This article has me fuming....thoughts?

[PrincessZ]

I just read this article and I am so shocked at how they can categorically ban cesarean sections!
www.dailymail.co.uk/femail/article-2028443/Hospitals-ban-pregnant-women-having-c-sections-cost-cutting-move.html?ITO=google_news_rss_feed

I'm pregnant and I was going to ask for a cesarean. Reading this article has made me lose all hope.

Oh, and the article got me riled too.

Obviously no one is calling troll on the basis of linking to the article In fact there have been a number of posts discussing it over the past couPle of days and the discussions have remained sensible and sane.

"There has been discussion before about the obsession the WHO has with cs rates and no one seems to be able to find out their rational behind it. They do not seem to offer guidelines say for tears that only, for example, 1% of women should suffer from these or only 2% of women should have forceps used etc."

This is an excellent point, gailforce1; and one I hadn't thought about. In fact, it's interesting how all the statistics can be read in different contexts.

I was very happy to have my caesarean (for you, nickschick ), I will be happy to have another one should I have a second child, and I will live a full and happy life without ever knowing what contractions, labour or a baby coming out of my vagina actually feels like. If this means I have not 'given birth', that's ok with me too. I probably would have opted for a caesarean if DD had not been breech and I'd been rich enough.

I know this thread is a bit iffy, but taking cost out of the equation, I do think planned ELCS is a valid birth choice, and should be respected as such; in the same way a homebirth is, for example.

"There has been discussion before about the obsession the WHO has with cs rates and no one seems to be able to find out their rational behind it. They do not seem to offer guidelines say for tears that only, for example, 1% of women should suffer from these or only 2% of women should have forceps used etc."

I would assume that they look at examples of best practice and extrapolate their findings to similar populations. If some models of care result in an extremely low rate of perinatal and maternal death, while still maintaining a low c/s and assisted delivery rate, then - with a bit of juggling with the figures to take into account the variations in obesity, poverty etc in different countries - they conclude that these are the best possible outcomes women can hope for.

Are there WHO guidelines for assisted delivery rates too then, spudulika?

Having re-read the article on the front of the Sunday Times money saved is not going to be spent within the maternity sector.

The article says "The trusts stance is at odds with the position of NICE which is expected to acknowledge for the first time that cs on non-medical grounds area legitimate childbirth choice".
This must be leaving many women confused and unsure of how to proceed if they do wish to request a cs.

I think that it is a great shame that this thread has taken a side turning discussing whether or not the op is a troll. This is a serious issue affecting women and it is a great disservice not to discuss it fully and support the ideal of choice for women.

If this thread has got somewhat out of hand, in a way that others on this topic haven't (haven't read them, so I don't know), then other posters have been contributing to this state of affairs. There have been some pretty strident comments made about women, and presumably this includes the OP, who prefer not to have to have a baby come out of their vagina because they would like to keep their pelvic floor intact. If the OP has reacted "badly" then I think this is understandable based on the fact that some people have basically called her a spoilt prima donna and have accused her of being a troll.

There are WHO guidelines for 'normal birth'. I think 80% of births should be classed as 'normal' and I assume this means without instruments/c/s. (though could also include without augmentation/induction/episiotomy).

Agree gailforce1 that this is an important issue.

My understanding of the NICE guidelines at present is that women's request for a c/s on non medical grounds should be taken seriously and not dismissed out of hand.

Have to say - my heart sinks at the thought of c/s on demand within a birth culture where women continue to have poor experiences of vaginal birth and high rates of avoidable intervention because of substandard care - much of which can be attributed to poor staffing levels.

It's a vicious circle (cycle?) - poor care leading to worse births, leading to more requests for c/s, leading to more poor care for women trying for a normal birth, leading to more requests for c/s.

"and support the ideal of choice for women"

But it would be wrong to offer c/s on demand before 'fixing' the things that result in so many women having awful birth experiences which result in so many wanting surgery instead.

Women who want a normal vb a right to have that wish honoured too, and at present that's not happening consistently.

Thanks for info, spudulika. I agree with lots of your points, but not this one:

"But it would be wrong to offer c/s on demand before 'fixing' the things that result in so many women having awful birth experiences which result in so many wanting surgery instead. "

I think assuming that most women are choosing/would choose caesareans over vaginal births out of fear is a dangerous one. I would like to see a system which trains staff effectively to deal with natural births and allows women to choose caesareans. I don't think that the two have to be mutually exclusive. In fact, the only reason they are is cost.

Does anyone know what the WHO classify as a 'normal birth'?

Cadamomginger this isn't about people having a go at a a woman who doesn't want to give birth vaginally. That is not why troll has been called. Really it is not.

