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?

To be fair, lot of labour is just having contractions and hoping all your obs stay normal. There isnt actually good evidence about how often they need to listen to the heartbeat. They do it every 15 mins just to have a number, it isnt based on actual research that says 15 minutes is the right interval of time.

I was a high risk pregnancy, yet they managed to totally miss my preeclampsia risk factors and failed to prescribe aspirin.

I was a high risk for a precipitate labour, and they fobbed me off on that too. I was begging to discuss elective c sections, but even being high risk, they brushed it off and suggested sweeps at home.

As it was, I was in hospital for pre-eclampsia when I went into labour and gave birth in 90m, with a bad haemorrhage. I retained some placenta too.

My mum got dismissed for her precipitate labour risks 40 years ago and was told to make her way to the hospital with me, when she lived 45m away, and her first three kids were all delivered on under 2h - I was born in 30m.

Maternity care is a shit show in this country.

Elective doesn’t mean medically unnecessary.

It’s highly unsurprising that the rates have increased.

We created interventions that led to children and mothers surviving when they would previously died. Genes leading to those conditions and circumstances get passed on more frequently leading to more interventions required.

Pre-eclampsia would’ve killed most people 100 years ago. My mum survived it twice as did I.

I think however doctors seem to be much more likely to jump the gun if you srd older, or a little heavy, and not give any real attempt at vaginal birth. As soon as things go a bit longer or whatever they assume it won't work and go right to pressuring for a section on the basis of statistics, even without trying to manage the birth in simple ways.

In many cases, and you can see it in this thread, people are making decisions based on statistics, not their actual birth. But the thing is, statistics can't really be applied to individuals that way, that's not how statistics work. It will inevitably push stats further in the direction they are already weighted to, as well. So the more you make decisions on a mainly statistical basis the more statistics will reflect that.

Out of ALL of that post, the ONE thing you picked up on , was THAT?

I applaud your nerve.

There are also many cases of the opposite though, where there are emergency c sections because medics are leaving things too long to see how they go. This was the issue with my DC1, EMCS after failed induction at 42 weeks.

Don't you know this doesn't happen, it's just a sexist trope.

Haven’t read the entire thread so this may have been posted but there is very limited research on elective sections that are maternal requests. Most electives are all lumped together in statistics, so electives for health reasons for baby and mother (which would obviously carry higher risk factors by their nature) are included with maternal request sections. So the statistics are not accurate for either type of elective section.

One of the few pieces of research done where the types of section were separated found that a maternal request section resulted in fewer adverse outcomes for mum and baby compared to a vaginal birth.

We need to be capturing this data properly so women are informed.

The article and link to data is here: https://www.theguardian.com/lifeandstyle/2022/feb/13/caesareans-or-vaginal-births-should-mothers-or-medics-have-the-final-say

‘The data shocked the study’s head author, Darine El-Chaâr, a perinatal researcher at the Ottawa hospital. In the planned vaginal birth group, there was a higher percentage of negative outcomes compared with the MRC group, driven by serious vaginal tears and babies admitted to intensive care. “I myself am challenged by the data,” she says, underlining that she believes vaginal birth is natural. “I wanted it to be the other way around.”’

I don't think that's probably what the pp was talking about.

More likely things like offering help with non-drug pain relief, changing position to facilitate labour, offering strategies like a bath, and all the other things that should be happening rather than leaving a woman who is feeling scared alone to manage.

The fact that you think it's about frequency of listening to the heartbeat kind of says it all, all the rest of it is that far out of people's experience.

Some of the debate is over whether some factors that women might be told are indicative of a section aren't actually indicative that it is necessary. One example being a baby who is considered "big".

NICE say that a woman should not be recommended a caesarean just because they have a "big baby". It seems like some women still are.

However, this week in another baby group i am in, a woman reported that she had been told she had to have a section as the baby is big. A few people pushed back on this and cited research that shows that there is no basis for recommending one. It then turned out that the woman had been offered one, explained the risks of both, and she preferred to take the risks of the caesarean.

I found it interesting because it is either that she was initially somewhat untruthful due to the perceived criticism for "just" having a section, or she perceived them offering her one as them saying it is the only safe way to have the baby.

Why wouldn't it pick up on it, it's total bs to say it doesn't happen.

If you’re trying to suggest that from an evolutionary point, then surely the only way to prevent that would be to allow women and babies to die in childbirth if they struggle? That way only the women able to deliver naturally pass on their genes. Is that what you’re suggesting should happen?

