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?

I would love a VB my section experience wasn't good. Couldn't walk, bend to look after dd etc. However I know that I will end up with a section so would rather have a planned one than an emergency one.

oMG its like friggin groundhog day

'im not surprised women are pushed into cs by fear of poor care'

Poor care happens in a maternity unit, it is not strictly allocated to those having a VB!

xstitch that is a totally understndable and valid reason for opting for a CS i hope it goes ok for you this time round

"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?"

Where do you get your figures from Cote? I have got my information from the C-section guidelines on the RCOG site.

The poorest outcomes for both mothers and babies are associated to emergency c/s.

The best outcomes for women are associated with vaginal birth NOT ending in c/s.

RCOG C-section guidelines. Go to page 22

here

Note:

Admitted to intensive care: c/s - 0.9% v/b - 0.1%
Maternal death: c/s - 82.3 per million v/b - 16.9 per million

"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."

According to the RGOG guidance c/s reduces:
urinary incontinence three months after birth (4.5% with c/s compared to 7.3% after v/b), and utero-vaginal prolapse.
The figures for fecal incontinence are: 0.8 (c/s) to 1.5 (v/b)

For babies the RCOG finds no statistically significant difference in rates of
Neonatal mortality (excluding breech); brachial plexus injuries or cerebral palsy.

Babies born after c/s are 7 times more likely to experience respitory distress than babies born vaginally.

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

Did you mean 'minimising'?

If you did then I couldn't agree with you more.

"oMG its like friggin groundhog day

'im not surprised women are pushed into cs by fear of poor care'

Poor care happens in a maternity unit, it is not strictly allocated to those having a VB!"

No - this is true. But at least women having planned c/s are pretty much guaranteed the full complement of experienced staff at their birth. A room full of them!

V/B so often go pear-shaped because of under-staffing.

Most c/s are supervised by a consultant. How many vaginal births involve staff of that seniority?

mosschops: You wrote: "It just really niggles me the way generally on here CS is painted as a great option for giving birth and VB is not."

I just don't think that's a fair representation of what goes on on these boards. Every time there is a CS thread, people will join and post the risks of CS, sometimes in totally alarmist ways (e.g. stressing the risk of neonatal mortality, when this risk rises from 1/100,000 for a VB to 2/100,000 - I think - in a CS. People talk about "double" the risk, which could frighten an expectant mother; but it is double the risk from such low odds anyway). I would challenge anyone to find a CS thread which hasn't had a number of posts about the risk of CS.

I think you are confusing people's reports of their own botched VB with a more generalised discussion of what a "good" or desirable birth might be (consensus seems to be that it is a non-induced, short labour, non-intervention VB - but these seem not always to be the norm).

People are perfectly entitled to complain - and bitterly - about their poor VB experiences, particularly if these were at the hands of medical professionals. It is a small wonder that women who have had damaging VBs should feel that a CS would be a better option next time round. And they are no doubt right.

And given that the majority of women who have CS are fortunate not to suffer as you have, it is also unsurprising that they should seek to reassure people that it is a good birth option.

Its true, you have a big team of people in with you when you are having a C-sec. And I found also (certainly the first time round) that you go in a ward with other c-sectioners - I suspect its easier for them to tend to your needs if you are all in together - and that that particular ward, or bay of the ward, had more midwife traffic/presence than the straightforward natural birth bay, most of whom go home within a few hours unless breastfeeding is not happening well.

On that note, I was in a mixed bay of various types of birth with my 2nd child. There were about 10 of us and we were all but one trying to breastfeed. It was a busy, busy night, the postnatal ward was full, the delivery suite was chocka with no beds for those giving birth to move on to.

The midwives were stalking round looking for people well enough to go home. I nearly got released the day after my section and would have if my daughter's blood sugar had been 2 points higher.

But, its no surprise that by morning, of the 9 of us attempting to breastfeed, 5 had moved onto formula and were released and went home.

That's a different debate though...

"I just don't think that's a fair representation of what goes on on these boards. Every time there is a CS thread, people will join and post the risks of CS"

Do you honestly think you can have a sensible discussion about this subject without acknowledging these things?

Are you arguing that they're so rare they're actually irrelevant and shouldn't be alluded to?

