Why is there so much judgement directed at c sections?

[DanceLikeTheWind]

I honestly don't want to start another endless VB v/s CS debate. I am just eager to read any insight that people may have on this topic- Why are other women so judgemental towards women who opt for c sections, whether elective primary c sections or repeat c sections?

There are several reasons why I will opt for a c section: a prior (minor) uterine prolapse, anxiety issues, and a family history of erb's palsy and incontinence.
I have faced nothing but judgement, ridicule and even hatred from other women :(:(

I am well aware that this is a major surgery with a longer recovery. I'm well aware it shouldn't be done prior to 39 weeks (unless of course I go into spontaneous labour). I'm well aware of the increased risk of complications in future pregnancies, however I don't plan on more than two babies.
I'm also aware of the risk of staph infection.

However, by opting for a c section I'm reducing my chances of developing
incontinence and prolapse. I have a zero chance of suffering an obstetric fistula, a third or fourth degree tear and perineal trauma.
My baby will be at a reduced risk of cerebral palsy, erb's palsy, brachial plexus nerve injuries and trauma caused by a possible assisted birth.

I'm not hard-selling c sections here, just pointing out that there are some benefits to a c section as well.
Why then do people only focus on the negatives? And why are the varied risks of a VB ignored simply because it's 'natural'?

MrsLowmain

Gosh, I really didn't know that an uncomplicated vaginal birth carries the least disadvantages. Thanks for clearing that up. Had I only known before choosing my ELCS or indeed my EMCS

Absolutely horrified at the number of ladies who have said they had caesareans and no one took any notice when they said the anaesthetic was not working. Please ring an obstetric litigation practice if this happens - interviews are often free. Failure to check the efficacy of regional anaesthesia for an operation is clinical negligence. Please throw the book at them. It stops them doing it to other women.

My mum had 4 CS. She would love to have had the chance of a VB but at least she got 4 healthy kids. So don't listen to the critics. Your true friends will support you and the others do not matter. With your family history I would probably do what you are doing - examine the evidence and make an informed decision for yourself.
Good luck.

Mrslowmain it is NOT necessarily safer to have a VB. if you stick to that argument you are just being ignorant. Are you actually a caveman?

It is about choice non? The best choice for each woman and her family on that day. Give us the peer reviewed papers and let me make my own choice.

Read thread with interest. I'm currently pregnant with my first and am deciding what my initial position is before going to see the midwife.

The initial question was along the lines of why do people have such strong opinions and emotions when it comes to this, and why do they then feel the need to be rude or defensive? It seems to me that because child birth is such a major life event coupled with real risks and high expectations, women want to feel they've made the right decision and done the best thing for their baby and themselves. There's bound to be some anxiety even if you are not fearful and looking forward to it. So when women argue strongly for a different choice then it provokes anxiety and defensiveness as to whether you've made the right decision yourself, whether the argument is presented as personal experience or as scientific evidence one way or the other. Hence why otherwise nice supportive people start acting out of character!

Have read through the NICE guidelines at length and been doing my own research also. As with so many of these things - the quality of the evidence is graded 'low' or 'very low'. Also, the absolute differences seem to me to be rather slim. Theres also a paucity of evidence on any number of things that I would consider relevant to the decision. This includes long term outcome for baby (I'm a psychiatrist so the idea of 5- 10 years as a long term outcome from childbirth is laughable to me) and long term outcome for mum. Again, because of my job I'm probably rather paranoid about the studies of long term psychiatric associations with 'minor' obstetric complications (increased risk schizophrenia, antisocial personality disorder etc) which I notice are not mentioned in the NICE guidelines at all.

I am aware I'm also influenced by anecdotal and subjective things. For example my medical training means I don't find the environment of a hospital or operating theatre frightening in the least and I personally was horrified by my experience as a medical student on the labour wards. I've never been interested in the 'because its natural' school of thought and can take or leave 'the beautiful experience' - I just want a healthy baby first, with the minimal risks to me. I also think people can view risk differently - I personally wouldn't accept the complication rates given for planned vb for any other procedure and feel disturbed at how commonly things seem to go wrong.

