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'?

Absolutely i agree, there is no one reason why this rate is so high, there are a number of factors. There is always more to it than meets the eye. It does actually say on the website amongst the reasons that some women do request them for 'convenience', I would take this as meaning so it happens on a day which suits them for whatever reasons or commitments they have. These are the cs that I don't think the nhs should offer. I don't have any issues what so ever with any of the other reasons.

Devils Advocate Hat firmly on.

If you live outside London, then perhaps there might be a valid reason for picking a certain day. And its more of an issue than if you live locally. Perhaps the mother might be staying in London in the run up to the birth, but need her husband who is less flexible to be there? Convenience doesn't just have to be able fitting into a schedule, it can be about other factors and concerns, that may also come into a wider decision...

Grrr I just lost my post!
I think if you were a candidate anyway then fair enough, it needs to be booked in and you need a date. I don't think it is a good enough reason to say, I want to go private, I don't live near by so will need a section to ensure I can be there at the right time, if that is what is anyone does. There are lots of local hospitals near by, then at least if any problems arise in the pregnancy then at it is easier to deal with. I am saying this as I had numerous admissions during both pregnancies and after my last one. Just because a cs is booked for a certain day it doesn't mean you arent going to need intervention sooner, or even make it to the date. My babies arrived at 36 and 37 wks. this kind of scenario probably wouldn't arise with the nhs anyway as women tend to go local.

No I agree, baby might disagree with your plans, but it does give you the opportunity to have plan A, and plan B. But then thats the same for any delivery... My point is that, if you are having a baby locally, then time/scheduling is less of a worry and something that perhaps doesn't need to be accommodated in the same way.

As a matter of interest where does it say this? Had a quick look and couldn't see it on their website. (Maybe I'm being blind here). I'm intrigued now! (Kinda want to know if they are pushing this as a reason for birth and it has a baring on my opinion) Is it exclusively about delivery date or more general (including antenatal appointments etc)?

No its not stating it is a reason or births, more so that it is a reason that sometimes a woman may want one. It's on the cs facts page where it gives all of the reasons why a cs may be necessary or desired. It does say that sometimes a second opinion would be necessary which I would say would be the case of requests such as this. God I'm destined to have one on this pregnancy after all of this! My fear about cs extends to any medical things being done to me so this is not unique!

Your choice, take as much advice as possible, look carefully into post adhesions and complictions thereof. Best of Luck for the future.

wish i'd have been warned about the dangers of a vb before having my dd, noone warned me i couuld get a 4th degree tear have to have a repair operation and still have problems 4 and a half years later.

imo alot of people slag off cs, as they object to the cost and they think if ive suffered you can too.
which is really sad.

i think woman should be treated like mature adults told the risks of both options then make an informed descion.

hcp should be able to look holistically about mental/physiological impact of a vb and why some mothers have valid clinical reasons and are eligible for a cs. rcog guidelines clearly acknowledge and endorse taking psychological/mental health factors into consideration when making decision

and yes this too posh to push is a bit of a stick for birth zealots to beat mothers with

i also had an antenatal class were it was implicit that a "proper birth" was push pain,and perspiration. none of your wussy cs sections favoured by princesses who didnt want sweat to make mascara run.no siree she made it clear what a real birth was

there seems to be an assumption that elcs is psychologically less traumatic than vb, which seems strange to me. i found the whole process surreal and upsetting in comparison to my vb, which were by no means easy.

hazeyjane - an ELCS can be great, or traumatic, same as VB - there aren't absolutes.

I've had someone spending ages explaining to me that I'm just deluded for having found my ELCS a great experience, and I haven't worked through the trauma yet, my brain is shutting it out, and that's the only reason why I'm not admitting to how horrible it was. Obviously she's an idiot.

I've no doubt that you found your ELCS upsetting, and that's a normal feeling but that doesn't mean that it is upsetting to everyone, and that not having found it upsetting isn't as normal.

It's difficult to think outside the box and realising that one's own feelings aren't invalidated if not everyone feels exactly the same, I guess. I have the same problem with not quite being able to understand whysome people would enjoy the actual birthing process. However it's quite obvious they do, so that's cool and doesn't make either of us wrong.

I completely agree, Widow, I guess I am not saying that it is an either or thing, and that i can't understand why anyone wouldn't find it traumatic. It is just that when people talk about having had traumatic vaginal births, an elective caesarean is offered up as a solution, the assumption being that it couldn't be worse than a bad vaginal birth. I was convinced that a caesarean could not be worse than dd1's birth, and on threads here I had only really read positive experiences, so I was shocked by how I felt after having ds.