"And given that the majority of women who have CS are fortunate not to suffer as you have, it is also unsurprising that they should seek to reassure people that it is a good birth option."

The majority of elective c/s stories on this board describe calm, happy and straightforward surgery. Compare that to the number of difficult vaginal birth stories you read here. Because a lot of vaginal births taking place in understaffed hospitals in the UK are NOT well managed. Many start with induction and end with forceps or ventouse deliveries.

That's fair enough, but you also have to take on board that though serious problems associated with c/s are rare - meaning you will have very few women who experienced them discussing them on these boards - when they do occur they're very, very traumatic.

Theright thing to do is to offer women who have had nasty VB experiences counselling immediately after that experience.
But surely the CS rate is increasing at least in part because the average size of babies is increasing? Obviously some people have CS and average sized babies, but there is a correlation between big baby and CS, and more women are having big babies.

No, of course these things should be acknowledged, Spudulika. And they always always are. But I think that sometimes people talk of the risks in alarmist ways. That's all.

And, as you admit, many women are forced to give birth in understaffed units, resulting in difficult, poorly managed VBs. That is the reality of maternity services in the UK today. Of course a straightforward VB is the most desirable birth; but given the state of maternity services, who can be assured of that?

It is true that the majority of women are not instructed as to the possible realities/risk of VBs in British hospitals - e.g. episiotomies, ventouse, forceps, tearing, incontinence, fistula, and so on; but I think most women are well-versed in the dangers of CS. Why is that?

Many women express surprise and distress at a VB gone wrong; no-one warned them it was possible.

Also, I would be interested in whether those figures concerning, e.g., incontinence following VB are entirely accurate; many, many, many women do not report to their doctors that they are suffering post-birth. Some are too embarrassed; others think it normal. I read a post by a woman who has not been able to poo properly since the birth of her child, and she had chanced to read a post by someone else explaining this as a consequence of damage caused by birth. And the first poster expressed genuine surprise, assuming that it was normal after birth. And that she wasn't going to do anything about it because she was used to it. How many more women are like this. They simply won't appear in the figures.

Yes, the serious problems associated with CS are very, very traumatic to their sufferers. But so are the serious problems associated with VB. We should discuss them all. But it seems we do not.

"Theright thing to do is to offer women who have had nasty VB experiences counselling immediately after that experience."

Not sure that all women want to debrief straight away. Some will. Some won't want to talk about it for months or years. Or ever!

"e.g. episiotomies, ventouse, forceps, tearing, incontinence, fistula, and so on; but I think most women are well-versed in the dangers of CS. Why is that?"

I'm not sure I agree. I don't think the posts on the childbirth board bear out your view that women don't know about the drawbacks of vaginal birth, or that they are aware of things like increased rate of placental problems and possible stillbirth in pregnancies following c/s. What they are worried about tend to be things like post-operative pain and problems with breastfeeding.

Wanted to add that it's not really sensible to lump in 'incontinence' and 'fistula' with 'episiotomies' and 'ventouse'. It's true that perineal damage is normal following birth (at least in our hospitals it is) and that assisted birth is common for first time mums. But most assisted births are uncomplicated and not associated with any problems in mum or baby in the medium and long term. Fistula is VERY rare in the UK now, and incontinence is a problem that both c/s and v/b mums can suffer from. Really major problems with incontinence aren't massively common.

"Yes, the serious problems associated with CS are very, very traumatic to their sufferers. But so are the serious problems associated with VB"

Given that the serious problems associated with c/s may well involve bowel damage resulting in women needing a colostomy; admittance to ICU; unplanned hysterectomy; stillbirth and placental problems in subsequent pregnancies; and (rarely) death, I don't think it's fair to imply that they're usually on par with each other.

Agree that minor issues with continence and bowel function may well be unrepresented in the figures though.

"Obviously some people have CS and average sized babies, but there is a correlation between big baby and CS, and more women are having big babies."

But women themselves are getting taller and bigger so size of baby shouldn't necessarily be a growing problem.

But increased levels of obesity and higher maternal age are. Big time.

So the risk of dying in a c-section is 1 in 2500 (that includes emergency and elective)

The risk of dying in natural childbirth (not sure if this includes VBAC but I'd assume it does as it is natural childbirth) is 1 in 10,000

And the risk of dying in a car accident if you do 10,000 miles a year is 1 in 6000.

