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.

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.

As much as I advocated for HB for myself, these statistics are made on a bad sample.
Simply because women being supported to have HB in first place have low risk pregnancy and are healthy.
If there are any concern, woman will be encouraged to have hospital birth.

So for the real comparison you would need to compare women with same risk,weight, age and other factors.

As much as I advocated for HB for myself, these statistics are made on a bad sample.

If the NICE guidelines are based on the Place of Birth study of 2011, I don't think that is the case. It's some years since I read it, but I believe they were comparing like with like with quite large samples - they were comparing two large cohorts of low risk women. Hence they could show some home births ended in Caesareans - and they weren't being done on the kitchen table as in the 1920s. They didn't dump them out of the sample as soon as a transfer happened.

On the contrary, accepting the status quo is to condemn women permanently to unsafe and inhumane treatment. We need to shout from the rooftops about the unacceptability of the status quo; women and children are dying and sustaining trauma avoidably. These are political choices rather than inevitabilities.

These are political choices rather than inevitabilities.

They are indeed. There was a statistic somewhere upthread which I can't now find, which said that in some hospitals CS rates had doubled from 25% to 50% from 2011.That is not evolution, or suddenly a half generation of women becoming massively more unhealthy, older or fatter. That will largely be a political choice of austerity running down the NHS.

I may have got the figures slightly wrong - I'd have to trawl back pages and pages to find the figure.

Nor is it just maternity care - plenty of people waiting for e.g. hip replacements in the end have to find the money to go private because they feel they can't wait any longer.

NICE guidance states that maternal choice is a sufficient reason alone to have a c section. On the NHS
Indeed, but that's only after everything has been discussed. So it is correct that midwives should provide information. Of course, if you go in already fixed on having a C-section, it might feel like trying to convince you otherwise, but they ARE following NICE guidance.

Again, let's remember that these are only guidance. It doesn't mean hospitals have to apply them. No hospital will be able to provide services that meet all NICE guidances in the current climate, so shouting 'well NICE says that...is pointless' unless as stated already, the guidance is a TAG.

On the contrary, accepting the status quo is to condemn women permanently to unsafe and inhumane treatment
And here we go again...me, me me and my demands because I'm a woman....those are the posts that irk me.

Unsafe and inhumane is so not appropriate in the instance of giving birth vaginally in the UK. That is catastrophic.

So many more urgent areas of medicine that need prioritising way before methods of giving birth!

Yeah logic would say men should have a choice with their births of children also

Oh wait men can't have babies so why on earth are men to blame for this as well?

Our bodies are designed to give birth sure sections need to happen but no I don't see why on tap, but we have to find a way to blame men for everything as us women can't cope with doing things for ourselves

We could just try to give birth ourselves and hope, but having a midwife on hand to help massively reduces the risk of complications.

But there are just not enough midwives to give 121 care these days, increasing the risk. Why not have a CS when you know your baby is much more likely to be born without harm, then risk the horrendous butchery and baby in resus situation that I had with forceps due to the midwife leaving it much too late for an EMCS. Why risk it?

But there are just not enough midwives to give 121 care these days, increasing the risk. Why not have a CS when you know your baby is much more likely to be born without harm, then risk the horrendous butchery and baby in resus situation that I had with forceps due to the midwife leaving it much too late for an EMCS. Why risk it
Because there are the level staff required for a C section if increasing significantly.

An anaesthetic error is no better in terms of outcome than a midwife one.

What we need is training more midwives and make their working conditions pleasant so that they don't leave in masses.

If we haven't got enough midwives, have we got enough surgeons, anaesthetists, and back up staff needed in theatres either?

One of the latest maternity scandals, I don't remember which, highlighted that there weren't enough senior obstetric staff on duty to cover emergencies and cover was being provided by very junior medical staff.

Reading some of the posts, you would never realise that some women do have straightforward births that don't leave them physically and mentally scarred.

@vivainsomnia

But doesn't the fact that there is no data on the additional costs of incontinent make your point neutral at best. It's not a reason to deny c sections on costs, just as it isn't a reason to grant them. It's an admission that we don't know what c sections actually cost. The NHS needs to do its job and gather evidence. It has a huge advantage over other healthcare systems in treating almost the whole maternal population. It has been around for decades. If we had better record keeping and use of data, we would have a much better evidence base for maternity care overall.

