AIBU to think we shouldn’t worry about an increase in c-sections?

[PancakeCloud]

I came across an instagram post earlier where someone had shared data indicating the UK’s c-section rates have increased significantly in the last five or so years. The commenters almost universally consider this to be ‘tragic’ and think it is ‘so so sad’ that some women are electing to deliver via section. There are also a whole bunch of commenters who think if only women were properly informed they would push for a natural birth even if drs are recommending inductions etc.

I accept the UK’s maternity system is under strain and needs improvement, but really isn’t the point that we have healthy mothers and babies not that women give birth via one method or another.

There are downsides of attempted vaginal births, because of course not all of them go to plan! There is an increased risk of severe birth trauma or hypoxic brain injury to baby vs choosing a c section. For women, tears and pelvic floor injury are very common. While C-sections come with their own risks, these are well known and often presented without acknowledgement that vaginal births have downsides too.

For the NHS I understand planned c sections are cheaper than other births, given so many of them end in emergency sections anyway and because of payouts when things go horribly wrong.

Are we not looking at this all wrong? The goal should be healthy mothers and babies irrespective of how those babies get out. Why are people so fixated on reducing the c section rate?

Not sure what relevance your points have when talking about natural vs c section deliveries, but the stats don’t lie in showing that a spontaneous vaginal delivery so “natural” is “better”.

A spontaneous vaginal birth has the lowest overall risk for healthy pregnancies, both for mum and baby, with the fastest recovery.

Induced birth has increased risk due to cascade of interventions, especially in first time mum’s and the risk baby cannot tolerate the forced contractions.

C Section birth has highest risk of maternal complications due to it being what is actually a major abdominal surgery- infections, bleeding, clots, other injuries, and has the longest recovery.

Obviously there are exceptions, cases where a c section is safest for baby, safest for mum, but in terms of generally the lowest risk and so “best” for mum & baby in a standard healthy pregnancy, natural is best. That’s a fact, it’s not an agree/disagree situation.

Your point about breastfeeding really just shows ignorance on the whole subject. Breastmilk literally changes to meet your specific babies needs, even mid-feed to match your particular babies developmental needs, it provides antibodies and immune protection that no tub of powder can ever replicate because whatever goes into that tub is what is in that tub- it isn’t changing day by day or even mid feed to best support your baby. Feed however you want, but it’s silly to ever think that a formula can replace all of those qualities breastfeeding provides.

There is a proven link between planned c-section and breastfeeding issues. I hope mums are being made aware of that if having a planned c-section.

My sort of concern with this “on balance of factors a woman chooses alongside a medical team” part is that in my experience, and that of to be honest all of the women I know, the risks of c section delivery are not explained as clearly or as fully as everything else to allow you to make a full picture decision.

I was in this position with my first baby, in the middle of an induction and they were talking about moving to a c section, they stressed the risks associated with continuing vaginally but the section was very much provided as a “this is your get out of jail free card”. Nobody explained those risks to me, it was presented to me as the solution and nothing more. I had done my own research beforehand and was consultant led through pregnancy so I’d had a conversation about it all with my consultant at 36 week appt and knew the risks myself, so opted to continue trying and did have have vaginally with some intervention but has I been sat in that room and making a decision purely off of the information those professionals were giving me, I’d have taken the section because it genuinely was presented as the perfect solution. That isn’t an informed decision.

This & there is also research ongoing showing a link between c section deliveries and increase risk of allergies.

If your baby is bum first (not foot first), then you're choosing to have a section over a breech vaginal birth. The last breech study found no difference in outcomes between people having an elective section and breech vaginal birth (of a bum presenting baby). Therefore, it isn't clinically indicated that a caesarean is safer. There are risks to both options and mum should choose what risks she wants to assume. That makes the choice for a caesarean elective.

There's a group on Facebook ran by a specialist midwife (Shawn someone) for breech presentation. I had a successful ECV in one of my pregnancies so followed since then. Some people do have vaginal births with breech babies with other presentations than bum first.

I had an elective after 3 naturals delivery’s because each delivery went horribly wrong and I ended up in surgery each time. My 3rd baby we nearly lost because of it.

I was given an option between elective or induction. But an induction wouldn’t have prevented the complication. Just meant I’d be in the hospital already as I labour extremely quickly.

I chose an elective because it was the safest option. Though personally I also found my elective the easiest recovery out of all of my deliveries.

When you say a spontaneous vaginal birth has the lowest overall risk, risk of what? It doesn’t have a lower risk of prolapse for example.

Given different people have different risk appetites and different concerns, I’m not sure how you can possibly conclude it is an established fact that a spontaneous vaginal birth is the lowest risk.

This thread isn’t about breastfeeding but my understanding is that the relationship between sections and breastfeeding rates are not well established. Obviously if there is an association pregnant people should be made aware.

https://www.tommys.org/pregnancy-information/giving-birth/caesarean-section/c-section-benefits-and-risks

They measure lots of things in terms of adverse outcomes. Excessive blood loss, admission to ICU, low APGAR at 5 mins plus others.

