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'?

Actually oldmum if we were so badly designed then we'd be giving birth later. We have evolved to give birth earlier. That's doesn't make our bodies poorly designed.

And Widow I didn't say CS were unnatural

"so having a homebirth doesn't neccessarily mean that you will be getting a problem free birth"

No. I don't think anyone's suggested that this is the case have they?

"as above experience probably isn't the norm"

No. Homebirth is associated with excellent psychological and clinical outcomes for women. Better than for low risk women giving birth in consultant led units. And women who've had both a hospital and a home birth almost always express a strong preference for giving birth at home.

"The mortality rate for women and babies in unattended "natural" births is massive compared with other animals."

Yes, this is true.

But the vast majority of healthy mothers who've had proper antenatal care are capable of a complication free vaginal birth, with nothing more than low-tech midwifery care, as evidenced by the very high spontaneous birth rate achieved by independent midwives in the UK.

And what's really interesting is that the really massive falls in maternal mortality in the UK happened long, long before the advent of routine c/s. In the 1950's we had maternal death rate of less than 1 in a 1000 at a time when the c/s rate was less than 2%......

TheRhubarb - Try reading the guidelines about the costs. There is a WHOLE section called, "health economics" and an appendix later on in the document...

Its here:
guidance.nice.org.uk/CG132/Guidance/pdf/English - Page 100.

prince - I do not agree with giving anybody a CS by request, how stupid is that!

About as stupid as not actually asking the million dollar question - WHY ARE WOMEN ASKING FOR THEM?! If you know the answer its not so stupid its actually very understandable. If you are at high risk of a EMCS where the risks are MUCH higher than an ELCS or you have mental health issues for example. But I do appreciate its much easy to just shout and make others feel like crap for trying to do what they think is the best option for them and their child, just because it doesn't fit into your little world view and knowledge.

oldmum42 - I love the old nature argument, as if nature doesn't screw up too...

With regard to EMCS, I hope they do a lot more with this:
Latic acid test to see if a C-Section is likely in labour. Its a shame its being lead by Sweden when the initial research was done in Liverpool. We have missed out on this one...

1/1000 is still rather high compared to today's [http://www.patient.co.uk/doctor/Maternal-Mortality.htm stats]].

1/1000 is still rather high compared to today's stats.

I think shag's point is an interesting one - CS haven't resulted in a magic improvement in outcomes, especially maternal death (I think overall the risk may be slightly higher for mums). It's better care overall which has helped - especially things like hygiene.

I think the CS v VB debate is more about offering choice to women who have a fear or medical reason to not want a VB - it's not about CS being better or worse overall because there are so many factors to consider.

oldmum, I totally agree. The circumstances under which I would agree to induction would be very few and far between - I think they're responsible for so many bad outcomes.

I havent read the entire thread, but CS is a procedure which is expensive and I feel like any other procedure which is rationed by the NHS, it would need to be rationed.If you need CS due to previous birth difficulties, previous CS, etc, then that is ok and justifiable expense, however if you want it due to other reasons, I think its reasonable to deny it.NHS has to prioritise procedures, and I agree that more ops mean more diverting of resources from labouring women.Is that a justifiable cost?

I think, if we're all honest about it, that there are quite a few women who had VBs, who would have given their eye teeth for a CS. And now that it looks like you can have a CS if you want one, a few of us are perhaps a little envious.

I also think that we all secretly suspect that CS is the 'easy' way out, hence why so many of us who have had CSs go on about it being major surgery and now much longer the recovery time is - to somehow try to put forward that we have had just as tough a time as those who had VBs. How much longer 'recovery time' can you get than a lifetime of incontinence though, I ask you? And sadly, for the child born starved of oxygen during a difficult VB, there sometimes simply is no recovery.

I think the statistics on 'incontinence' after VB are vastly skewed by the fact that many of us simply don't report it. One friend wouldn't dare have a go on her children's trampoline because she doesn't have the bladder control anymore, and another has to stop drinking any liquids at all after 6 p.m. so that she doesn't have to get up in the night to go to the loo. Another cannot sneeze without a little leak. In fact, I'm not sure I know one single woman, who has had a VB, who can honestly say that their bladder control is as good as it was pre-birth. Personally, I have great trouble stopping mid-flow now, whereas before, it was easy.

I shan't go into the problems of faecal incontinence that some women suffer, but those too are under reported.

