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"?

I had an EMCS for no 1 and was very happy with my elcs for number 2.

When they told me I had placenta praevia for number 2 and so would need a section (despite what poster upthread claimed!) and so I realised I wouldn't have to decide between a VBAC / section, my emotion was one of elated relief. No disappointment whatsoever.

All women are different and all should have the risks explained with reference to their medical history, and then be left to decide what is best for them as adults.

And YY to previous posters points about what are the costs of cs vs vb in the long-term, not just in the short term. Most women I know who have had vb or vbac are damaged, or at least changed in ways they don't like. Some have long-term problems. Many didn't tell the medical people as they didn't want to bother them and struggled on.

Because this is the other thing. The risks of VB are not made transparent. There are many risks, and many of them are in no way minor, and they can be of a long-term or permanent nature. But these risks are played down / minimised / not talked about because it's "natural" and women should just get on with it and not make a fuss, type thing. If the risks of pregnancy and birth were written down, and presented to someone as the risks of something different, something medical, people would say that it was a really major thing.

Has anyone ever done that - written down the risks and tried to find out the frequencies of problems and compared them? The person in that article who said the cost of decreasing sections was increasing serious permanent damage to a high % of women, that was interesting.

Also, most women ive known to have Emcs desperately wanted vbacs and had to really push for them. I think it's good they're helping build confidence in women to have a VBAC and believe they can

I don't think that is representative though. I believe theres a much higher proportion of people who have an emcs go on to an elcs with the next rather than vbac. I also question how many of the people doing vbac have been influnced by a feeling they must experience natural labour and birth as part of societal pressure that it's somehow better.

Also I'd just like to add as someone who had a vaginal birth first time and elcs second time. CS really can be fabulous - no problems after. Whereas my first birth was awful - vaginal but DS nearly died, bad tearing - poorly repaired - stitches dissolved too fast, they won't restitch, infection, 3months before actually "fully" healed. Then left with long term problems, with scar, causing problems in sex (limited positions because pressure needs to be kept away from scar). I also had PND and PTSD. Those things all cost extra money - im fairly sure my first birth was not only much worse for me but also cost a damn site more than my elcs.

My friend who had a vbac after elcs for no1 regrets it. She had a very difficult birth, a massive tear, subsequent infection. Some other stuff but, even as close friends it was all a bit veiled in euphemism. She said she was reading about trauma afterwards and said that was how she felt, traumatised. She couldn't think about it for months without bursting into tears.

And that's the thing isn't it, we don't have the words to talk about it, to tell about it, we don't know what's normal and what isn't, because it's all some kind of secret women's business, there's a lot of eyebrow waggling and talking about "down below" and women stoically "getting on with it" because this must just be what it's like.

I would strongly support moves to find out the true cost of VB, monetarily, emotionally, physically, if we are to make comparisons to other births. Let's bring it all out into the open, transparent, talk about it.

If the risks of pregnancy and birth were written down, and presented to someone as the risks of something different, something medical, people would say that it was a really major thing.

This is so true. It's almost odd that to get a cs you have to sign a consent for it with all the risks outlined; Yet vaginal birth the risks are, as that Australian article put it, the elephant in the room. They are never really discussed and if healthcare professionals are asked directly, by a patient, they are usually played down.

I was asked to research the risks of both VBAC and ELCS so I did get quite far with comparing stats etc. Then I realised a) I didn't need anyone to tell me what the risks were. I just didn't want a VBAC. b) a lot of the research, including the info sheets provided by the Trust were contradictory e.g. Higher risk of blood transfusion for VBAC in one paragraph, lower risk in another! I have no pelvic floor issues despite always forgetting to do the exercises and I didn't want to end up with any through a VBAC.

I agree that if you look at the one off costs a vaginal birth is cheaper than a planned C section. However there are some people like me who are physically incapable of giving birth vaginally and a crash section and subsequent high dependency care for me and baby must have cost a hell of a lot more than a planned C section would have.

