Green Party pledge to reduce c section rates

[TTCaxristi]

Is this something a political party should even get involved in?

I had understood that a focus on keeping c sections below an arbitrary threshold was at least partially responsible for the Shrewsbury maternity scandal.

https://news.sky.com/story/shrewsbury-maternity-scandal-the-babies-who-died-in-the-uks-worst-hospital-childbirth-scandal-12576727

It looks as though the greens are reviewing the policy now but am I alone in finding this chilling? What does it say about their attitude to women? I really strongly believe that it’s up to the individual woman how she gives birth, and the focus on arbitrary targets is misguided at best and dangerous at worst.

YABU - this is something a political party should have a policy on
YANBU - this is not something a non medical entity should have policy on

https://www.standard.co.uk/news/politics/green-party-nhs-lbc-b1162105.html#

Why are women still not trusted to know what is in their own best interests?

As I say above, educated women have the best health outcomes in every other area of medicine. They are the best placed to understand and make informed decisions.

Yet for maternity care this is often dismissed as too posh to push.

Because does that only apply to ‘educated’ women? You hear posters wanging on about improving the breastfeeding rate and how sad it is it’s ’so low’. If you believe in choice then there is no ideal number

The point is that women across the board are able to make good decisions about their health if well informed.

The fact that even educated women are dismissed as not being capable of doing this and are instead labelled as posh rather than educated is the issue.

It's worth noting that educated women also tend to have children later (higher risk factor) and have less children (less risk from multiple CS). If you are in your 40s having your first child and your chances of intervention are much higher and your chances of having multiple future pregnancies are much lower. On balance this makes a much stronger clinical argument for an ELCS overall based on risk factors versus a woman in her early twenties who is hoping to have a large family.

If women who work in healthcare and research aren't able to make informed decisions about their maternity care then why are they able to get good outcomes in all other areas of medicine? Why are they suddenly making bad or posh decisions when it comes to maternity?

Are we seeing a massive upsurge in complications in birth as the result of ELCS? I've never seen evidence for that. We should be looking for it, but surely if we are saying it's a really bad thing we should be backing up these type of claims with substance especially in the context of scandals involving lack of access to intervention.

There is no ideal number.

Risk profiles vary massively based on maternal age, health and other demographic differences.

Trying to apply an ideal rate across the country is nuts if you consider massive differences in inequality of health in this country.

What might be appropriate in a leafy suburb with healthy older women might not be appropriate in a deprived provincial town with high rates of obesity or in an area with greater ethnic diversity with younger demographic who have more children.

This is important stuff. The greens are trying to over simplify to cs = bad v VB = good.

It should be want is appropriate for each individual woman. And each individual woman is the best placed person to do that with accurate information and decent support and care.

Educated women are most likely to get this because of privilege and being taken more seriously than someone who is less educated simply because educated women are better able to challenge and question where appropriate.

This is an absolutely brilliant post that nails the issue down. Thank you for this, personally i feel a little more seen and that someone else out there gets it.

I was scared of childbirth when i was pregnant and spent the whole time in a state of high anxiety and fear. My pregnancy was complicated for a number of reasons - any one of those reasons should have been enough to get me a c section. Turns out i am asd/adhd too, so it makes sense why i was so badly affected by the doctors and midwives completely ignoring my mental health in the drive to push me into a vaginal birth. Had they agreed to an ELCS early on, all the things that followed wouldn't have happened. I wouldn't have ended up with ptsd, and i might have enjoyed my pregnancy instead of dreading the birth.

And yet I'm told that I should be nice to the green party if they knock on my door.

@RedToothBrush

Your post about Tokophobia is very enlightening. I also was completely unaware of this and it makes me angry looking back that I was treated as a precious timewaster when I said I was terrified of a vaginal birth.

Literally no one, even my counsellor, mentioned this!

“We will work to reduce the number of interventions in childbirth, and change the culture of the NHS so that birth is treated as a normal and non-medical event, in which mothers are empowered and able to be in control.”

I hate the increasing belief that childbirth is a non-medical event. There is a very good reason most births take place in a hospital in the presence of a healthcare professional (and often with an entire team of midwives, doctors, and nurses).

Yes, women's bodies are capable of childbirth. But childbirth is incredibly risky. Women lose excess amounts of blood, tear, go into shock, and babies suffocate, and go into distress. These are not uncommon occurrences. I would have died both times I gave birth had I not been in a hospital.

In society, childbirth is a normal, everyday occurrence. To a woman? It is something that happens a couple times in a lifetime, if at all.

Childbirth is medical. The government needs to keep its nose out.

@MooseBreath

I hate the increasing belief that childbirth is a non-medical event. There is a very good reason most births take place in a hospital in the presence of a healthcare professional (and often with an entire team of midwives, doctors, and nurses).

