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.

welsh it’s sexism. Like you say, no other area in medicine can do this. It’s assumed women can be treated like this.

Just realised my post is rather long! It just annoys me so much.

It annoys me too Flatback!

purringkitten It's funny because in other areas of medicine there is an obsession with discussing every possible small risk. I'm a nurse and one of my jobs is giving people an injection for a ct scan. The risk of being allergic to this injection and dying is extremely rare, about 1 in 400 000, but it has happened. I have to get the patient to sign a consent saying they understand the risk of death. A risk of 1 in 400 000 is discussed as if its a likely outcome!

I only have 1 child and am 40 now, so quite possibly no more.

But, if I ever had another baby, I would definitely request a c-section. My son was a traumatic birth and the whole experience definitely contributed to my PND.

I would love to say that I agree re the sexism, but actually, it seems in my experience that at least as far as medics go, men seem more open to this than women.
As I said, I'm really lucky to have had a supportive consultant (male). I know that he as now left the hospital, and the new consultant (female) has blocked requests for this.
Also, in my scientific journal, it seemed male medics who were supportive of explaining risks, carrying out c-sections etc. and the letters which followed condemning this were from women.
But then you do get the neanderthal types on radio phone ins who say they would never let their DPs have a c-section (like it's their choice- and my DB I'm sorry to say is one of them).
Societal conditioning that natural birth (in a hospital, with monitoring, drugs, interventions etc. natural?) is better perhaps?
Obviously, for those who are aware of the risks of either mode of delievery, their wishes should be fully respected.

Me.

Had two babies, gestational diabetes with both. First birth "oh, there's no reason why you shouldn't give birth naturally".

Yeah, no reason except the huge amount of monitoring which means you're labouring on your back in bed with no ability to get up and move around. And they have to keep your bloodsugar stable so even though I wasn't induced (was meant to be but baby decided to come a few days before) they had to keep giving me drugs to speed things up. Ended up with epidural and forceps delivery. I was incontinent for a week, unable to walk more than a few steps for a fortnight (not that the nurses were at all sympathetic about this -- it was days before anyone checked and realised I had a cut that was reopening every time I leaked which was why I was in agony) and 8 months before I was feeling vaguely normal.

Second pregnancy -- asked for c-section the moment they diagnosed GD. "Oh but you don't want to rush into that decision, dear" "Are you going to let me give birth while moving around?" "Well..." "Yeah, thought so."

It was BLISSFUL. In contrast to my first, I was cheerfully up, about and loading the dishwasher two days later.

Thursday- bizarre, isn't it?

I didn’t quite have an elective caesarean- we discovered at 9cm dilation and after 36 hours that my son was breech. I had started with intention if all was well to birth at home. I was offered the chance to continue with vaginal delivery or c section, and had 10 mins to decide! In my head I had my sister’s voice, who is a surgeon (though not obstetrics), saying ‘screw instrumented delivery, take the c section’. I knew I was tired, and felt that we were both more at risk of injury had I continued with a vaginal delivery. I agree that I had the risks of a c section very clearly outlined to me before consenting, where I would have not had the same risks outlined had I continued with vb. As it turned out he was long and a fair size. Maybe we would have been fine, but I felt our risks increased. The (female) surgeon said to me afterwards that she felt it was the right call. I agree, but would I have made a different choice had I not had the risks of vb in mind? Oth, I think it’s ok for there to be uncertainty in birth. I think the only bit I found stressful was when I had meconium I transferred from home to hospital. A slightly stressed drive! I put that down to feeling like my opinion was being listened to and a good standard and continuity of care. So it’s not all bad in terms of attitudes to maternal care. I accept that this isn’t always the case.

Societal conditioning is a better description but that conditioning is based on sexist ideas, in my opinion. Even women have absorbed it.

Bear2014 the better way to think of it is as informed consent to attempting a vaginal birth with the NHS, and part of this involving the provision of accurate information about the risks and benefits to you. Obviously if a pregnant woman is left for long enough, her body is going to attempt a VB, but that doesn't mean we can't have legal provisions stating that she needs to be given accurate information about the risks and benefits of making that choice.

And this is kind of what the case law is moving towards anyway. The case law I mentioned upthread, Montgomery v Lanarkshire, the woman concerned had particular factors that made attempting VB more risky and the doctor lied to her, deliberately, because she'd be more likely to opt for ELCS otherwise. The court found that this was the wrong approach and that the legal requirements regarding patient consent hadn't been satisfied. This is despite the fact that the woman concerned would (and indeed did) attempt a vaginal birth if nobody intervened to prevent it, regardless of whether she consented to this or not.

TBF purringkitten the fact that it's often women policing other women's bodies doesn't mean it's not sexist.

Yes it is bizarre. I also find in other areas of medicine the focus is on the worst that could happen - for example, a doctor will often perform surgery, give drugs or scan a patient in case the problem potentially occurs or worsens, when a wait and see approach could also work.

