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?

A perineal tear vs a total hysterectomy. Do they include all tears in the statistics?

The issue is that there are relatively few reasons where a caesarean is medically indicated. Especially when you haven't even laboured yet.

The unnecessary medicalisation of birth is a real shame. It’s an amazing option when needed though.

Ive had one c section and a VBAC. C section was horrific to recover from. Injection, stuggled with mobility, felt bloody awful for weeks. Not to mention the risk of disrupting breast feeding.

I was up and showering within an hour of my VBAC, home within 6 hours and at the park with my baby and toddler the next day. It was SO much easier.

I absolutely wouldn't be championing women who half way through a section were told they'd need to have a vaginal birth instead for their safety and that if their baby, and instead chose to proceed with the section. But that's theoretical as that really doesn't happen.

If such a scenario even existed then absolutely the section would be stopped. Whilst you can't force a woman to undergo any procedure she doesn't consent to (so can't force a section), a doctor can absolutely stop a procedure if it's not on their patients best interest. You couldn't force a doctor to continue the section.

So your reverse scenario couldn't even happen.

I totally agree with this.

I’ve never had a c section so I can’t comment on the recovery time. I did have 2 vaginal births. The first was dreadful and took a long time to recover from. Longer than some of my friends took to recover from c sections

I opted for an elcs because I was told that I needed to be induced at 39 weeks due to ivf... I still have no idea whether I actually needed to be induced or not. But there was no way on earth I was going for an induction at 39 weeks first baby. Just walking into an emcs.

Also patterns in family planning are changing- the birth rate is low, many women who are choosing to have children are having them later on average, and only having one (or two maximum). If you’re on the ‘older’ side (from a maternity perspective) and also ‘one and done’ I can totally see why opting for a planned c-section might make sense, even without any factors such as mental health or trauma.

I’ve had a planned csection followed by a vaginal birth ( with forceps). Recovery and pain was definitely better for the csection for me

@PancakeCloud I completely agree with your premise that the goal should be healthy mothers and babies, not fixating on how a baby is born.

But, I also think that @AnneLovesGilbert 's point that Rates of sections are increasing due to maternal age and obesity from what I remember reading so that’s not to be celebrated because women are having major intervention through necessity rather than choice. is really important.

In an era when having a child is a choice, not something that happens to most women due to lack of contraception (like the bad old days), maternal health and fitness really need to be prioritized.

Why is medicalisation a shame in and of itself? Surely it’s a good thing when it leads to better outcomes.

I’m sorry for your difficult caesarean experience, that sounds unpleasant.

I’ve had three natural births without any pain relief, stitches, intervention etc. I had an injection to help with the afterbirth and that’s it.

But it isn’t uncommon at all

This is just so different to my experience (over last few years). In antenatal education I found there is huge influence of the natural birth movement and hypnobirthing and it absolutely felt like the only right way to want to give birth was with minimal pain relief vaginally. Even mentioning an ELCS felt a bit taboo. There was emphasis on women’s choices but the choices were all presumed to be around rejecting intervention (rather than asking for it).

I didn’t see any support for CS and many women who ended up having EMCS were made to feel like they had somehow failed, which I think contributed to their birth trauma.

So if there's not support why are people able to choose it if not medically necessary?

Less than one in 10

I'd want to understand more about the reasons.

I've had 2 c-sections, one emergency and one elective and I'd chose an elective, or semi elective over the emergency every time. But it is a major operation and surgery carries risks. Plus links to secondary infertility. Not a decision to be made without awareness.

The awareness and ability to weigh up risk in an informed way, plus mental health support if needed for all birth choices is key.

I don't care how anyone gives birth as long as they were looked after and supported and this is something that sometimes falls short. I've never been sad about my births but the recovery is hard especially with complications.

For the purpose of balance, I have had 5 vaginal births. One in hospital (because she was 4 weeks early) and the others at home.. the worst I have suffered was a tiny tear on a labia which healed on its own. I haven't done anything special and am not particularly fit but me and the babies are all good. I have a friend who had one hospital vaginal birth, one home birth and then a section because her baby had her head on the wrong place. It is the luck of the draw. My bestie ended up having an emergency section after labouring at home because her son was mal-positioned and she wasn't cracking on as she should.. you just don't know what you're going to get but I think low staffing levels contribute to rising section rates because the outcome is controllable in a time scale that is planned and natural labours are not. Also a more letigious culture makes staff more cautious.

Because being allowed isn’t the same as being supported?

Perhaps some women have a different experience, but my experience was that ELCS was very much frowned upon.

https://www.nursingtimes.net/policies-and-guidance/normal-birth-campaign-abandoned-by-royal-college-14-08-2017/

Apologies, it was 2017, but well after 2003.