For all of these reasons, I think if I knew I was only going to have one child I'm fairly certain I'd want a CS. However, I might want 4! In which case the limited available evidence seems to me to point towards VB for at least the first one or two.

Ultimately however, I feel reassured that whatever I decide (assuming I can persuade my local trust to do an elective section for maternal request!) at least the risk of the most serious complications like neonatal and maternal death is very very low in this country for which we should all feel grateful.

I have had 3 sections, 1 of those elective. Althought really I didn't elect for it-it was medically required. I also have had VBs. 1 of these was difficult with a bad tear. I did prefer it to CS though very much. I felt a failure after m 1st baby's birth. At my post natal group, me and another caesarean mum were left out of talking about birth and a friend sneered,'well you didn't actually give birth though did you?'Hmmmm no I just bought the baby from a shop? Of course I gave birth! I also had the worst luck with twin births; combined delivery. 1st twin natural, 2nd crash section. People actually said I was lucky having twins as it meant one birth! Hmmmm

It is quite bizarre but that reaction is indeed out there- people say I shouldn't be disappointed with myself that I ended up with an emcs....errm i am not.It was totally positive and I look forward to the possibility if this next baby is too big, that I will have one again.

There is a reason the majority of female urologists and ob/gyn s choose elcs for themselves- when vb does go wrong and let us not pretend that indeed this is not spoken about nearly as much as the risks of CS, it can have life long consequences for mum and sometimes the babies....they see that and although chances are that most avoid this fate, enough experience and are witnessed by the female professionals who deal with them, it so that these professionals make a calculated decision to take the risks of the c section instead.

OP- ignore people- everyone is so opinionated on stuff to do with kids- just smile and nod and say how good you feel about your choice.
Sometimes having good manners is ignoring people's bad manners.

Welcome back Carriebradshaw.

FYI my baby has a huge bloody scar from a CS right across her upper arm which was fortunately in front of her face.

CS have risks too.

And you still need help before you get pregnant. Serious help.

Don't you love it when the shrink on the thread is in agreement with you;))
Me too Aramanatha- having worked with kids with cerebral palsey I am all too aware of the potential complications of a vb that do indeed happen for enough of a minority of women to make me willing to take the risks of cs to avoid being one of this unlucky minority.Healthy baby is all I care about and I find it a little odd all this focus some women place on them having this amazing, natural experience. Welll okay I find it selfish if the baby is put at risk through someone's pig minded desire to do it their way, in the face of complications.

Oh don't mistake this as hostility or judgement towards you if this is your position- I just think you are wrong.Sorry other second or third poster I could not resist.......

Aramantha, I couldn't agree more with you!

I had a CS under general anaesthetic, not out of choice but because my doctor thought it'd be safer for my baby due to complications. I had a very relaxed experience (considering the circumstances), little pain or discomfort, and what's more, the baby was born healthy and well. That's good enough for me. So I never went into labour and never experienced giving birth, but so what? Most of my friends who had VBs have horror stories to tell and many haven't recovered from the trauma even years down the line. Are these women accounted for in the stats? I very much doubt it.

Have three children. No pain relief in any of the periods of labour (all very fast, no time). Both girls were breech, the first undiagnosed, born feet first at home. When the second breech presented (17 years ago) the consultant asked me if I wanted a CS and I chose not to elect for that. I appreciated his respect for my wishes. I did not fear labour and would have feared an operation more. Also, I knew about the long recovery time (difficult if you already have a LO/LOs and in my case no family support other than a commuting, long hours working H). There should be choice but that choice should be accompanied by full, unbiased information on pros, cons etc from medical staff and respect for the mother's views.

I don't agree with the prejudice or negative reactions towards CS or other forms of intervention either. There is a long and murky history of society's (and women's) attitudes to mothers giving birth which have at times been misogynistic and occasionally downright sadistic (stirrups at birth, for starters - you'd never do it to a man).