Those j listed are lower with a SVD over EMCS and some are lower compared to.ELCS

Low breastfeeding uptake is considered a poor outcome due to the health benefits to BF and the health risks to FF. So if birth mode or intervention really obstructs BF, then it is counted as a poor outcome

I didn’t conclude that myself, the research and stats do.

Spontaneous vaginal deliveries have the lowest OVERALL maternal risk compared to induced deliveries, deliveries with intervention, or c section deliveries. Lowest risk of major surgery & surgical complications, lowest risk of significant blood loss, lowest risk of infection, lowest risk of blood clots, lowest risk of complications in future pregnancies… all of this is out there, it’s not just my opinion.

Of course there are exceptions where a section is safest, but when we are talking a typical healthy pregnancy, a spontaneous natural delivery carries the lowest overall maternal risk.

The problem is that we don’t actually know that spontaneous vaginal birth is best for low risk pregnancies because of the way statistics are gathered. We can say that spontaneous vaginal birth has fewer adverse outcomes than elective sections, but those elective sections may not all be low risk pregnancies. In fact a significant number may be elective because of issues with baby or mum that increase risk.

The data we have that compares planned vaginal births with purely maternal request c-sections, a statistic not usually recorded, shows fewer adverse outcomes for mothers and babies in the c-section group. I posted the study further up.

So I’m not sure it’s fair to say that vaginal birth is the safest option compared to a maternal request section as that may actually not be the case. Unfortunately no one really cares about women’s health enough to record the statistics properly so women are being told half-truths and making decisions on incomplete data. Which sucks.

Where oh where did she say that we should take medicine back to the 1800s?? No fucking where, that’s where. Yes for gods sake of course you want intervention in those situations! But more intervention is not always better, and many women are not really informed of the c section risk nor of the benefits of natural birth. Which unlike c sections for most women gets easier and safer with later dc. Women are just not informed enough of our natural bodily functions. I was so sad to hear some young women at the hospital behind me once talking about how disgusting breastfeeding was and who would do it, they clearly didn’t grow up seeing babies fed that way like normal life. And I do know a woman who elected a c section because pushing a baby out your vagina is just ewww. She was comfortable saying it and gave the impression her friendship group felt the same. Life is full of ewww and choosing the hygienic path that you feel is neater is not really the right way to live it, it’s not choosing better health or better outcomes, it’s trying to minimise any discomfort without realising you can’t actually make that choice, only the first easy step in it, after that everything has consequences.

3 natural births and they were all fine. Good midwives are essential and education of mums to be.
I had the most amazing midwife led unit with my second and third. They invited me to the unit two or three times before birth. Had excellent informative talks about how labour progresses, coping with pain, breathing etc and what would happen if things didn't go to plan.
I had super active labour, moving about, in waterpool, squatting etc and gave birth standing with two midwives holding me and dh supporting feom behind

We need more education for women in birthing!

Also who cares how baby comes out. As long as its safe and well. Iv teens and no one asked me how they were born

Here is the actual study, based off a hospital
in Ontario which unusually did record maternal request sections separately.

https://www.cmaj.ca/content/193/18/E634

The takeaway was: ‘Planned CDMR is associated with a decreased risk of short-term adverse outcomes compared with planned vaginal delivery. Investigation into the long-term implications of CDMR is warranted.’

It’s an interesting study and I looked at it when deciding what to do about my own birth but it has a lot of issues.

One of the biggest being that it compares 1827 CDMR to over 400,000 planned vaginal deliveries, so it’s not a true comparison, and it also doesn’t look at long term outcomes beyond the labour itself so doesn’t factor in infections, post birth complications, complications in future pregnancies, even those involved acknowledged both of these things. It also doesn’t weigh all complications correctly, the way it measured adverse outcomes vs severity outcomes means that while vaginal may have more in numbers things like minor tears, infections so their number looks higher, CDMR has more severe outcomes so higher blood transfusions, it’s not an easy thing to compare.

The problem with this study is that they included women who ended up with emergency caesareans in the vaginal birth group because of their intention to have a vaginal birth.

This is further confounded by the demographics of the planned section group:

Factors associated with CDMR included late maternal age, higher education, conception via in vitro fertilization, anxiety, nulliparity, being White, delivery at a hospital providing higher levels of maternal care and obstetrician-based antenatal care. Women who planned CDMR had a lower risk of adverse outcomes than women who planned vaginal delivery (adjusted relative risk 0.42, 95% confidence interval [CI] 0.33 to 0.53).

These factors I've bolded are particularly associated with better health outcomes overall. So we can't say whether the real reason the planned section group "did better" is because they didn't have the risk factors associated with poor outcomes to begin with. They always more likely to have responsive clinical care than their less-white and less-educated counterparts.

Also, note this: However, the severity of maternal outcomes was greater for planned CDMR than planned vaginal deliveries (MD 20.1, 95% CI 10.6 to 29.7).

I think it's sort of silly to compare the perineal tears of someone who has laboured vs someone who has not. I mean, of course, there will be more 4th degree tears when the baby is trying to come out of your vagina compared to being taken out of your abdomen. I'd be really worried if I went for an elective section, wasn't in labour, and ended up with a massive perineal tear!

