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?

Thank you, I recalled this article but no one posted it. It does suggest to me we are looking at this all wrong.

Of course C sections are not always the right decision, and the choice to have one must be considered in light of all the various risks (including placenta accreta, which has been mentioned), but it clearly isn’t always a bad choice.

But surely it wouldn’t be the case that 1 in 3 babies would be brain damaged if they hadn’t been delivered by EMCS? If that was the case the human race would’ve died out long ago.

Societies with high caesarean section rates have higher maternal mortality rates. That’s not coincidence. Repeat caesarean sections carry far greater risk to the woman. Yes, they remove the risk of perineal trauma, likely psychological trauma, but at the cost of rising morbidity and mortality.

Italy had extremely high caesarean section rates and they’ve seen a significant reduction as they’ve improved antenatal education and public health campaigns. Nearly every bit of research which looks at long term health outcomes compared between vaginally born and caesarean born people, finds poorer outcomes in those born by caesarean. Look at microbiome research.

It’s a really sad thing we’re seeing. It’s women requesting caesareans because they don’t trust the staff/system enough to safely look after them, it’s lack of education around normal physiology of birth and what to expect and adequate postnatal care, or it’s staff acting defensively or on their own trauma and performing unnecessary caesareans to avoid any potential litigation. That is tragic.

I think there are a lot of pregnancies happening that years ago wouldn’t have happened. I know a lot of people going through IVF and taking every drug under the sun to get and stay pregnant. The pregnancies themselves then tend to be fraught with problems before the inevitable early C section. We are forcing nature in so many ways at the moment and I’m always wary of the outcome of that.

You are wrong on so many levels.

I had two very good vaginal births, no trauma at all

my 3rd baby was a c section - which was botched, left me with trauma, ptsd, years of counselling, unable to bond with baby, unnatural scarring etc etc

c section does not = good
vaginal birth does not = good

and vice versa

It really annoys me because we just aren’t recording data accurately to allow women to make the right choices. If maternal request sections are actually safer than planned vaginal births then that’s information we need to know, obfuscating it by lumping all sections together is a disservice to women.

It’s obvious that sections due to the unborn baby having health issues or mother having health issues (or both in some cases) are more likely to have adverse outcomes, but if maternal request sections are less likely to have adverse outcomes then that’s important information. But outside of a few places, no one is recording that information.

It is challenging data because we want to believe in vaginal birth being the ‘best’ option, but if it’s not then we deserve to be told about it.

Are they? Because I bet £10 if I asked a random childbearing age woman in the street, she wouldn’t have a clue. We do, because taking part in this chat makes the participant more likely to have an interest in this area. But I don’t think it’s common knowledge at all.

I saw the Panorama documentary a couple of days ago. There were some very sad cases of women losing babies in labour but what they all seemed to have in common was very long, stop start, painful labours with bleeding, which should’ve been a waving red flag but for some reason wasn’t. Every time I hear a woman has been in labour for days, it always seems to end with a malpositioned baby and caesarean, so maybe they need to get better at spotting that. It isn’t normal to have strong contractions on and off for a week.

EMCS it itself a traumatic birth experience for many women. It was even a traumatic experience for my DH watching it. I don’t understand how you can say it’s not.

Just out of interest, how much oxygenation do you think comes from breathing while it’s still in utero normally?

Yes my mistake. Point still stands that lack of oxygen is no joke.

I am absolutely not saying it isn’t traumatic. I’m saying it may be the lesser of two evils. No one has an EMCS for fun, they have one to avoid a more catastrophic outcome (whether or not they are truly necessary is another question).

But it's not 'inevitable'.

I'm pregnant after IVF, have taken lots of drugs (mainly, TBH, out of caution), and ... I've had a totally boring, uncomplicated pregnancy. I'm 39 + 3 and not showing any particular signs I won't reach 40 weeks. My work is quite physical and heavy and I was still working on Saturday. Might give tomorrow's scheduled visit a miss, will see how I go. So not exactly struggling through to 40 weeks!

It is important to be accurate though. A pretty common reason for women to request a c-section is because of sexual trauma and that’s completely reasonable and understandable. But an epis isn’t done using a scalpel (which as well as probably being more traumatic for maternal tissue, would increase the risk of injury to the baby and the HCP) and isn’t done by ‘slicing into the anus’ (because it’s done to try and prevent an anal injury). It sounds like the decision you made for your delivery was the right thing for you, but it is really important to not be spreading inaccurate medical information that other women trying to make a birth decision might believe.

I think the bigger question is ‘why are so
many women now being being induced, and is this really medically necessary’.

Half the emergency c sections seem to be failed inductions.

My first birth was an (awful) induction at 42 weeks. My second they were trying to book me in for an induction at 41 weeks - I had no medical issues.

Induction rates are the next big scandal.

I have said this earlier in the thread but I think it's so relevant here too.

Many inductions are done because we are all (reasonably!) afraid of stillbirth.

