Women are encouraged to have vaginal births due to…

[Undkonm]

1. cost
2. because women are not treated like men in terms of pain management

I have read (and also strongly believe) that the nhs encourages vaginal births to save money. A consultant has recently come forward to say exactly this. It is appalling and women are still falling for the narrative that vaginal birth is the only real way to give birth.

Don’t get me wrong, I know there are huge risks with all medical intervention such a c section. But I know so many people who have ended up with an emergency c section and it’s been awful for them. In contrast, those I know (including myself) who elected a c section by choice had a peaceful and largely predictable birth.

This toxic narrative that birth is only birth if you give birth vaginally is another abuse of women. I am glad I had the insight and confidence to push for what was best for me. I know other women who desperately wanted a c section but were pushed around and didn’t get to have it elected.

When will this end? I should add that I also strongly believe women who want vaginal births should be absolutely supported but it should be an active choice to do that, not the expected ‘norm.’

Do others agree? Do you have other thoughts on this? To go one step further I think the abuse of women continues when the baby arrives with huge pressure to breast feed. Just leave women alone to make decisions that are right for THEM.

EMCS requires use of surgical rooms, as do some instrumental births. And unlike with an ELCS, because these are emergencies the NHS isn't able to schedule them at the most efficient time and can't make any staffing economies that way. There's also the issue of resources used by staying longer on the postnatal ward. And this is just the short term.

Again, if you are going to make these resource based arguments, do them properly. You haven't so far.

I agree. I didn’t personally want a c section, but then I didn’t have any high risk markers of being likely to end up needing an emergency section.

I have a friend who was encouraged to go for a VBAC after twins and it went horribly wrong. Baby nearly died, was delivered by emergency section, and was only saved from brain damage by brain cooling technology which is apparently quite new. She is also a tiny woman with quite a large husband - I mean surely this increases the chances of a baby being too large to come out - and in the case of a VBAC, why risk it?

Yes I’ve heard so many stories of women not getting the pain management they request - especially if they aren’t middle class, or aren’t white.

Again, I didn’t want an epidural but I bet if I wanted one they’d have given it to me as I’m very pushy when I want to be - and am a white middle class woman!

see further down you had two painful vaginal births with minimal pain relief out of some form of strange martyrdom to the NHS. I am not risking my baby or my health in martyrdom to the NHS who just leaves you to suffer for years regardless of what's wrong with you because it's such a shit show. And if you think for one minute someones gallbladder is more important than a babies life you really are stupid.
What are you on about?

I'm not talking about situations where professionals are recommending a section! Of course that if life of the mum or baby is at risk, a cesarian is the correct planned intervention.

But that's not what OP is talking about. the question is about choice. When it is perfectly safe and they are no contradictions for a vaginal birth, it is right that it should be encouraged because indeed, someone needing an emergency procedure should take precedence.

It's clear that most posters here are clueless to how hospitals work and that ultimately, it all comes down to priorities.

EMCS requires use of surgical rooms, as do some instrumental births
But that's exactly the point, they ARE emergencies. There will always be some no matter how well planning has taken place.

Nobody is questioning emergency cesarians!

Statistics can absolutely be stupid, if they are measuring the wrong things, or making generalizations about things that are not the same. People decide how to make groups and compare, that's not a neutral decision.

You can't take a huge group - all babies that seemingly go past 40 weeks, and treat them as if they are the same. What may be good for some could be detrimental to others.

No one really knows what triggers labour, there are a lot of theories about interactions between the baby and mother that may be involved, but it is a bit of a mystery as are many things about the human body.

It is entirely possible to assess the placenta and its function if that's a concern.

She is also a tiny woman with quite a large husband - I mean surely this increases the chances of a baby being too large to come out - and in the case of a VBAC, why risk it?
Unless you are a gynecologist, you have no idea.

I am small, 5'1'' and gave birth to a baby the size of an average 3 months old baby. Head was above the 100% chart. I managed to deliver him vaginally with no complications for him or me.

Do you have evidence for some of this stuff? As it sounds like spurious nonsense to me. What 'infant reflexes'?  Both of mine are C section babies, both breastfed, one crawled at 9 months and one at 5 months, neither have any of the problems you're described and I doubt very much that any of the problems your children have were caused by C sections. It's natural to want to find a 'reason' for things sometimes but you have two ND children, so genetics are the likely culprit here, not method of delivery.

No, the point is that attempting a vaginal birth doesn't mean you get one. So the expensive emergencies that inevitably occur with some attempted VBs need to be included in any resource based analysis. You cannot simply say ELCS resources as though that's a complete answer. I know you accept the need for some emergency sections and instrumentals, pretty much everyone does.

No, the point is that attempting a vaginal birth doesn't mean you get one. So the expensive emergencies that inevitably occur with some attempted VBs need to be included in any resource based analysis. You cannot simply say ELCS resources as though that's a complete answer. I know you accept the need for some emergency sections and instrumentals, pretty much everyone does

The ratio of vaginally started delivery that end in cesarians doesn't justify offering cesarians to all those who want it. Especially when it won't forcibly reduce the ratio. Many who end up with cesarians want VB and will continue to do so.

It will just be overall many more ELCS which the NHS can't cope with for the reasons already mentioned.

If you want to go that route, when the data is adjusted for conditions requiring emergency c sections and that may mean an ELCS is safer than vaginal birth, statistics show that an unnecessary c section done totally through choice is safer for both mum and baby than vaginal birth with fewer long term complications. But all the happy clappy natural is best people don't like to accept that so stick with the "stupid statistics" that a vaginal birth is safer. Which is not true.

