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 wasn't actually saying that CSs shouldn't be performed for non-medical reasons, but that I felt that the media portraying that a vast number of women choose ELCSs because they are" too posh to push" is wrong and misleading, and that once again it vilifies women in the eyes of the public, by insinuating that vast sums of public money is being spent on "unnecessary" CSs. I personally think a woman has every right to chose the birth she wants, but I was simply asking where are all these women who demand CSs for non-medical reasons and get them on the NHS because I have never met one. Clearly there are some out there, as this thread has proven, but I don't think there are as many as the media is making out.

Inastate - yes, sorry, I realise those weren't your views - I was referring to the premise in the OP, from the Matthew Wright show, not your take on it. Sorry if that wasn't clear.

That's ok!

I think the figures support the view that only a very tiny number of c/s are done on the NHS on maternal request. And I assume that for most of these there's a medical reason, namely tokophobia. So Ian Wright can fuck off!

Re: the ethics of the whole thing - I do think that in a publically funded healthcare system where lives are being lost or blighted because of a lack of resources, it's hard to think of an argument in support of c/s on request when there are no physical or psychological concerns.

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

In the interest of fair debate I should point out that my CS was performed by a registrar with an F1/F2 assisting. I didn't actually know this until after because there were so many people in the room I just assumed one of them was the consultant and I couldn't see who was cutting me once I was lying down! The pair of them had scanned me before to make sure dd was still breech, and the registrar was teaching how to do the scan, but yet a little while later she was cutting me open! In fairness they did a good job and perhaps this goes to show how routine an ELCS is considered, but I was still a bit when I found out later when I was chatting with the midwife! Ironically both of my ECV attempts were performed by a senior consultant with a registrar assisting. They are a lot less common than ELCSs so the registrars aren't as experienced in performing them.

Going slightly off topic

Elective Sections are routinely performed by Registrars - Consultants only tend to do them when considered more complicated.

Likewise registrars tend to do instrumental deliveries (kiwi,ventouse,forceps)

Vaginal birth - supervised by a consultant - not my choice - fine if potentially needing instrumental or C/S, but I was talking to medical student yesterday - she needs to witness 4 normal vaginal deliveries - no more, if she persues her career in Obs she is unlikely to see any further normal vaginal births - but will become more experienced for instrumental/CS. Whereas all midwives must personally manage 40 normal vaginal deliveries before they qualify. Therefore (in the highly unlikely event of further birth) if all was going well and not deviating from "norm" I would want midwife led care, with the reg/consultant wheeled in immediately the labour deviated from norm

I think expecting women to shoulder the ethical responsibility for the allocation of the NHS budget is a bit rich.

Even if every woman requested an ELCS (unlikely), the cost of maternity services to the NHS would still not exceed 4% of the total budget. At present, less than 2% of the NHS budget goes to maternity services.

Almost as much money (£1.4 billion) is spent on claims deriving from obstetrics as is spent on maternity services in total (£1.6 billion).

Perhaps if the NHS were less concerned with saving money - i.e. refusing CS - - than focussing on good maternity care, some of that £1.4 billion in costs and damages could be saved?

I'd rather the money was clawed back from the costs relating to obesity (c.4% of NHS budget).

The thing is, people talk about ELCS as "unnecessary surgery" as if it's comparable to someone normal-looking demanding a nose job, or a healthy person asking for a fully functioning arm to be amputated.

A CS is just not comparable to these in terms of "unnecessary" or "vanity" surgery. There's a baby in there, and it HAS to come out, one way or another.

stoatie - I hear you, I am a medical student and was considering obs and gynae, but the one thing that puts me off is that I'll rarely encounter any normal healthy pregnancies/births, but rather scary, complicated ones!

InAStateOfReflux - You are a medical student considering ob/gyn and you didn't know that abdominal muscles are not cut during CS?

And they wonder why care is so bad in some hospitals.

I do know a couple of women who had ELCS privately paid for. No medical reasons they just didn't fancy giving birth and had the funds to do what they wanted. More too rich than too posh

Never heard anyone having ELCS on NHS though.

Cote DAZur - OFGS I have done two years and I have learned in depth anatomy and physiology of the human body, I am moving on to the clinical stuff next year. Pardon me for not knowing the intricacies of every single surgical procedure known to man already, all I knew was the abdominal muscles were there, in the way, so I wondered how one got to the uterus. AFAIK the abdominal rectus muscles are joined in the middle by a sheath called the linea alba which must be cut through I'm guessing. I'm sure that IF I decided to specialise in obs/gynae in 5 YEARS TIME from now, I will know a bit more about the procedure. Anyway I am aware of my limitations and am aware I have lots still to learn - would be great to start out knowing absolutely everything but I guess that's why a medical degree is 5 years long...

Thank you anyway, you condescension is lovely to be on the receiving end of when I have taken a year out to have a dd and am going back in September. I feel a bit apprehensive about going back after taking some time out but I am brimming with confidence now. Cheers!

If you wondered how surgeon gets to the uterus during a CS, you would have Googled it. That kind of curiosity and eagerness to learn is what I hope most medical students are made of.

Instead, you got cocky and wrote "CoteDazur, How are they meant to get to your uterus without cutting through your abdominal muscles? "

Don't you cry now. It will make me go all soft and bubbly.

NHS can't offer c/s on demand if it doesn't have the staff to meet the need. And it doesn't. You can't magic midwives and doctors out of nowhere.

"people talk about ELCS as "unnecessary surgery"

But if a baby can safely be born vaginally then it is, in the strictest sense of the word, 'unnecessary'.

