To think the NHS discourages c sections on purpose?

[tablebrush]

I often hear a lot of negatives about c sections (and not usually from women who have had them). You hear how it's not natural and how it's major surgery and how the recovery is awful and how it's all so much worse etc etc
But the women I speak to who have had them often speak of how positive their experiences were and how it was much more pleasant than a vaginal birth.
I understand it is major surgery but giving birth isn't exactly a walk in the park, and can (and often does) leave you with ongoing injuries.
AIBU to think the NHS/midwives put women off c sections due to cost and that they may actually be a better or at least equal, option for birth?

I've had both - vaginal delivery with 3rd degree tear and an elective C-section for breech. The C-section was MUCH worse to recover from. My milk took 6 days to come in compared to 3 for the normal delivery. The only part of my recovery from the normal delivery that was worse was that I got a dural puncture headache from the spinal anaesthetic for the repair of my tear, which could easily have happened again with the section.

My experience is they encourage C-sections when the risks of a vaginal delivery are increased - for example when DC2 was confirmed breech, a vaginal delivery became more risky than a c-section. Also if I'd had any ongoing problems from my tear I would have been recommended to have a C-section.

slippermaiden I'm short and used to be slim, but it was a few things that made it difficult, something to do with my pelvis on the inside plus the angle/presentation/awkwardness of DS, and he was a 9lb lump too so that didn't help admittedly I only occasionally piss when I sneeze but that's more to do with pregnancy overall I'm told and not birth.

I find it fascinating, everyone knows of someone who had a great/terrible experience. Just goes to show how individual each birth is I think. No birth will have the same outcome because it's personal to the patient.

www.nice.org.uk/guidance/cg132/chapter/Appendix-Planned-CS-compared-with-planned-vaginal-birth

Aha, found the NICE research. Consultant made me read it before agreeing to an ECS (which was an absolute walk in the park compared to previous VB).

Difficult to follow, but admissions to NICU are higher for ECS but other risks to Mum are (broadly) lower.

What strikes me is the points other pp have made about birth injuries and the cost of follow up from VB.

I think any surgery that is by "choice" rather than by "need" should be paid for by the individual.

After a 4th degree tear delivering my first child I was actively encouraged to have a Caesarean section.

The section was calm, peaceful and a lovely experience.

I didn’t experience the intense ‘rush’ that you get from vaginal delivery with no numbing drugs. I didn’t even do skin to skin just two days of bed rest in hospital with baby in my arms nearly constantly.

Seven years on there is no difference in the bond I have with either child.

Second child was also bottle fed from birth whereas first child was breast fed. It doesn’t matter. The years that pass and the time spent together as they grow is what is important.

I've had two EMCS and they were both flipping awful. I'd take a vaginal both over them any day!

However, elective sections are a different thing and many women have very positive experiences with them.

I don't really know why they are so actively discouraged. Vaginal births are safer IF straightforward but you can never predict that.

Despite c section carrying g much higher risk than vb, when I was a student nurse in obstetrics lots of c sections happened on a Friday as none of the medics wanted to work at the weekend. Someone audited it and the results were very telling.

Yes, we (as midwives) discourage sections, as do many obstetricians.

They are inherently more risky and reports of, for eg, planned sections being better/easier/less risky than vaginal births are usually simply anecdotes.

Women have a far greater risk of placenta praevia, accreta, post partum haemorrhage and a variety of other issues when they have a section. It limits the number of children they can safely carry and birth.

Incidentally, babies born via planned sections have surprisingly high chances of requiring resuscitation at birth and admission to scbu as they haven't gone through physiological labour and birth. There is also an interruption to the normal hormonal cascade which can (and regularly does) impact on breastfeeding.

And it's expensive. In an NHS that can't afford to provide enough staff I think that's a pretty huge consideration.

Why, if you don't mind me asking, in your opinion, is "because I want one" not a valid reason?

For me, with an NHS already on its knees and people being refused various surgeries, I don’t think there’s the budget to cover “because I want one” unfortunately.

The fact that there are so many emergency sections ( which are essentially a risky and often life and death situation) is enough to tell me that vaginal deliveries are not the best option.

Why this didn’t occur to me before my own disastrous vaginal delivery which ( which left me with a third degree tear and long term issues) I will never know.

I do wish that I had pushed for a section with my first. I had electives with my next two which were blissful in comparison.

If everyone had the option elective sections at term, without the guilt, there would be less emergency sections, it would be a lot slicker operation and the costs would go down anyway, there would be less fetal death.

The stats don’t lie, the further you go past your due date the more likely it is the baby will die ( however small the risk).

The final thing that convinced me was an obstetrian friend who went straight for elective despite a normal pregnancy. Colorectal surgeons tend to opt for them too - that is rather telling.

I really don’t believe when you take in the entire picture that an elective section is more expensive. And overall it is safer with less unknown variables.

Think of the cost of lawsuits and long term care of children who have cerebral palsy from oxygen starvation in labour. Payouts go into the millions. These are not costs that are taken into account when comparing them.

I've had 3 natural deliveries. 1 very long and difficult and 2 easy and quick. I would have done everything possible to avoid a CS because why undergo major surgery unless absolutely vital?

My own personal view is elective CS should not be permitted unless absolutely essential for health and safety of baby and/or mum.

The NHS is on its knees financially and so costly and unnecessary surgeries simply should not be available unless they are absolutely necessary.

