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?

But why do we need to reduce the CS rate? What is wrong with it being as high as it is? If it's due to the cost, then couldn't we address the impact of smoking/binge drinking/obesity epidemic to cut the NHS crisis first?

Is there any research into the hidden cost of a VB? Any treatment for incontinence, 3rd/4th degree tears, poorly stitched episiotomys, treatment for PTSD/PND? That list doesn't even include any treatment needed by the baby.

I had a hideous VB, wanted to go to CS when I couldn't push her out (transverse arrest) but the consultant insisted on trying a Keillands forceps delivery first. She came out vaginally but we were both in a terrible state. Her face is permanently scarred, she was so traumatised by the birth she couldn't feed. My milk didn't come in until day 6 and DD lost in excess of 15% of her birth weight. She had to be readmitted to hospital and fed by gastronasal tube. I was faecally incontinent for several weeks after and had no sensation for my bladder so had no idea if I needed to wee or how to make it come out when I sat on the loo. My episiotomy wound (about 3in long) opened up and took several months to heal. The pain was unbearable for 2 months and the scar still hurts 20 months on. I was on close watch for PND seeing a midwife several times a week for 6 weeks after the birth.

At the hospital the midwife's comment when the consultant turned up at the end of my bed the day after the birth? She championed him as "This is the man who keeps our C-section rates down!"

But at what price? Is my birth really preferable to CS? Is that what the NHS wants for everyone?

So I've got special connective tissue yay!!!!!!!!! At long bloody last, something in my reproductive system that works as it should .

confuddled it is normal, at least not unusual, to have ongoing symptoms of mild faecal incontinence after a third degree tear. I don't think there was anything wrong with my care. Forceps were used, which is not particularly unusual, and where they are used it's more likely that a 2nd or 3rd degree tear will happen. I'm afraid this is the vaginal birth that NCT classes don't tell you much about. A bit unlucky maybe, but by no means unusual or down to bad care during the actual birth. It's an underacknowledged fact that vaginal birth is dangerous; it's just been made safer by medical science. But even with medical intervention, the nasty scars, literally, can remain. Mother nature didn't get it completely worked out. Big brains, relatively small pelvises.

I nknow someone given one becuase her DH was being deployed to war and tehy couldn;t induce for some reason.

But although not medical understandable.

there was talk i might be offered one asnI ahve 2 ASD chidlren and here were serious childcare issues (DH worked miles away and wasn;t always contactable) but we had a HB with a doula instead and it was never actually approved as it wasn't wanted.

As for CS being easy- huh? A good well managed VB is by far easisest but sadly also partially down to luck. I as ill before my first (eclampsia) but well quickly after all and doings chool run when ds4 was 18 hours old. Pure luck.

VeronicaCake - I don't actually disagree in principle with the guidelines being changed, I was just so appalled my the flippant slant the media gives it.

I also think that counselling for women who have had bad experiences in order to support them in having a vaginal birth is actually a good idea.

I also think that instead of placing all the blame on the women who are behind the relatively small proportions of CSs that are "requested" by the mother and instead concentrate on reducing CSs that may just be brought about by poor decisions in that or previous deliveries. Then of course there will also be a proportion of CSs that are absolutely unavoidable and the NHS will just have to MAKE SURE that they can afford them as they are NECESSARY!

Why do people talk about vaginal delivery as if its cornered the market on traumatic births?
I had the most horrendous cs experience, left me very ill, further emergency surgery, and ptsd. I am now left unable to have any more children due to fear of a repeat CS.
I had had two previously unremarkable vaginal deliveries.

Please stop talking about cs as if its the answer to everyones prayers, it is not!

Having had a planned (refuse to call it elective) cs and a VBAC, I have never understood this "too posh to push" thing. I appreciate that I had a fairly easy VBAC and a slightly worse than average recovery from cs, but I found the vaginal delivery a million times better physically, even with a second degree tear. I'd be really interested to know the average recovery times from each, to see if I was just a freak!