"I think expecting women to shoulder the ethical responsibility for the allocation of the NHS budget is a bit rich"

I agree. Individual women don't have a responsibility to the NHS and to other mothers. But politicians and health policy planners do. They have a responsibility to make sure that the money is spent in such a way as to maximise good outcomes in childbirth. (by 'good outcomes' I think I mean a well mother going home with a well baby).

" That kind of curiosity and eagerness to learn is what I hope most medical students are made of"

Pompous? Moi?

as someone who's had 4 cs (first one was an emergency,second was a crash section,third was elective as was fourth due to previous surgery) i am certainly not too posh to push.
i wonder how many of these cs's were repeat surgeries,seeing as britain is going through a baby boom?

I wasn't "too posh to push".

My Consultant scheduled a CS because 1) my baby was breech and 2) he felt that I would be unable to have a VB because during our numerous conversation I was petrified of it. My baby turned at 37.3 weeks and I suppose I could have gone for a VB but I was too exhausted, and I just wanted him out, and having been given a date - my heart was set on that date.

Its a personal choice and i don't think anyone should be blamed for choosing the birth they want. I'm not sure how it works with the NHS but if the Consultant thinks its the best option for the mother, why should we blame them?

Spudulika "people talk about ELCS as "unnecessary surgery"

But if a baby can safely be born vaginally then it is, in the strictest sense of the word, 'unnecessary'.

Safe for who? I had an emergency CS with DS1. DS2 was born 14 months later. In theory I could have easily had a VB with DS2 as there were none of the problems I had with DS1 which lead to the CS, but there was a very real risk of labour and the birth rupturing the scars, so it was a CS for me again. It would have been perfectly safe for DS2 to have been born vaginally, presuming I had a reasonably swift labour, but it would have been potentially very dangerous for me.

I think it is also a bit misleading to say 'can safely be born vaginally' as many ELCSs are as a result of risk (and cost) management. Yes there is a good chance that a VB may be perfectly fine and safe in many cases, but the consequences and likelihood of something going wrong are what prompts the decision to go for a CS.

Plainly put, an elective CS section costs a damn sight less than an attempted labour followed by an emergency CS. If I had attempted a VB with DS2, so had a consultant in to check on me, midwives keeping an eye, taken up a room on the labour ward etc, then a contraction had ruptured my previous scarring I would then have been rushed to an OR, needed blood to replace what I had lost, required a more highly trained surgeon than the regsitrar who would have done the elective, needed far more after care etc... That isn't even getting into the potential for PTSD from the traumatic birth eperience which may then have cost the NHS a gazillion pounds in therapy for me. As a simple cost cutting exercise, ELCS makes sense. As a 'being decent enough to consider the mother's needs' exercise, it makes utter sense.

yes, like whoneedssleepanyway - I know someone who claims she refused to endure a vaginal birth and made such a stink the obstetrician agreed to her having an elected caesarian.

Think - if the story true, she was definitely too posh to push.

Piousprat - when i said 'safely born' I did mean mother and baby. I should have said it explicitly though, knowing through long experience that there is always someone here who'll go out of their way to give the worst possible misinterpretation of your words.
Re: risk management - if there are concerns that the mother is a higher risk of a poor outcome because of prior surgery then obviously docs have to factor this in when trying to plan the safest birth. But this thread is primarily about women with no health conditions which might make a c-s a safer option than attempting a vb.

Remembering back to DD's birth, I have to say "safe for both mother and baby" was not quite how staff at our hospital were prioritizing things. In fact, I was cut up well into my buttock and kicked out of the hospital some days later in the throes of a raging infection with no pain medication and no antibiotics. I was told "Don't worry, you'll be fine" when I couldn't walk from the pain, let alone sit.

The distinct impression I got at the time was that all they cared about was for baby to be fine and for mother to leave the hospital alive. Who cares about the damage to her body?

I don't know of anyone personally but the day I went in for my elec c-s due to 2 previous c-s, there was a woman in the bed opposite who was 35 weeks having one. When the doctor came round he said he was uncomfortable doing it at that stage, to which she replied " I want it out today! I am going on holiday in 8 weeks and have got to be back in my bikini and my mum needs it to be sleeping for a few hours while I'm away ". The doctor agreed and told her she needed to remove her make up and nail varnish to which she went ballistic, she only calmed down when he said it's either that or you go home. I am so glad the curtains where closed so I didn't need to engage with her.

Where did you give birth?

And WHEN?

Wasn't UCL, was it?

Spudulika "people talk about ELCS as "unnecessary surgery"

But if a baby can safely be born vaginally then it is, in the strictest sense of the word, 'unnecessary'.

Problem is some babies can't be born safely vaginally and those mothers who find themselves in that situation shouldn't be made to feel bad and certainly shouldn't be told (like I was) that it meant I wasn't a proper mother and should have my child taken away.

keepingup now that woman gives me concerns as a mother.

Spudulika Wed 25-May-11 23:10:32
"NHS can't offer c/s on demand if it doesn't have the staff to meet the need. And it doesn't. You can't magic midwives and doctors out of nowhere.

"people talk about ELCS as "unnecessary surgery"

But if a baby can safely be born vaginally then it is, in the strictest sense of the word, 'unnecessary'."

In the case of a tokophobic woman, about as unnecessary, I suppose, as offering counselling to a woman who's been traumatised or ADs to a woman suffering from depression.

My gran was so traumatised by giving birth that she could never contemplate having another baby- since ELCS were not available in those days. Fortunately, contraceptives or an understanding husband (I don't know which) were an option.