I hate it too. I can’t hide my contempt for this nonsense. And the fact it has dictated attitudes to childbirth for so long is a disgrace.

I spent years researching this before getting pregnant.

I was so bad I wouldn't even get pregnant before I knew I could get a CS. I was exceptionally lucky because my GP agreed to refer me to the specialist I had tracked down at a nearby hospital.

I had looked into every conceivable alternative option.

Tokophobia is really poorly understood - there are very common features about women in each group. There is a definite pattern. And there is massive social stigma.

I've posted extensively on MN about it in the past - particularly in the run up to and after the NICE guidance was changed.

The NIcE guidance was a response to a lot of very distressed women raising the issue over the course of a number of years. There are cases where women were so distressed about the prospect of giving birth vaginally that they terminated pregnancies despite desperately wanting children.

It infuriates me that even after the NICE guidelines were changed - in response to mental health concerns that the NHS failed to change the way it recorded mental health related ELCS. This means that there's no data for it and there was not real official acknowledgement that it was valid to do so for mental health reasons. It's led to the stigma and ignorance continuing.

There are some awful stories about women not being allowed a CS. Women were travelling across the country to hospitals far away because their local one prevented them. Others were denied and were traumatised by the experience.

And here are the greens who were happy to roll back on all that because they couldn't be arsed to look into the reasons why the change happened in the first place.

It's all effectively documented on MN so it's not like it was hard to research if you could be bothered. Everything I posted years ago was referenced and linked to reputable sources.

As I say I'm pro ELCS and pro homebirth - there's no 'right way' to birth. Both options definitely have benefits to particular type of women and in a number of cases would be less risky for that particular woman than some other options. There is a most appropriate for your circumstances that's the crux of it (I don't think it's a good idea for every woman to be encouraged to have an ELCS and there are women who need additional information particularly if they want more than one child or are particularly young).

@Thepeopleversuswork "I hate it too. I can’t hide my contempt for this nonsense. And the fact it has dictated attitudes to childbirth for so long is a disgrace."

And yet back in the real world of maternity services (rather than deep in the culture war chat around birth on the talk boards, and clickbaity articles in mainstream media) decisions around how labour and birth is managed are actually ever more shaped by defensive and highly medicalised approaches for managing labour that are resulting in rocketing rates of complicated & traumatic births including among low risk women.

If you have had an uncomplicated previous VB and a low risk pregnancy a homebirth is statistically much less risky than a birth in a consultant led ward. It's still less risky than being in a midwife lead unit too. Which surprises a lot of people. It's not the preferred option for all women (partly for anxiety reasons) but that's what the data says.

Women getting access to this has been greatly reduced due to staffing issues too though. You know cost and all that... (Funny how NICE also support homebirths isn't it?)

This doesn't make logical sense unless you factor in that anxiety has a role to place in childbirth as well as other factors. This isn't total woo woo - it's about hormones release during birth. Anxiety interferes with this process but it's not particularly well researched especially not to high standards without a predetermined ideological agenda. Mainly because it's an area of medicine that isn't regarded as a high enough priority and there's too many politicians trying to score points with their core red meat voters over childbirth.

It's not as advisable for a first birth (the statistics aren't so favourable) though.

And this comes with a caveat that a planned homebirth is a birth with a trained midwife present.

A free birth is highly risky and different again. That's a birth with no medical assistant present. It should not be confused with a planned homebirth.

It infuriates me that even after the NICE guidelines were changed - in response to mental health concerns that the NHS failed to change the way it recorded mental health related ELCS. This means that there's no data for it and there was not real official acknowledgement that it was valid to do so for mental health reasons. It's led to the stigma and ignorance continuing.

Absolutely. As you say shocking that it isn’t acknowledged as being related to mental health.

I had my daughter nearly 14 years ago so this wouldn’t have helped me at all.

"It's not as advisable for a first birth (the statistics aren't so favourable) though."

Depends what you're looking at. Lancet series on place of birth looked at a good number of studies involving vast number of births and didn't find a significant different in outcomes for babies of first time mums. Birth Place 2011 did. Interestingly though Birth Place 2011 found excellent fetal outcomes for first time mums choosing freestanding midwifery units - birth centres where obstetric input would require transfer by road to hospital, so suggests out of hospital birth per se isn't necessarily less safe for low risk first time mums.

ALL the evidence points to a mental health related issue.

To the point that I actually say that a request for an ELCS alone with no other information is probably an indicator for underlying mental health concerns and that midwives should treat accordingly.

I was put under the perinatal mental health team and had additional appointments during my pregnancy. This alone I would argue had long term benefits to me personally.

There was a report by a maternal mental health charity which looked at the cost of poor mental health due to pregnancy and childbirth birth related issues - the figures were mind-blowing in terms of cost to the economy. It has a huge impact on women long term. It was from a few years back and have to look it up on MN but it was shocking. As in if we invested much more in staffing the impact would be huge and the cost to the tax payer would be massively covered by improvements to women's lives and economic output. It's financially crazy to be proposing such regressive shit.

