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'?

Also does anyone know the cause of incontinence in women who have had babies?

Is it the actual giving birth vaginally that causes incontinence or the fact that you have carried a child and your muscles have been stretched regardless of method of birth?

well i have had three, one emergency, two planned. My first was a prolonged rupture of the membranes, followed by that drip thing, a dural tap, 6 hours of active labour, baby in distress, failed forceps and ventouse as baby stuck in birth canal, couldn't find heartbeat, GA and emcs, meconium stained non breathing baby, really quite ill mother (blood count of below 4) Eventual disabled child

I couldn't give a flying fuck if people judge me for choosing to have two subsequent electives sections tbh :o

Has anyone actually come across someone who is a first time mum and actually wants a caesarean for no medical or mental reason??

I haven't, I think most first time mums want to have a natural birth.

I could be wrong, it would be interesting to hear from those who want a caesarean first time around and their reasoning.

buterflies the only people I've met who are first time mums and want a ELCS are in the country I'm originally from. There, everyone has private medical insurance, and the CS rates are 40%+. All the women I know who've had an ELCS in that country for their first baby are all of the mindset "why should I go through all the pain and agony when someone can just whip it out for me". I don't agree with it, but it's down to what money can buy you and never being forced to consider VB at all.

Don't agree with it personally, but if I was still living there, and I had had a crystal ball showing me what my VB was going to be like, I would have been joining them!!

nowaynohow
Do you think this is a lack of education though? Are these women fully aware of the risks of caesarean and the recovery time? (Not saying VB is free from risk)

Following my experience of giving birth by planned (not emergency) CS, I think I would have been wise to have opted for an elective CS. I didn't, because everyone, incl. my OB/GYN, said VB is best, but now that I've seen what an elective CS can be like, I'm glad I had to have one :)

If you want to significantly reduce the risk of having a section, book for a home birth. You will be in control of your environment and likely to have a midwife ( or two) in attendance. This was not the case when I had a hospital birth as there was a shortage of midwives due to the number of sections taking place at the time...

The idea that loads of women will ask for an elcs because they are "too posh to push" (hateful phrase) is absolute crap. Some women will ask for an elcs after trauma or because of a phobia, these are real reasons.

For the record I had one emcs after a horrible and terrifying 36 hour labour. I then had an elcs for a breech baby, it was very clinical and completely and utterly fantastic. I recovered from the elcs so much better than the emcs and I would have one again.

"Some women will ask for an elcs after trauma or because of a phobia, these are real reasons."

Can we stop this "real reasons" crap, though? I don't think it helps at all to distinguish between "good ELCS" and "bad ELCS" - Any reason a woman has for wanting an ELCS after looking at the ins and out of every possibility is a good enough reason.

If people stop condemning ELCS which are requested for the "wrong" reasons, that would stop women from having to justify themselves for exercising autonomy over their own bodies.

girlafraid This is my point, I don't think anyone thinks "oh I know I will have a caesarean" without looking at the pros and cons. Yes there may be a minority who are too posh to push but IME first time mums generally want a natural birth and its only after a bad time in labour the first time around that they consider elcs for subsequent births.

Well said, WidowWadman, couldn't agree more.

The potential dangers from an elective CS are the same, irrespective of your reasons. The only difference is in cost - if the NHS encourage only women with phobias to ask for CS, then fewer women will have CS and the cost to the NHS will be lower. Other than that, it shouldn't matter to me or you or anyone else why someone had an elective CS, it's their body, not yours.

jchocchip

If labour isn't going well then midwife would most likely send you to hospital anyway.
I had a vb with my son but I needed monitoring and a drip as baby had poohed and I wasnt dilating. It wasn't a good experience but I am glad I was in hospital as when DS was born he wasn't breathing and it was terrifying. Would hate to think what may have happened if I had been at home.

I am not against home births, if things are going well then I am all for it.

Tinsie I don't think the NHS should be encourage/promote asking for CS, but simply not put boulders in the way when a woman asks for it.