Just to give the various options something to compare...though obviously your individual circumstances would weight it differently...

I think it's also worth looking at risk in two different ways. Pure statistical risk, and relative risk.

With Asherman's Syndrome, as I understand it, the risk of rupture is a little higher than it would be for normal elective after previous section. However the severity of that risk is higher. It's Very Bad News and outcomes are, well, you wouldn't want to go there.

A rupture in both cases (but it's worse with Ashermans) is very, very serious. So although it's a small risk, it's a very serious risk.

This is worth bearing in mind when making decisions.

Tatty, I'm sure I remember reading a thing on the RCOG site about how doctors can explain risk. They relate it to context

Very common 1/1 to 1/10 A person in family

Common 1/10 to 1/100 A person in street

Uncommon 1/100 to 1/1000 A person in village

Rare 1/1000 to 1/10 000 A person in small town

Very rare Less than 1/100 000 A person in large town

I think your example is helpful though.

Ah that's quite clever.

Yes, my example doesn't really factor in all the variants of course like an obese diabetic 41 year old woman having a VBAC at home but who doesn't drive a car could not really take much notice of my example!

Side effects of VB CAN be serious; we almost lost ds1 and me after I developed eclampsia during a VB that was indicated for CS but no Consulatant available.

A lot of issues IME are in that grey are and that's where an individual consultant is likely to influence choice between CS or VB (or indeed PCT / equivalent body).

Luckily I went on and had 3 further excellent Vbs but I had to deal with PTSD first.

mosschops30 Wed 25-May-11 11:23:06
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?

People are mentioning the risks of VB because they are responding to a premise that c-s is wrong. If the premise was that VB is wrong and c-s is better then people would be talking about the risks of cs.

What a poor argument.
This thread isnt about cs being wrong, its about women who want CSs for no medical or psychological reason.
There still has to be a balanced argument for this debate to be valid

"Side effects of VB CAN be serious; we almost lost ds1 and me after I developed eclampsia during a VB that was indicated for CS but no Consulatant available."

Of course - some women end up in ICU after a vaginal birth.

But on balance this happens less often than with c/s.

"they are responding to a premise that c-s is wrong"

I don't think anyone here has said that c-s is 'wrong'! (laughing - thinking of the way my kids use the word wrong...... dd used it this week when I proposed getting a bikini for me to wear on my hols!)

"What a poor argument.
This thread isnt about cs being wrong, its about women who want CSs for no medical or psychological reason."

And why do you think people are so keen to debate whether or not it's acceptable to have a c-s for no medical or psychological reason? Why would there be ANY need at all to differentiate??? Some people OBVIOUSLY don't consider c-s a valid choice otherwise there wouldn't be discussions about bringin g in psychiatrists to convince women to give VB a try, would there?

I can honestly say, I have no idea where you've been living if you have never heard a single sole criticise c-section birth. I wish I lived there too though!

Sorry, spudulika, I meant c-s is wrong without medical reasons. I thought that was obvious from the content of the thread but I should have spelled it out.

Risks to cs are serious too. I friend of mine nearly died due to her cs. She was in a coma for several months and the docotors told her family to prepare for her not to pull through. Her ds is now in his teens and she is still poorly. This wasn't due to any other compliction just the cs went wrong

Thats because its not acceptable imho to have major surgery without a meical, physical or psychologicl reason. This includes women who have had previous cs, tokophobics, etc etc.
Im just discounting women who just dont fancy a VB for whatever reason (fanjo issues, too posh to push etc).

I dont like my nose, my stomach or my breasts but im not about to go and demand surgery on the NHS

Mosschops, I just tried to explain why people are spending a lot of time talking about the risks of VBs ON THIS THREAD - because they're discussing the premise that unless there are medical indications people shouldn't have them because of the risks.

And that's why there is a big focus on on VB risks ON THIS PARTICULAR THREAD. Because people are saying, actually, VBs carry risks too, and then explaining what they are.

That was my only point to you.

I am not remotely interested in your personal views on when it is acceptable to have a c-s or not, so you've completely lost my by responding to my point in that way.

Actually, the OP started out being about how ELCS shouldn't be performed for non medical reasons and then the thread (inevitably) moved on to talking about risks (which can also result in higher costs).