Not having any extra risk factors other than going overdue does not mean it is safe for your baby to go overdue. It means it is low risk, not safe. And any taking any risk of death is stupid in my opinion. Telling women they are safe to go as overdue as they like because they are not over 30, obese or a smoker is not true, and is dangerous.

Statistics are not stupid. Just the people interpreting them.

There does appear to be some correlation (unclear if this equates to causation) between some sensory difficulties, mostly proprioceptive difficulties and c sections. Some studies show a c section is a 'risk factor' for ND but the actual association appears to be very small. I'm not sure any of the studies are that robust tbh (I haven't looked that much in to them) but there's a few out there.

I'm SI trained and any correlation was not enough to put me off choosing a section. My LO is neurotypical, hit all milestones, no problem integrating his reflexes and has no sensory difficulties so certainly not a given. Although I have heard therapists say pretty much what @ItsAShame2 has said to explain what may have caused a child's sensory needs like it is an absolute (which I think is dodgy territory).

I’m pretty sure I read somewhere that ELCS are NOT actually more expensive than attempting vaginal delivery once you take into account emergency sections, instrumental deliveries, complications and injuries from vaginal births and compensation pay outs.

These are the sort of claims that require proof. Show us your working out.

due to...that's how babies are naturally delivered.

Yep, NICE did this calculation a while ago and found the difference to be minimal. And of course, the birthing population is only getting older and fatter with time, which makes straightforward cheap VBs less likely.

it was several friends with stories like this that made me choose elective c-section for my first. I simply wasn’t willing to take the risk with longer term complications given the current state of maternity care in England. Much more investment needed

Agree that there’s a heavy focus on the risks of CS and hardly anything ever mentioned about the risks of vaginal birth.

When DC was breech I had to weigh up CS vs ECV vs breech vaginal birth. Scoured lots of threads like this and the consensus was do anything to avoid a dreaded CS. Think of the painful recovery. Think of the infection. Think of the scarring. Think of the time spent in hospital. Think of breastfeeding. Think of the golden hour of skin to skin.

As it happens, DC turned last minute, my CS got cancelled and I had a very fast very painful back to back labour that ended in an episiotomy. Got the painful recovery. Got the infection. Got the scarring. Got the time in hospital. Breastfeeding was an absolute nightmare to establish because we were both traumatised. I spent the golden hour of skin to skin being stitched up whilst baby was being checked over by a paediatric team.

These debates always seem to be the worst case CS vs best case vaginal birth. And whilst I agree best case vaginal birth is ideal it’s often not reality. And there’s a lot to be said for having some control and managed expectations of birth and recovery.

I have had one of each.

I think this situation has a lot of parallels with the breastfeeding vs bottle feeding issue.

Option A is cheaper and better for baby but can be painful and unpredictable. Option B has a lot of other benefits and could become the default choice.

The institutional machinery is mobilised to uphold Option A as absolutely the best and most responsible choice to try to make a marginal difference to the numbers choosing B.

I agree with PP that it would be much better to invest in making VB safer, less painful and less chaotic. Having enough anaesthetists on-call and enough midwives on duty that birthing women feel secure and confident and get the pain relief they need when they need it.

I had a patient-controlled mobile-epidural for my VB though I had to deal with an unreasonable length of labour without pain relief before I got it. It was absolutely brilliant when it was in, I was able to control the exact balance to have enough sensation for an active birth without letting the sensation get overwhelming. Every single woman should have the choice to have this nearly-perfect option (only "nearly" because the spinal needle would be a problem for some) but it's not automatically available, it's completely luck-of-the-draw whether the equipment and an anaesthetist will be available when you need it and whether there are enough midwives to monitor and assist while you are on it.

Without the funding, VB can be a terrifying prospect and I don't blame those opting for CS at all. If they want to bring CS rates down they need to massively increase the funding for VB.

I’m pretty sure I read somewhere that ELCS are NOT actually more expensive than attempting vaginal delivery once you take into account emergency sections, instrumental deliveries, complications and injuries from vaginal births and compensation pay outs

of course, any complications with vaginal delivery is going to increase the costs, but overall, of course cesareans are more expensive!

Statistics in UK:

• 52% are spontaneous vaginal births.
• 11% had instrumental assistance.
• 15% are elective cesareans.
• 19% were emergency cesareans.

Now for costs...
Normal deliveries (or vaginal deliveries) are anywhere from £2,341(majority) to £3,806 with many complications.

Cesareans are £3,806 with no complications up to £6,945 for cesareans with many complications.

Now let's do the maths....

@BrokenSushiLook, totally agree with you. If we can reduce elective cesareans, we could use the funding for better pain relief for vaginal deliveries.

I would have hated a c-section and thankfully had two easy natural births but I understand others are different. I agree with @pointythings .

how many other mammals do you see having c-sections?!.

How many other mammals walk on two legs?

How many have brains our size?

Oh and I'll refer you to a story by another mner on this subject ... Her h was out fell running and came across a dead deer lying on the ground with a baby deer stuck half out of it.

"Nature" let's lots and lots of "mistakes" happen.

The point is that you can't put the cart before the horse. Put in the funding first, then see the investment pay off with reduced ELCS rates eventually once forums like mumsnet are overwhelmingly flooded with everyone sharing what a good, well supported and positive experience their VB was.

There is no funding to put first. The NHS is told all the time it's got to make savings or better reinvest. That magic money people see to make their lives more convenient health-wise just does not exist!