WidowWadman again, I agree. My point was that since we're not discussing this from the POV of NHS cost, we shouldn't be distinguishing between good and bad reasons. Either an elective CS is a dangerous/poor choice or it isn't, the reason why one chooses to go under the knife should make no difference at all.

Buterflies, labour is more likely to go well in a relaxed environment with one to one care from a midwife. They can deal with meconium and do monitor you. Babies often don't breathe straight away at birth but as long as the cord isn't cut they still get oxygen from the cord and pink up and home birth midwifes carry the necessary equipment for resusitation and get on with it if required. Obviously you can choose to transfer to hospital if necessary. The more information you have helps you accept what risks you are prepared to take. A second birth is likely to be more straightforward than a first. I do hope things go well for you this time.

Where I live a very high percentage of 1st time mothers opt for ELCS (in my hospital upto 90% in total but very few obstetricians will carry out vbacs and there are sometimes medical reasons so this % is higher than 1st time mums requesting but I would say it is easily 75%+). As I said in a previous post we have a private medical system in place...it is definitely unusual to hear of mothers having a VB even for 1st births. Sometimes it's for medical reasons and because the obstetricians advise this for dubious reasons....mainly mothers say they don't want incontinence (even though my gynae told me this is a risk for all women who have carried babies - obviously some complicated VBs clearly can worsen this condition)/want to choose the date they give birth/find it gross to give birth vaginally etc.. Etc...now these aren't necessarily stupid people. It just seems standard here...phrases such as my baby is coming out of the sunroof at 8am on xx March etc.. is common. Am not criticizing these people and quite honestly don't care as they are paying for this procedure and their choice. However this is why I find it hard to believe that some 1st time mums in the UK won't start to feel this way...and this would increase the numbers of ELCSand therefore costs..

Nearly every person I know from this country who is in the UK (and there are many) have complained as they see it is their right to have an ELCS on the NHS as they can do here but refuse to go private in the UK.

I've had 3 vaginal births then 1 CS and I can honestly say that the one I recovered fastest from was the CS. I know I was lucky not to get any secondary infection or other complications, but honestly having been a very committed natural birther (two of my children were born at home) I now no longer fear caesarians. In fact in the immediate aftermath (and still secretly now) I was quite a fan, not least because both DD3 and I are alive thanks to it.

Arguably, it is C Sections being done in non-crash situations that have enabled the improvements to be made to the operation that have made it as safe as it is now. So I thank all the ladies who have chosen over the years to have a CS as they are helping surgeons hone their knowledge and skills all the time in a non-pressurised scenario. If it were reserved for the 2% who really need or would die, I doubt recovery times would be anywhere near as good.

jchoccip so midwives can deal with the meconium, right. Do you want to tell that to my friend who's perfectly healthy term child died of meconium aspiration (albeit in hospital and not at home)

I don't dispute that a relaxed environment will help a birth going well, and I absolutely support a woman's right to choose where she gives birth.

However suggesting that either obstetric emergencies never occurr in a relaxed home atmosphere or that any obstetric emergency can be dealt with at home as easily as in hospital is disingenuous. It doesn't help women making an informed decision if you gloss over the risks of one setting.

We are having to FIGHT to get "REAL" reasons recognised because the press have created the MYTH that women are making decisions based on lifestyle choices. What little evidence there is out there does not support the idea that women are making decisions with "improper" reasons. What little evidence there is out there supports the idea that reasons behind a request are complex and take into consideration a lot of factors - all of which in my book, seem to be completely understandable and justifable as they are about physical and mental health.

Reasons for ELCS are extremely poorly recorded, and inconsistent. A government report in 2003 recommended it be changed. It hasn't changed anything - theres no standardisation to it. And they do not record 'mental health' considerations anywhere as part of that. The fact that women who may have mental health issues are getting caught up in a mythical situation where some reasons are 'ok' and some are 'not acceptable', and feel under greater pressure to justify something that may actually be very difficult to explain is appalling.

