s rate and good staffing levels, opt for a homebirth, get a doula, get an independent midwife).

Re: the OP - I wonder if the stories of celebrity planned c/s influence public perception of this issue.

So many (mostly US) celebrities have planned c/s - I suppose that's where the 'too posh to push' idea may have come from.

Slightly increased risk of future pregnancies has nothing to do with the risk for this baby. As I said, CS at 39 weeks is safer for the baby being born than VB.

"the main risks with v/b that stop it from being vastly safer than a planned c/s is the chance of it ending in an emergency c/s"

That is a pathetic lie. You forget that most of us have given birth here, some with catastrophic consequences. Who do you think you are fooling?

The main risks of VB are stillbirth, cerebral palsy, brain damage, nerve damage, and various other irreversible and life-changing events that are for the most part unforeseeable. And that is only to the baby.

To the mother, and off the top of my head: death, hysterectomy, prolapse, fistula, fissures, incontinence, huge episiotomies that don't necessarily stop hurting, broken coccyx. Oh and have I mentioned trauma causing PTSD? I believe many of us have.

"So I reckon you to maximise chances of a safe birth you EITHER plan a c/s, or you opt for a vaginal birth, but you do EVERYTHING you can think of to reduce the likelihood of a c/s (ie, choose a hospital with a low c/s rate and good staffing levels, opt for a homebirth, get a doula, get an independent midwife)"

Ever tried to have a homebirth after an emergency c-section the first time round?

I did (before I was diagnosed with Placenta Praevia). Hospital/consultant/midwives said absolutely no way.
Tried to get an independent midwife, the only ones who would cover my area urged me to reconsider and then actually stopped returning my calls and emails.
Hospital were unable to reassure me that I would be able to have an active birth and said absolutely no way to water birth. Would have to be strapped up to monitors the whole time due to risk of rupture.

Its no wonder women do opt for the elective section really, when maximising their risk of emergency section is so damn near impossible.

Minimising their risk, that should say!

Its true that if you are planning a large family or subsequent babies its generally worth trying for a VBAC, on the basis that the more sections you have, the higher your chance of something happening in future pregnancies/births where things go wrong. Placenta praevia can be pretty serious, and it would be awful to end your reproductive years with a hysterectomy.

I'm not sure of the stats on all this though as I was only planning 2 children and I'm adamant that I am done!

Some of those risks CoteAzur mentions to the mother for VB also apply to ElCS. For instance, friend who had 3 EmCS she was happy enough about, then had a somewhat traumatic ElCS. Hysterectomy a signif. risk with CS. Breastfeeding rates reduced by CS (for whatever reasons). Some other long-term effects discussed on Livestrong, which list doesn't include ectopic pg, or increased risk of adhesion pain.

Personally due to my own circumstances I'm taking the section. VBAC and chance of future pregnancy become pretty irrelevant when the alternative is almost certain death. There would be no other pregnancies then would there?

Again people mentioning the risks of VB without even acknowledging any risks with a CS. There are just as many you know!
How blinkered can this argument be?

Just looking at the link I can't see whether the actual CS is the risk factor for a hysterectomy, or whether the CS has been performed because of reasons, which subsequently also led to the need for hysterectomy.

I get that previous CS increases the risk of placenta accreta, rupture etc, which may cause the need for hysterectomy, but can't see from just the abstract that ELCS in itself would immediately increase the risk

mosschops - with all respect, I think you are reading this thread through the lens of your own very traumatic CS. Quite a few people - Spudulika, bidibidi (only 2 posts before you) and more - have mentioned the risks of CS.

In fact, I think that on the whole, more people are happy to stress the risks of CS than they are to stress the risks of VB, and this is certainly the case in the medical profession as well as on these boards.

mosschops - the risks of CS are pretty much known, and ususally they make you sign a long fat form detailing every single one of them before you get one. Plus you get the "CS is horrible and dangerous" line everywhere the idea of ELCS is discussed.

I usually get the feeling that risks of VB are more readily swept under the carpet. (And e.g. at least at the antenatal class I went to, they weren't discussed to the extent of caesarean risks, if at all)

bidibidi - True, some risks are shared by VB and CS. You might die as a result of both. You might also have a hysterectomy with both.

As I said, it is just not true that the main risk of VB is that you might need an emCS.

misschops I was talking about my circumstances which I described further up thread.. For me to insist on VB only would mean certain death personally any percentage risk is better than that.. I was not talking about the overall risks for women in general. The clue is when I said personally.

I was referring tocotes post listing all the bad things that can happen with a VBand not one for a CS.
There are more risks than thy list on tht shitty consent form.
And having talked to others i know im not alone in my horrendous CS experience.
It just really niggles me the way generally on here CS is painted as a great option for giving birth and VB is not.
The fact is that childbirth is dangerous however it occurs, there are risks associated with both VBs and CSs.

I totally accept that for some women through psychological or medical need have to opt for a CS. For those women its imperative that they get to make a choice that is better for them and their babies.
Painting CS as a valid choice for all is wrong imho

Considering the quality of care women recieve when giving birth and the scary stories or real life situations that have occurred, I am not surprised women are too frightened to go through that and would be pushed by fear into a cesarean.