why the drive to reduce cs rates in nhs trusts?

[cakebaby]

Hello ladies
Long time shadow dweller, after 12 week scan its definitely a real baby and not just cake, so I've ventured into the light.
l'm 39 & have had to delay pregnancy for a number of reasons, one of them being a total horror of all things birth related. I have no idea where this has come from & cannot rationalise it. I hate hospitals & have to visit them fairly regularly for work. I get light headed, sweaty, spots before eyes, the works. I suspect this is related to my mothers slow death in hospital when I was in my teens.

At my booking in appt the MW briefly mentioned the b word & gave some options like hospital, birthing unit, home birth, completely ignoring elcs. My pack from the MW with hospital leaflet also completely ignores elcs but states they are proud to be reducing the cs rate. She laughed off talk of an elcs as if I was bonkers and gave the old line 'women have been giving birth for millions of years.... body designed for it' blah...
This was not a great start for me, in one sentence she has compounded my suspicion I will not be in control of my body and what happens to me when it comes to birth, that I won't be listened to or have any say in things. This is not just about requesting an elcs, but about being treated with respect & being listened to.

So, why are NHS trusts so keen to reduce the number of cs, to the point of seemingly aggressively campaigning against them or at least cheerfully ignoring the possibility of one?
Sorry for long post, this is causing me increasing anxiety already.

But they DO have obstetricians at the Portland, who work at NHS hospitals and the facilities to deal with most problems. They should be able to be able to cope with most complications, and it would only be the most extreme complications - that are outside the field of obstretics - that would need to be transfered; for example a heart condition.

Since there is greater specialisation of NHS services with the closure of specialist department in some hospitals, its highly possible that the same thing could start happening within the NHS. (If it already hasn't).

I do feel that the Portland is something of an easy target for this, because of its private status, not because its necessarily 'more risky' or has less facilities.

You make some very valid points about what would basically be closing ranks on women by opposing alternatives for them...but what is to be done? How does one take their power away?

Its all about balance and all about doing EVERYTHING possible to support the choices of other women, as much as you can.

I'm of the firm belief that women do not endanger the life of themselves of their baby willingly or deliberately. If women do something that goes against all advice or evidence, then they do so for a bloody good reason; you need to get to the bottom of those reasons and you need to make sure that woman is supported as much as possible to minimise her risk as much as humanly possible.

If a woman does, she generally will have some sort of belief or ideology at the heart of it; most generally I'd say there's probably a previous trauma of some description at the bottom of it.

Which makes her a vulnerable woman who needs help not judgement or controlling.

Yes I know they do. My point was in reference to how is this really any different to a woman giving birth at home or in a stand alone MLU tbh though?

This is why consultant led maternity units and A&E departments are sited together in NHS.

Absolutely, RedToothBrush, and I don't think it's to do with lack of money either. It's to do with a lack of will. 50 odd years ago fathers weren't allowed in the delivery suites, 40 odd years ago, shaving, enemas and episiotomies were de rigeur. Women objected and those things got swept away, so it's time now to start objecting.

This is going to sound extremely cynical and forgive me I it does but perhaps I'm just too jaded..vulnerable women have always been treated in general as hysterical, neurotic, half-witted, poor-darling-to-be-humoured (or the opposite, silly-cow-to-be-controlled) entities who need to be managed. I don't see that changing, ever.

Good comprehensive maternity and obstetric care must be provided on the NHS to ensure everyone can access it regardless of status or finances.

How to get it when patriarchal views persist is the question.

This is why consultant led maternity units and A&E departments are sited together in NHS.

Perhaps I am just too cynical, but I thought that was either to do with it being cheaper to build on one site, or in some cases to cut staffing costs down so that anaesthetists can be shared between A&E & Maternity.

It won't change until women and men stand up and make it change.

Yes, that too. Definitely cheaper to have them all on one site but also safer because of the risks of patient transit.

OP just read your post nothing else. I can totally relate to your feelings of fear. Before having DD i would nearly vomit at the thought of birth... I can now proudly say i gave birth in a midwife run birthing unit with out an iota of pain relief to a healthy (10.5lbs!!!) baby. I laboured at home until in active labour and used water as pain relief. I know you want to hear people saying you should definitely get your choice of an elcs but trust me... A natural birth is NOT THAT BAD! If you are afraid of hospitals then an elcs is not for you as you will spend more time there recovering. If you are serious about addressing your fear of birth and hospitals and are not just looking for an easy way out (cs is not easy btw) then i strongly suggest you look into a hypnobirthing class or seek some therapy in the lead up. And don't listen to people who tell you their horror stories! They're silly and unwise!

trustissues75 Sun 03-Mar-13 18:01:59
This is going to sound extremely cynical and forgive me I it does but perhaps I'm just too jaded..vulnerable women have always been treated in general as hysterical, neurotic, half-witted, poor-darling-to-be-humoured (or the opposite, silly-cow-to-be-controlled) entities who need to be managed. I don't see that changing, ever.

It doesn't sound extremely cynical. It sounds pretty honest and realistic unfortunately. Hell, if you read this thread and had a penny for every time someone misses the point...!

But although I am jaded by it, I refuse to give in to it or believe that it won't ever change. The minute I do, what is actually the point in doing anything in life. Why exist as a woman? I think I am better than that, so will fight it bit by bit on the stupidest and daftest of reasons if need be. Its what makes me, me.

I don't think this is unachievable. Difficult. Nearly impossible maybe. But not an absolutely unachievable goal. Not if we stick together and realise what the REAL issues are about homebirth, ELCS, pain relief or any other choice or option in childbirth that are defended by the piss poor and wrong arguments that are repeatedly used to divide and blame women. Its not resourcing and rationing. Its willpower and belief. Its politics over evidence.

