AIBU about "Birth after Caesarean" clinic.

[Caff2]

I had an elective section for my second child after previous traumatic birth. At booking in appointment for current pregnancy, I asked the community midwife about elective section this time, and she said she would refer me to consultant again, and did, to same consultant I had last time, and I got an appointment letter through to see said consultant in September.

Today, I had a letter from the "Birth after Caesarean" team giving me an appointment in August to "discuss options for women considering vaginal births aftersection or planned sections". I was confused as to what this clinic was, as I already have an appointment to see the consultant to discuss this. So I rang up to enquire. The hospital midwife I spoke to was quite cagey about what the appointment was for and said it was to "discuss it". So I said "Well, I already have an appointment to discuss the elective section I want with Mrs X (consultant) in September - won't she go through it all with me again?". At which the midwife said "Well, I'll cancel this appointment then, as it's clear to me that we won't be able to change your mind, so there's no point"!!

AIBU to be a bit upset about this and think that they should be more honest about what this clinic is for, as it is plainly to try and talk people out of having planned sections, and not to discuss "Options for women considering vaginal birth after section OR PLANNED SECTIONS"?

And indeed like your own clinic was? As it's the dishonesty I'm upset about as I say.

You sound like you have made your mind up and that's fine! We know there are issues and risks with c sections, just like vaginal births. Your choice! You take the risk with your baby, therefore you choose!

I know what it's like to be upset at a clinic, I chose to go against the Dr and try for a VBAC. But it was my choice. Sometimes people make remarks that they should keep to themselves.

on a wider note, if everyone had sections the mortality and morbidity rates would increase with childbirth: this was widely acknowledged. So on a population level, the right thing to do is reduce it. However, everyone is an individual and needs to have a right to choose. For them it might be right to have a section.

Caff2 I totally get your point. It's a clinic to talk about VBAC not all possible birthing types post section. If I'd known my appointment was purely about convincing me to have a VBAC (letter simply said 'you have an appointment with MIDWIFE on xth month' (their caps) I'd not have bothered either!

Saltedcaramel - the clinic's whole reason for existence is to push for VBAC. If you read the article, that is why it was set up and why it won an award.

I do not object to the clinic, I think discussion of birth options is a great thing.

I DO NOT like the lack of transparency.

YANBU. I'm not sure how a clinic can win awards for reducing sections and maintain informed consent with unbiased advice.

Sorry Caff2 - after posting I realised I'd kind of missed your point.

I do get what you mean. I guess they do this because if they called it a vbac clinic a lot of people wouldn't go. I'm probably only about 5% likely to go for the vbac option at this point l and if they called it that, I wouldn't go. Who knows though, it might change my mind.

YANBU OP, as PP says they can't have an objective of pushing VBAC and be unbiased. If their objective was "to ensure women who have had a previous c-section are fully aware of their subsequent birthing choices" and they discussed each option objectively, laying out facts then great. Clearly not what they're doing though.

BUT - I disagree that minds can't be changed with unbiased advice. We make decisions taking into account only facts all the time.

Many women choose ELCS out of fear - often of the unknown. Information (not brainwashing) can assuage fear.

The reason why more C-sections would be dangerous at a population level is because of the lack of skill medical professionals would then have in dealing with vaginal births and associated complications. This is a very real risk. Unfortunately this is an area where as Headofthehive said, individual and societal interests may not be aligned.

It's important for women, however, to have access to all info and to know that the professionals dealing with them have their individual best interests at heart.

I really don't think we can make judgements on what takes place in the clinic - and les so complain about it - based only on the awards won, and without knowing what is actually said.

I think you can win an award for reducing sections, by giving information. By even raising it as a possibility, that it's allowed could reduce the section rate. That's just unbiased information you have a right to?

Thanks Salted caramel - I guess that's my point - I don't like an attempt to con me into attending something. And I don't see the point either - I guess the agenda would have become pretty clear when I got there, so I would have travelled there and been upset and they would not have achieved their objective, AND it would have taken time away from a woman who'd really like to discuss VBAC.

I also didn't really like the fact that even when I phoned, the lady STILL couldn't be honest until she realised "we won't change your mind so there's no point" and was then pretty abrupt.

Raising it as a possibility, yes. But if the response is that there is no point in OP attending if they can't change her mind then it clearly is not about just giving information.

Although the delivery is slightly more expensive, as sorting cat points out, when you include everything down the line the total medical costs to the NHS may actually be higher for a VB.

This is before considering the colossal cost of obsetric litigation which has cost the NHS £8billion over the last 20 years. www.nhsla.com/currentactivity/Documents/NHS%20LA%20Factsheet%203%20-%20claims%20information%202013-14.pdf

This works out at £400m per year. This is just conjecture, but I don't think planned c-sections make up much of that total.

