I had a emcs but I absolutely love this!

[RubyBuckleberry]

"When women understand what?s available to us at birth, then we won?t ever give that over to an expert? the birth power, the orgasmic power that?s in our bodies. When you meet a woman who has had an ecstatic birth, you can?t talk her into taking drugs that aren?t good for her body. You can?t talk her into a hysterectomy that she doesn?t need. You can?t talk her into a crummy diet. She?s come home to her body. She knows what this body is capable of. She loves this body. This body loves her. And there?s nothing like the transformation available at birth to nail that in there in such a way that she becomes illuminated, because she?s a channel for life. And then she becomes a channel for life in all its forms."

and

"What we?re finding is that it does matter?it absolutely does matter?how somebody comes into the world. And it doesn?t mean all babies should be born this way or that way. It just means that we have to pay attention and recognize that those babies are having experiences. And the way that birth happens when it?s left to happen naturally, without drugs and without forceps, is really what the baby?s body is expecting. There?s a biological readying that?s happening. So it?s incredibly important that we start thinking about this time period in a new way, and we start caring for moms and babies and families around the birth experience in much more thoughtful and mindful ways than we are doing right now."

from this website

Just to pick up on Ushy and Flyingzebra's points - surely CS's in the 60s, along with most major surgery, were different experiences than they are now? longer procedure, longer stay in hospital, less advanced surgical techniques, less sophisticated drugs?

I don't think a direct comparison between the 60s and now is helpful. After all, there were no heart transplants before 1967 - that doesn't mean there was no need for them before then. Or that the fact there are more of them carried out now than in the 70s means they are being done irresponsibly frequently.

Agree barkfox - traditionally they involved a vertical incision which is riskier, not sure when they routinely began to do the bikini line incision but I would imagine it was later than the 1960s.

Agree, no point comparing with 1960s , just look at the evidence now, which shows that natural vb is the safest birth for most babies

flyingzebra

Going by your example (of your births) dd1 should be a highly strung child & dd2 should be laid back & easy.

Not so. Dd1 was born after great distress in which we almost lost her heartbeat, she was an emerg section under GA. She was & is a placid child, very lid back & easy.

Dd2, an elective section. Is the exact opposite of her sister.

I had two emergency c-sections, one for a transverse oblique lie and it was on the whole really quite a good experience. Except that I'd really wanted a home birth, so there was the sadness about losing that dream, and staying on the post natal ward wasn't great.

The other was a scary, traumatic experience, which damaged my relationship with dh and meant that dd came into the world with two traumatized parents. There is no doubt that it wasn't what either of us wanted. I don't blame my body for it though, I regret that my uterus doesn't seem to do spontaneous contractions, I regret that I ever said I'd use syntocin, but mostly I blame a really disengaged midwife. She could have done her job and helped us, enabled me to move around, despite the monitoring, helped dh to understand what was going on, given me at least some reassurance that I ws doing OK etc rather than doing basically nothing (including leaving the drip in still delivering syntocin when it had been agreed I was going to have a cs).

Even a medicalised birth can be managed so that labouring women feel listened to and cared for. Too many new mothers start off life with their babies having been traumatised by birth.

I think it is helpful comparing the 1960's with today. I suspect that many, perhaps even the the majority of the 26% of women who have a c/s today believe that they or their babies would have died or been seriously damaged had they not had access to c/s. The fact that the most mothers and babies got through birth in good health when there was only a 5% c/s rate suggests otherwise. As does the fact that the vast majority of babies born by c/s after a diagnosis of fetal distress today are born in tip-top condition.

"Even a medicalised birth can be managed so that labouring women feel listened to and cared for."

Wouldn't disagree with this.

so interesting what you say tittybangbang - DS was a brow presentation - 5 days of labour (first two totally manageable, second three less so - 8 hours of established labour on the 5th day). i am totally happy with how it turned out (did lots of yoga and had active birth hat on - made our own decisions so to speak and put the docs through their paces making them justify decisions, was monitored due to dodgy heartbeat but moved around alot etc etc) except for one thing: DS came out with an APGAR of 9. He was totally fine it seemed, despite the consultant being pretty serious and his heartbeat dipping to 70 ish (can't quite remember the number) AFTER contractions. It was stressful hearing the beat really slow down (on the monitor) and I def am against fetal monitoring per se but it was very difficult to refuse after his heartbeat was found to be faltering.

The reason for the emcs was brow presentation which as I understand it, is an absolute indication for emcs, but what i don't understand is how he had such a good APGAR. I'd only had gas and air and had been doing lots of yoga during the labour which may account for it, but might he have moved? and would he/me have died if it had been happening 100 odd years ago?

tia for any thoughts.

Differentnameforthis - sorry, I was talking about my DD's and not yours. My DD1 had some very medical complaints which were a direct result of her birth.

