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?

Pensethelia I agree that's not nice.

I used to sit at work with a woman in her 50's who had no children.

She was quite smug about the fact that she was the "other woman" in a love triangle and the other woman had given birth a couple of times and therefore must have a "bucket chuff". I asked her if her lover had confirmed this and she admitted he hadn't, but "its always the way isn't it".

So incredibly smug - really ugly trait. But its really all she had over this woman apart from the fact she was shagging her partner, I suppose - vile, anyway.

Anyway - going back to the OP - sorry OP!

By definition, if you are too posh to push, you will have ZERO influence on NHS costs, since you would have gone private.

So absolutely no logic at work on The Wright Stuff, quelle surprise.

In the Portland, a CS is only 20% more than a VB.

So, I don't think the costs can be as much as 3 times... I don't know that for sure, just commenting on the Portland costs.

non - you're right - just googled, and found this Telegraph article from 2007 which suggests it is just under twice as expensive.

I think I am thinking that a CS is 3 times more expensive than a homebirth...

noname - yes that is probably to account for the complications that may occur with a VB. Or do they add those on at the end if they occur, and the price quoted is for a straightforward one?

I never considered a VB, so I don't know for sure. But, I would imagine that any complications (and the costs associated with those complications) would be added onto the bill.

With homebirth being cheaper - I guess in case of emergency, if an ambulance transfer is needed it might well turn out to be the most expensive option of all. And there's no magic crystal ball which can predict whether this will happen or not.

Which doesn't mean that I think that low-risk women shouldn't be given the option, just that the cost argument is just a really really weak one.

Does anyone have any figures on how many vbacs end in emcs?

Although I've pretty much decided on another ELCS, and my consultant says you can't really base the decision on statistics (which I thought was a wise thing to say) I do wonder. It is part of the reason I'd like another fairly calm and controllable situation.

I heard that something like 20-30 pct of natural births end in sections? Did I imagine that? Am I going mad? So I guess the number could be thereabouts or even higher given protocols are more strict in vbac situations.

Apols, I haven't done any research myself.

And widowwadman. Agree. It's luck of the draw, not an ability to hypnobirth, or be 'in the zone' that results in an easy birth. Humans are not particularly well designed for the purpose.

"In the Portland, a CS is only 20% more than a VB."

My friend has had two babies there (vaginally) and her costs were roundabout the same as mine in the comparable hospital in Asia for a section.

Otch - Honestly, I don't know. All I can comment on is that my CS was 20% more expensive than a VB (but I know that my CS was more expensive again because it was not medically indicated).

My second child (medically indicated on account of being breech and my previous CS, plus the discount the Portland gives for subsequent births) was nowhere near as expensive.

Widow - I agree that cost is not the issue; I was simply reflecting on cost because it tends to be brought up - like in that Telegraph article - as one of the reasons the NHS wishes to reduce the rate of CS; and I was wondering what would happen to that cost if you took a more whole-picture view of birth and long term medical attention required for VB gone wrong, etc.

Penthisileia didn't think you were bringing it up as an issue, just tried expanding on your thoughts :-)

otchayaniye figures for how many VBACs end in EMCS vary from trust to trust - when I looked it was about 30% at my trust, which was for me personally too high to want to attempt it.

I really don't buy the "pregnancy is the cause of pelvic floor damage". I went into hospital to have DD with a perfect pelvic floor, even at 42 weeks. I now clearly don't and am looking at potential surgery if it gets worse with age.

I'll be having a CS (it has been recommended by various doctors) if I have any more DC. If people know me well enough to know my experience with DD then they will understand. But if others ask why and won't take a vague "medical reasons" answer then I will probably tell them I am too posh to push as I don't actually want to discuss the state of my fanjo with anyone.

I am pretty shocked that our local hospital doesn't offer maternal counselling as, based on NHS costs, it would probably be cheaper than the difference between a CS and VB if it is successful in changing tokophobic women's minds.

breatheslowly - There's nothing for you to buy... Pregnancy is not an inevitable cause of pelvic floor dysfunction (not damage) for everyone! It's not a case of pregnancy = dysfunction, 100%. It is that a percentage of people will get pelvic floor dysfunction, regardless of whether they have a CS or a VB.

In your case, you were not predisposed to pelvic floor dysfunction, but suffered pelvic floor damage through a VB.

Well that makes me feel so much better about my pelvic floor damage. Your pelvic floor is still likely to be better off not attempting a VB, which is not what is implied by many advocates of VB. There is a certain twisting of the terminology and stats by some people to imply that CS doesn't have advantages.

otchayaniye figures for how many VBACs end in EMCS vary from trust to trust - when I looked it was about 30% at my trust, which was for me personally too high to want to attempt it.