The best delivery method is the one that is safest for both mother and baby and for some it will be a VB, for others a CS, and for others induction and whatever follows on after that. The point of giving birth is to end up with a healthy baby and well mother, not join some sort of club about who suffered the most or was more heroic. You want heroics, go and join a mountaineering club - or go volunteer in sub Saharan Africa.

The terms used in labour like "failure to progress" also don't help - as though a VB is a project that a woman and her midwife must somehow complete and if they don't it is somehow not a "success". Perhaps the term "obstructed progress" might be better. As healthcare professionals, we once looked through a textbook of obstetrics and noted that a lot of terms used had very pejorative tones and really needed a name change - we found ourselves having to explain them to the patients not to take the words literally.

I had a VB but for about 30 minutes at the end of it it could well have been an EMCS - the obstetrician attended and it did look as though it could go either way. In the end he felt the baby was almost out and we had a bit of time before we needed to do a CS. I don't see it as success or failure - I see it as a pretty great thing that baby was born with no major problems.

Am not normally a confrontational person but if someone said to a mother "you didn't actually give birth, did you?" I'd eject them from the premises! Even friends - or maybe they are really frenemies.

One of the main points raised here is the substandard care of mothers at the hands of midwives/nurses in the NHS.

I know a few of you have said you were up and walking around 2 hours after a CS, but this is unusual as I know hundreds of people who have had CS (I am abroad and am in the private sector and the CS rate is extremely high - upto 90% in our hospital) and in order to heal properly mothers should remain in bed for 12-24 hours after said operation (as per many other serious ops.)...I had an uncomplicated CS but had a drip and catheter in for 15 hours following the op. and felt very demeaned and helpless...DS was also "taken out" at 38 weeks and he wasn't ready and am sure that's why I struggled so much in the first few months and why he was so colicky...

We charge/pay a lot more for CS births as the cost of specialists not to mention the aftercare in hospital (an extra night or 2) is significantly higher than a VB. Obviously there are cost implications surrounding both complicated VBs and complicated CS but they pretty much cancel each other out..
My fear is that the NHS will not cope with even the smallest increase in CS and that this will lead to even more neglected mothers and babies as quite honestly the money and resources are not there....if money is found to cover the difference between VB and CS then in my opinion it should be used to employ more staff and train them to an acceptable level.

I also find it difficult to understand 1st time mothers who have such a strong fear of given birth vaginally but not by CS...

sleepywombat your friend may be upset about the EMCS, but if she failed to progress and it was deemed medically necessary, then her VB was going to be like the ones on "One Born Every Minute". It's not like she went straight for ELCS and now regrets it.

And this is the kind of story that makes me so sad - what kind of message have we been shoving down mother's throats when a woman who was NEVER going to give birth naturally in the case of that particular pregnancy feels like a failure for not having given birth naturally?? Poor thing. Please, it's your job as her friend to explain to her that VB isn't natural at all for many, many women, and that she should count herself very lucky that her and her LO came out of childbirth well and fine. If they'd forced the issue with the VB, who knows what could've happenend...

sometimes i wonder who these people are who OPs have such a problem with! I've told dozens of people I'm having a scheduled c-section (in a few weeks) and no one has said anything negative.

Montsti, FWIW I had a troublesome VB with forceps/episiotomy first time around and was on my back with a catheter for 20 hours.

I'm aware and wary of the ELCS risks but it has been advised by my NHS consultant for various reasons and I'm frankly glad to avoid the possibility of another unpredictable and prolonged labour that was traumatic for both me and my son.

monsti I second goodnight - I was flat on my back for 48 hours after VB, and yes, whilst it can be demeaning to have a catheter and not be able to move around for a few hours after CS, it's equally demeaning to need help going to the loo because you're so terrified of the pain from stitches. Or to need help just to clean yourself.

I also cost the NHS and absolute FORTUNE with my VB due to Dr's needed for surgery, a total of 5 days in hospital (pre and post delivery), the post-operative infection which raged for three months post-partem and required further medical attention, and the 6 weeks counselling they gave me to get over it.

Like an earlier poster mentioned, until (a) the stats for ELCS and EMCS are split up, and (b) until the follow on costs of complications from both CS and VB are taken into account, I fail to see how we can accurately determined what the true difference in cost is between VB and CS.

the problem is, you see, that there is a correlation between maternal death rate and C-sections.