I have a friend who has had one VB and one CS. She'd go for the CS every time. I also have a group of friends who all live abroad, and who have all had access to ELCSs. All bar one have gone for the CS, including one who is a nurse. Their reasons? Safer for the baby, and no risk of all the nasty post-vaginal-birth things the OP mentioned. All had a wonderful experience and all recovered very quickly and nicely thank you.

I know that as a profession, midwives are going to denounce this new 'choice' we might have access to, but let's be very clear - part of this is a fear of their jobs becoming redundant.

I'm personally not sure what side I'd come down on, but if the safety of my baby were better assured by having a CS, then that would be my choice without a doubt.

I had a very straightforward, fairly quick VB with DC1, no pain relief. I thought it was a horrendous experience. When DC2 was breech, I was secretly pleased because I thought I could avoid all that pain and have a nice easy c section.

I had the straightforward c section, no complications but boy, was I wrong. Having had both, I would pick a VB over a CS every single time.

What my story illustrates is that a CS is generally perceived to be the 'easier', 'nicer' etc. option and I think that is a misconception. Obviously there are exceptions when things go wrong with a VB but when you compare the two like-for-like, assuming no complicating factors, why is it a CS would come out on top for a lot of people?

op, i agree with you. having had an absolutely horrendous vb with all the possible nasty complications, 2nd time i had an elcs and it was all so much better. i realised how much i missed out on enjoying the newborn stage with ds as i was in so much pain shock and trauma after the vb. after elcs it was incomparable and was able to bond with dd much more. no probs with breastfeeding in fact it was much better with dd.

i think its true those who have had a straightforward vb just dont get how bad an experience it can be. i have definitely had judgement against me for having elcs even when i try to explain re incontinence etc, but then why should i have to? its because the risks of vb arent talked about. i had never heard of forceps until they were used on me just as well i never saw them till after!

even my sis in law who is a medic and doesnt have kids is always going on about risks of cs. she doesnt seem to get how bad a vb can be as she has only assisted in normal deliveries.

anyway i know where you are coming from. good luck!

"Obviously there are exceptions when things go wrong with a VB but when you compare the two like-for-like, assuming no complicating factors, why is it a CS would come out on top for a lot of people?"

In my case it is because you can only know whether a birth is complication free in retrospective. Even if you had the most straightforward pregnancy in the world, there is no guarantee that it doesn't go tits-up at the birth. But I guess other people have other reasons.

Good post passmethebucket. I had an elective CS for my 1st DC last year. I've been surprised by how many women, including the women who were very pro natural childbirth, 'no epidural for me' etc before they gave birth have privately asked me how I 'got' my caesarian. Often the same women who are very negative in general conversation about CS. And sometimes rather angry at me for having one. Some very confused feelings and attitudes out there.

Passmethebucket
There might be a few women who would have preferred a CS but there are probably a few who had a CS who would have preferred a VB.

"I also think that we all secretly suspect that CS is the 'easy' way out,"

Not all of us. I certainly don't and am quite happy to have had VBs.

"How much longer 'recovery time' can you get than a lifetime of incontinence"

Not everyone has a lifetime of incontinence.

I think the statistics on 'incontinence' after VB are vastly skewed by the fact that many of us simply don't report it.
Is there definite proof that it is VB that is the cause of incontinence and not pregnancy or age?

does anyone actually discuss their births with others? Really, do they? How tiresome.

I must live in a parallel universe as the subject has never come up!

Nowaynohow - I think you have misinterpreted me! My main point is that I find it very difficult to understand how something that is a natural function should in itself be frightening to someone who has not experienced it compared with the prospect of actually being cut open and having the baby removed by someone you don't know - which seems a terrifying idea in the abstract. Like a lot of people on this thread I've recounted a positive experience of VB and only added that in a hospital that was committed to natural birth methods encouragment and support helped me through.
Obviously if I'd had a low placenta or pre ecampsia or any one of the other life threatening conditions that can develop I'd have been off to the theatre for a CS like a shot, and been very grateful for it.

but in case any strangers on the web care, i've had two planned sections, one in singapore (extended breech) and one in london very recently. i actually went into labour a few hours before i was booked in and still went with the section (can't quite believe that they were surprised that i opted for that given the state i was in contracting like that)

both were joyous, delivered my babies safely and were easy to recover from in my case.

have been bfeeding for years. it's a myth that it affects it.

can we please stop falling into the natural fallacy.

higgle have a conversation with someone suffering from primary tocophobia, and they will often use language that other women don't (OP stinks of it). Your difficulty in understanding them or even trying to understand is about YOUR beliefs and not theirs. You need to ask questions not close your ears and go "la la la well my experience and I think". Trying listening...

