The Observer's health editor says women ought to have C-sections instead of vaginal delivery.

[dizietsma]

\link{http://society.guardian.co.uk/health/news/0,,1723873,00.html\link to article}

I'm appalled. I haven't read it all the way through yet, but you can bet your bottom dollar I'll be writing to the Observer to complain about this shocking and irresponsible opinion piece.

WWW, you are saying everyone should be ecouraged one way until proven otherwise (at which point it is rather late to be discussing the other options). I am saying everyone should be given all the fact and allowed to make their choice.

Waggle, by Patient led care I meant when we get to the point where someone like me gather information for unqualified sources (friends, journalists, whomever) and then goes to the consultant hving made up their mind and demanding treatment x. It's crazy. Patients should be led by medical professionals whom they trust. But it isn't happening (at least not consistently) in todays NHS. And I think it's a real pity.

I agree with you Uwila (about being informed about choice). The problem is that it's very hard to see beyond one's own experience of birth and make judgements from that. And proper statistics seem incredibly hard to come by.

Uwila - the NICE guidelines were quoted to you earlier!!!! Sorry - were they not to your liking?!

Not really paolos girl. They are just that: statistics, which are not to be confused with cause an effect.

Also, the NICE guidelines are written with the intent to persuade women to have vaginal births. They are not necessarily unbiased. They are written from a point of view of national health, and not my health in particular. They take cost into consideration. It's all covered many posts down from here.

I am not saying everyone should have a caesarean. I am saying that a pregnant woman has as much right to a caesarean as she had to a natural birth. Ask her what she wants.

Morningpaper, can't cite just now but did read it recently, remember it cos results surprised me. Important bit is probably that there wasn't a statistical difference. This suggests the majority were similar but doesn't include small minorities who would have had different experience. Like all data its all open to subjective interpretation, "lies, damn lies and statistics"

Is a caesarean as safe as vaginal birth? Have a look at \link{http://www.radmid.demon.co.uk/csrisks.htm\this}

Nuff said eh

I think that if we really want to sort out the facts that we need to invite experts from both side of the debate to take part in the conversation. We can all find studies that support our particular views. I think it's fair to say that midwives tend to support natural births ad ob/gyns tend to support medicalised ones. Let's get representatives from boths schools of though here and hash it out.

ob/gyns are not involved in natural vaginal deliveries. go figure.

midwives by contrast are often present in cases of medical intervention including c-section aren't they?

why is the WHO putting pressure on national governments to bring down c-section rates? for economic reasons? i think not.

waggledancer, was it this \link{http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15937606&query_hl=8&itool=pubmed_docsum\one}

The women with least incontinence and happiest sexually were those who had truly uninterfered with births, surprise surprise: when a scalpel or a pair of forceps comes near you, either above or below, it aint going to be pretty :(

Uwila, I think midwives support natural birth because they see more of it. You just don't get obs/gyn at a homebirth. They tend to see only high risk and emergency cases, and so don't get exposed to normal birth. This is bound to bias your viewpoint ... if 100% of the cases you see are the dramatic ones, that's 100% of your experience and expertise. It must surely pale into the background that you are not seeing, say, 75-80% of births.
Also, obstetricians are fab at surgery and problematic cases. This is where their skill lies, often, and they must have the professional confidence that they can do a good job. Hey, if I was an ace surgeon I would want to intervene and help too - but maybe it would be tempting to intervene a tad too much.

I am a big fan of some midwives, but have encountered others some that in my experience have been terrible ... like every profession, you get your good and your bad. But the midwives I have met who attend homebirths, and are good at sitting on their hands and listening to women are wonderful. They have the experience and knowledge of birth to trust women and how good their bodies are at birthing. They know when to leave well alone, but also when things are not going well.

So its like comparing apples with elephants. They deal on a daily basis with completely different cases. One sees emergencies, and yes will see the disasters, and the other sees the vast majority. Would getting them to argue it out help?

I do agree you can find any study to back up your argument. But that radmid article was a summary of an awful lot of research. I read blinkin loads of research when planning my third child, and saw not a single credible piece of research from any reputable journal that showed that caesareans are safer than vaginal birth in normal circumstances.

Am a big fan of cs for the 5-10% of cases where it saves lives. But not as a vaginal bypass by choice. For me, just personally and with no offence intended, that feels like choosing artificial insemination over sex. Like insemination, cs is great if for valid reasons it cannot happen naturally - and accept that extreme fear, trauma as well as physical reasons can prevent normal birth. But lets face it, its not designed to be a choice substitute for the real thing.

fantastic post rachp...i was wracking my brains for a good analogy and you've hit it with AI.

