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.

This nails it.

@izimbra

But are women who are young and who have already had a straightforward vaginal birth actually requesting c sections? I agree that those women will be better off in a MLU or even at home if they are comfortable with this. I think the system supports this - all my friends in our trust who had easy births went to the MLU for the next one. And, aside from one friend who was blue lighted for bleeding afterwards (couldn't be predicted, but straightforward and easy recovery) all stayed there and had good births with no real interventions, just like their first births.

I don't think women who have had one very easy birth are requesting c sections. The system would like them to have vaginal births and generally they do, unless they are unlucky enough to have had a difficult or high risk second pregnancy, or, say, had a prolapse with first birth that they are advised to try to protect with a section.

The difficulty is those who had hard births first time round or who have not given birth yet. This is where the system is really poor IME:

1. If you are over 41 weeks or over 40, you have to be in a hospital in my trust and in my experience there is absolutely no triage if you are considered low risk (which is only about whether you are young and healthy, not how your baby lies unless you are transverse or how big you are or how your labour has progressed so far) - they will push you as far as they can get you down the vaginal birth track very unrelentingly and without much reflection and see how far you get (an obstetrician family friend of mine is of the view that, with more skill and expertise in hospital settings, more vaginal births would be successful - helping baby to turn, fewer tears - AND more emergency section scenarios would be quasi - elective sections, where women are advised that a VB is unlikely a lot earlier and helped to have a section where the risk profile is much closer to an elective section).

1. If you had a difficult birth the first time around and want to discuss your birth options, the system is totally incurious about what might be best for you second time around. I know people who have had midwives and junior doctors who have tried to persuade them for a VB based on dodgy statistics and personal viewpoints, when they have already had advice on, for example, prolapse.

In my case, I had to change my community midwife because she just kept telling me that having one big baby was not a good predictor of having another one - it is! It's literally the biggest predictor aside from GD. Obviously, people do have easy births with big babies, but I had one who got stuck last time around so it was a relevant consideration (I agreed with second midwife that we would have section booked for 40 weeks and I would try for a VB if I went early - reader, I did not go into labour and he was indeed big so a section it was). A junior doctor told me "2/3 women in our trust who choose to try a VBAC get one" - I said "but 1/3 don't, which is also quite high, so in your view, which camp would I be in?" and junior doctor said to me that she hadn't read my notes! I know that not everything can be predicted, but I don't think that the system even really tries to work with statistics - it is a shame, because the NHS looks after almost all U.K. births, so really it should have great data to inform clinical experience. But it isn't willing to countenance the idea that some women might be more likely to have bad births - if it could better understand this and support those women better, some of them might have good VBs, some would have earlier sections and the system would be saved a lot of money in negligence/deprivation of oxygen claims.

Part of the issue is that the birthing population are trending away from the examples where straightforward VB is most likely. The age at first birth is rising, TFR is dropping and more of us are only having 1, meanwhile on a population level our BMIs are climbing. We're much less 26 year old second timer than we used to be. So analysis of individual situations is important. But it's bloody hard, as a woman, to hear that when our society makes it harder all the time to achieve financial security in your 20s.