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?

https://www.bbc.co.uk/news/articles/cqxpxjrqd1po

op, this was in the news recently. It refers to an increase specifically in emergency c sections, which is a very different conversation than elective c sections by choice. So surely, yes this would be something to be concerned about?

Also consider it is more common to then have a second elective c section if you had an emergency one previously, rather than attempting a VBAC.

I had an EMCS at 40+3 after a failed induction at 39+4 (medically necessary because my DS needed to come out ASAP because I needed urgent thyroid surgery after he was born), I didn’t want a CS at the time because I wanted to avoid two major surgeries within four weeks! I ended up having both surgeries within 28 days and it wasn’t fun.

However, I would have an ELCS if I do decide to have a second child because I’m so traumatised by the induction that I just can’t fathom going through an attempt at a vaginal birth again. I don’t care if there’s a chance that I might not need a single intervention, because there is a chance that I might.

On the other hand - out of my 8 schoolfriends - I'm the only one who has had a CS. It was an EMCS after a failed induction - DC1 was back to back. I had a planned section with DC2 as was terrified about the risk of scar rupture.

I've had one of each.

35 years later, I still have pain from the section, endometrial tissue is embedded in the scar, I still can't tolerate anything touching it and I still have dreams about when they started cutting without checking that the epidural had taken effect.

Other than feeling a bit bruised and tender, the forceps delivery of my second child (after six years of thinking I couldnt bear to have another child and so scared they'd do the same again that i avoided all hospitals until the day i went into labour) was an absolute doddle.

I had an emergency caesarian. I had fatigue for 2 years after. Also it has ruined my stomach.

The fatigue is from having a child, not the operation.

It’s thought that the biggest influence on a baby’s gut biome is whether they were born vaginally or not - with breastfeeding coming second.

https://www.bbc.co.uk/future/article/20251103-what-a-babys-first-poo-can-tell-you-about-their-future-health

I think the increase is something to worry about if it’s a sign of something else eg if part of the increase is because women hear more and more negative stories of vaginal birth and do not have the trust that they’ll be properly cared for, then that’s a problem. Not because there’s any issue with c sections themselves, but because of the underlying issue (poor care during labour) that they could signal. Would the rates be lower if women had more confidence that they’d be listened to in labour, get an epidural quickly if they want one, get decent post-natal care etc? I think it’s a shame if any woman makes the decision out of fear of poor care - not because I think having a c section is a shame. Just because I think ideally it would be a decision between two options where you feel you’ll get proper care whichever one you choose, and it’s a shame if that isn’t the case.

First post nails it. I wouldn't risk a vaginal birth given the state of our NHS and levels of 'care'.

I think it would be a little bit sad if vaginal births died out. You really can have a great experience, but obviously you won't know until you get there. There are risks with a C-section too, but I very much understand why people choose them. It does feel like a more controlled risk.

I've had two vaginal births (the second was only 3 days ago and in the passenger seat of my DH's car 😅) and I'm grateful that I was lucky enough to be able to do that and not have any complications.

If we are inducing more women which is leading to more caesareans but the inductions arent saving lives, then it is iatrogenic harm.

I read that 600 women have to be induced at 39 weeks to save one baby from dying. So 599 women are induced unnecessarily to save one baby.

We need to be better at predicting what babies and mothers are at risk and inducing those labours.

Also remember the profile of mums have changed. They’re older having their first baby, more likely to be overweight, more likely to have some kind of health complication.

My mum had her first at 22, my MIL at 25, this was the norm back then but seen as very young now. Which it isn’t, from a biology perspective.

Hmmm but you risk a c-section with an obstetric workforce that has grown 4% while their workload has doubled?! 🤔

The NHS isn’t resourced appropriately to cope with this shift in birth mode, so suddenly in a decade. The resources and buildings are all in the wrong places.

It’s been a good few years since I had my last baby, but the main reason C section was seen as a necessary plan B/C as opposed to a viable choice when I was researching was due to the health benefits to the baby being born vaginally. Immune system, bacteria, breastfeeding, all that stuff. Not sure if that’s still an accepted train of thought, I know a lot of people see a lot of that stuff as woo or insignificant, but I do think it’s telling that even though my youngest is 12 I was asked about his birth at a recent medical appointment! It does matter.

We are very good at C Sections. We are extremely bad at treating birth injuries and prolapses. Knowing what I know now I would advise women to have a planned c section.

If you look at stats:

Approximate odds of an emergency C-section during a first delivery by maternal age include:
Under age 25: ≈ 10% - 12%.
Ages 25–29: ≈ 15% - 18%.
Ages 30–34: ≈ 18% - 22%.
Ages 35–39: ≈ 20% - 25%.
Age 40 and older: ≈ 26% - 30%+ (reaching up to 45% in some studies, with odds ratios increasing by roughly 6% per advancing year of maternal age).