Women should be free to choose the birth method they prefer and the options should be presented in an unbiased manner. The clinic the OP cancelled clearly had an agenda.

Maybe my AIBU should have been" AIBU to want a clinic to be upfront about its purpose and objective?"

Why do they feel they have to try to encourage women to have VBACs by stealth? As this clinic is SPECIFICALLY to encourage VBAC and not merely to provide information about them.

I get it OP. It's dishonest. Why can't they just say upfront that they want to talk about vbac. Do they think that people who would be put off coming to the clinic if they knew it was about vbac will suddenly change their mind once they get there? They're going to peer pressure people into having a vabc, maybe? Which says volumes about what they believe of people who've had a c-section.
It slightly reminds me of those pro-life pregnancy crisis helplines, who profess to talk you through your options when actually all they want to do is put you off having an abortion.

You didn't go to the clinic though so how do you know it's to push for a vbac?

How many of those saying yanbu have been to a clinic like this?

Like I said a found it an extremely valuable resource, it helped me emotionally too as they went through the how's and whys if my emcs, why it happened, and the likelihood of it happening again. The m/w actually put quite a few of my demons to rest in the process.

It did not push vbac, it laid out all the information so I was able to make an informed decision. I'm a hcp so not uninformed to start with.

Your community midwife may be under the impression that the clinics try and persuade women to try a vbac. Mine was. But the clinics themselves simply help you through the process of your decision.

Personally I do think all women who've had a cs should be referred through these clinics. If only to talk through whatever their choice is and help them understand why it's the best decision for them. They're amazing!

If the meeting was titled 'birth after cesarean' then was it not just a meeting to discuss all your options so that you can make an informed choice? Your next baby will have a 'birth after cesarean ' whether it is vaginal or cesarean. I had an elcs with last and am pregnant again-I have had nothing but information to make an informed choice regarding the birth this time from mws and consultant.

BUT I keep saying - the agenda became clear when I had the phone call when they said there was no point attending if they couldn't change my mind, so IT WAS ABOUT CHANGING MY MIND!

Interesting that the clinic won an award for reducing sections, id be interested in the other figures to (like mortality rate!!)

And the article which I googled afterwards which anyone here can also google (Birth after caesarean NGH will take you there) DOES make clear that this clinic is in fact specifically to encourage VBAC! So why do they pretend it's not?? That is my point.

"I'm not sure how a clinic can win awards for reducing sections and maintain informed consent with unbiased advice."

Because some women may not know they can have a VBAC, or may want one but be a bit worried? After hearing all the information some women choose VBAC . If the clinic wasn't there they may have just opted for CS because they didn't know there was any other option or would have been too afraid to try and so the clinic manages to reduce CS simply by talking through options.

"I really don't think we can make judgements on what takes place in the clinic - and les so complain about it - based only on the awards won, and without knowing what is actually said."

Yes to this.

The clinic wanted to push the OP into a VBAC or they wouldn't have been so quick to cancel the appointment when it became clear the MW couldn't change the OP mind about her section. The appointment didn't appear to be for an open, honest and transparent discussion.

YANBU, at all. And it does matter, very much.

The people who are disagreeing with you about what the purpose of the clinic is appear to be taking a different view to the midwife. Personally, I'd go with her assessment of the purpose. She's more likely to have some idea what she's talking about then randoms on the internet. If there is to be a clinic to persuade women to try a VBAC, it shouldn't be called a misleading name. If, in fact, it is genuinely a birth choices clinic and the midwife was mistaken, staff members ought to be aware of this and not misrepresent the purpose of the clinic to patients. Either way, there's a problem. The fact that lots of women do want VBAC is beyond irrelevant- you don't. With that in mind, I think it's probably for the best you don't go to the appointment. As well as it being upsetting for you, you'd be freeing up a slot for someone who might actually benefit from it.

Youareallbonkers, you're a fuckwit. Neither the cost nor the welfare issues are as simple as you make out. The more people have sections, the cheaper they actually become. NICE have said ELCS would actually be the cheapest option if everyone had them. As for vaginal birth being better for baby, that depends entirely on the circumstances. You don't know OPs. Until and unless she provides a medical history in order to receive the benefit of your doubtless valuable opinion, that means you need to be quiet.

bumbleymummy, I really don't disagree with any of your points about it being great for people to have info about VBAC if they would like to and talking through that option.

My whole point is WHY does this clinic not say what it actually is about until really pushed? WHY pretend to be anything other than a VBAC clinic? Why not be honest about its purpose straight away when I phoned to enquire? I DO KNOW what she actually said, the lady from the clinic, because EVENTUALLY she told me what the clinic was for and what takes place in it - when she cancelled my appointment!