Rachp, yes it was thanks. Am reading loads at present cos back to work April, and get mixed up where i see things.

You have put succinctly what i have been trying to say all day, so thanks for that too

I think one thing in this article that most everyone is overlooking is the fact that it was the author's sister who went through a traumatic birth and subsequent elective c-section for her second child. Even though the author states categorically that she had two unremarkable vaginal deliveries, you can bet that she has suffered birth trauma by proxy in watching what her sister has gone through. That is where this article is coming from. If you have never experienced birth trauma personally or through someone close to you, you really cannot imagine what it is like. The sheer amount of anger at what happened - no matter where the fault lies, if any - the recurring fear that comes at odd moments, especially at night, especially in your nightmares, that something horrible is going to happen to you or your child...it's an ongoing thing. The trauma has now become part of you, it's part of your life story and it colors everything from that point on, period. So, this woman has written her opinion because she has had a driving need to do something about what happened to her sister. And, really, how many times have you heard someone say they had a traumatic elective c-section?

As far as the cost issue in health care of vaginal deliveries vs. c-sections, I'm surprised there has been any debate about that at all. Cost is an issue in health care. It's just an unfortunate fact. And particularly a government-run program will have to look at this from every angle. It's not just deliveries, I'm sure. It can be something even such as when to do cataract surgery on a patient. There are guidelines. In the US, every day patients are denied some type of procedure because of the cost. Whether it's because they cannot afford to pay for it or because their insurance refuses to, the result is the same. But uwila has covered this subject admirably already.

Traumatic electives do happen and the distress is just the same as after vaginal deliveries or emergency sections. Giving all women choice of elective and presenting it as risk and consequence free is just as irresponsible as advocating one size fits all in any aspect of childbirth

WD, I'm not aware that anyone c-sections as risk and consequence free, certainly not the author of the article we have been discussing. If you will read to the end you will see this:

"Serious injury as a result of caesarean section is rare but there can be infections, damage to other organs and complications after the use of anaesthetic."

that is "I'm not aware that anyone has maintained c-sections are risk and consequence free,"

Good post rachd, I agree with you.

Exactly, Jabberwocky. Sections come with risk. Nobody says they don't. But so do vaginal births.

Expat etc: Just be thankful that you have a good sex life. The only person who would make sarcastic comments about sex not being that important are people who are lucky enough not to have suffered the trauma of not having the choice of having a sex life. Ever counselled an impotent man, or a woman who can't have sex because her body clamps up? For a lot of people who can't have sex, sex IS the most important thing in their lives. Lack of sex /inability to have sex destroys families and marriages and people's lives and mental health.

Who said I have a good sex life? I have raging PND. My meds have pretty much thrown a cold bucket of ice water on my libido. It's NOT the most important thing, and thankfully I have a partner who feels the same way I do.

What if my partner fell ill and was uanble to have sex? Well, I'd still be with him. I didn't marry him for sex.

Sorry but to use that as an excuse that women should have major surgery is just ridiculous, especially coming from a doctor whose job it is to do as little harm as possible is equally astonishing.

Expat: You are very lucky that you are your partner are happy if necessary to live in a long-term celibate relationship. Most people are most definitely not, and the possibility of never having a sex life again is devastating.

k, so what the hell does that have to do w/an article recommending every woman have a csection or a doctor who thinks women should have them to preserve their sex lives?

sorry i don't see the juxtaposition.

uh well I have had two vaginal births (one traumatic) and although dh did describe having sex as 'being in a familiar room with a lot of the furniture taken out' quite soon after having my babies, I can assure you that our sex life has been very pleasing for both of us for years after having my children. Hence my third due end of April.

Medical people often seem to live in a fantasy world where what they see is the norm, rather than accepting that it is the people that they dont see who are the norm.

CarolinaMoon, thanks for that. My worry about having to have a section is the skin to skin delivery as it is my firm belief it is essential for established good breastfeeding, so it looks like it is possible.

jabberwocky, I don't think anyone here would refuse a woman who has suffered with birth trauma the right to decide to have a c-section if she wants, I really DON'T think that was the jist of the article though. That anecdote was used to justify the author's position that women should consider c-sections as somehow superior to vaginal delivery, and frankly I think that viewpoint is rather niave, it is perfectly possible to suffer birth trauma from a c-section as much from a vaginal delivery!

The position that vaginal delivery somehow precludes a good sex life is ridiculous. I personally gave birth 8 months ago and the only difficulty in my sex life is when the baby wakes up and interrupts us! Yes some women suffer after traumatic births, but I know of a woman who suffered pelvic floor weakness after a C-Section too- it can happen you know!