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?

It is much more likely than either one of those that abortion would be accessible, cheap and safe.

And how does the healthcare work? Are the people going for planned c section the ones who are comfortable paying for it?

Yes and the point is on initial birth if everything goes as it should a c section is more expensive - but as we know there unfortunately can be 'costly' complications for both types of birth which are not factored into this figure.

Damage and repair following vaginal birth is absolutely to be considered but doesn't show in the initial cost for the birth.

In the same way that surgery complications are not shown either.

Why should we? For a start, it's cheaper than a vaginal birth once you take into account the cost of birth injuries. Should you be making those wanting vaginal births to pay because it's more expensive?

pregnant WOMEN.

Only women can get pregnant.

And I think in that case planned maternal request comes out on top?

the point of comparison has to be planned vaginal v planned maternal request.

Or planned caesarean birth vs spontaneous vaginal delivery.

Completely agree it’s not an easy thing to compare. Given that, I find it bizarre you state it’s an established fact that vaginal birth is best. You have a higher risk of surgical complications with a c section (obviously) but a lower risk of perineal tears. And while the absolute risk of surgical complications with a section is low, the absolute risk of perineal tears is pretty high.

I don’t think c section necessarily better, I just think it different women may make different choices based on the information available (even if they might be considered ‘low risk’).

I had three positive natural births, strange you didn't/don't know anyone at all that had one.

Again, read the research yourself. A spontaneous vaginal delivery does have the lowest overall maternal health risk.

Comparing the risks as you’re trying to do doesn’t make sense either. A perineal tear obviously isn’t nice, but isn’t a huge issue, surgical complications can really be huge issues. It’s a bit like saying I’m very likely to get a grazed knee doing X, I’m less likely to get an amputated leg doing Y… I’ll take X, every time. Okay I’m not going to get a perineal tear having a section, but I’d be taking a bigger risk, I’ll take the tear!

Thanks I’ve looked at the research and didn’t find it clear cut at all. In particular, when making birth choices I was really struck by the studies which indicated ELCS has better neonatal outcomes (because that was to me the most important outcome of my births.)

I appreciate your analogy re maternal risks but I still think it would be reasonable for a woman to take a very very low % chance at a serious risk of ELCS than a higher chance of a smaller risk of vaginal birth. I think women can use their own critical faculties to determine which risks they wish to take, rather than just being told one approach is superior to another.

I don’t know what the best way to compare is. A woman can’t really make a choice between vaginal birth and ELCS (unless she’s freebirthing). Really it’s a choice between attempted vaginal birth and ELCS, and comparing these two things can give a very different picture.

I’d actually be interested in those studies because as I said I was consultant led in both pregnancies so this very much was a chat I had many times and in great depth, the NICE guidance is actually or at least 7 months ago when I had my second the opposite- for low risk, single, full term pregnancies the overall was that vaginal deliveries had better overall neonatal outcomes.

I think it’s very much an “every action has an equal opposite reaction” phenomenon. The push for natural child birth that was so prevalent in midwifery until 2020 was followed so doggedly that women and babies died for the sake of trusts’ statistics, has been followed by a boom in c-sections as professionals fear litigation and women fear becoming one of the stories from the inquiries.

That's because they're basing it on the data for planned and emergency sections being lumped together.

A stitched up first or second degree perineal tear might not be a big deal, but a third or fourth degree can leave women with life altering damage and in need of further surgeries. I would not compare anal leakage leaving postpartum women insecure about leaving their home to a grazed knee.

It's also pretty subjective. The possibility of a first or second degree tear would have been enough to prevent me from having kids, if section wasn't an option. To me, it sounds horrific and barbaric. To others it's an expected bit of childbirth and no big deal.

Fair enough, but my point was really the objection to comparing a perineal tear to a grazed knee. A grazed knee heals in a week without much intervention beyond clean water.

I’ve had a vaginal birth that was so traumatic that I ended up suicidal with PTSD. I’ve also had an elective C-section that was an incredibly positive experience, with a far quicker physical recovery than my traumatic vaginal birth. And I’ve also had a vaginal birth that was amazing, with a similarly quick recovery.

You cannot guarantee any particular experience or outcome with birth. However, forcing women to experience it when they don’t want to, for whatever reason, is wrong.

There is no other situation involving that level of physical risk and pain where people are manipulated into doing it by medical professionals and society in general.

So don't have it if it's not what you want. It's not complusary you know

There's so much support for women if they want a CS but sod all for those who dont

Has it been so pushed up to 2020? I had DS in 2003 and the hospital had 1 in 3 cs then. I made sure I wasn't booked into that place and went to a MLU in maldon a good few miles away

“To posh to push” used to be associated with celebrities and the rich.
Given the choice I’d rather an elective section. I didn’t have the choice. An emergency section is a lot more risky and often used to prevent complications when DM isn’t in the best health or is very tired, it can be very rushed, I’d imagine it’s scary for that reason mainly.
Once the baby is out safety it doesn’t matter how they get here.

Really? So much support?

You are having a laugh aren't you?

This thread is a good example So many people saying anyone should have a CS if they want to ( which I agree with). But not so much of standing up for those who are told they " have" to have a CS against their will

Women should absolutely be supported to have the birth of their choice where possible.

That doesn't mean we should be championing the decision of women who risk their baby's life by refusing a medically necessary/advised c section. It's their body firstly, and if they have capacity, their decision is the only one that counts even if it leaves two people dead. But that's doesn't make it a good decision.

Same could be said for the other way round also. You are quite correct that it should be the mothers decision so it's wrong to try and railroad them into a different decision