1 in 3 in a hospital without a MLU is actually probably quite low. Nowadays in my area it’s 1 in 2 of all births end in c-section, including MLU and home births, which I assume would not have been part of your hospital’s 1 in 3 statistic.

I think elective c-sections are much better than emergency ones.

And maybe if medics stopped telling women what was best for them, the NHS wouldn't have to pay so much out for botched maternity services.

Our NHS board often post a monthly birth post, includes - how many, no of water labours, skin to skin at birth rate, breastfeeding from birth rate, number of boy/vs girls and lastly number of vaginal vs c section. Now this is quite a small county population wise with just a population of 120k max, so not many births a month really.

June: vaginal, 48. Section, 27
April: Vaginal, 48, section 27
March: Vaginal 30, section 28
Jan: Vaginal 44, section 21

Seems to be quite the difference here.

Just adding my thoughts. I work for a NHS Trust - I wont detail what I do as it'd be outing...

In my Trust, there hasn't been any changes to the workforce for the last 5 years in terms of capacity. But we have gone from 20% to 45% of births being a c-section.

The theatre staff are overworked and burning out. They don't have enough staff to cover all of the sections. When there are two sections being done, there is no anaesthetist available to do epidurals and spinals on the labour wards. So mums are waiting hours for pain relief.

There are so many issues with such a high rate - I could list them all - but the biggest issue is that the NHS is not equipped to deal with the demand as it is. Babies and mums are at risk of injury or death, and that's a genuine fact.

I had a c-section and you wouldn't have known there were these issues behind closed doors. My team were so calm and professional, and dealt with me incredibly well even in such a scary situation.

As others say, worry may be the wrong word, but there should be enough concern to gather good data around the increase and what the risks and benefits mothers and babies are dealing with because of it.

It seems obvious that younger women’s bodies are more primed for labour for whatever reason, and this decreases over time.

I'd be wary of feeding into the myths that younger is better. It's only 'obvious' if you treat a vaginal birth as equaling primed for labour while ignoring any other data. Those stats aren't giving any other interventions, how well their labours went, or the outcomes of those deliveries.

18 and 19 year old young women are significantly more likely to experience haemorrhaging during labour and are at higher risk for having lifelong injuries, disabilities, or dying from pregnancy and childbirth compared to any other age group that's in that list with the higher C-section rates. Not as high as those under 16, but they're generally left out of data samples unless specifically looking at teen pregnancies even when a study says 'under [age]'.

The babies of 18 and 19 year olds mothers are also on average much smaller, are at a higher risk underweight, are significantly more likely to be born prematurely, more likely to born stillbirth or die shortly after birth. Being able to birth vaginally doesn't mean a good outcome.

Taking all data, the 'primed for labour' isn't a young women best at all - the risk for mother and baby go down with age (all other things being equal) until around 24, plateaus, then slowly goes back up from the early-to-mid thirties - though even with c-sections going up, the risks never get higher for mother or child than with teenager mothers.

I had an okay vaginal birth at 19, it took ages, he was smaller than average, I had an enlarged placenta that hurt more to deliver and weighed about as much as he did and caused more tears while it took the over two hours to come out (would have been a manual removal if there weren't more urgent cases). I still have issues with my hips from the issues that came up during that pregnancy and childbirth over two decades later. My body was not more 'primed' than when I had a far better vaginal delivery of my 9 pounder also with a very enlarged placenta at 26 with no tears and both came out much faster.

I guess the question we need to ask is are these c-sections actually safer than the risks of vaginal birth for the woman that choose to have them?

I think there was a time when c-sections were "saving" so many children and mothers from death and disabilities, that it looked almost like vaginal birth would be a lead cause of these things. C-sections were seen as generally "safe" compared to the generally "dangerous" natural births. The reality was and still is though that the "saving" power of a C-section, generally only applies where something abnormally bad is making natural birth abnormally dangerous.

C-sections are MAJOR abdominal surgery too... so way harder to recover from than a "normal" vaginal birth.

C-sections are MAJOR abdominal surgery too... so way harder to recover from than a "normal" vaginal birth.

Meh, mine was a 45m procedure from start to finish, out shopping 3 days later with no pain. 90% back to normal in a week.

Yes for some women recovery takes a while, but it's not always harder. My recovery was quicker than my friend with forceps, my friend with ventose, my friends with bad tearing, my friends with inductions that went a bit wrong, my friends with emergency sections. My recovery was quicker than the one friend I have who escaped with only a minor graze. On average, a planned section stay is half a day longer in hospital than an uncomplicated vaginal birth. That's it. Oh, and far less time before.