My MIL, however, is still convinced that I was too posh to push (especially as I am southern and she is northern and I am therefore posh by default) - actually I was too pre-eclamptic and ds was too premature to push, but never mind.

herethree- wehilst CS is a fantastic option for some, overall they are higher risk and after all, involve invasive surgery.
And many people don;t want a C-S: their wishes should be as recognised as those of people who definitely do want one.

herethere just read your post. I completely sympathise and agree.

If a percentage of those CS are not medically indicated then of course they should be reduced if possible.

In a normal low risk pregnancy, CS is major surgery that has bigger risks for the mother and child than vagnial delivery and if the mother can be helped to deal with her fears or concerns to help her have a vaginal birth then whats wrong with that?

I'm trying to find the most definitive links possible, parakeet, ones that go on Metadata, not just results of single studies.

BMJ website which states "The strongest risk factor for pelvic organ prolapse is parity..." (ie, having kids at all).

but admittedly another BMJ webpage just puts down vaginal birth (and nothing about parity at all).

Nursing Times article that argues that pregnancy itself is the main risk, not method of birth.

This study concluded El.CS does not reduce the risk of moderate prolapse, but does reduce the risk of severe prolapse. Not to anywhere like the risk of never had children at all, though.

I need to go find my life again, lol. I wish I could find it now, but I once found some statistics on the relative incidence of prolapse among non-parous women, those who only gave birth by CS and those who gave birth only vaginally, and the non-parous women were the only safe ones. CS was about half the incidence of vaginal, iirc.

Genetics, baby weight, obesity, smoking & other pelvic surgery come into it, too.

eastegg, please don't put me down as learning everything from NCT. I'm a Doula. It might not be a rare complication of the procedure you had but it's not common in natural birth in general. I've never seen anyone talk such tosh! How have we survived as a species for 1000s of years if we're built so badly? Why are we the only mammal built so badly? And why was birth SAFER before doctors became involved? Why are homebirths so encouraged as being safer?

Yes, really it was safer. Placenta previa only started to be fatal when doctors started to deliver babies. Childbirth fever was the result of doctors coming from post mortems and not washing their hands. Before then and when they started washing their hands it was/is unheard of.

The reason they want to bring the rate of section down is because it is safer to deliver naturally. They recognise that it is not the case for all women which is why they have this target.

The term too posh to push is deeply offensive to me and should be phased out! I had a EMCS (26hr labour, 11lb baby) and the night before my 2nd CS (elective, but not much choice) my childless cousin told me I was too posh to push.

It offends me. And OP, no I have never ever met a woman who had a CS because she didn't fancy a VB. YANBU!

Bogeyface, I agree with you entirely. I'm just not sure that there are that many women out there who actually request a CS for trivial reasons, and must represent such a small percentage of ELCSs performed. If there are, then yes they should be counselled, because if they think a CS is an easy option, then they are seriously misinformed!

I just think the media suggesting that there are oodles of women asking for them because they are too posh to push is complete bollocks.

As an aside, I think it would be an excellent idea to make counselling available to any woman traumatised by a difficult delivery.

I doubt it will happen though.

Hell, after my traumatic delivery I would have taken just not being treated as though I was an inconvenient piece of meat. While I was being stitched after my forceps delivery sans pain relief the junior doctor was giving others in the room a running commentary about what bits of me were being stitched up "now, it's hard to tell, but this is the lower vagina". Someone else had to say to her "um, your patient is screaming in pain" so oblivious was she to the human being she was treating.

The day the medical profession RECOGNISES fully how traumatic a bad delivery can be will be the first step towards tackling this.

confuddledDOTcom: "Placenta previa only started to be fatal when doctors started to deliver babies."

Can you expand on this please?

"Placenta previa only started to be fatal when doctors started to deliver babies"

Can you give me a source for that, Confuddled? How is it that a doctor makes your placenta ripping away from your uterine wall and haemorraging till you die and your baby dies a deadly thing if he is not even present when it happens?

