C section - do you agree?

[ndpp]

I always wanted a vaginal birth. Due to some significant trauma in my pregnancy, mentally I did not feel able to do this and I asked for an elective c section. I was sad at this choice but felt it was best overall in the circumstances I was in. Although it was a tick box exercise to have the elective, I was surprised at the emotional pressure from nurses, doctors, HV, friends, etc to avoid a c section.

However, having had it, and a close friend desperate to have a vaginal but ended up with forceps delivery and massive tearing that two years later she’s not recovered from, I can absolutely say that the c section was easier all round. I know that’s not the case for everyone. But since then, 9/10 women I know from work and friends have all ended up with emergency c section which is of course worse than an elective.

AIBU to think that the main driver for woman to have a vaginal delivery is actually cost and not safety? I wonder if men were giving birth whether they would have comments made to pressure them into going through such trauma when actually, an ELECTIVE c section, although major surgery, is less painful for a woman and less dangerous to her.

My first c section was planned but early because my placenta stopped working and DD was very small so it was considered an emergency section, I also wanted a vaginal birth.
My recovery was extremely hard, I was in so much pain for over 6 weeks, I think I only really started to feel normal again around the 12 week mark. And I vowed that if I ever had more children that I would have a vaginal birth as I couldn’t face another section.

18 months later, water broke on my due date. I did my research on uterine rupture ect and we had decided if labour didn’t progress then I wouldn’t not be induced and would instead have another c-section.. as that would be he safest option for me and baby. Labour didn’t progress, I had another section and I felt absolutely fine within 3/4 days, no pain, not even needing to take paracetamol by day 5. It was a night and day difference to my first.. although the second was classed as more of an emergency than the first since I was 36 hours in with broken waters.

I think any birth is hard, I haven’t had a vaginal birth but it certainly doesn’t look easy. But I wouldn’t say having a c section is in any way shape or form easy either. It’s major abdominal surgery that you then have to take care of a newborn hours afterwards like nothing happened.

There is no easy way out of birth and we really need to stop implying there is 😅

Both my births were straightforward vaginal deliveries, in and out within 6 hours with no tears etc so that versus an elective section obviously how it went for me was better.

Textbook vaginal v textbook section - vaginal wins hands down. That said, everyone is different and many women don’t have a textbook vaginal.

In many other countries, elective sections are considered the norm/more widely accepted but I imagine they’re privately funded.

All these people saying it’s a cost thing, do you honestly think the drs and midwives pay any attention to what things cost? Do you think they have an excel spreadsheet that they fill in after every shift and put down the cost of procedures / interventions? The hospital management of course deal with costs of things but they’ll hardly be telling the clinical staff to deny women c-sections because of cost.

I don't think that the big maternity unit scandals have all been due to cost pressure, no. Some at least of them have been ideological, where it became a matter of personal pride to achieve the lowest possible intervention rate at all costs.

Straightforward vaginal is best, but nobody gets to choose straightforward vaginal birth - they can only choose to attempt one.

From a medical perspective, a c section is more dangerous and carries increased post operative risk. Most vaginal deliveries are problem free. The recovery period afterwards is also a factor. That’s why medical professionals encourage natural birth and cost has little to do with it.

I think that issues that have a severe impact on a woman's quality of life (e.g. prolapse, incontinence) aren't taken seriously enough by the NHS when comparing the two. Yes, I had a couple of days of pain after my emergency c-section and it was a week before I was up and about as normal but I have friends who can't exercise properly years after birth due to prolapse or suffer from incontinence and the NHS doesn't seem to take this sufficiently seriously enough.

My pelvic floor is watertight after 2 sections, and almost being through the menopause. I can run, jump around at cardio, trampoline and sneeze without a problem. I'm not convinced I'd have that if I'd ended up with vaginal deliveries (I had no choice).
The recovery takes a few weeks but being able to keep fit at (almost) 50 gives me a good quality of life as I get old.

YABU to suggest cost is the main driver, I work with obstetricians and I can say hand on heart not one of them thinks about cost for a second and tbh even if they are aware of the cost they do not give a rats arse. No one seems to believe this any more, but most obstetricians are genuinely motivated by what they believe to be safest for both the mother and the baby.