It really worries me that the 'laywoman' is not up to deciding how to birth. That is just damn insulting. The role of an HCP is to provide the facts, advise and help 'laypeople' make a decision not dictate to them.

In answer to the OP's question it is to do with competitiveness and one-upmanship amongst a small minority of women.

Women should be given the facts and be allowed to choose. Right now few facts are given at all. If based on this someone decides that they want a CS then that is up to them. It isnt tbh a particularly pricey procedure anyway. Most women given the choice will avoid major surgery so I doubt the CS rate would even change much.

I just dont really get why anyone thinks it is their business how someone else chooses to give birth.

I dont get how it is insulting that the 'laywoman' doesnt have all the info or statistical knowledge to make a truly informed decision. I have a day job and I dont have time to go through the hundreds of possible side effects of CS or VB and compare all the data and run the cost/benefit analysis on a hundred simultaneous variables.....

When you get a mortgage you get a questionnaire asking how important it is to you personally to be protected against various possible future financial disasters so that they can cover their arses make sure you end up the right policy for you. Sure you could spend 6 months solid understanding everything to do with various forms of insurance and mortgage repayment policies and in the end you over look something important.....

So why cant medical procedures be the same? You fill in a questionnaire saying which side effects are particularly important to you to avoid and then the doctors tell you which procedure matches your requirements best.

"When you get a mortgage you get a questionnaire asking how important it is to you personally to be protected against various possible future financial disasters so that they can cover their arses make sure you end up the right policy for you. Sure you could spend 6 months solid understanding everything to do with various forms of insurance and mortgage repayment policies and in the end you over look something important....."

I don't have a mortgage but I wouldn't sign any contract without having properly researched what I'm doing. Especially when it is a high value thing.
If I get missold anything I've only got myself to blame.

Well I am glad you have both the time and the mental facility to do that.

Are you suggesting that everyone who does not deserves whatever they get?

I helped to teach year 10/11 students bottom set maths and you should know that there are a significant number of people leaving school each year that would struggle to calculate change from a pound let alone the pros and cons of job insurance or medical procedures. By your reckoning these people deserve to be taken advantage of, told what to do or (imho) worse told that their birth method is entirely up to them to research understand and make a reasoned decision the result of which may have profound implications for their babies safety and quality of life.

The mortgage comparison one is an amusing one. We've just been missold a mortgage. Funny thing is the building society bent over backwards to sort out the mess, when we threatened them with the FSA. Why?

Well, we had asked all the relevant questions and had them in writing, when we arranged it. We had a concern that they were selling us a package that was unsuitable for us, and we did query it. But they insisted it was fine. Turned out we were right all along...

mmaaan nobend mortgage advisors wrecking my otherwise water tight not point.....

Haha! Sorry. You were admittedly unlucky with that one. Worked out to our favour in the end. They paid fees for even better deal with better interest rate.

I think it probably says a lot about my and DH though. We don't take it for granted that the experts will always get it right and its in your interest to find out information on any important decision off your own back in addition to what you are told. There is a always a risk of experts to make assumptions, be too busy or miss something important. If you are informed you are able to question things better and better placed to get whats right for you. We never take anything at face value as a rule. I think that to place complete faith in anyone is misplace blind faith. I think where ever possible you should take responsibility too. We've the type of people who go independent holidays, sometimes to unusual places rather than getting a sunny package holiday where its all done for you. Its just not in our mindset to just let others take control of a decision like that.

entropygirl

Nobody deserves to be taken advantage of, but people will be taken advantage of if they're not careful. Sometimes not even willfully, but if you sign a contract without checking, you might end up out of pocket. Or without insurance protection you thought you had etc etc.

If a woman decides that she rather goes by the professional recommendation without querying it, it is still her decision to do this. But just because some women rather get not involved with the risk assessment and subsequent decision making with regards to the birth of their children doesn't mean that every woman would decide to hand over to the HCPs completely without being involved.

Going to a CLU and following the HCPs recommendations is as much a decision as deciding to read up on it and stating preferences about your care.

This is being compared to a mortgage?!?! Sheesh.....!

One of our recommended hospitals is Queens. Assuming anyone has seen the news this past 12mths and 5 deaths, and numerous dodgy births later then frankly you wouldn't assume that either version of birth is simple.

In either direction its the quality of staff that matter. Neither is "best". Its so individual, hence the issue, accountants hate "what ifs" and only work on absolutes. CS = a much more monetary mathematical certainty more or less so is probably preferred.