But when it comes to giving birth, it's assumed the best outcome, an uncomplicated vb, will happen, no need to worry that it won't.

Violette and Beetle- yes, you are right I think.
It seems that for some reason, the idea of letting a woman make her own choice on this (and it may have life-long consequences for her) is somehow unacceptable.
And I agree, if it were men in this position, there wouldn't be any issue over allowing them their own choice, without making judgements.

To be honest, even an uncomplicated vb frightens me. I just don’t want to do it. I don’t want to squeeze a baby out. I can’t explain it.

Beetlejizz a pregnant woman presents to maternity services - if a doctor or midwife then deliberately denies her access to a c-section even though she would probably benefit from having one, that is malpractice and negligence. Same with denying access to any medical treatment. But pregnancy and birth are natural processes so it seems odd to 'consent' to letting nature take its course. Obviously it is a midwife / medic's job to help keep each woman and baby safe. Each additional procedure/intervention requires consent. What you are saying suggests that far more education is needed about birth before the point that women (girls) choose to get pregnant or not! If both methods of delivery are seen to present significant personal risks.

welsh New Scientist reported in 2016 that the RCOG were looking at the 'medical paternalism' around childbirth and wanted to see women given the risks for VB and CS. The hold up appears to be the staunchly pro-VB attitude held in many maternity units

www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks/

Bear I’ve had to sign disclaimers for not having injections. That’s the natural state. What’s the difference?

Bear this extract may explain why it is being considered:

FOR the first time, pregnant women in the UK may be given official advice about the relative risks of vaginal births and caesarean sections.

The move comes in the wake of a landmark 2015 UK Supreme Court case that awarded damages for a baby who sustained brain damage during vaginal birth. In this case, the plaintiff had a higher than usual risk of having a difficult birth, due to having a small pelvis and diabetes. But doctors didn’t inform her of theseincreased risks– an act of “medical paternalism”, said the presiding judge, who decided in the mother’s favour.

This ruling is seen as applying to all births. Although advice is available for those who seek it out, women are not officially warned about common risks such as tearing and incontinence, because vaginal birth is seen as the default outcome of pregnancy.

Violette - if you're already under their care and are going against their advice? Perhaps you have to sign something if you refuse a c-section against medical advice too, I don't know. Merely presenting as pregnant to a maternity unit, to sign something to say you consent to giving birth just seems counterintuitive.

I think it's interesting that you consider it 'odd' Bear2014, and worth interrogating the reasons for that. Why?

You obviously accept that there are scenarios where it could be negligence not to tell a woman about the risk factors for attempting VB, and it actually seems that you set the bar for this quite low (I would agree with you on principle!). As you simply said it would be negligence 'when a woman would benefit from one'. That could cover a helluva lot of pregnant women, you know. Potentially all of them, given that VB does have risks and it's theoretically possible for the whole population to find them less acceptable than the risks of ELCS. It's arguably a lower bar than the case law imposes now. So you're kind of saying you do agree with the need for a move towards informed consent for VB!

And even a woman who's going to die if she attempts a VB, to take the most extreme example, is still a woman for whom nature will take its course if no section is performed before birth. It would still be negligence for her care provider not to make her aware of this.

I was offered one on my first, I declined as I had no stretch marks and didn't want to end up with a scar or overhang.

Childbirth seems to have some weird showing off around the fact one did it vaginally, and with no pain relief.

It's totally bizarre. No-one would show off about choosing to have any other medical procedure without pain relief!

And the "it's natural, women have done it fine for millenia brigade" are morons. Women used to be much younger (less risk of tearing) and babies heads used to be much smaller. Also, millions of women/babies used to die doing it the natural way....

Btw the landmark Supreme Court case from 2015 being referenced by a pp is Montgomery v Lanarkshire that I've mentioned a few times. It really is worth a read for anyone with an interest in this area. There are some good summaries out there too if you're (understandably!) not wanting to plough through the whole thing.

www.supremecourt.uk/decided-cases/docs/UKSC_2013_0136_Judgment.pdf

ukscblog.com/case-comment-montgomery-v-lanarkshire-health-board-2015-uksc-11/

For anyone who is pregnant and thinks they do or might want a maternal request CS, it's essential reading. Take a copy with you to your appointments. Make sure your care providers know you know the case and you understand what their obligations to you are. Take notes.

I completely agree with you in principle, I guess what I'm saying is that if everyone does their job properly and acts with sense and compassion, then all our bases are covered. If a woman will die by attempting a vaginal birth, like me with my transverse DD for example, it is the professional's duty to book her in for a c-section. Job done. If a woman is anxious, had a traumatic first labour, listen to her and book her in. Job done. Clearly some are not doing their job and doing a disservice to their patients, or we wouldn't be having this conversation.