Personally, I would find it annoying if someone kept hovering over me, suggesting things. I have their dad to annoy me doing that. A lot of labour is just dealing with contractions the best you can.

Labour can also last under an hour. My dd2 was born 12 mins after first pain (I was at antenatal appt) . Dd2 had her 2nd in under an hour at home

Both no stitches or after effects

So hardly using up a lot of staff. The midwife was still filling in details from me when dd2 appeared ( still wrapped in sac) and Dgc3 didn't even go to the hospital, instead a community midwife appeared an hour or so after birth, checked mum and baby and off she went

I don’t think anyone is saying this is not relevant? These benefits just need to be considered in the balance of factors overall. I think most would agree it’s more important not to have a seriously ill mum or baby than to seed the gut microbiome this way

I know more than one person who has secondary infertility and has had to have further operations due to scarring from a c sections.

I've had two vaginal births I’ve recovered quickly from, the second in particular was honestly great, it felt weirdly satisfying pushing him out. Once you’ve vaginally birthed and if you’re low risk you have much more chance of having a successful uncomplicated delivery the next time too. I have no pelvic floor issues and find sex even more enjoyable than ever!

I agree with what a previous poster said that it’s sad midwives are losing skills to deliver breech babies and twin births for example. I’m pregnant currently and I did research into the best positions for breech births as my baby didn’t turn until very recently. I would have definitely opted for a VBB and I think these situations if a woman wants to vaginally birth then it should be encouraged.

I'm not sure how that follows, you are talking about an emergency section sooner with less evidence, or later with more.

Can people wait too long, sure, but waiting to see what actually happens to an individual is not that.

And the statistical outcome looks the same either way. If they did a section at 40 weeks, or 42, as long as things look healthy to or the placenta, it's still an emergency section. Induction reduces the chances, it reflects a reduced chance, of successful vaginal birth either way.

They don’t use scalpels. They use blunt ended scissors.

Some people feel that way in which case a good midwife will tend to back off. Lots don't, they feel alone and scared.

That being said, good management increases chances of a successful birth so it is typically part of the job even if you find it annoying. Husbands are fine but don't typically actually have any expertise in helping the labour progress. Standing around chatting is not doing that. And even rushing from room to room for basic monitoring because you are understaffed is not doing that.

You've been arguing the whole thread it's not important if section rates are going up.

I'm really not going to feed posts like this.

Perhaps we can focus on the actual issues with maternity please?

There's plenty to choose from.

I’m glad you’ve had such positive experiences and totally agree if a woman wants a vaginal birth no issue with that at all.

My issue is the way we discuss the crisis in maternity care is to focus on c section rates (and other intervention rates) as if they are per se bad, when imo this should be neutral.

You said that medics will presure some women (eg older) for a c section if things are taking a bit longer. You also mentioned ensuring the placenta was still ok.

In my case, they made me wait until a couple of days before 42 weeks for an induction. Then made me wait another 2 days to ‘see how things go’ before me ending up needing an emergency c section. The placenta was no longer fully functioning but they had absolutely no idea.

I think that there are massive failures in maternity care that need to be resolved far before we determine what the “ideal” ratio of c sections is. People probably are having c sections that are not strictly medically necessary because of fears about poor treatment or poor treatment when giving birth first time around (as well as the rise in older births), but it’s not sensible to spend time hand wringing about this. Maternity care is very very poor in our country, despite the fact that in theory we could be running the world’s best maternity care trial - we could collect data effectively, triage effectively and know which women have a good chance of having an uncomplicated vaginal birth beforehand and which women might need more support or a c section (obviously still supporting choice). Instead, we have a system that tries to drive people towards vaginal birth and pretends for the average first time mother that it is purely random whether they succeed and gives them very little support on average.

They said failure to progress. I was just turned 20 at the time so they tried treating me like some ignoramus. Id laboured slowly for hours previously which I coped with . It's only when I went into the hospital they started prodding and poking and upsetting the baby. As soon as they left me alone all the monitor stuff went back to normal levels And no I wasn't worried about lack of oxygen. My gut instinct said she would be fibe

As for babies being blue when born. Well they usually are until they take a few breaths. DS was so went on the resusitator for a bit. Pretty commonplace, same as the old fashioned holding then upside down and slapping their bums to get them to cry