@lemonstolemonade, absolutely, 100%! I am not saying that cesarians should never be offered. If it can indeed be demonstrated that over 10, years say, the costs are lower than vaginal births, that they are overall safer for mums and babies, and providing the staff and room required doesn't negatively impact on the other services, than bring it on!

Unfortunately, identifying the cost of incontinence support and everything else is going to be very difficult because these services are not usually priced by the number of patients or visits, which is probably why it hasn't been done yet in the UK.

My angst is with people who demand things, claim their rights (incorrectly) and cite supposed evidence that isn't scientific evidence.

Ultimately women and babies are suffering unnecessarily in the current situation. Out of my 10 NCT couples in early 2022, not a single one of us had a "good" natural birth. In fact, only 1 woman ended up having a "natural", i.e. no c-section or forceps (still had epidural) and even she had a terrible experience. 9 of us had always been open to natural birth and did a hypnobirthing course etc. (and fair play to the mother of twins who wanted a planned c-section!).

Of the 4 couples who have gone on to have a second child, all opted for planned c-section as they did not feel able to go through the same traumatic experience again. Our local birth centre has been shut since Covid due to staff shortages and we are a 45 minute drive from our nearest hospital so too far for safe home birth really. Therefore the labour ward is the only option.

The current situation is dangerous and has long term costs and health consequences for a very large proportion of the population. We need huge investment in midwives, training and pain management so that more women can safely deliver vag1nally, without the very real risk of long term health implications. Only then can I see the requests for ELCS coming back down (which I do agree would be a positive change in an ideal world).

What defines a 'traumatic' Vs 'good birth'?

I wouldn't say mine were either. They were unpleasant, painful, made feel out of control, a bit frightening at time. I was sick, had to push for over 1:30 with my first, 1 hour for my second. Then I lost quite a bit of blood, borderline needing a transfusion and I had to be stitched by an obstetrician due to the 'damage'.

I wouldn't call this traumatic though. It's part of the process of giving birth and I moved on after a few months.

@vivainsomnia

I wouldn't say that mine were either necessarily. I've given a long description of some of the things that happened to me, but I wouldn't say that I feel huge trauma about it. I had 48 hours with back to back baby (induced), no pain relief, then EMCS.

I think trauma generally comes from:

• not being listened to or treated as a person
• believing you or baby would die
• long term physical damage

Sadly, I do know a couple of people who are within the third category and who are long term incontinent or have little to no feeling during sex. I think that is a traumatic thing to happen to you in your thirties and hard to prepare for as the "cost" of having a baby. I'd say that my friend, who was repeatedly told she wasn't in advanced labour, was left in a corridor on her own to labour, nearly gave birth on her own and suffered a tear to her anus that meant she was uncomfortable for a year and had continence issues for a few months could probably say it was traumatic.

I think that the conveyor belt nature of an induction and being basically on my own did make me feel a bit like point 1), but mostly I felt like I had a lucky escape and hugely relieved that it wasn't worse.

I don't feel traumatised, but I do think that there were lots of moments in which my care could have become quite unsafe and I think that, had I been under consultant care (was borderline due to past medical history but decided I was low risk overall), there would have been a person actually thinking about my care overall and better decisions would have been made about me as an individual. I actually think I would have had a VB - a family friend who is a senior obstetrician told me that he would have encouraged my baby to turn before he induced if he had seen me either in the NHS or privately, but that most midwives wouldn't attempt it. But after 2 days, I was taken down to the operating theatre to decide if I was having forceps or a c section the consultant said baby was so poorly positioned she would never make it down the birth canal. I think that there is just a bunch of very skilled midwives that used to exist and now the system is really short of them, so the system is very passive and feels very unresponsive to new information.

Ultimately, my decision to have a c section second time wasn't about trauma. The system spent a lot of money on me first time around, far far more than if I had an ELCS from the outset. As I had a large back to back baby last time, my birth plan was that if I went into labour before 40 weeks I would give it a full go for a VBAC but otherwise I would have a section before 41 weeks, as the likelihood of a VB/avoiding an EMCS were less after that point, as baby would be large (and he was, over 9lb at 40 weeks and I have a very small frame).

The thing that irritated me about the system was the failure to look at data properly. One community midwife could not accept as a starting premise that having one big baby was a good predictor of having another one. There are so many studies on it - other than having GD, it is the single biggest predictor. Science is not very well applied in midwifery IME.

