To ask how many people have asked for a cesarean out of preference?

[VioletteValentia]

I did it. I’ve never met another person who has, or who has admitted to it. I have come across people who seem convinced that supporting maternal choice would lead to everyone asking for cesareans, which I think is bullshit. Not everyone wants one!

Did you do this? Would you? Would you be more likely to if you felt the option was equally acceptable?

I’m interested in how many women feel like I did.

I shouldn’t have to say this but...no “natural v cesarean” insulting please.

I’ve read some of the Montgomery judgement. I study law and found it fascinating, and really sad. It struck a chord with me because I could’ve easily been Mrs Montgomery. I had very little warning my DS was struggling. When they got to him, he was transverse, back to back and wedged in. He didn’t cry and needed respiratory support.

“Thank God you chose a cesarean” was said to me by someone. I was told he would’ve at best, needed longer in SCBU and at worst had severe cerebral palsy or been a stillbirth had I attempted VB, and that I would’ve ended up with forceps and likely EMCS.

Beetle- I agree.
Sad that women may have to fight though, for the right to have control over their own bodies.
Also NICE guidelines

www.nice.org.uk/guidance/cg132/chapter/1-Guidance#planned-cs

See section 1.2.9 Maternal request for CS

I chose an elective CS. It was fab, virtually entirely pain free. I was out of bed the same day and healed v quickly.

Well it's basically where we choose to draw the negligence line Bear2014.

WRT Montgomery v Lanarkshire, I also think paragraph 58 is really, really significant here. The court says, basically, that it's ridiculous to expect the patient to be able to take responsibility for asking the doctor about risks themselves.

58. The significance attached in Sidaway to a patient’s failure to question the doctor is however profoundly unsatisfactory. In the first place, as Sedley LJ commented in Wyatt v Curtis [2003] EWCA Civ 1779, there is something unreal about placing the onus of asking upon a patient who may not know that there is anything to ask about. It is indeed a reversal of logic: the more a patient knows about the risks she faces, the easier it is for her to ask specific questions about those risks, so as to impose on her doctor a duty to provide information; but it is those who lack such knowledge, and who are in consequence unable to pose such questions and instead express their anxiety in more general terms, who are in the greatest need of information. Ironically, the ignorance which such patients seek to have dispelled disqualifies them from obtaining the information they desire.

They're saying that it shouldn't be up to the patient to ask if her risk of complications is greater with one approach, but rather than the care provider should just tell her. And not limiting the circumstances in which this should happen either.

How is it then acceptable that women don't receive written information regarding the risks of vaginal birth and the alternatives available to them?

^

If we did I think a lot of women would insist on sections, costing the NHS billions more.

halfwit, the article in New Scientist which has been referenced included overall costings.
It concluded that overall, given payouts etc. when VB goes wrong, elective c- sections would be cheaper for the NHS.

Why do you think more women choosing sections would cost the NHS billions more halfwitpicker?

If we did I think a lot of women would insist on sections, costing the NHS billions more.

Sounds like you’re saying women should be misled?

The thread has already established it costs £80 more, and when you take into account the costs of botched VB, it’s pribably cheaper.

I requested a c-section at 20 weeks with no medical reason. I'd never been keen on the idea of giving birth vaginally and after reading up on the risks of VB and c-section, I opted for the latter. As an older first-time mother (37), my chances of the easy uncomplicated VB weren't great and I hated the thought of risking my baby getting stuck, incontinence, tears etc.

I live abroad so it was simply a case of paying a higher fee for the c-section delivery package. My obstetrician was a bit surprised because she said most westerners seem to prefer a natural birth, but booked me in straight away.

As fate would have it, my son was breech anyway, which where I live is pretty much an automatic c-section. It's hard to find an OB who'd want to attempt it. As it happened, my c-section was painful but I don't regret it. Healed fully in about 6-8 weeks and if I have another baby I will request one again.

It makes me furious that not all women are clearly told the risks of both birth types so they can make an informed decision.

My earlier message re New Scientist- just read it again and seems I got it wrong re costings- it doesn't seem to be mentioned.
I'm sure I have seen a study which made this conclusion somewhere though.

However, on DH’s side of the family (different culture and country with only private medical care), every single one of our friends and family have elected for a c-section out of choice. They are amazed it’s not the default option in the UK.

coffeeforone is some element of that due to being given a more balanced view of pros and cons? My consultant was keen to discuss in detail the risks of a CS but less so to go into detail about the figures she gave suggesting CS reduces the risk of stillbirth by half.