Sorry for the hijack, and thanks for the answer (I reckon that 25-30 pct is about right, then) but did you meet any resistance? I'm 6 months so far and no consultant (see them for blood pressure checks) has indicated that I wouldn't get a repeat section, in fact one said that with Ashermans Syndrome the risk of a rupture is higher and outcome far worse, which doesn't make me think there would be someone pushing me to vbac. But my midwife early on said I might have to dig my heels in, which didn't fill me with confidence.

But I've heard some stories that some trusts and consultants will try to bulldoze you into a vbac. I just don't want to be dealing with that at 8 months' pregnant and then have to sort another hospital or arrange a late private one.

breatheslowly - I wasn't twisting terminology; I was distinguishing between different things.

I agree that CS have many advantages.

But it would be untrue to state categorically that a woman will never suffer pelvic floor dysfunction if she has a CS; as I posted above, it is not a magic bullet, and a percentage of woman will suffer this regardless.

otchayaniye - I've had hardly any resistance - I went into my post-20 week scan appointment armed with my reasons why and the reading I had done to back me up - the consultant was impressed that I based my request on reading NICE and RCOG guidelines and not just "some internet forum", and when he was satisfied I had looked into risks and benefits of both ELCS and VBAC he quite happily gave me my section date there and then.
We were discussing whether I wanted to attempt VBAC should I go into labour before the date, but as I had a post partum infection (which according to RCOG guidelines increases relative risk of rupture further) he accepted my wish not to without trying to talk me out of it. I had the impression though, that he would have been supportive if I had my heart set on a VBAC, and that the most important thing for him was that I made an informed decision based on all the options.

My midwife (or rather one of the many CMWs I've seen during this pregnancy - whatever happened to continuity of care?) filled me with fear until this appointment too, telling me that they probably would try to push me into VBAC, but she could "understand my wish, as it's easier to arrange childcare..." (which really got my hackles up, too).

Midwives at the hospital (am a frequent flyer due to some problems in this pregnancy) usually ask me whether I've thought about maybe wanting to do a VBAC, but whenever I say "Yes, thought about it, but no, definitely don't want to", they smile and don't push the issue any further.

Is confuddled confusing childbed fever ie puerperal sepsis and low lying placentas, ie placenta praevia? I think she may be. Because I can't see any other reason for her claiming that doctors delivering babies causes pp rather than ps.

Slightly worrying if she really is a doula.

I have a close female friend who had ELCS in private hospital in London. She wanted to fit the birth around her career and epecially so she would not miss important meetings.

She herself was shocked though to be asked by the Consultant whether she wanted it to be combined with liposuction. It is apparently offered routinely as a joint procedure and is the reason so many 'sleb' women are seen looking slim, tanned and gorgeous in the papers only 8 weeks after the birth. Its all completely artificial. They never lost the baby weight at all - they just had it sucked out under anaethetic when the baby was born.

Now that is one I can verify.

I was offered cosmetic surgery as part of my ELCS. Not lipo, but other cosmetic surgery.

On the basis that, you are out of the public eye for a few weeks and people won't notice / less likely to notice minor tweeks.

Penthesileia - I don't mean you - just various people try to give the impression that the pelvic floor would be no better off with an ELCS than a VB. I am a bit hacked off all together with the presentation of risks before/during childbirth as in my experience the risks are very clearly stated with some procedures (I'm thinking of my epidural where the stats on risks were very carefully recited) but more or less glossed over with others (induction with ARM & drip springs to mind). It seems to me that procedures that the hospital is keen on (e.g. induction rather than expectant management) get a rather light touch on the explanation of risks, whereas those that are either choice or not conducive to good statistics are very carefully explained).

Morebeta - A real friend of yours or is it one of these friend of a friend things?

The liposuction thing sounds to me as probable as the alleged tummy tuck some slebs supposedly get at the same time as the c-section. It's folklore, and not based on reality, at least where reputable surgeons are involved (they advise a minimum of 6 months between tummy tuck and section if you want to have any kind of success).

I really get annoyed when women who manage to lose the baby weight quickly (mostly because they haven't put on much in the first place and work on it pdq) get vilified or accused of having had plastic surgery.

It's not ok to attack women who don't lose their baby weight straight away, but why is it ok to pass judgement on women who do?

Widow - I can promise you that cosmetic surgery is offered, routinely, in private hospitals.

Not just lipo. Facial cosmetics, nose jobs, boob jobs.