Sorry if I didn't make that clear - I had no intention to extrapolate that to your births, of which I know nothing.

very specific

Re safest for baby

I too had a long chat with my consultant about this. We have no choice - the LO has decided a c section is how she wants to come out in spite of all the hypnobirthing, acupuncture et al that her mother indulged in in pregnancy.
Perhaps he was trying to cheer me up but here goes

Elcs is the only way for my baby to come out.
Generally speaking elcs are safest for babies (but slightly less safe for mothers who could have done it otherwise.). Why? Because of the unpredictable nature of birth and the possibility that things will go wrong

No, she will not be traumatized or psychologically damaged by the experience.
The increase of subsequent pregnancy risk is very small and does not refer to delivery unless it's vbac. Unless I plan to have 10 children there should not be an issue

So why no c sections for all? Well, the safest for babies must be qualified to include "provided that":
A good experienced surgeon is available
Good operating theatre conditions plus back up
Good post operative care
Additional support for mother in the weeks afterwards to allow for recovery / healing
And finally, mum does not end up blaming self for it and get depressed

The WHO knows that these conditions cannot be met for large numbers of women worldwide.
Since some women do not need it they must focus on securing them for those who do

For nhs
There is not enough staff / hospital space to provide this for everyone who fancies it as opposed to who needs it for various reasons
The cost of extra nights in alone is £2600 plus, not to mention staff, operating theatre fees, aftercare
For women
Not all women will get enough support afterwards leading to issues with scar healing etc

Plus - bitter truth - the number of staff really truly competent to deal with bad complications / interventions can be woefully low at times ESP nights and weekends. There is not enough training in some things and too few senior doctors available at times. That is usually what you find behind horror stories in papers and many mothers awful experiences.

So you get to consensus that
It is better to encourage women who can give birth vaginally and then deal with any complications later if needed (and hopefully minimize those by careful antenatal monitoring so that you don't have women who cannot do it attempt vaginal birth)
The overall increase of risk to baby is v small but people don't understand risk ( I mean to say risk as discussed in medical papers - the whole business of probabilities and variation etc) So widely publicizing a soundbite of safer for babies could make it less safe

I hope I did not offend anyone by this post. For the record I would have tried for a natural birth were it possible. Equally I would have tried to "accept whatever turn my birthing may take" to quote the hypnobirthing mantra
Now I am just trying to be positive about the c section tomorrow

Oh and final thought: just remember reading that the "too Posh to push" headlines were bogus. The rate of truly "elective" as opposed to medical reasons c sections is extremely low throughout this country. At the private hospitals it is increased by the higher average age of mothers and incidence of ivf - often linked to problems which make vaginal delivery unsafe.

studies of this sort would lead to some women pushing
for unnecessary c sections, putting more strain on resources and affecting the safety of everyone as a result.

I hope this doesn't offend anyone.

However, the elcs safest for babies must be qualified:
A good experienced surgeon
Good operating conditions - no rush, competent staff
Good post operative care
Support for mother in the weeks after to allow for recovery and proper scar healing
Acceptance of what happened by mother - if I were to
start feeling guilty depressed about te section - and for
various reasons women DO that could be harmful

Why not have c sections for all then?
Some women really don't need it
Resources - the extra 2 nights alone cost nhs £2600

Safest for baby?

Surely not - there is an increased risk of respiratory distress.

A quick search on google immediately produces the following study:
www.bmj.com/content/336/7635/85.full

which concludes

Conclusion Compared with newborns delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of overall and serious respiratory morbidity. The relative risk increased with decreasing gestational age.

Thanks for that blondcat.

I agree that the outcomes for planned vaginal births could be better. Far too many are ending in emergency c/s.

I suspect that if even half as much as as is currently spent on funding c/s was spent on mums having planned vaginal deliveries the emergency c/s rate would plummet and the outcomes for both mums and babies would be better.

Sorry girls but here it is...after a very traumatic labour and birth of my first daughter who was 2 weeks overdue and i was induced 3 times I was really hoping that I was going to go into natural labour and have the birth experience that I wanted and thought I would like to know what it's like to progress into labour naturally....
Well after 41 weeks and 4 days of my second pregnancy, I went into natural labour at home, managed to "progress quite well' and when things got really painful, went into hospital begging for an epidural only to be told I was 8cm and then 5 minutes later I was fully dilated and ready to push...a few minutes later my beautiful daughter was born...but she was not breathing and she DIED!
I finally got the wonderful, natural labour that I had hoped for but no baby at the end of it!
Tallula was a perfect, healthy baby weighing 7 pounds. There was nothing wrong with me either????
No answers from Kingston hospital...but they should have monitored her more closely.
It does not matter how your child enters the world as long as they are ALIVE at the end....

Rest In Peace Tallula...03.10.10

Good post, blondecat.

Margles - re: risk - there is an increased risk of respiratory distress in Csection babies as you say. The absolute risk is still pretty small, but not to be taken lightly, obviously.

However, as others have pointed out, 'risk' is a complex picture. It's not as simple as VB GOOD/CS BAD. For example - the risk of trauma or 'serious trauma' is less for a baby born by CS than by instrumental VB.

