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

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\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.

Ah, now I'm back to disagreeing. The risks and benefits of both should be presented, and the mother should be given the choice. But, that is not the experience I had. Natural childbirth is promoted. Caesareans are barely mentioned. They are certainly not freely offered as an option. Women are kept in the dark. And then when things go wrong and they end up in an emergency section, you are made to feel disappointed with the way things turned out. I can't even count the number of people who upon hearing my first birth story said "oh, I'm sorry" or "poor you". Sorry, have I done something wrong? I have this lovely baby here, and you are sorry for me?

I have toured 2 NHS hospitals prior to giving birth, and on both occassion they could not answer medical questions. Couldn't seee the theatre. Weren't prepared to talk about caesareans, but boy oh boy was the birthing pool talked about. And, I thought now why have I wasted my time coming here?

I think the other side is true as well - there can be a lot of undue pressure to go down a more medicalised route - for example with inductions being the 'only' option at 7, 10, 12 or 14 days overdue (depending on which health authority you happen to be with), interventions if you happen to be having a slow labour, all of which contribute to the increase in CS operations - so I would be surprised if cost was at the route of anything tbh. My second was a very straightforward home delivery, no stitches, no pain relief so cost to NHS was minimal. Only had the midwives in my house for less than an hour! Yes if the NHS had followed their own protocol I would have been hauled in for induction 2 days previously, which surely must have cost more than my actual delivery did.

Uwila, I disagree (you won't be surprised to hear!) IMO vaginal childbirth should be promoted, it's safer for women and babies (I'm fairly sure I'm right in saying this but feel sure someone will correct me if I'm wrong). I don't think c sections should be allowed on demand. I think they should be carried out where there's a clear clinical need. The caesarian rate is now at 25% in the UK, the WHO acknowledges that 10% is the rate expected.

People aren't shown around theatre on hospital tours because operating theatres are kept as clean as possible and in maternity can be needed in less than 10minutes in emergencies. Parent education definitely involves discussion of operative deliveries near me, so it isn't the whole nhs in a conspiracy of silence

Well, WWW, that's how we get sinics like me. Keep me in the dark. Push me towards a natural birth I don't want, only to later discover there were other options for people who knew to ask for them. And the result is that I no longer trust you. And then we find ourselves in a culture of patient led care which is definitely not a good thing.

Fair enough waggle. I wasn't really expecting to walk in and have a nose around. But the person leading the tour wasn't prepared to talk about the theatre. You know things like, how many anaesthitists are on duty on a Saturday night? How many surgeons? Who will typically be in the room if I have an uncomplicated planned section? What is your policy on resuscitation? What kind ao anaesthesia is on offer? These are all valid questions. But there is no one there prepared to answer them. It isn't the fault of the person leading the tour. When they set up the tour the hospital should arrange to have someone there (a registrar?) who can adress these questions.

On one of the tours, she announced to us that she was new and wouldn't be able to answer ANY medical qustions. Why did she think I was there. To see what colour the curtains were?

WWW, I don't think it's been scientifically proved that vaginal births are any safer for either mothers or babies. Of the doctors who were quoted in this article, some of them are saying (or implying) that C-sections are actually the safer option, and one says he would like a proper scientific survey done to confirm this but that it hasn't been attempted yet.

Anecdotally, I know several women who have been rendered incontinent and/or had difficulty having sex after a vaginal birth, and I also know babies damaged (one brain damaged) during vaginal births. I don't know anyone suffering the equivalent after a Caesarean.

Obviously I'm not claiming that my limited experience amounts to a scientific survey, but I don't think it's an open and shut case that vaginal births are safer - if anything, I reckon the opposite.

Tuttifrutti, I'd like to know the answer too. I thought I'd read that maternal morbidity was higher for c sections but I would like some facts/stats. Someone here (eefs? Elliott? Am I making it up? It was someone on my ante natal thread) does maternity stats for a living, come and tell us if you're reading this!

I think elective c sections are as safe as vaginal delivery?

emergency not

WWW, I think the point is debatable. There have been correlations about the symptoms suffered (including death) post caesarean. But it is impossible to tell if those effects are a result of the caesarean or a result of the complications that led to the caesarean.

I will just point out a story of a c-section that happened in the East Midlands (cant remember where but it was on our local news) where the mother had a planned section and the surgeons cut through the placenta.
This wasn't realised and the baby died a few hours later due to problems directly related to this, so there is evidence of babies being damaged/killed in a planned section.
I had to sign a consent form which talked about the things that could go wrong in surgery. Blood clots, loss of feeling, infection, blood loss leading to hysterectomy. Dont think you usually have a potential problem of hysterectomy in a natural delivery. That's when it hit home for me, I was a bit like "Damn, I'm only 24, this is my first baby, what if it results in a hysterectomy?". But the other part of me was "what if the babies feet come first and push out the cord and starve it of oxygen in a normal delivery" so I opted for the safest route for my baby.