And cote is absolutely right. When you are on a countdown to 40 weeks and your next delivery you don't have the time or emotional resources to wait and hope for some kind of counselling that may or may not materialise and may or may not help.

very much the done thing here (in South Africa) unfortunately.

I just gave birth (naturally) and people think it odd I didn't choose a CS.
In fact when people ask you your due date they want to know if you mean the actual due date or the booked in CS date!

reason? Well most people on private medical... doctors encourage CS as less can go wrong, and they can book in to suit schedules....

Penthesileia thanks for that link, as I have not yet had time to dig up my original research papers. The problem with most of the studies the article cites is that they do not distinguish between women who had an elective CS and those who had an emergency one, after attempted vaginal birth, including god knows how many hours of pushing and damage.

The one study (according to your article) that did distinguish found this:

In a prospective study of 363 women up to one year after delivery, Groutz et al (2004) found that a similar percentage of women who had vaginal deliveries and Caesarean section for obstructed labour developed stress urinary incontinence (10.3% and 12% respectively). A significantly lower percentage (3.5%) of women developed stress urinary incontinence following an elective Caesarean section with no trial of labour.

Seems the norm in the US as well.

sorry - to be clear those are the reasons the doctors push CS.

the ladies love it as they are scared of natural labour, and it keeps things "intact" down below!!!!!

my local hospital is referred to as Caesar's Palace !

Why are so many people on this thread so sure that the NHS won't give elcs for non medical reasons and that it's all media tripe?

There are genuine stories on here of people that have had elcs because of non medical reasons. My friend was given one because she didn't want a saggy fanny. Her words. She cried to her MW that she was terrified, got referred to a consultant, cried to him too, and voila. She freely admits she made the whole thing up.

It does happen. That is why the cs rate needs to be pushed down. It's not like the NHS or the media are trying to but lives at risk here, it's that they don't want to be doing unnecessary major abdominal operations!

Quite, mosschops! I had a natural birth where the baby died (not related to the birth she was just too young) it was the most positive experience you can imagine - as crazy as that sounds! My next birth (CS) left me with PTSD for 2.5 years and physically in a bad way, I'm almost housebound now, I don't drive and can't walk far enough to go most places, last time I did school run took me 40 minutes to walk 0.8 mile so now my parents or sister do school runs or my partner at a push (his hours are more set than theirs). If I need to go anywhere I have to plan it in advance to make sure someone can take me. Like today I need to go shopping, Dad will take me when he does school run and OH will meet me there. I'm going to be in a lot of pain afterwards so I'm having a pyjama day to save up the spoons.

I know the VBAC is going to take a lot of effort and the consultant doesn't want me on the bed, SoM said she'd put the bed up to it's highest setting if she was there so I couldn't get on it! I'm going to be physically exhausted afterwards but it beats spending a week on my back having to get people to sit me up and pass my baby each time she needs feeding or having to keep her in the nursery so she can be fed as soon as she's hungry. Then spending weeks in my own bed (at least I can babymoon at home so don't need so much help, although care of the older children is going to be interesting).

I know I'm unusual but if we're going to start pulling out terrible vaginal births we need to understand that the flip is true.

confuddled - I am very much a supporter of natural birth wherever possible, but I have to say that as far as I knew infant and maternal mortality was actually very high in the past compared to now? Yes, most births can go safely with no complications, but there are probably lots of mother and children alive today who may not have been if their birth experience happened 100 years ago. I do not agree with over-medicalising childbirth but I think it is dangerously naive to think that all births should happen with no medical intervention whatsoever.

We have survived for 1000 of years because the majority survive, so the species carry on. But, a small but significant number may not survive. And in modern times noone wants their baby to be one of the ones that doesn't because that's "nature". Hence we sometimes intervene with modern medicine. It's not such an evil thing really.