Whirlpool, by the same token a friend of mine had VBAC with her second pregnancy and was very clear indeed that the experience was much better. With the first one she had an infection in her incision, and generally felt awful for some time afterwards, whereas with the second she was up and about much more quickly and found things like breastfeeding much easier. When it came to her third birth she had no hesitation about opting for VB. Anecdotal evidence proves nothing.

You're right, icimoi, that anecdotal info doesn't help an individual to make the right choice for them. It can help with questions to ask though, I think. The trouble is in making this choice I'm not sure women get presented with unbiased info on both choices. I think that should be a given & that is why I agree with the OP that is is not on for the clinic to misrepresent what it is for. For me, that would make me distrustful of any info they then went on to give me. Whereas with healthcare providers I know & trust I'd be open-minded & happy to consider all options (if I was lucky enough to have a choice!).

It's irrelevant whether the risks are greater, smaller whatever, you should choose which you want and for whatever reason.

Sometimes you can explain why you want a particular type of birth, for the op she couldn't face another attempt vaginally, whereas I was the opposite and could not under no circumstances face another section. (Even though mine was a good one , nothing went wrong, etc etc. it was still the worst day of my life).

I think the constant having to explain yourself is the annoying bit!

I don't think anyone is complaining about people needing emergency c sections as that saves lives. It's more about vbacs

Interesting point re EMCS being included as a cost of vaginal birth. Makes no less sense than lumping it in with ELCS anyway. There never seems to be any awareness in this discussion that greater access to MRCS would reduce the rate of both EMCS and complex VB. I don't know by how much, but the number of women who ended up with either an emergency section or an instrumental delivery (or both!) who'd have had an ELCS if offered is going to be more than zero.

The risk to subsequent pregnancies needs to be taken into account also. The risk of placental accidents increases with cs for subsequent children, the consequences can be dreadful. Whereas the risk of prolapse after birth ( and I've seen several have this after a cs ) maybe is more preferable to some people?

My point it risks occur later as well and risks have difference levels of severity and mean different things to different people.

I researched the risks very carefully before I decided I wanted an ELCS. First baby, no previous CS - I just didn't want to risk a VB. most women in my family have had problems with them, including 4th degree tears, EMCS, severe blood loss and depression. I'm not somehow stupid or "wasting resources" for deciding that the risks for me personally are too great. Until I had it booked I was having nightmares daily about dying giving birth.

If women have full choice over contraceptive options regardless of cost, I don't understand why giving birth should be any different. As PP have said it's ridiculous to compare a perfect VB to an ELCS anyway as there are costs of VBs that have complications

"Birth" after caesarian bothers me. I had an EMCS, I still gave birth!

The risk to subsequent pregnancies needs to be taken into account if there are going to be any, headofthehive. As you correctly point out, different risks mean different things to different people. A significant minority of women giving birth are sure they don't want any children after this one, so the increased risk of stillbirth in future pregnancy after a section isn't going to be something that concerns that cohort. It would be more accurate to say that risk to subsequent pregnancies may need to be taken into account when making a decision, depending on the plans of the individual woman. For some, it will be irrelevant.

But you're right to highlight risks that occur later as well as at the time of delivery, and this ties in with what several of us said upthread about the need to consider later complications when costing the various options.

I had a bad experience with an emergency section following failure to progress with DC1. I ended up with several blood transfusions and being taken back into surgery, though not as bad as some people who end up in intensive care etc obviously it was still fairly terrifying for both DH and I.

I was so conflicted about what to choose when pregnant with DC2 - I wanted a successful vbac but was terrified of it following the same course as my first birth and ending up in another emergency section. A planned section was appealing because it avoided the chance of an emergency one!

In the end I was relieved to be told at a 35 week growth scan that DC2 was such an enormous baby that a vbac was unlikely to be successful and a planned section recommended - even though in the end the scan results were inaccurate and he wasn't that big!

My planned section was so many hundred times better than my birth experience with DC1 that I would have fought bitterly for a planned section with DC3 if it hadn't been automatically assumed anyway. For me it was all about avoiding the emergency section after a failed labour.