Crudely speaking it takes the most sever risks of VB away from the baby and transfers them to the mother and to her subsequent pregnancies.
Yes, this was essentially my experience. My planned section in my first pregancy was very straightforward, no complications, good recovery, healthy baby - what's not to like. If I had only had that one baby I would have been completely pro section. (And of course there is a place for them.) It wasn't until my 3rd pregnancy that the effects of that section could have killed me as my placenta implanted into the scar and I had a huge bleed. (I had a fairly straightforward VBAC in between so thought I was out of the woods regarding future pregnancies and births...wrong...)

Since my experience I have read quite a bit and met plenty of other women who have had similar problems to me or had other major complications in subsequent sections despite their first and sometimes second being very straightforward - it's not that rare. Yes, my sample will be biased I know, and of course there are lots of people who have no late complications and have multiple sections safely. But surely it stands to reason that if there is an increased first section rate then there will be a numerical increase in late section related complications going forward even if the incidence remains unchanged. It's a topic that needs to be discussed.

I don't blame anyone for what happened to me. There is no suggestion that a lack of surgical skill caused it or anything like that. It was just bad luck. But one of the commonest advantages of a section that is cited is that it gives you control, takes away the chance element of labour etc, and at the time it probably does. However, it opens you up to a whole new range of potential bad luck later and it will influence your care and decision making in every subsequent pregnancy - you don't necessarily get a lot of control ovet anything then.

I'm all for maternal choice, but it needs to be fully informed and I just don't think that the potential long term effects are well enough known. Of course there are also long term risks from a vaginal birth but I think more people understand those and in fact avoiding them is often seen as a pro for having a section. Whereas, in my experience at least, there's something of a prevailing view that if you have a section and it goes smoothly then that's it, over, nothing to worry about, and that unfortunately is not necessarily so.

I'm not anti section and even given what I now know it's still fairly likely I would make the same decision again as I did have sound reasons for opting for a section first time. I just think longer term risks need more discussion as too often they are either not mentioned at all or flung into the "really rare, won't happen" basket and not fully considered. That's my only criticism of my care in fact, I wasn't really fully informed though I thought I was at the time.

I didn't have a C section and can do all those things too.

I had a massive post partum hemorrhage with my first. I had to have a blood transfusion.
My second had shoulder dystocia, so was stuck for a while and we nearly lost him. I had to have a massive cut and was left in a mess. It left me with a bit of PTSD, which didn't come to light until I was having my third.
I had to beg for a c section with my third. I was crying and shaking with my consultant, terrified at what might go wrong that time. I got it in the end and it was the best decision. Easier all round and the recovery was brilliant

I had an "emergency" C-section which wasn't really an emergency - failed induction - and an unassisted vaginal birth and would choose the vaginal birth every time.

The thing is I think most C-sections, whether elective or all but the most traumatic emergency cases, are harder to recover from than an uncomplicated vaginal birth but easier to recover from than a complicated or traumatic vaginal birth. And the only type of birth you can really choose is an elective C-section. If you try for a vaginal birth, a lot of how it goes is down to luck.

No, I don't suppose individual clinicians are directly influenced by cost very much at all. But Trust policies and government strategies and targets are and they influence the behaviour of individuals. Cost effectiveness is a big driver for NICE when all said and done.
I doubt many, if any, Obstetricians see a patient and consciously think "I am going to deny this particular woman a section as it will save the department £X" but I can well believe that if they have been told by their Clinical Director that their section rate is becoming an outlier or their department is already over budget then that might at least subconsciously influence their thinking.
Of course financial considerations influence care, even if those directly delivering that care aren't actively thinking about costs at the time. And it's probably only going to get more marked as the demands on the NHS continue to rise and the budget doesn't keep pace.

YANBU. I looked up the NICE stats that staff were advised to give women asking for maternal request c sections - and it knocked my socks off. The differences in risk is tiny...

Risk of Neonatal mortality is indeed higher with a c section. But how much?
C section - 0.05%
Vaginal - 0.03%

Risk of the child developing asthma later in life:
C section - 1.81%
Vaginal birth - 1.5%

So with each situation, thankfully, the risks are always very low. And look how similar the risks are - we're not even talking as much as a percentage increase in risk.