There is a thread elsewhere on MN where a woman complained about how the reasons why she was having an ELCS was recorded. Another woman came along and when she was asked that despite having been signed off by a doctor and a pyschologist for psycho-sexual reasons when a receptionist asked her, she couldn't bare the thought of trying to explain it all again to a non-clinical person when it had already caused her so much distress. In the end it was recorded as 'social' which upset this lady further.

The idea that hundreds of women are going to be queuing up for a CS to 'fit into their schedule' is part of the problem with judgments. And its UTTER bullshit. Preconceived ideas and judgments are hindering research and care into the subject and are damaging to vulnerable women.

Making a division into "REAL" reasons is at best judgmental and insensitive. At worst, very damaging.

Monsti
Nearly every person I know from this country who is in the UK (and there are many) have complained as they see it is their right to have an ELCS on the NHS as they can do here but refuse to go private in the UK.

How exactly are people supposed to go private in the UK, when the only private maternity wards in the country are in the SE? It really does make it rather difficult. I would be very happy to go private if they built a private ward in the NW of England. Sadly there seems little prospect of this happening, in the next couple of years to benefit me, due to the fact that people are just so precious about the NHS in this country.

People telling others to go private on this subject is something that absoluetely infuriates me and just highlight the complete and utter ignorance on the subject.

Its as bad as people saying that women should 'pay the difference' between an ELCS and a VB if they want one, and being the very same people who are protesting about private enterprise being brought into the NHS.

The public in the UK, want to have their cake and eat it. At the genuine expense of women who desparately want choice that is available in other countries but not in the UK and they feel is better for them on a psychical or mental level. Its not about being 'precious' about anything. Its about not wanting to suffer problems years after the fact and I think thats a pretty reasonable thing to expect from the NHS tbh.

Okay maybe Im being thick but I don't get the whole it's your body it's your choice thing.

For each person there is a delivery method (which could be CS, VB, home/hospital) which will give the best long term (physical and mental) prognosis for both mother and baby.

In the case of there being no prior information to indicate which of these options will be best on an individual basis, then you should opt for the one which gives the best results on average. As far as I know that is currently VB in hospital (although things may have changed since I had personal reasons to look into all this).

I don't see the role of the mothers choice in this (except in the mental aspect of the prognosis)?

Or rather I think that 'your body your choice' was the rule that was applied when you chose to conceive and bring the baby to full term. Having made that decision you are now committed to act in the babies best interests (who didnt get a choice and will be stuck with the consequences).

widowwadwoman that is terribly sad but happened in hospital. I did not say that emergencies never happen at home, they happen and are dealt with. The statistics are worth checking out. I'm not glossing over the risks, just think that women should decide for themselves which risks they are prepared to accept. Some women might assess their risks and decide they want an elective section. Others might decide that the umbilical cord is not to be clamped until the baby is breathing (resusitation can take place with the cord intact) I'm all for informed choice and no one should judge anyone for the choices they make.

NICEynice - also there is little consistency as what constitutes a "real" reason.

E.g. I requested my ELCS as I already had an EMCS, with a post partum infection (which increases risk of rupture), and because I knew that the monitors in the hospital I would be giving birth in would not allow me to move freely, which would reduce chance of VBAC success. I knew the stats for that particular trusts was 30% EMCS when trying to VBAC. This, together with having found the trying to do it vaginally part quite scary and very painful, I decided that I would not want to put myself through this again, if there's a high chance of ending up with a section anyway.

My consultant found my reasoning convincing and was happy to believe me that I had properly researched it. But you read a lot nowadays that previous CS is simply not a good enough reason anymore to request an ELCS.

So from fighting those who denied women the choice of trying to VBAC if they wished, they're now gone to denying women the choice of of ELCS.

Same with breech - if someone wants to attempt a vaginal breech birth and finds a supportive midwife and consultant, that's great for her.
But to go full circle and saying that every woman must attempt it vaginally, is patronising and doesn't take into account that people weigh risks differently.