Possibly...when I have discussed it with them they seem to say things like:

• cost is the same, so went for the 'better' option of c-section
• didn't want to risk something going wrong, c-section is less risky for baby (their opinion not mine)
• didn't want to go though labour and risk tearing
• they want to plan/avoid a certain birth date (usually for religious reasons)
• consultant recommended it for X reason. X usually being a reason that wouldn't mean a c-section in UK

...and they go on to question why the UK, which they believe has very good medical care does not give c-sections as a matter of course. The only downsides I can give are the general risks of any surgery, plus the much longer recovery time.

It's in this article in New Scientist
www.newscientist.com/article/mg23130812-000-a-womans-right-to-choose/

If we did I think a lot of women would insist on sections, costing the NHS billions more.

So women should be kept uninformed, denied choice and continue to suffer unnecessary trauma because you think it will cost billions more even though the costings show otherwise?

I cannot think of any other medical situation where risk information could be withheld, patients suffer unnecessarily and that all be defended because it is cheaper and natural

Exactly - doctors should tell patients if attempting a vb would be riskier in their case, not wait to be asked. It is negligent to not tell them.

Surely if vb was riskier overall than cs then NICE guidelines would reflect this? And then the NHS would move towards advising them. Especially with the costings you mention, with electives being cheaper than emergencies and instrumental deliveries.

The problem is people put EMCS with elective statistics, which confuses it a bit.

coffeeforone CS being safer for baby was the deciding factor for me so it's interesting to see the other factors which your relatives also considered.

The following is from the New Scientist article purring linked to but I think it is really important:

The medical evidence is on their side. Planned C-sections are the safest option for the baby, because they avoid any chance of brain damage from a vaginal birth and the not-insignificant risk of stillbirth after 39 weeks.

Bear there are two risks involved here. The risk to the mother and the risk to the child. A CS is safer for the child but risks to the mother vary between VB and CS depending on many factors. Personally that's all the more reason to tell each woman the risks as just because Sally down the road had an amazing VB doesn't mean you have the same risks and chances of the same outcome.

I will be having one next time. I kind of feel like I've earned it. Three vaginal births, denied pain relief every time, lied to and disrespected by midwives. I had a friend having a baby by c-section at the same time I was having mine and as I was trying to push out a back-to-back whopping baby in sheer agony, legs in stirrups and a stranger's hand in my vagina, I remember wishing I was in my friend's shoes.

Aside from associated costs, I wonder if the midwife led culture is a factor - in the UK at least..

I was once at a dinner where there were a few ob/gyns present. This very subject was raised and overwhelmingly the expert opinion was that the safest delivery is a ELCS. Drinks flowed and opinions were exchanged, but I took away a belief that countries like the UK take too many risks when it comes to maternity. Forced vaginal births from militant midwives, and being left to go passed a due date featured as common risky practices.

Aside from associated costs, I wonder if the midwife led culture is a factor - in the UK at least..

I definitely think so. I’m consultant led now due to other issues but I know you can go your whole pregnancy and not see a dr!

And I have heard it said that midwives are more pro VB as they don't see the consequences down the line when things have gone wrong.

as they don't see the consequences down the line when things have gone wrong.

It’s not midwives in SCBU, or doing physio.

'It’s not midwives in SCBU, or doing physic.'

And it isn't them performing a c-section. I can't imagine that a midwife could actually see surgical birth as a threat to her livelihood, but I have heard some awful stories of bullying towards mothers in labour - hopefully in the minority - which makes me wonder about motives.

Having said that, I know of friends and family who have delivered under the care of dedicated midwives. So I am not disparaging midwives or their work, It's just the cult like belief from some, that a pain relief free VB has to be the ultimate aim that bothers me.

So I am not disparaging midwives or their work, It's just the cult like belief from some, that a pain relief free VB has to be the ultimate aim that bothers me.

I had a wonderful midwife (Andy!) who was brilliant. He was extremely supportive of my decision to have a cesarean and was a godsend as I had a few problems throughout. He was wonderful.

I’ve heard some horror stories though.

I haven't yet been in this position but I have read this thread because it really strikes a chord. I already know I would really push for an ELCS. Just on a gut instinct level, it's always felt the right, natural choice for me in terms of autonomy and needing control. VB would not appear to give this. I also suffer with fatigue and exhaustion and everyone always comments on how tiny I am/how they need really small instruments to do anything to me internally. These might mean nothing but I am genuinely worried about being ignored, bullied and butchered after reading some of the stories on MN.

I think the fact that so many hcp seem to request elcs is very telling, too. So I'm not prepared to take no for answer. especially not if it is DPs because he has a ginormous bonce