I know that is not why troll has been called. But I don't think this is the same person that started all those other threads, for the reasons I've already given. Those threads were utterly appalling. The way this OP is behaving is different. Why do you think this is the same troll? The similarities between the other threads were blindingly obvious.

But I still think, and this happened before the first accusations of trollery were made on the thread, that comments were made that could easily be construed as "having a go". Someone posted a comment about how this thread had all got rather nasty, unlike the others discussing this story. I just wanted to point out that if the OP has lashed out a bit, then others have too and the OP's reactions do not IMO, in and of themselves, indicate trollery. They could just be the reaction of someone who now feels got at. Some of the comments about putting your fanjo first make me feel got at.

[Bows out of thread]

"I don't think that the two have to be mutually exclusive. In fact, the only reason they are is cost"

I don't think it's as simple as increasing budgets overnight. There simply aren't enough midwives, qualified or in training, or experienced obstetricians to provide proper choice for women. Even if the government stumped up 500 million pounds tomorrow it would still be years before the staffing infrastructure was in place.

The World Health Organisation definition of normal birth is:
?Spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously [without help] in the vertex position [head down] between 37 and 42 completed weeks of pregnancy. After birth mother and baby are in good condition.?

"Even if the government stumped up 500 million pounds tomorrow it would still be years before the staffing infrastructure was in place. "

Indeed. But offering ELCS to women as a birth option need not preclude this; so the staffing infrastructure being in place is not necessarily a pre requisite for ELCS to be offered as a choice; nor should it be, IMO. My point is that the only reason it's an 'either/or' situation WRT ELCS and natural birth choices is the cost.

Interesting WHO definition, thanks- so that would seem to exclude all forms of intervention then...

I've only read the first 2 pages of this thread so sorry if I just repeat stuff. It may depend on your area but my understanding is that for a 1st baby with no complications attached or ann psychiatric note saying patient had a true phobia, you cannot get a cs.

I did get a consultant to agree to a cs for dc2 (before we even ttc) as dd1's birth led to more than 30 internal stitches and my care was poor - mw not listening etc. Consultant looked at my notes and apologised as it was clear things did not go like they should. He did agree but pg turns out to be ID twins and twin 1 is breech so cs is the only option anyway.

Basically, you will need a better reason than I don't want a vb for the NHS to cover it.

The reference to Canada as giving women the right to opt for a CS is ill founded, as the CS rate is lower there than here. They do have lots more epidurals though.

cardamom - the stillbirth troll also started a number of inoffensive threads and engaged in normal discussions as well as the highly inflammatory ones.

Of course not everyone who wants an ELCS is a troll but prolific trolls do alter their posting styles enough to keep people coming back to their threads as though they were genuine.

I am learning a lot about trolls this thread :)
I don't think CS should be offered free or optional on the NHS. It is major surgery. I don't really know any women who 'enjoy' giving birth or who don't worry about it. Most go through feelings of dread at some point but unfortunately thats childbirth for you.
If you have medical reasons where the consultant thinks a c section is preferable for safety of mother and child, that is entirely different.

Ivor, lots of major surgery is offered free on the NHS

Primafacie, is that Canadian lower rate necessarily an indicator that optional ELCS are a bad idea? Or have I misunderstood you? Apologies if so...

"But offering ELCS to women as a birth option need not preclude this; so the staffing infrastructure being in place is not necessarily a pre requisite for ELCS to be offered as a choice; nor should it be"

Women having ELCS have longer hospital stays and need more care after birth than women who've had a vaginal birth. In subsequent pregnancies they're more likely to have placental problems and complicated surgical deliveries. They're also more likely to be readmitted than women having vaginal births. I really can't see how the NHS could shoulder this increased burden the way things are right now. Especially in relation to postnatal care in the community. In some areas women are only getting one home visit from the midwives in the week after birth.

I know tethered but generally (unless it is an emergency) you have to wait for months before you get onto a waiting list and usually it is for something that is not 'optional' in making someone better.

"Women having ELCS have longer hospital stays and need more care after birth than women who've had a vaginal birth. In subsequent pregnancies they're more likely to have placental problems and complicated surgical deliveries. They're also more likely to be readmitted than women having vaginal births. I really can't see how the NHS could shoulder this increased burden the way things are right now. Especially in relation to postnatal care in the community. In some areas women are only getting one home visit from the midwives in the week after birth. "

Yes, but spudulika, all that refers to cost. There is no ethical or moral reason why it should be as you describe. The next part of my post was "My point is that the only reason it's an 'either/or' situation WRT ELCS and natural birth choices is the cost."

So I can see no other reason than cost for ELCS not being a valid birth option.

True enough, Ivor... but I'm trying to ascertain if there is a reason other than cost as to why an ELCS shouldn't be a valid birth option. Or perhaps cost is the only factor?