Link to NICE info here - www.gserve.nice.org.uk/nicemedia/pdf/IntrapartumCareSeptember2007mainguideline.pdf

It's buried on p.243 under 'CS versus assisted vaginal delivery.' Very few people are aware of this. I wonder why.

And it's a bugbear of mine - but the costs of CS are often quoted as a reason for keeping rates down. However, the balance sheet is distorted. The costs of VB postnatal care don't show up on a hospital balance sheet. It's very difficult to know what the true cost of a VB is, especially where there is any kind of aftercare, physio, surgery, counselling etc. Of course the 'on the day' costs of a CS are higher. But we don't really know how much a 'birth' costs if we take a holistic view, rather than one which stops as soon as the mother leaves the hospital.

That's why I think it's insane that hospitals get to pat themselves on the back for keeping CS rates down, without focusing on the rates of instrumental births. I know to my personal cost that forceps can cause more than a few bruises that fade with time! and I think pelvic floor injury in general isn't taken seriously enough, by a long shot. Instrumental births may be cheaper for the hospital 'on the day' - but that emphatically does not mean there's no long term cost to mother, baby, and the NHS elsewhere.

michel odent says that an in-labour caesarean is better then forceps etc.

interesting book

Dimi

Tallula is a beautiful name.

So sorry you lost your darling daughter.

Barkfox - brilliant post and you are spot on. We are being duped.

Yes, there is more respiratory distress from c/s which sounds awful alhough rarely results in long term damage but actually what women AREN'T told is that there is more death and brain damage OVERALL from planned vaginal birth - virtually all of it in the subgroup that are overdue or end with instrumental delivery or emergency c/s.

Most people don't want c/s as first choice but may be there needs to be a real rethink about what should happen when things aren't straightforward - like offering the chioce of an early c/s rather than doing everything possible to avoid one

Heart goes out to you Dimi. :(

Dimi, I'm so very sorry for the loss of your lovely DD

Ushy: It seems then that they should be looking at why the instrumental births happen so often.

I can't help wondering whether the number of inductions for being 'overdue' (i.e. having to deliver to the hospitals timetable rather than genuinely being overdue) are the cause of a significant number of problems. I say this as one who had forceps for my first but the clock decided how my labour was managed, not any medical need. (Had the next at home to avoid all that.)

"virtually all of it in the subgroup that are overdue or end with instrumental delivery or emergency c/s"

"I can't help wondering whether the number of inductions for being 'overdue' are the cause of a significant number of problems".

A very large proportion of induced labours in first time mums end in c/s. And those that don't often end in a forceps/ventouse delivery.

And of course the very high rates of epidural use in some hospitals don't contribute towards increasing the levels of normal birth.

These birth debates are always so emotive one way or the other. The reality is that the protocols are based around risks. The NHS seems to try to minimise risk, but that can make for a much more unpleasant experience and medicalised birth.

For example, my wife (40 weeks today) is going to have a VBAC. The hospital wants her on constant monitor which will restrict her movement and stress her. In an ideal world, she would like a home hypnobirth after our first baby (now 17 months) was eventually delivered by GA emergency C section after induction and amniotomy. However, we know the risks of uterine rupture are 1/200. Of those, some will be "benign" (small tears with no sequelae). Statistics of uterine rupture are not split up so we cannot find out how many will be benign and how many would be fatal to either mother or baby. So, ultimately, for maybe 399/400 mothers in my wife's position, the home birth would be the far better experience. For the 400th though, it would be a disaster.

It is a similar story with induction/C section for women who do not go into labour after a certain time after due date. Most would be fine deliver a healthy baby but a few would not.

I guess it is all about personal risk tolerance. There is no right answer. We all take risks in life without thinking about it (I think natal mortality is about 1/8000) but we all want and have children. People have to make the choice that they are personally comfortable with.

However, this idea of "medicalised" birth being bad and "natural" birth good is ridiculous. Prior to interventions, about 1 in 5 babies died in birth and a fair proportion of mothers. I know that you can argue the statistics but interventions do save mothers and babies' lives...there is no question of that.

Prior to interventions, about 1 in 5 babies died in birth and a fair proportion of mothers. I know that you can argue the statistics but interventions do save mothers and babies' lives...there is no question of that.

it is nigh on impossible to get a real picture of how much intervention really is necessary - as countries where none is available also suffer poverty, and a malnourished woman giving birth in insanitary circumstances unattended is not 'natural' either in my book.

i understand the point of the OPs post - birth matters, what happens to moher and chil matters - people should pay attention to birthing issues, and not dismiss it with the 'so long as you get a live baby' line.

incidentally, whoever mentioned the thread about the Nethelands, if you actually read the thread, you'll note that the stat quoted by the op of that thread was bollocks, and the neonatal morality rate is lower than France or the UK , the reason for their higher than previous mortality being a large immigrant population from poorer nations....