But this shows that while you are less likely to have a perineal tear if you plan a section, the chances of needing a life saving hysterectomy are increased just because someone is cutting your uterus open and that becomes a risk of such a surgery.

I think what it tells you is that if you are white, middle classed and 40ish, you have a lower chance of adverse outcomes if you plan a caesarean with your first baby.

The people I know with the most positive experiences of birth are those who had very uncomplicated vaginal deliveries, and those who opted for elective sections early on and didn’t even consider labouring.

If I had known what my births would be like, I would have opted for c sections. I’m currently saving to have private perineal repair surgery as I still have issues with pain and discomfort 10+ years after a poorly repaired tear following a shoulder dystocia. I also think my first traumatic vaginal birth was a big factor in failing to establish breastfeeding and awful PND I suffered. Also fucking ruined my sex life.

But that’s sort of the whole point: planned vaginal births can and do end up in emergency sections with all the issues that those come with. That is one of the potential adverse outcomes of a planned vaginal birth, same with use of instruments. So it has to be part of the comparison. It’s the only way to compare. You can’t in hindsight only take smooth vaginal births because that can’t be predicted, the point of comparison has to be planned vaginal v planned maternal request.

If men had to go through pregnancy one of two things would happen:

1. the human race would become extinct

2. we would have the most comprehensive, fit for purpose and empathetic maternity system ever.

Number 1 is more likely in my opinion.

The issue too is that MR sections are still very uncommon v planned vaginal births, so you run into issues with scale, even if adjusting, because your c section group is so small. That’s why it’s a shame the data isn’t captured on a grander scale so the outcomes can be further investigated. I’d be interested to see any follow-up they do because I think it’s potentially very important. It’s frustrating to think women aren’t being afforded the opportunity to have accurate information.

The statistics on sections versus vaginal birth are incredibly misleading. They usually include emergency sections within that data which means that both mum and baby are with risk to begin with and more likely to have adverse consequences. Even where they separate out planned and emergency sections, because a lot of plant sections are for reasons relating to health of mother or baby again they are difficult to compare. From recollection, the limited studies that look at vaginal births versus planned sections where there are no health concerns, shows the lowest risk to be section not vaginal birth. I don't have the data on that, but I think it was a referred to up thread somewhere.

As to your comments on breastfeeding, either that shows a lack of imagination for what the future may hold for science, or that you approaching this with a religious like belief rather than looking at science. I breastfed one of my children for nearly three years, so I'm certainly not anti breastfeeding, and I think it's great when it works. But I don't know what science has in store for the future. Go back a few generations ago the idea that computers could do half the tasks they now can would be unthinkable. Computers and robots can now perform surgeries that human hands are just not precise enough for.

What is a specifically about breast milk that you think is different from everything else in the universe in that we don't know what impact science will have on it? Breast milk is great but it's not golden elixir of perfection which would be inconceivable to improve upon.

Anecdotally, I was a planned vaginal birth with my first that turned into emergency section after DD1’s heart nearly stopped during labour.

DD2 was a maternal request section. I could have gone for a VBAC but after the experience with DD1 and a close friend who in the intervening period had a traumatic vaginal birth and a baby who ended up with cerebral palsy as a result, I went for an elective, which was lovely and smooth.

My consultant was actually very balanced on the issue. I was prepared for a fight on it but she said ‘I have to give you this list of risks. I could also give you a list the same size of risks of a vaginal birth. This is your choice’. And that was very refreshing.

Ideally I would have had two smooth vaginal births but unfortunately we can’t predict that and the odds of needing either a section or an instrumental delivery for your first birth are very high.

The thing that makes this more murky is why people end up with unplanned caesareans such as whether they were all warranted. Remember the planned vaginal group were people who intended vaginal births but were overall higher risk. There would have been women who planned a vaginal birth but where found to have some serious issue +/- a compromised baby that indicated a emergency caesarean before they were in labour.

It would have also included women who were told they had to be induced for reasons that aren't clinically indicated and consequently ended up with an emergency caesareans when it didnt work out.

Also, going back to the initial point, these women didn't all go into spontaneous labour and/or have a spontaneous vaginal birth (as in no assistance by ventouse/forceps).

Do you understand how evolution works? It means that those with a particular trait survive while others die, so their genes are not passed on.

You are advocating for babies whose mothers cannot deliver them vaginally to die rather than being saved by C-section.

I don’t think this thread is really in any way about views on medical advances that are at least a generation away, if they happen then that’s great and we can all adjust. But right now, nobody understands how breastmilk interacts with a baby, it’s basically magic. And with research into women related things the way it is, nobody probably will a generation from now either. But many things are more complicated and advance stupendously. Let’s say the research generates results as fast as diabetes. 60 years ago it was pig insulin, life saving but hard to balance, generated sharp highs and lows as not a perfect match to humans. Then it was synthesised insulin- game changer, much easier to produce and better to use. But the smoothing of sugar levels did mean people could slip onto hypos with less warning signs. Now it’s moving to electronically monitored and auto delivered although that’s not available to everyone and people’s ability ti manage the condition seems very variable, some never get very stable . But men get diabetes so let’s not assume the same speed.