I had an emergency CS with the first child, and elective with the second. Both lovely experiences with no pain and easy recovery. No troubles in bonding or breastfeeding. Based on my personal experience, I would never choose to deliver ‘naturally’. I never understood why people feel they are missing out on something if they don’t. I just feel very lucky I didn’t have to!

Sections are much more expensive and much more staff intensive. Outcomes are broadly similar for VD and sections so of course they are going to encourage healthy women to give birth in the way their bodies were built for.
If everyone had sections, the costs would impact on other services enormously. They’d also not be enough midwives, anaesthetists or obstetricians. There aren’t enough operating theatres in most hospitals. Very few hospitals have more than one obstetric theatre.
Good reasons to discourage them - they’re not just being mean.

I have had a straightforward elective section and a straightforward natural delivery. I would never ever pick the a C-section over the natural delivery.

OP, read about placenta accreta. I've been through it and very nearly died. Knowing what I know now I'd never choose to have a c section (which carries the risk of placenta accreta in future pregnancies) unless medically necessary.

One of the problems regarding cost is that funding for NHS is year by year.

Cost in year 1 from a VB is lower that CS.

Further down the line there are many more costs to be charged to the VB account. Problem is that this is for next year's budget so the cost is ignored in calculating what is 'cheaper'.

I had a c section 5 weeks ago. Not technically an emergency but not elective either (failed induction as I got stuck at 7cm after 21 hours on the drip so 56 hours since my waters broke they couldn't wait any longer for a natural delivery as my temperature had gone over 38C)

It went slightly wrong during surgery as my baby flipped over as he was being delivered and tore my uterus which meant it had to be removed and repaired externally and then put back. Sounds grim but I actually found it a good experience

I recovered really well with minimal pain and am perfectly happy to have future children by ELCS (I've been told due to the uterine tear I will not be allowed to have a VBAC)

I've seen friends have awful vaginal births with nasty birth injuries and lasting continence issues and feel I had a better deal by far and actually feel lucky I will be guaranteed an ELCS next time without having to beg and plead my case

I had a 6inch deep open wound for 3 months after a C section. I didn't fully heal til about 6 months and took a year to be anywhere close to "normal". A C sections is major surgery and carries the associated risks. At the time I didn't realise how ill I was. I brushed it off with a "oh that's just giving birth". Next time I'll be pushing for a vbac.

I bet that if men had to give it would be c section only!!!!! I had 2 sections, both elective, both amazing. However I would happily have paid for them.

I tried a natural birth.
My pelvis is extremely strange. Ended up with a shattered coccyx, huge episiotomy which ulcerated, and a prolapse from the forceps.
Second time I pushed for hours. No pain relief. Drs advised on emergency CS, as my pelvis was not equipped for vaginal delivery.
Third time was elective section.
I felt like a failure, but sometimes it's not really an option.

Sorry, if men had to give birth they would have sections!!

Opposite for me. I had a tough time with my first. Had a crash section and was quite unwell.

For my second I wanted an ELCS and went in all prepared to have to fight. No need, given my experience they advised it and said I could only try vaginal birth if I went into labour naturally prior to 40 weeks, but things would need move quickly and if they didn't I'd have to have a section.

Anyway I didn't go into labour and had an ELCS second time round. It wasn't great and I nearly lost consciousness. I'm desperate for a third but feel like the birth will never be good. I'm very jealous of those who can deliver naturally. And some of the comments are a bit insensitive.

Re the bonding issue- in my case bonded fine. Breastfed both babies for 9 months. I think it's so individual and I also think women should have more choice in general with births.

Why, if you don't mind me asking, in your opinion, is "because I want one" not a valid reason?

For the same reason lots of other non-essential procedures aren't available on the NHS.

Cost - I don’t think it is because of cost. The latest figures I have seen said the difference was approximately £80 (not accounting for birth injuries) so in the long term it is likely to be less expensive to have a c section.

risk analysis - this thread shows that a lot of people misunderstand statistics and risk analysis. Very few studies separate planned and emergency c sections so those statistics are almost lumped together which artificially shows an increased risk for a planned c-section when compared to vaginal birth. Even some midwives misunderstand these statistics and that is reflected in the way they practice. A planned c-section is actually very low risk, particularly with regards to birth injuries.

Birth injuries - we have a greater awareness of these now and the effects are becoming more apparent with increased life span and modern lifestyles. But the NHS hasn’t caught up yet. The costs of these are not factored into birth costs. They should be!

midwifery - midwives are usually the first HCP to see a woman in her pregnancy. They have become the default. They rightly want to provide continuous care and are therefore biased towards natural births so that they can assist the mother rather than a surgeon. This ties into ideology.

ideology - I don’t think it is always NHS policy to discourage c-sections (although I believe some trusts do and may not have updated policies in accordance with NICE guidelines). I do however think that a lot of heath practitioners take the view that avoiding intervention is best. Even if a c-section is planned, it is still an intervention. Ultimately, the vast majority of babies can be born vaginally (no intervention) but that comes with risk of injury or death to the mother which is when emergency or planned intervention rightly happen.

But I do think a lot of people believe that if intervention can be avoided it should be because ‘natural is better’. I would suggest that they remember that antibiotics, laser eye surgery, and fridge/freezers are also not ‘natural’ and see how they would like to fare without those.