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.

I never said c elective c section was perfectly safe. I said it was safer than vaginal birth. Which it is.

Someone else is claiming vaginal birth is perfectly safe. It is not.

You are being deliberate obtuse and missing the point on purpose 🙄

FWIW - my concerns are the impact of the massive increase in planned caesareans among healthy women that we're currently seeing, on the safety of women planning vaginal births who may need an urgent unplanned caesarean.

Because the 60% increase in planned caesareans at my local hospital hasn't gone hand in had with a 60% increase in anaesthetists, obstetricians, or theatre staff. :-(

Major surgery is safer for WOMEN than a vaginal birth? Not sure this is true.

I accept it's marginally safer for babies - partly because you'll have a full team of doctors, anaesthetists, nurses and midwives managing your birth, rather than a single midwife who may be caring for two women at once (with current levels of understaffing).

You have to be joking. I was basically forced into two sections as I wasn’t supported to have breech vaginal births because they didn’t bother to have suitably trained staff available on labour ward. In my experience the recovery from a c section is awful, and the pain relief offered after is inadequate and only given after a huge fight, and care for you and your baby is non existent in hospital. The NhS should be promoting vaginal births - they are much lower risk for women and most women want them. Yes, some people will need sections and some will want them for mental health reasons but they absolutely should not be encouraged or promoted as the best option.

I promise you it is true. The statics for adverse outcomes in C-section Vs vaginal birth in the UK, once adjusted for other health conditions prove it to be so. This argument has been had many times already on this thread.

I am not joking. Sorry you had a bad experience but the statics for adverse outcomes in C-section Vs vaginal birth in the UK, once adjusted for other health conditions prove it to be safer to have a planned c section.

This argument has been had many times already on this thread. It is the promotion of vaginal birth over sections that cause the tragic outcomes we are seeing in maternity care.

Women should be able to chose, not be railroaded into a vaginal delivery they don't want because "it is safer" when it is not.

The after care is shit for all births in my experience but that's not relevant to the safety of the birth itself, being in pain sucks but it's not dangerous and doesn't cause lasting damage to your body which is what we're actually talking about when discussing safety of birth - injury, long term damage to mother or child and death. Not recovery time or pain.

You’re correct, especially on cost. My midwife despised me when I came with NICE guidelines to discuss this topic. Specifically the statistics on Vaginal vs Caesarean, they make for interesting reading.

Trouble is, the spontaneous vaginal birth category which is apparently so cheap covers a very wide range of outcomes. It could be a blissful few hours in labour home birth.

Or my spontaneous vaginal delivery which involved shoulder dystocia, tears, haemorrhage, ten days in hospital, baby in SCBU, infections and antibiotics for both of us, pain for weeks and a lengthy recovery. Which I imagine was rather more expensive.

And you can't predict which of those outcomes you might end up with in advance!

I was advised at my age it was risky to go overdue, so induction was scheduled for my due date. In the event I’d been contracting really painfully for 2 days by then anyway so going past 40 weeks was not an option. They ended up breaking waters and putting me on the drip on the day I had been booked for induction. If it hadn’t been booked I wonder if they’d even have found me a space on labour ward, they were so overstretched/understaffed for midwives. Though they managed to find about 20 people when I was eventually rushed to theatre.

It seems to me that a major part of the solution (ie producing better, safer birth outcomes in the U.K., for mothers and babies), would be to do a complete reset of the availability of pain management - specifically epidural pain relief.

If epidurals were available from an early stage of labour (and sited before induction medication is given), the rate of assisted deliveries, emergency c sections, stillbirths etc, would all be significantly lower. It is scandalous that so many women are denied proper pain relief in labour, against NICE guidance.

There is so much misinformation on the safety of epidurals. Midwives and the NCT are very much to blame for this. They are the ones peddling lies about the so-called cascade of intervention, low AGPAR scores etc - all of which have been debunked.

@izimbra

But if doctors headed off those situations that would be dire emergency sections by advising a section, fewer women would be terrified into electing for a section without medical teams advising on it. There's nothing wrong with a precautionary section - it's probably best practice given what has happened in maternity care recently. But as the culture of midwifery is very against heading issues off with a section, many women are then terrified they don't want to have the vaginal birth as base case

@vivainsomnia

My point was just around cost - c sections are not much more expensive when you bear in mind vagina births that go wrong and look at electives rather than EMCS (which are vaginal births that have gone wrong themselves)

I'm not actually saying we should necessarily increase the section rate on purpose. What we should do is better triage women, because the base case in maternity care is to assume all women who are in good health are in low risk and therefore likely to have a good vaginal birth and then to take them as far as possible down that line without considering if it is the right line to take. This has several consequences:

• midwives do lots of gatekeeping, rather than assessing whether a good birth is likely and how best to proceed

• children get brain damaged from having been pushed too far

• we spend almost 50% of the maternity budget on the damaged babies that could support better care.