"Nowaynohow - I think you have misinterpreted me! My main point is that I find it very difficult to understand how something that is a natural function should in itself be frightening to someone who has not experienced it compared with the prospect of actually being cut open and having the baby removed by someone you don't know - which seems a terrifying idea in the abstract. "

So, you don't need to have experienced a CS to be scared of it - I don't need to have experienced a 4th degree tear to be scared of it.

I was scared of CS more than anything else before I experienced it, btw and then found my fear to be unfounded.

"I think the statistics on 'incontinence' after VB are vastly skewed by the fact that many of us simply don't report it"

I agree.

Ditto women with minor incontinence who've had planned c/s. Because a great deal of minor incontinence following pregnancy is linked to the strain on your pelvic floor caused by having 20lbs+ of baby/uterus/aminiotic fluid/placenta bouncing around on it during the third trimester, regardless of mode of birth.

And most women with minor incontinence don't report it because frankly they don't care about it that much. It doesn't impact on their quality of of life enough to want to do anything about it.

"I know that as a profession, midwives are going to denounce this new 'choice' we might have access to, but let's be very clear - part of this is a fear of their jobs becoming redundant."

Yup. Because women who have c/s don't need midwifery care do they?

"Even if you had the most straightforward pregnancy in the world, there is no guarantee that it doesn't go tits-up at the birth."

I've just been looking at research from Australia showing that less than 1% of low risk multiparous women who have a vaginal birth will need an emergency c/s. And of course the vast majority of emergency c/s are without complications.

I really think that it's hard to talk sensibly about this subject without actually knowing much about the rates of complications in labour among different groups. The comparative risks and benefits of v/b and planned c/s will be very different for women from groups with very low rates of complications in labour.

"before they gave birth have privately asked me how I 'got' my caesarian"

I think what you'll find is that women tend to talk very differently about this subject according to who they're talking to. Just like many women who are passionate about breastfeeding will play down their feelings about it, or even sound quite negative when they're trying to show sympathy and friendship to women who're formula feeding. Same with women who have their babies at home. Often when they're talking to friends who've had hospital births complete with epidurals, they'll talk about how during their homebirth they experienced feelings of desparetion and longing for an epidural. But when they get together with other women who feel the same as they do, whether it's about breastfeeding or homebirth, (or planned c/s!), then the brakes come off and they let rip with their true feelings - which tend to be strongly in favour of whatever mode of birth/feeding they had (as long as they had really good care and a good outcome).

"I'm personally not sure what side I'd come down on, but if the safety of my baby were better assured by having a CS, then that would be my choice without a doubt."

It may be that there is a TINY advantage to the first baby born by c/s. But then I imagine this is offset by the increased risk of complications caused by abnormal placentation and scar rupture for pregnancies following c/s.

I find one of the most frustrating things about this discussion is that there's very little acknowledgement of the fact that ALL women who have a planned c/s will face increased likelihood of complications (some very serious, like placenta accreta and percreta) in subsequent pregnancies, whereas only a minority of those opting for a vaginal birth will have a c/s resulting in the same worries for future pregnancies. Really - we should be looking at the risks and benefits over a woman's whole reproductive life, not just with the present pregnancy.

I think some people have a thing with vaginal childbirth being some sort of right of passage, part of being a woman type thing and by having c-sections women are somehow shirking their duties, wriggling out of it etc. The attitude towards it shown in the press demonstrates this. you can get boob jobs on the NHS, but not much attention gets given to that. Yet this morning a male news anchor on the BBC asked someone from the royal college of midwives if this guidence from NICE wasn't going to "arm women" when they talk to their doctors. Seriously "arm women". I hope if he gets piles, he opts to go with nature and keeps them.

If you're in the less than 1% group, then you don't care that it went alright for the other 99%. Statistics work on a population level, but not for the individual incident.

I certainly didn't expect to have my first pregnancy end the way it did and had no reason to

If you want to take the gamble, yes, you've got a pretty good chance that things go well. Doesn't mean though that you should be forced to take that gamble over another. Doesn't mean you shouldn't be allowed to choose which set of risks you take.