I might feel that if men gave birth Im really not sure it would be an issue however a woman runs Queens maternity and is doing away with lots of the local population quite well with none stopping her/staff. Anywhere else she would be locked up for something like murder, apparently here she just says "oops sorry Ill/We will do better" and gets away with it! Its farcical. Seriously want to cry when I see National/Local Press on it now...... Its just not right.

I have some health problems and have recently been strongly advised to have an elective c-section by obstetrician/anaesthetist etc for my first baby. Initially i was gutted not to be able to deliver my baby "naturally" but having looked into it extensively in the context of my medical problems i have agreed. I now know that no matter what anyone thinks of it or says to me being a good parent is about making the best choice for your baby over and above what you might want yourself and that for me trying to go ahead with VB for my own selfish reasons would be irresponsible. However its not all plain sailing, i am a little embarassed telling people and I am struggling to know how to meet other pregnant people in my area as all the NCT classes etc are about childbirth and labour! any tips would be gratefully recieved. thanks :)

Clueless - I'm in a similar position to you, and I'm midway through my antenatal NCT classes. I'd say they are still really useful, only one out of the 6 sessions is dedicated to 'normal birth'. The rest: feeding, first few days with baby (nappies, bathing etc), what the hospital will be like and how to get the most out of ante and post-natal care, and most of all meeting and getting to know other mums-to-be. Don't rule NCT out - yes they can be a bit focused on ideal situations, but at the end of the day there are 8 of us there and statistically I won't be the only one there who ends up having a c-section, whether elective or emergency!

Like what the op said I wished I had been told I could get a 4-degree tear and end up with a bag I was never told that could happen now my life is ruined with nerve pain/tissue damage and having a stoma in the new year

This link clearly states that anal sphincter damage and fecal incontinence are more common after vaginal births.
"Occult sphincter defects are common after vaginal delivery, especially forceps delivery, and are often associated with disturbance of bowel function."
www.nejm.org/doi/full/10.1056/NEJM199312233292601

The following link states
"Trauma to the perineum is a serious and frequent problem after childbirth, with about 350 000 women each year in the UK needing sutures for perineal injury after spontaneous vaginal delivery, and many millions more worldwide"

www.sciencedirect.com/science/article/pii/S0140673602093121

HealthGrades has stated in a recent study that the rate of complications with vaginal births was higher in hospitals with lower c section rates.
The say that their findings are suggestive( but not indicative ) of an under utilisation of pre planned c section births.

www.healthgrades.com/media/english/pdf/Patient_Choice_Csection_Study_July_2003.pdf

The WHO has admitted subtly that there is no longer a need to impose a 15% c section rate as the evidence indicating that is ambiguous.

www.unfpa.org/webdav/site/global/shared/documents/publications/2009/obstetric_monitoring.pdf

Countries which are moving progressive.y towards lower maternal mortality such as China have the high c section rates.

www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60518-1/abstract
( The above link shows research indicating the progress in Egypt, China, Bolivia and Ecuador. For individual c sections rates refer to Wikipedia )

This link
www.seminperinat.com/article/S0146-0005(06)00100-5/abstract states that the incidence of brachial plexus nerve palsy is lower with c sections.
"Currently, the occurrence rate of brachial plexus palsy at the time of vaginal delivery ranges from 0.047% to 0.6% and for cesarean section from 0.0042% to 0.095%"
It also states "Overall, the frequency of significant fetal injury is significantly greater with vaginal delivery, especially operative vaginal delivery, than with cesarean section for the nonlaboring woman at 39 weeks EGA or near term when early labor has been established."
And,
"It can be estimated that delivery at 39 weeks EGA would prevent 2 fetal deaths per 1000 living fetuses. This would translate into the prevention of as many as 6000 intrauterine fetal demises in the United States annually?an impact that far exceeds any other strategy implemented for stillbirth reduction thus far."

This research article from medscape states that elective c sections should be allowed for informed women.
It also states forcing c sections on women is not advisable.

www.medscape.com/viewarticle/720648

This is a very interesting research article ( with research citations at the bottom ) from the British Medical Journal, which states the elective c sections are justified for informed women and that 31% of London's female obstetricians would opt for an elective c section themselves.

www.bmj.com/content/317/7156/462.full

This is a research paper on the safest mode of delivery for twins with the following conclusion-
"Conclusion: Planned caesarean section may reduce the risk of perinatal death of twins at term by approximately 75% compared with attempting vaginal birth. This is principally due to reducing the risk of death of the second twin due to intrapartum anoxia."

onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2005.00631.x/full