Interestingly, I have just searched Pubmed quite aggressively and can't find a single meta-analysis relating to morbidity or mortality as a result of sections. Not one. There are several about VBAC, but that's obviously a different matter. So I have no idea where any of these figures come from, but presumably from relatively small studies.

That's interesting Tamum, you really would have thought a study would have been done wouldn't you? Gosh, well, I'm perfectly prepared to be corrected for being wrong!

Oh www, I would bet any money you're right, actually, I was just so surprised not to find anything :) Maybe I missed it....

OK, have before notes from a lecture by UCL obstetrician, so i though I'd throw some stats into the mix...

1. Maternal mortality stats: 20.6 per million with vaginal delivery; 58.5 per million with elective CS; 182 per million with emergency CS.
2. When midwives and obstetricians asked which kind of birth is best (2 different studies in 2 different journals): 96% of midwives said vaginal delivery; 92% of male obstetricians said vaginal delivery, and 69% of female obstetricians said vaginal delivery.

The female obstetricians who favoured elective CS cited 'fear of perineal damage and effect on sexual function.' Go figure...

Ah, thank you juliab, the cavalry :)

interesting stat about the female ob/gyn's. i just had my postpartum smear test today at the local FP clinic, performed by a female ob/gyn. she asked a lot about how my delivery had gone - and i told her, 'got to hospital at 9cm and gave birth with no pain relief, just a graze, was up and about soon thereafter - and she remarked that if and when she had kids, she wanted a csection.

Oh THANK you Juliab! So, does that prove it then, does it? does it? :)

As long as they really are per million, and not per 20 multiplied up to look good then yes, that proves it www :)

Also, in my new position as Queen of Stats [smug emoticon], I can reveal that the increase in CS rate is thought to be caused by 3 things:

1. the big increase in older women giving birth
2. the big increase in maternal BMI (ie: we're all fatter)
3. maternal request

in that order.

Just to pick up on something I keep reading ... phrases like 'you have to be induced at 41 weeks' 'my hospital will only let me go to xxx weeks' ' I have to have a cs because' ...

Just a reminder that you don't HAVE TO do anything. While it may be hospital 'policy' to induce at a certain time, or whatever, it is not the law. Nor is it always based on medical evidence. You have the legal right to birth however you want, wherever you want and imvho as long as you know the risks and benefits, its up to you. If you want to wait until you are 43 weeks pregnant and then birth a breech baby at home, or whatever, it is your choice and any attempt to force you into a course of action can be deemed assault by the medical practitioner.

The World Health Organisation defines normal pregnancy as lasting between 37 and 42 weeks, so you aren't even overdue until the 43rd week. Why oh why are hospitals inducing women at 41 weeks, especially after 1 previous cs, when the average pregnancy in the UK lasts 41+1 anyway??

I wish so much that I had known my rights before I caved in and had a cs simply because I was 10 days'overdue' ... I got a scar, PND, a baby who wasn't ready to be born yet, increased risk in subsequent pregnancies, significant blood loss, (and that was an OK, elective cs!) all because my consultant got getting fed up of waiting, and the weekend was coming when staffing levels are down.

Thank goodness I hung on for number 3, who was born 15 days after the sacred due date, perfectly beautiful and healthy, still covered in vernix. If I had just agreed with the first medical advice given, rather than gone away and found out for myself, she would have been cut out of me 3 weeks too early.

Maybe ultra cynical, but I don't believe the NHS always acts in our best interests. Nor do I think they always tell women what their rights are and what the relative risks of different options, like waiting, doing nothing, cs, induction etc carry. There's a famous quote by an obstetrician which says something like 'if women were truly informed about the risks of caesarean section, they would run away and give birth under a tree'.

Agree completely with rachp about "overdue" inductions. Induction increases the risk of complications for mum and babe yet it is treated far too cavalierly by Obstetricians IMO.

Ooh, I found that quote! ""'If one went to the extreme of giving the patient the full details of mortality and morbidity related to cesarean section, most of them would get up and go out and have their baby under a tree,' [Dr. McDonald] said." [Neel J. Medicolegal pressure, MDs' lack of patience cited in cesarean 'epidemic.' Ob.Gyn. News Vol 22 No 10]

Why do older Mums require more CSs?

Yes, I wondered that. Older shouldn't = less able to labour and deliver vaginally, surely? Any idea Queen of Stats?