So 1 in 10 under 25s need an emergency C-section, compared with 1 in 3 or 4 mums over 40. That’s a huge jump. It seems obvious that younger women’s bodies are more primed for labour for whatever reason, and this decreases over time.

There’s also the weight aspect:

Compared to women with a normal BMI (18.5 to 24.9), a nulliparous woman's risk of an emergency cesarean section roughly scales with her weight class:
Normal weight: Baseline (EmCS rate typically around 10% - 13%).
Overweight (BMI 25–29.9): The risk increases by about 50% to 60%, with EmCS rates climbing to roughly 18% - 23%.
Obese (BMI > 30): The risk generally more than doubles, with EmCS rates sitting between 25% and 30%

Given we’re all older and more overweight, this figure shouldn’t really be a surprise?

No it’s still all relevant. A baby’s microbiome is mostly determined by whether they were born vaginally or not, and breastfeeding is secondary to this. I posted a link upthread.

I think there’s an awful lot going on with health and gut bacteria that we don’t know about. I think C-sections have their place of course, but I think like every other takeover of artificial means replacing natural functions, it will have those drawbacks which we will understand more about in the long run.

Not read the full thread but the ‘issues’ with the rising Cbirth rate boil down to these;

1. these are not all elective - meaning women are having c births that aren’t their choice. Anything that impedes maternal choice isn’t great.

2. we deskill our midwives and doctors when it comes to vaginal birth (already happening with newly qualified midwives) making vaginal birth less safe and reducing maternal choice

3. there is growing evidence about the importance of microbiome for long term health and the impact of c birth on this. Always there will be a balance between safety or birth vs long term health, but parents deserve the full information to be able to make informed decisions

4. There are complications that arise from repeated c births. Often women are not fully informed of these before consenting

5. the rate of induction is rising and not always within guidelines or evidence. This in turn is leading to the increase in c birth. As with point 1, not all these inductions are driven by maternal choice.

6. increase in birth trauma often linked to choices being taken away

7. this is not a trend being seen in countries with comparable demographics so what is happening here (it’s not because women are too old or fat!)

8. our maternal mortality rate has risen - it’s still very low but you’d think if increase c birth was the safest way we’d see a fall in maternal mortality not a rise.

I think it’s fine if the women who are having c-sections genuinely want them or need them.

I do think it’s sad though if women who want to try a natural birth are pushed into having a c-section (unless there are strong medical reasons obviously).

I actually felt like some of DH’s friends were judging me and thought I was a bit of a hippy when I said I wanted a natural birth. Feels like a total switch now from how it was a few years ago and c-sections are now seen as the sensible, acceptable choice (there’s loads of it on this thread).

As it happened I had a good birth (as these things go) and I’m glad I wasn’t pressured into having a c-section.

It's not a "sexist trope" to say that some women prefer to schedule birth, if it's true, if you think that's objectionable that's really your problem if you can't deal with it.

Women have talked about this being a reason, I've personally talked to more than one woman who say it as a significant element, and I've also seen women, particularly professional women, talk about pressure around work being a factor with that.

As for planning timings for doctors, there is a woman on this thread who said that she chose a section to be sure staff were available and I've been asked myself if I wanted to go ahead with a section because my doctor was lesvi g and I would probably need a different surgeon if I waited.

It always seems like claims like this of "sexist tropes" are mainly a way to tell women to shut up about their actual experiences.

I feel like people never take this stuff seriously though, sadly. Just look at how people react to “middle class mums obsessing over UPFs” there is so much in our environment disturbing our natural state, cancer rates are going up, allergies, food intolerances, people don’t want to accept our modernising lifestyles are a huge contributing factor.

My neighbour chose a section as she had a young child and no childcare for him other than me who honestly doesn't know the kid that well. She understood that awaiting spontaneous labour and then bringing him over at 2am was not the way to go so she scheduled a caesarean so it was just him spending a weird day with me in my garden until dad came back in the afternoon to get him.

And if I’m being brutally honest all the midwives I encountered were practically useless. Honestly, they seemed to be there for doing obs and virtually nothing else bar chatting to each other and standing at computers. The actual labour part seemed to baffle them - they had no intuition whatsoever, or knowledge beyond offering pain relief that never turned up. Other than that they just stood in the corner, waiting for it to be over.

I think one potential issue, that a PP has also said, is the resulting reduction in skills the fewer vaginal births there are. Skills in breech births are already virtually extinct.

Obviously that would take time and a lot more lean towards even more sections but it isn't impossible as a future.

Someone needs to be looking at why the system creates so much birth trauma and/or fear for women as this is such a big factor in them choosing to have a CS. Dangerous levels of staffing, burnt out midwives......

Yes I agree. The ‘air freshener’ thread being laughed at derisively because ‘an air freshener isn’t going to kill you’. They seem unwilling or unable to grasp that it’s thousands of small decisions all together that build a picture of health, and limiting chemicals is really important.