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.

You are fascinatingly contemptuous of the opinions of women - what's that about for you?

You are in all likelihood arguing with research scientists, economists and ethicists amongst others on this thread, as well as the lived experience of people who have given birth. People who from multiple standpoints have expertise and insights that form as legitimate a part in debate about access to different sorts of obstetric care as you and your friends?

Does it control for place of birth?

Because low risk women who choose midwife led settings (ie birth centre or home birth) for birth have MUCH better maternal outcomes than similar women who choose obstetric settings for birth. Lower rates of admission to HDU, lower rates of OASI, lower rates of blood transfusion, lower rates of infection, lower rates of unplanned caesarean, lower rates of assisted birth.

Because if a study just controls for risk status, and the cohort in the planned vaginal birth arm of the trial are all, or predominantly giving birth in settings where all the things I've mentioned above are much higher than in midwife led settings, then it's not going to be a fair reflection on the intrinsic risks and benefits of trying for a vaginal birth.

Just by way of example - for low risk women having their second baby, in the evidence used by NICE to advise on place of birth, unplanned caesarean is 5 times less common for low risk women who opt for a home birth, compared to similar women who choose an obstetric setting for birth. Instrumental birth 4 times less likely for home birthing multiparous women. Episiotomy 4 times less likely.

Models of maternity care delivery have such a profound impact on the outcomes of planned vaginal birth. Same can't be said for planned caesarean.

BTW - quite ready to acknowledge that planned caesarean is lower risk for both women and infants if the alternative is a highly medically managed labour on an understaffed hospital ward where rocketing numbers of women are currently ending up in theatre anyway.

How would they know what those situations are before they arise?

You are in all likelihood arguing with research scientists, economists and ethicists amongst others on this thread, as well as the lived experience of people who have given birth. People who from multiple standpoints have expertise and insights that form as legitimate a part in debate about access to different sorts of obstetric care as you and your friends?
Haha, that did make me smile. But no, that's not me at all. In real life, I don't need to argue.

If people here are genuine scientists and economists claiming that offering medically unnecessary cesareans and yet don't understand the basics of cost effectiveness or that the NHS is suffering from the worse human resources crisis, then we are indeed in serious trouble. Thankfully, I'm confident it's not the case

Happy to prove you wrong.😁

So far you have said, 1) women are entitled, 2) we should ignore NICE and considerations of care quality and evidence-based effective clinical practice in favour of legal minimums, and 3) you are the sole arbiter of who else is a professional on this thread.

@vivainsomniaThis is hilarious! We'd beat all call our governing bodies and tell them we need to be struck off because someone on mumsnet thinks we're not real professionals 😂

Thanks for the laugh!

I disagree everyone should be entitled to a c-section actually. They come at significant cost to the NHS and as with all treatments the NHS has to decide what it will and won't fund, even if it means some individuals have poorer outcomes. I don't agree with it being a postcode lottery but neither do I think you should just be able to decide on a riskier, more expensive procedure because that suits you.

......compared to similar women who choose an obstetric setting for birth.

I highlight this because where the home birth or birth centre services or never are suspended or never existed in the first place, there often is no choice.

Sorry I garbled that.
I highlight this because where the home birth or birth centre services or never are suspended or never existed in the first place, there often is no choice.

Over the past few years many hospital trusts have repeatedly suspended/closed their home birth service & birth centres in response to staffing issues.

It's frustrating that the answer to 'women are being traumatised by labours that are ending in unplanned trips to theatre' always seem to be 'so it's obvious more women should be having planned caesareans' rather than to ask why there's been such a big and rapid fall in the number of women having straightforward births. Also frustrating that people are either unaware or not interested about the impact different models of care can have on the likelihood of a straightforward birth.

👏 Excellent post!

"Women with brain damaged babies from poorly managed births after being refused ELCS don't care about cancer patients. They care they tried to do what was safest for their baby and was denied because apparently there's nothing wrong with a vaginal birth"

Anyone who's in a position to refuse a request for an elective also knows that any birth can leave a woman or a baby with serious, lifelong damage. Not one obstetrician or midwife would agree with the statement 'all vaginal births are uncomplicated and safe'.

Actually thinking about it, if c sections weren't a thing both me and my son would have died. Was reading a book earlier that's set in the 17th century and felt very grateful for modern medicine.