Not sure why this isn't talked about more.

IN countries where the OB/Gyns are knife happy and like doing Caesarians, such as the US, the maternal death rate is sky high. Compare it to the maternal death rate in developed countries where vaginal birth is the norm and the outcomes are much better for women.

It's important to point out that often, C-sections are money-makers for the hospitals.

Male ob/gyns in particular are not keen on the unpredictability of birth, and may seek to control the outcome by preferring C-sections over vaginal delivery. THis is puzzling, because as mentioned above, there is a greater risk of the mother dying.

it's silly to say that women who needed a c-section are failures and. THat line of thinking is ridiculous.

however

it's equally silly to pretend that C-sections are better for the woman's body. They're not. In cases of pathology, then yes, they are necessary. BUt when you have some countries with a third of women giving birth by C-section, you know that this is not about women's health. It's political, and needs to be examined.

Is the maternal death rate in the US sky high because of CS alone, or because their health system is a bit pants, leaving especialler poorer people without cover? Or both?

I think it probably is a bit more complicated than just the CS. What's the maternal death rate like in areas where you've got a 90% CS rate?

The correlation between maternal death rate and C-sections may well be due to the fact that the vast majority of problematic births end up in C-sections, often emergency ones where mother and baby are distressed following an attempted and failed VB.

To look at how CS compares to VB from a safety point of view, we need to compare healthy women who have elective C-sections to healthy women who have VBs in developed countries with adequate health provision. Is the maternal death rate for CS considerably higher in those cases? I very much doubt it.

Apologies that part of my post was misinterpreted. I was just giving another opinion of post-CS in response to the few mothers on here who have made it sound as though it is completely standard to be up-and-about after a CS. As I said there are additional costs surrounding complications of both VBs and CS and they probably would cancel each other out and therefore we would be comparing straightforward VB and straightforward CS.

I have absolutely no issue with CS or VB (and don't understand the negative attitudes towards either - ironically here people are very judgmental towards those having VBs) and both can bring about positive and negative experiences and both carry risks so neither is an easy option. Experiences differ not only from mother to mother but also birth to birth. My CS wasn't all negative and I am having another one next year..

My main concern is the apparent negligence and lack of proper care by hospital staff and my fear is that this will only get worse should the CS rates increase...please don't compare the NHS to other countries medical care as in most of the perceived better countries either you pay for the service (in addition to high taxes etc..) or the populations are considerably lower. And yes when you pay the CS rate is much higher as obstreticians make more money from CS and obviously have a more predictable workload I.e. 30 mins in theatre much better for them than hanging around whilst their patients labour for hours...

tinsie you're spot on. EMCS take place when the labour is already going wrong, and there are already problems and risks, so it wouldn't surprise me in the slightest that EMCS carry a higher rate of both infant and maternal mortality.

That's why that stats need to be split to show information about ELCS alone. Although, I wonder that maybe the reason this isn't done is because, actually, the stats show ELCS in too favourable a light when taken out of the shadow EMCS?

I have previously posted saying that VB has got to be in the best interests of the mother and child. However since reading up a little more I am becoming more and more undecided.

I have one DS who is 6 and the birth was quite traumatic to me, as I was continually monitored ended up having a epidural as wasnt progressing etc etc.
To be honest I was petrified as I didn't know why I had to be monitored etc.

I am now pregnant with my second child and whilst my personal choice is to go for VB again, this is my choice and my choice alone. I am nervous about it but having read a book on labour and why intervention is needed and what forms of pain relief are available I feel much better prepared and personally it feels preferable to a caesarean.

I think women should read up on the pros and cons of both VB and caesarean and be able to make their choice from there. As long as the woman is making an INFORMED choice then tbh its no one elses business.

One of my best friends has just had her first baby by emergency caesarean as he was breech and really big 9 pound 3! My friend is a very petite size 8. She would have loved to have a natural birth and had done hypno birthing classes but it just didn't work out that way for her.