Back in my grandmother's generation - or even my mother's - stillbirths happened, and in considerably greater numbers than today, but there was less of a culture of talking about it and far less of a culture of considering that the medical institution might bear some blame. Lots of women were just told it was inevitable that their baby had died, or 'there must have been something wrong'. It is wonderful that this has changed. But one result of the change is that now, medics are rightly afraid that if someone has a stillbirth, they will blame the hospital or the medical team. So we have more inductions.

Stillbirth remains a statistically very small risk, even for older mothers or those with pre-existing health conditions. But god knows most of us don't want to risk it. I'm 41, and I'm booked in for an induction, because although I know the stillbirth risk is tiny, and although I've had a very unproblematic pregnancy and every indication and every scan has been that the placenta is coping well, I don't want that risk. The consultant and the midwife don't want that risk.

What we need is more research into stillbirth, which means more research into the placenta. We really don't know enough about this.

Shit you caught onto my dastardly plan to spread misinformation and get all those silly vapid women to believe inaccurate medical info 🙄🙄🙄

Well it wouldn’t have died out because 2/3 would have survived?

Not the point though. The point would be if a dr thinks at some point the chance of death/ serious injury is high enough they may move to EMCS. I don’t disagree we should endeavour to improve assessment so we can get better at determining when a EMCS could be avoided without compromising the health of mum and baby, but in the meantime I don’t think it’s wrong to be cautious if that does mean we lower the rates of serious adverse outcomes.

I just think the conversation is all wrong. We shouldn’t be worrying about whether something is natural or not, we should be trying to achieve the best outcomes possible in the system we have (and, in the background, trying to improve the system so outcomes are even better).

But that didn’t happen. Women giving birth in the 1800s had far better personal odds than we seem to. As I said, even without any modern care at all, their odds of stillbirth was 1 in 20, not 1 in 3.

I don't think it matters much whether it's a scissors, a scalpel or a specially trained crab pincer. The terror is something cutting through your most sensitive bits, often whilst your are able to feel it. Oh and then stitching it back up again after. The specific instrument used is irrelevant to that fear.

Thankfully not a problem I had to risk because although my sections obviously involved their own pointy instruments, I felt nothing, saw nothing. Hurrah for a pain free birth with no vaginal trauma.

What’s natural IS better, unless in the case of things like infection. The birthing process is as it is for a reason, because it is beneficial for the baby’s lungs and microbiome. It’s also better for the mother provided there are no major complications. It’s the same with breastfeeding - it’s always going to be better than formula; because it’s natural. This is what nature intended.

We don’t actually know the population based long term effects of c sections. They weren’t normal and were fairly rare in the 50s and 60s, so the oldest wave of c section babies are now only approaching middle age. What we do know is that allergies, obesity and general health is getting poorer.

A large part of this will be the fact many women are unhealthy going into motherhood, and risk aversion is now so extreme it’s creating more risks. When I was pregnant I had to attend consultant appointments, the number of very overweight and clearly much older women sat in the waiting room was very noticeable. If you start a pregnancy at 35 and overweight, of course your outcomes will probably not be the same as a fit and healthy 25 year old.

What are the figures for damage and repair following vaginal birth? Women who are incontinent immediately and a few years later?

There have been reviews of maternity services where “natural birth” advocated by some midwives has led to baby deaths. Any mum reading the accounts might well think a c section is safer!

YANBU. There's nothing "tragic" about C-sections. As you say, the outcome should be a healthy mother and baby.

It should speak volumes about maternity 'care' that a significant minority (31%) of female obstetricians with uncomplicated pregnancies would choose a c-section for themselves (and that figure's just in London). I also don't know anyone who had a vaginal birth that was uncomplicated or where they weren't left injured and, often, traumatised. Personal views aside, women should be free to choose what is best for them, without judgement from others.

I had an elective section with 2nd and 3rd. First was shoulder dystocia that resulted in 4th degree tears, pph and a DC born with an apgar oz 0 (no signs of life), hospital stay was 5 nights and had the full gyane team for 2.5 hours whilst they tried to stop my bleeding, full paed team for nearly an hour and a double blood transfusion... pretty sure my elective c-sections combined were cheaper (only a one night stay no for electives!)

I think the fact that 25% of births are now emergency sections is really worrying to be honest, and not because I have anything against sections but because for me that statistic indicates a real problem and I’d bet a huge amount of money that what props that up is unnecessary inductions.

I’ve had 2 babies in the last 2 years, I’ve had 2 inductions for 2 totally different reasons, and have been very lucky (in my opinion, section was a scary concept for me) that both of mine ended in vaginal deliveries. Of my 6 baby class friends currently who had inductions, only mine ended in vaginal deliveries, the others were ALL emergency sections. Forcing the body into labour before it is ready increases the risk of it ending in emergency section, that’s a fact, they call it the cascade of interventions and it ultimately ends in EMCS.

I’m not saying inductions are inherently bad- I have had 2, both were medically necessary at the point I agreed to them, but they push them for their own convenience. My first baby I was being offered an induction because she was due over Easter weekend and it was to ensure adequate staffing, when I declined that one it was suddenly recommended because she was a “big baby” and may not be safely delivered at her due date. One of my friends was booked in for an induction without conversation at 40 weeks + 1- literally 1 day over due.

The more inductions done (currently 33% of births are induced) the more EMCS there will be.