And yes it was elective. But amazingly it was the right choice, because if I'd gone into labour with my little boy he'd have got stuck and I'd have needed an emergency c section anyway, might have been given a general anesthetic instead of a spinal block and it would have been incredibly stressful for us both. Instead I got a nice calm experience and a fairly easy recovery, unlike the poor woman in the same room as me who needed two blood transfusions after giving birth to her little boy. I know some women struggle with recovery after a c section, but I was up and about just over a week afterwards.

I hope you don't mind me asking - how do you know he would have got stuck?

@izimbra

I think it's actually pretty clear some of the situations that could have been headed off before they arose. I mean, the ockenden report outlines lots of them, as do recently maternity scandals.

But, in my experience, and as I have said below, the system really doesn't do very well at triaging women and moving between tracks when the facts change. So, if you are a low risk second birth, the birth centre might very well be best for you - super, that is what the evidence supports. The contrary position, where births are likely to be difficult and need extra support to birth well (baby position, larger baby, induction, not making progress), is not very well triaged in my view and it is very difficult to get more senior supervision or attention when things are not going that well, you'll just be egged on to keep going. In my case, I had a junior midwife who had no idea whether the fluid that had come out of my vagina was the induction pessary or my waters and couldn't tell me how baby was positioned (back to back - she really wasn't sure) and a midwife who ignored my pleas that something was not quite right and I needed to see a consultant because she assumed I was in transition and inventing reasons I couldn't do it was normal . When I spoke to midwives about my second birth, they seemed to be of the view that it was entirely random what I could expect - well yes, you can never totally know, but just as you can predict that a birth centre will suit a mum who has had an uncomplicated first birth, or that someone who births really fast might need a home birth, there seems to me to be way more that can be done for those women who are healthy but not easy cases.

(By the way, I wasn't even remotely in transition, wasn't a close run thing, baby had not moved down properly with contractions at all and was wedged in my pelvis, which consultant was able to tell me from an examination, but midwife could not)

So far you have said, 1) women are entitled, 2) we should ignore NICE and considerations of care quality and evidence-based effective clinical practice in favour of legal minimums, and 3) you are the sole arbiter of who else is a professional on this thread
Some women are entitled here. I deed, when you demand unnecessary healthcare, it's being entitled. For every other such wishes, people accept to access private healthcare.

I didn't ignore NICE guidance at all. I bother to read ALL of the guidance, which clearly isn't the case for some posters here. Not one commented on the fact that NICE acknowledges that more research needs doing about the added cost of incontinence and the rest because the research quoted was undertaken in the USA. Of course not, because that doesn't go in favour of their argument. I didn't make it up. NICE guidance states it clearly!

I certainly not the sole arbiter, other posters have also provided correct information. Sadly, whatever the profession of some, they do lack knowledge of the subject. If you can't even acknowledge the fact that hospitals have limited access to surgical rooms and that anaesthetists don't grow on tree, it's clear that ones' understanding of how hospitals are managed is very limited, scientist or not.

Maternity wards across England are struggling massively. Too many midwives left the profession, for different reasons but mainly an older age group not replaced by younger trained nurses. This left a serious gap and the work environment for midwives has grown more and more pressured, prompting yet more midwives to leave the profession. Add the same problem with HCAs and consultants, therefore less time to dedicate to training and it's a vicious circle.

People need to accept that NHS is in crisis, and that means a more limited service. That's not just in the UK, health services in most developed countries experience similar struggles. We need to help and support the NHS by doing our part, and that's accepting that as it stands, we can't get a stellar service as we get going private.

Absolutely agree.

I only have two regrets in my life.

One is that I didn't insist on a c section.

This is incorrect.

NICE guidance states that maternal choice is a sufficient reason alone to have a c section. On the NHS.

It makes people sound quite dim doesn't it!

Clearly they've never looked at maternal mortality rates in countries without medical assistance during birth. But sure, vaginal birth is manageable and safe for everyone.

So you are ok with "some individuals having poorer outcomes" or translated in reality may suffer from lifelong injuries, child loss or PTSD so NHS can save money?

Are you for real?

I do pay for NHS and do expect the best procedure being available to me, same way a man would not agree to have money saving option if there is clear more benefitial option.

I found the midwives were hellbent on making me birth in the midwife-led unit. No discussion possible. It was all "it's a normal pregnancy, you will have your baby in the MLU. Isn't that great?!"

Whereas what I wanted were facts about the % of my age group and medical conditions needing an instrumental delivery or tearing badly or ending up with EMCS.

Their priority was birth in the MLU. My priority was healthy baby, avoiding instrumental delivery because of the damage it can cause and bad tears. The only way to guarantee not having an instrumental delivery is an ELCS. But I had no idea I could ask for one.