Frankly it's the type of ignorant bullshit I expect from the hard Right. To see it coming from the greens says a hell of a lot. It's anti-woman as far I am concerned.

Suffice to say, if I didn't have other reasons not to vote green, this would firmly lose my vote as it's something I particularly care about and have spent a huge amount of time trying to support women with.

Actually, when post-birth complications like incontinence and tear repair are taken into account, CS are not necessarily more expensive than vaginal births.

Politicians should not be forming medical policy ever.

"Actually, when post-birth complications like incontinence and tear repair are taken into account, CS are not necessarily more expensive than vaginal births. "

Well - if your comparison group is women giving birth in obstetric settings who have high rates of induction, unplanned caesarean and assisted birth.

My issue with rocketing caesarean rates among healthy women is that this is happening in a context where we don't have enough obstetricians, anaesthetists or midwives, and where postnatal wards are heaving and inadequately staffed. I wonder if it leaves women with complex health issues who are trying for a vaginal birth with less access to surgical input when they need it.

As opposed to the ones squatting in the woods? My children and I would have died if I hadn’t had access to obstetric care in a world class hospital. Birth might be natural, but it’s also dangerous. And as someone who’s had both kinds of delivery, I can assure you I wish I had elected a cesarean instead of a vaginal birth.

I spent longer in hospital after my vaginal birth than I did after my CS. I also required as many consultants because it was touch and go whether I’d need an emergency CS.

I was pressured by society, myself, and fucking NCT to try VBAC, and it has left me permanently injured.

Any ‘top posh to push’, ‘only vaginal is natural’ narrative feeds into this pressure on mums. Leave us alone to choose what we want for our own births.

"I spent longer in hospital after my vaginal birth than I did after my CS. I also required as many consultants because it was touch and go whether I’d need an emergency CS.

I was pressured by society, myself, and fucking NCT to try VBAC, and it has left me permanently injured.

Did you do an NCT course when you were pregnant with your second child? Very few people do that. What form did that pressure take?

Really? That’s the bit of my post you want to discuss?

"Any ‘top posh to push’, ‘only vaginal is natural’ narrative feeds into this pressure on mums. Leave us alone to choose what we want for our own births."

BTW - nobody should be talking like this about birth. It's horrible.

But looking back through threads on this issue on mumsnet it seems to me there's vastly more sneering and cynicism about women wanting a non-medicalised experience than there is about women who want or need a surgical birth.

@izimbra

And yet back in the real world of maternity services (rather than deep in the culture war chat around birth on the talk boards, and clickbaity articles in mainstream media) decisions around how labour and birth is managed are actually ever more shaped by defensive and highly medicalised approaches for managing labour that are resulting in rocketing rates of complicated & traumatic births including among low risk women.

OK so just for starters: this is nothing to do with “culture wars”. The dog I have in this fight is my anger at having my terror of vaginal birth dismissed by HCPs and midwives.

After literally decades of being told that birth is “natural” and I should be able to manage it alone at home without pain relief if I am a real woman I discover that a lot of the rhetoric about “intervention” being dangerous turns out to be horseshit, as I always suspected but couldn’t ever prove.

As many posters on here have shown, there is no evidence at all that C sections are inherently more dangerous and mounting evidence that they are for many people in fact safer. The reasons women are given as to why they shouldn’t have them are largely mendacious and driven by a toxic combination or poor science and earth mother woo with a side order of NHS cost control.

So when I hear people chucking out that old line about the “medicalisation” of labour being responsible for the rise in traumatic births it makes me see red. Labour is and always been dangerous. Let’s be honest.

The “medicalisation” of it has saved millions of women’s lives. Yes if you are young and healthy it may be that it’s manageable with minimal supervision at home and I defend absolutely women’s right to do this. But it’s a lottery and you don’t avoid the risk of complications by simply pushing all women towards vaginal deliveries as the default.

I wish people would stop mangling this argument about “interventions” being the cause of maternity problems and pushing women to feel they are failing if they seek to make the process more comfortable. It’s bad science and it doesn’t help women make informed choices.

I disagree. I see much more ‘vaginal is natural’ and pride in no drugs on these pages. So I’m guessing we are both noticing more the argument we don’t agree with.

This a million times.

I know 4 people who had a home birth. Two had a magical and life-affirming experience and the other 2 got blue lighted to hospital with their dangerously ill babies and spent weeks in special care.

I don’t believe the home birth setting was linked to the dangers to the babies, but without quick medical intervention, their outcomes would have been unthinkable.

The point is that all women should be able to choose their own birth, including a CS.

There are plenty of things the NHS pays for that are the result of personal choice - from sports-related broken bones to vasectomies. Why is it only mothers who are expected to take one for the team and risk their health for money?