To compare to some other risks that we accept as normal in childbirth: the risk of a 3rd or 4th degree tear during vaginal birth is 3%. Needing a Ventouse, 4%. Forceps, 8-12%. Risk of 1st or 2nd degree tearing for a first time mum, 90%.

These risks are usually expressed as "50 women out of 100 000 women giving birth" as this is easier sometimes for people to get their head around.

Just to be clear, I'm not trying to sell c sections. I'm for women choosing for themselves; the more informed the choice, the better.

I had an elective c-section due to a health condition and it is major surgery. I had a great recovery but I think I was one of the luckier ones - if I have another child, I will have a section again but I don’t think it’s just down to cost. However I do agree about there being a lot of pressure to have a vaginal birth which can also have big health impacts

I have had a EMCS and an ECS and much preferred the elective one!
I have heard from two sources that surgeons themselves opt for elective c sections so that was push enough for me! (If you pardon the pun)

@MindfulGrateful

Yes! And it is actually more manipulative than that, as they go through the risk of maternal injury for a Caesarian at great length and all the disadvantages for your baby, but don't even mention the risk of brain damage etc for baby if vaginal birth goes wrong. When I said this to the junior doctor who took my second consultation, she said that the risk of damage to baby wasn't relevant and I strongly disagreed. I'm not saying they should scare women out of vaginal birth, just that if you decide to talk about some risks, you should acknowledge all - selective scaring is not on. A dehumanising of women in favour of the system knows best is at the heart of maternity scandals.

I complained in my trust and they seem to have taken me seriously.

@MargotBamborough

I agree with this.

Though I disagree that it is totally unknown at the time you go into labour. In many systems, they do a better job of triaging women. I had a nearly 10lb back to back baby and they absolutely insisted on inducing me (back when I didn't know my rights!). In another system, they would have considered my chances lower and discussed them with me. In some systems, they actually use scans prior to birth to identify cord issues etc. I'm not saying that the NhS could do all of this, but unfortunately they really don't use prior knowledge or data well

I also had an argument with a junior doctor second time around about baby weight - doctor was absolutely insistent that having a baby that was big first time was not an indication second one would be big. In fact, all the studies show very significant correlation - it is the main predictor. There's a real refusal to look at data and circumstance to inform chances - the junior doctor told me that they had a 2/3 chance of a VBAC in our trust, but when I said that that also meant a 1/3 chance of not having one and presumably some people had better chances than others and which, in her opinion, was I, she admitted she hadn't read my notes. I mean, WTF?! I know you cannot determine from the outset with accuracy what will happen in birth BUT you can use data and experience to discuss individual cases. Instead, my trust until very recently used a 2/3 chance of a VBAC to tell 100% of women they should have a VBAC...

(The 2/3 rate btw was of the women who attempted a VBAC, 2/3 were successful. Maybe in the 1/3, there were some women who had a less than 10% chance who could be identified - if this is the case, it would save a lot of risk and heartache to discuss this with them even if they ultimately wanted to go ahead)

I had an elective c-section ie actually chose that as how I wanted to have my baby enter the world. Never considered a VG birth. Totally appreciate that other women have different ideas about child birth.

I think cost is a factor (how could it not be? I had 6-10 people in surgery and had 20 visits from various individuals post surgery on the first day) along with statistics. The hospital where I had the c-section was one of the lowest for electives in the UK (Leeds 8%, 10yrs ago). A friend had an elective in London where, certainly at the time it was definitely seen as a legitimate choice; their stats were (approx) 33%.

My surgery was straightforward. Healed on the outside within a few days. Internally that took longer as had twinges for about a year whilst my tummy knitted itself back together.

Had very weak pelvic floor afterwards - and did a lot of work to rectify that. So be warned - not necessarily caused at birth, but often during the actual pregnancy. I am left with a teeny pale scar of 3 inches. Also had to strengthen my lower back, but again I believe this to have been caused by being pregnant.

Agree on the point about prior data. I had an emergency c section last time. Now pregnant and at a different hospital. Apparently they basically don't know why I had a c section. I didn't receive a debrief so the only info I had is based on what they told me last time I was in labour. This basically amounted to, the baby was stuck after 12 hours of labour. Without knowing why the advice I receive is, it won't necessarily happen next time, we recommend vbac. OK but how do you know this if you don't know why they were stuck!?!