You say hospitals don't have to follow NICE guidelines. You're right, but there should be strong reasons for not doing so. It can lead to legal consequences if they force a woman into a vaginal birth and she and/or her baby suffers severe complications as a result.

You might find this report by the medical negligence team at Tees Law interesting: https://www.teeslaw.com/insights/maternal-request-caesarean-section-report/

I had a maternal request c-section last year. In light of the NICE guidelines and the Ockenden review, the hospital now openly states that it supports all birth choices, "including requesting a caesarean when there is not a medical need." So I did a lot of research and thinking, discussed this with a consultant midwife and consultant obstetrician, and the c-section was booked in with virtually no pushback from either of them. I didn't "demand" anything, just showed I was informed.

He had a big head. When we were in recovery afterwards DS was found to have low oxygen and a couple of doctors were looking after him. (He was on one of those cots that blew oxygen over him.) One of them put her hand on his head and showed me what 10cm dilatation was and there was no way he would have got through.

@SapphireSeptember A episiotomy might have helped, but obviously a C-section was also effective. Keeping your baby safe is what’s most important and I’m so glad all was well in the end.

My DD was 9lb 10oz and also got stuck. I did have an episiotomy and she popped out. I was lucky though, my waters broke at home and she arrived six hours later so it wasn’t a long labour. I can’t fathom hospitals that allow women to labour for 24-plus hours.

@BruFord To be honest, I'm kind of glad I didn't go into labour with him, he was 11lbs when he was born. An episiotomy doesn't sound great either!

No, I actually enjoyed my c section experience. The surgeons, anesthetist, and the nurse who was looking after me were all lovely. The midwife annoyed me, but she was nice too. It was calm and controlled. Afterwards wasn't great as I started feeling really itchy and was sick after my tea and toast. Yes it's a longer recovery, and we were in hospital nearly a week, (baby was a bit poorly and I was trying to establish breastfeeding but that failed, so I was discharged after saying I was going to bottle feed him.) I stayed with my friend for a week after that and she made sure I was up and about and walking.

I struggle to understand why anyone would want major surgery that was not medically necessary. I also worry that elective c-sections may clutter up theatres that are needed for non-elective c-sections. The NHS does not have limitless funds afaik, and is not an elective service, either.

I struggle to understand why anyone would want major surgery that was not medically necessary.

because they don't wish to have the trauma of being induced, which in some cases can be barbaric imo

In the past, it was usual for mothers and babies to remain in hospital for 7 to 10 days. It was relaxed, the baby was cared for and most complications were picked up. I stayed in hospital for 10 days with my DS and 7 days with my DD, most of the time in the GP-run cottage hospital (though I had to deliver in the high-tech city hospital as I was 'at risk' - two miscarriages and, I think but no-one told me, I had pre-eclampsia, certainly I remember little of my DS's birth except lots of people dashing about and the sense I was rushing head-first down a tunnel). DD had jaundice, yellow face and blue feet - circulation problem which was resolved by the time we went home.

With respect - cervical tissue stretches and 10 cm cervical dilation is a guesstimate - all women built differently!. Not implying that c/s wasn't the best or safest option for you and your baby - just challenging the idea that babies with a head that's more than 10cm across can't be born vaginally!

For me, I was an older first-time mother with some family and medical history which meant I had a good chance of facing complications. I found the risk profile of a planned c-section more tolerable than that of an attempted vaginal birth, particularly given the CQC had rated the maternity unit I was under as "Inadequate" halfway through my pregnancy. I have absolutely no regrets about my choice.

The hospital had separate theatres for emergency and elective c-sections. I was told that if they needed the elective theatre for an emergency when I was due to go in, then my surgery would be postponed till they had capacity again. But they said this rarely happens.

Also, most elective c-sections are medically necessary. "Elective" just means planned in advance.

The elective caesarean rate in my local hospital has gone up by 60% in 5 years.

I'm pretty sure this isn't a reflection of an increase in clinical need.

I appreciate that average BMI is lower in Nordic countries, and that there's better public health, but it's hard to believe this is the only explanation for places like Norway and Finland having a caesarean rate that's significantly under 20%, when ours is now nudging 40% or 50% in some hospitals. (fwiw, their average age of first birth is only slightly younger than the UK). It must have something to do with the way maternity care is delivered. They also have better maternal and infant birth outcomes than the UK.