Why is everyone so convinced you need pelvic floor surgeries after vaginal births. I have no issues, none of my family has issues. My mum has had no issues and she had five children naturally including twins in the space of 10 years.

feedyourself I agree - if cesarean sections are not births roughly 1/3 of the people walking around the UK are unborn :o

Crumblybiscuits nobody has said or even implied that pelvic floor surgery is an automatic consequence of vaginal birth. The point is that some women need pelvic floor surgery as a consequence of their vaginal deliveries. This needs to be factored into 'costs' of VB to the NHS, and it's information that pregnant women ought to have access to. The fact that you and your family haven't is irrelevant (and, incidentally, doesn't mean none of you will in the future either). Just like my DM never having had a miscarriage or stillbirth despite several sections doesn't mean CS doesn't increase the risk of both.

Crumbly because you can't tell - all women in my family who had VBs have had problems afterwards. Lots of women have problems after it

Some really interesting points raised, I've been reading through.

For me, this was never about advantages of VBAC/ELCS (except insofar as FOR ME, VBAC is not something I would ever consider), it was about the misrepresentation of the clinic - TheSkyAtNight summed up my feelings about this in this post earlier

" I agree with the OP that is is not on for the clinic to misrepresent what it is for. For me, that would make me distrustful of any info they then went on to give me. "

That's why the letter from clinic and my subsequent conversations with them upset me.

"The risk to subsequent pregnancies needs to be taken into account also. The risk of placental accidents increases with cs for subsequent children, the consequences can be dreadful. Whereas the risk of prolapse after birth ( and I've seen several have this after a cs ) maybe is more preferable to some people? "

What is the prolapse that happens when you've had a CS - something that happens when you're pregnant because of the scar? I thought that prolapses were something that was more associated with VB? Looks like an opportunity to learn something!

Icomi I wasn't telling about my friend to demonstrate that VB / VBAC is always AWFUL, I was using it as an example of someone who had a "successful" VBAC, so would go down in the hosp records as a VBAC / section avoided, and therefore costing less according to how some posters measured it, but actually they cost to her was much larger, and her subsequent care needs might well have pushed that "low cost" of her VBAC up as well.

When talking about cost, all costs related to the procedure, whether they are immediate or later, should be taken into account, or it's not a fair comparison. Similarly, it would be useful to measure the rates of things like trauma/PTSD/problems with sexual function and so forth which are not "expensive" if left untreated but have a massive impact on women and their families.

I agree that the risks to subsequent pregnancies need to be taken into account but the risks need to be assessed on a case by case basis. For example in my case, if I hadn't had a section I would not be here to make a decision about other pregnancies. This is because in my case there are very specific risks to attempting a vaginal birth.

What I'm trying to say is its not as simple as saying vaginal birth is better than a section because individual mum's can have complicating factors that increase the risk of one or other option.

Crumbly I mentioned pelvic floor because my friend is a women's physio and sees loads of pelvic floor issues. It's great you didn't have issues but it is a known risk. I could have mentioned episiotomies or tears which are common in my family's history with awful consequences. My point was that VB is not low risk as health professionals tried to make me believe; it just has different risks which I had to weigh up. My first EMCS wad a traumatic experience with great healing. My ELCS was a wonderful birth experience with poor healing. I knew the risks and chose according to my balance of acceptability. MY balance. Not the VBAC midwife's. Not the 3 consultants. Mine.

I think the prolaspes can be due to the pregnancy itself not always the birth. people can also get adhesions after a cs which wrap themselves round other organs I.e. Your bowel which then needs more surgery.

Neither route is risk free, but I do strongly feel the woman should chose. Trouble is so much advice is loaded with previous bias.

As for the giving birth bit, I think it's what you yourself feel. I do not feel I gave birth to my child, As I had a section, rather she was delivered. But that's how I feel about it. Others might feel somewhat differently. And that's fine too!