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

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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?

Induction reduces the chances? HowwhatWhy? I was induced with my first and put on the drip whwn things slowed with my third. In what way did the induction that brought on labour reduce the chance of a vaginal birth? Not having been induced at 12 days over would have made an emcs very shortly critical. Not having been induced would have definitely reduced my chance of a vaginal birth.

I certainly think it’s notable and might be concerning, but if those emergency c sections saved lives or prevented severe birth trauma then I don’t think it’s necessarily a bad thing.

My personal experience and belief though is that many emergency c sections could be prevented by better maternity care. Note the stats are since 2020 and i don’t think it’s a coincidence as lockdown maternity care was even worse.

Through the PALs complaints process I went through after my first, they had to acknowledge that a c section could have possibly been prevented had they not failed so badly with my care.

So it is the care aspect and root cause of the increase in emergency sections i am concerned about.

Also just to note, i don’t know how an EMERGENCY c section prevents severe birth trauma.

I would say emergency sections cause birth trauma, electives prevent them.

Why would not bring induced reduced your chances of VB?

None of this is woo. It’s all complex and not well understood. From a busy working mum who tries hard to avoid upfs. It’s like I read recently about the scientist who discovered lead in everything all over the us, it was due to lead in petrol being pumped out everywhere a car went and a couple of decades later they made unleaded petrol the norm with massive health benefits for the whole country, especially everyone young. Nobody knew or cared.

I am not arguing this is the same but complex and not well understood women’s health related issues such as the ongoing impacts of birth could turn out some really interesting and very clear conclusions one day, I wouldn’t dismiss them, and it did make me think a c section the if needed outcome rather than an equivalent choice. But the worse the maternal care generally the more likely a c section I assume, I went private in another country for the third to feel more looked after.

Just an idea: I opted for a C-section with my first for many reasons, but one of the leading ones was that he was due December 2020 and I did not want to labour alone and wanted some control over the timing of his birth so we could keep ourselves well, arrange childcare for my step-daughter etc. This was 5 and a bit years ago. As it was an elective C-section it went as well as it could have and meant I was more likely to choose an elective for my daughter, born 3 years ago, both because of the positive experience and because VBAC is a whole thing. I wonder how many women share this experience and if it's one of the reasons behind the increase in the last 5 years.

I’ve had 3 natural births and an emergency c section
id take a natural birth any day over the c section. I’ve been left with no issues and I didn’t tear maybe u was lucky! With my section I lost most the blood in my body and got sepsis and was very ill.

I’m in my 30’s and had 2 babies naturally in 2 years, all straight forward, home the next day type of births, as did the majority of woman in my ward both times. We have a fantastic maternity ward at our hospital which put me at ease, but heard horror stories from friends that had babies in our next nearest hospital, which is around 40 mins away. So the team/hospital seems to have a big effect!

Well if a baby stops breathing getting it out very quickly via EMCS could significantly shorten the hypoxic episode and reduce brain damage for example.

I’m a midwife currently practising in the UK after 9 years in Canada. Something alarming has happened in this country that isn’t being replicated in other countries, and we should be worried when the UK is such an outlier, and we need to be asking questions about what is happening.

In Canada I worked at a small hospital, and I can remember two purely maternal request Caesareans in the past 5 years. It’s such an unusual choice that I remember our obstetrician’s surprise when a first time mum requested one. Certainly where I worked birth trauma was much less and women’s motivation was for a vaginal birth. Yes of course the Caesarean rate was increasing as it is worldwide, but not the steep rise we are seeing here.

There are so many things that are deeply wrong with the maternity system here, which other posters have outlined, and taken together they are fuelling the rise. If we’re serious about rebalancing, the whole system needs top to bottom reform.

I don’t dispute that but we need to look at all the factors in the round.

And I was unable to vaginally deliver my 11lb baby. I was induced bye ended up with EMCS but it was inevitable owing to my anatomy which became apparent during my failed 5-day induction. So my EMCS should have been a non-complicated ELCS without haemorrhaging and other issues.

With my second I was advised to try vaginal until the last minute in spite of a whole load of risk factors. They really did prefer to advise vaginal where possible in my trust.

I can assure you, needing one in the first place is traumatic, regardless of it preventing further birth injury etc.

interesting. What reforms do you think are needed?

Is it a "waste" of money if it saves mother and baby from a highly distressing and potentially dangerous delivery?

I read that article too, and it was very frightening. Placenta accreta must be horrifying, both for the patient and the medical staff, and worryingly it sounds as though it is often undiagnosed despite the known risk being heightened by previous c sections. One woman needed 5 litres of blood , I can’t imagine how you get over that.

I know it’s not, it’s how other people treat it.

The problem is if you start talking about breastfeeding or natural birth and the potential harms in alternatives you’re accused of guilt tripping women. I just don’t think people are properly educated on the risks and outcomes, parents need to know so they can make fully informed decisions and help mitigate the risks where possible. If you pick up a pack of cigarettes it’ll have a warning on it, we all know smoking is bad for us, how many people actually KNOW the impact to wider health on microbiome for example, I think most of the mums I know would look at me as if I had 2 heads if it was mentioned. And I’m not saying we should not give women a choice, of course we should, be it should be an informed one, and we are talking about long term health outcomes here, which is important for society as well as mum and baby.

In all honesty the most tragic stories I have heard have been where women haven’t had a c-section and should have done, rather than anything connected with the c-section itself.

Given the state of maternity care in this country at the moment I’d prefer to be in the hands of a trained surgeon unless I was guaranteed no risk factors and a decent staffing level on the maternity ward.

This is such patronising rubbish. Women are aware of the possible impact on the gut microbiome. Some assess that risk and consider it is still better to elect for a c section. Others attempt a vaginal delivery but it is subsequently medically assessed that a emcs is necessary. In neither case would it have been appropriate for a woman to continue with a vaginal birth.

If anything my experience is the risks of vaginal birth are hugely underplayed due to the prevalence of hypnobirthing / positive birth stories only type rhetoric.

I have no doubt, but having a live minimally brain damaged baby is presumably less traumatic than a severely brain damaged / dead one.

What I am saying is EMCS are not themselves the cause of birth trauma, they are a symptom of something gone wrong in labour.

BBC article on placenta accreta.

I don't feel clever but thanks for the insult. I wasn't saying I agree with it but on first glance this is what people think. It isn't a falsehood as it is the published info - what it doesn't include and you are right is the downstream costs.

Oh okay that's absolutely not a bladed item slicing into my vagina and anus so I'm sure it'll be fine.

You win at being pedantic. Did you even READ my reasoning? And you come out with that?!

My experience is completely different, I.e. women are pressured into vaginal birth / VBAC and shamed for making a decision about ELCS. It does all seem to change once labour is underway though.

Personally the friend who nearly died because her previous c section scar was rupturing was nearly the worst outcome I know of that could have been avoided, the other poor outcomes I know personally were from not knowing and you’d have to schedule elective c sections at 38.5 weeks for everyone to have avoided them. Better quality health care and believing patients would have saved the first case a lot of pain and struggle, all of these arguments are really solved or substantially mitigated by better quality health care. Confident supported mums who get suitable health care when needed would be amazing for all metrics.