The system for a long time asked itself "how can we get VB over c section" which is why we are in this mess. The question is actually, "how can we ensure that women are given optimal medical care to deliver their baby in the healthiest way in their individual circumstances and respecting their choices". The first question gave me a terrible birth ending in EMCS with my first baby. If I had any confidence that the system was trying to answer the second question, I'd have tried a VBAC. There are thousands of us. It really isn't just about staffing.

Absolutely this!
I am astonished the voting is not more YABU to the OPs post.
To me, their point is verging on the ridiculous.
As to breastfeeding or bottle, whatever, but unless there are sound medical reasons to not deliver vaginally, why would you not?

Obviously, but we know that anesthetics are pushed hard. And we also know that the outcome once an epidural has been administered is complications that lead to c-sections.

@thebestinterest Well, many people do have vaginal births with an epidural, I did with my DD. I didn’t have an epidural with DS and another vaginal birth.

This is categorically untrue. And has been for decades. Please can you state what data you are relying on - because the Cochrane reviews say the exact opposite.

I knew I had a slim to none chance of getting an epidural with my second DC at the hospital where I was due to give birth, and it was the main reason I decided against VBAC and had an ELCS instead. If it was men giving birth you can be sure the attitude to pain relief in labour would be radically different. .

Yes there was a study on this, my c-section recovery was fine. It was planned and we were both healthy. The risk of birth injuries put me right off having a vaginal birth. I don’t feel bad about it at all.

Because the 60% increase in planned caesareans at my local hospital hasn't gone hand in had with a 60% increase in anaesthetists, obstetricians, or theatre staff. :-(
Exactly that, but funnily, nobody is commenting on this! The implication of the above is significant and impacts on other surgery.

It's all good looking at claims and focusing on maternity. How about others, like the woman who bled to death because the obstetrician who could have saved her was in the middle of an elective C-section?

Because these are risks associated with increase cesarians. Also the higher reliance on locum consultants, with less experience, expertise, training.

The ramifications are far beyond what is discuss here. Mners are not a super intelligent group of women who know so much better than NHS experts, however highly they perceive themselves. If C-sections were truly safer, no more cost effective, didn't impact on staffing and space and was all around a better way to give birth, of course hospitals would offer them more widely!!

Understaffing is understaffing. No matter which way you look at it, someone is going to lose out.

yes, there are downsides to it, but it does no good to exaggerate them. I don't have time to go back over 10 pages but women are still regurgitating a lot of debunked research about birth.

I think you're right tbh.

For clarity, I had a vaginal birth that was utterly horrendous and required months of recovery and left me with a birth injury that is permanent (rectocele). I have friends who've had c sections and not find it too bad, be up and about within a couple days and felt that it was overblown how horrendous it would be after.

What I do find interesting is that women are often educated on the risks of c sections by medical professionals, yet they're not informed about the risks of a vaginal birth. Similar to how women are educated about the 'risks' of formula feeding (by hyping up the benefits of bf, many of which are outright myths) but they're not told the risks of breastfeeding (exclusive breastfeeding is the number one risk factor for rehospitalisation of newborns).

They educate women depending on which decision they're trying to sway them towards. It's all a gamble at the end of the day as you could have a smooth problem free vaginal birth with a textbook recovery, a horrendously difficult vaginal birth that damages your body for life, a smooth recovery from a c section or a c section that leaves lasting damage. There is no way of giving birth that is risk free.

Bravo, and I say this as a cs mum.

The NHS is not in crisis because women want to make rational choices about their care. Reform of the NHS will involve more respect and co-production with patients as this is a critical ingredient in change.

Your posts are sound rather contemptuous of women, and their ability to participate with their clinicians, in decision making.

@vivainsomnia

Private maternity hospitals do offer elective sections pretty widely! They wouldn't do so if they were massively more dangerous than vaginal birth. They are businesses

@Toptops

Fully agree with you on the staffing. Totally disagree that the system should "focus" on doing everything possible to ensure vaginal birth. All the recent scandals recently are basically about midwives focus on gatekeeping with too little staffing and then life saving interventions being offered far too late.

Vaginal birth should be the default. I don't know many first time mums who didn't think that. The issue is whether you trust that the system will ensure that, if things are going wrong, you'll get the interventions you need. Improve the system for VB, you'll get fewer sections. Scaring people about the consequences of sections is not the way to go - they are a necessary, life saving operation when VB goes wrong or cannot be achieved. Telling people how awful they are is not working, frankly. And it is unfair to scare people.

I had a first attempt at VB with an induction at 42 weeks that went awry and had an EMCS - I honestly believe that with better care earlier on a VB might have been possible, but I felt as if I had a really very lucky escape the first time around, so I had an ELCS second time around during Covid. There are quite a few of us around. I'd love to have had a VB, but I just wasn't willing to put the same people in control of the process a second time.