I'm quite happy to spend the rest of my life being a broken record or a pain in the ass to everyone and everyone who will listen. And to those who won't.

Because I refuse to give up hope.

Hear hear.

Naive alert but I thought a cs was a right for us all?

My experience, I was completely shit scare of forceps. I couldn't look at them in the antenatal class. When I was having dd they decided she was in distress and needed her out ASAP. The doc advised they were going to try a ventouse and if that did not work then they'll use forceps. I found the latter stages of labour very intense, I'm not of sound mind and cannot verbalize anything tbh. The result was I pushed like my life depended on it, as I truly believed it did. I was only using g&a which they took away from me for pushing as they felt this was hindering me. The result was a 5 push delivery where they just guided her head a bit. I had a bad two way 2nd degree tear. I know that my labour and birth was better with ds, still a vey fast labour and born in 5 pushes (almost in his sack), I still had a 2nd degree tear though so I don't know what to think.

What I do know is I told a midwife when I was asked about my birthplam, that all I wanted to write across the page was 'NO FORCEPS' and she replies saying she didn't blame me.

Op good luck I hope you get the delivery you want. I almost did with ds, cept he was born next to the pool as he came too fast

Abbyfromoz "I can now proudly say i gave birth in a midwife run birthing unit with out an iota of pain relief to a healthy (10.5lbs!!!) baby. I laboured at home until in active labour and used water as pain relief. I know you want to hear people saying you should definitely get your choice of an elcs but trust me... A natural birth is NOT THAT BAD! If you are afraid of hospitals then an elcs is not for you as you will spend more time there recovering. If you are serious about addressing your fear of birth and hospitals and are not just looking for an easy way out (cs is not easy btw) then i strongly suggest you look into a hypnobirthing class or seek some therapy in the lead up. And don't listen to people who tell you their horror stories! They're silly and unwise!"

No, Abbyfromoz, they are not silly and unwise, they were unlucky and you weren't.

No Loves, in practise it is not. I hear you on the foreceps....I've already told DP that if I end up in a hospital for whtever reason and the word forceps is mentioned (except for the very low down ones which |I cannot for the life of me remember the name of) then he is to support me in my resolute no and we are going straight for a C-section. I sincerely hope though, since I've been told (and I hope I can trust my midwife) that I'm a good candidate for homebirth (though she did use the word 'allowed' to have a home birth ) that I wont have to go any where near Leicester Royal.

LovesBeingWokenEveryNight, a CS is NOT a 'right'.

New NICE guidelines from 2011 were badly reported so women thought this was the case. But the guidelines are just guidelines and not enforceable. They are not being adopted by all hospitals and many have conflicting policies that are deliberately blocking this, because there is so much ignorance and ideology stopping it from being widely accepted as best practice because they are failing to properly and fully understand the problems that are leading to requests and the limitations that other solutions may have.

Just read the post that the reason why birth happens how it does is because we live in a patriarchal society. It has nothing to do with that and everything to do with cost and efficiency.

I am very cynical about the NHS and childbirth. They don't care about the woman being comfortable or it being a pleasant experience as possible just that no-one dies. Because that is the aim they succeed well however, I know a lot of women who say it was not a nice experience or have put off having a second child because of their first experience.

Ushy...on the subject of unlucky...how much of this can be attributed to the cascade of intervention? Who do we trust with the correct information to give us informed choices? With my first pregnancy I researched and researched and researched but in the years following I'm left wondering about how much we can believe of what is written out there. You go to one website and they say one thing with studies to back it up...then you go to another and they say something else with a pile of studies to back it up and this time around I can't help feeling that everyone has an agenda when it comes to showing you best practise based on evidence.

Cochrane Reports trustissues75.

en.wikipedia.org/wiki/Cochrane_Collaboration

They are an institute that collect all these reports and analysis their strengths and weakness and report of what they say to see if there are patterns in the studies.

Its not an infallible system, but its the best we have, and is supported by people like Ben Goldacre who are campaigning against this type of agenda bias in the search for true evidence based medicine.

There needs to be some basic principles that are undertaken when doing research into CS v VBs too. EMCS and ELCS need to be distinguished from each other as a bare minimum and results displayed in terms of planned method of birth needs as well as split up into spontaneous, instrumental, EMCS and ELCS. There needs to be standardised terms about 'natural' and 'unassisted' which are used universally.

There are ways in which studies and evidence could be massively improved.

It also required the press to accurately report studies and not pander to sensationalist and selective headlines either.

I think the later might be the harder to shift, and the former is proving mightly difficult as it is!

Haven't read everything here but just wanted to say that I found midwife care ridiculous in so many ways (and I had lots of midwives). The assumption that nothing will go wrong and women should just get on with it means you are rarely listened to, and is quite frankly dangerous.
Once under consultant care I was treated like a rational human being and my pregnancies were properly monitored. I had 3 ELCS and they were lovely, painfree and calm.
Unfortunately you have to stand up for yourself when pregnant OP, get a good consultant and talk things through with her/him. That should make you feel more in control.

en.wikipedia.org/wiki/Cochrane_Collaboration

Oh dear

get a good consultant

That's hit and miss too. The 'Consultant' will probably be no more than a name on your notes and is more likely to be a registrar. They might be OK, they might not.

Trustissues75- i can't disagree with you more...Telling your horror stories to a woman who clearly has major fear surrounding the issue is VERY silly and unwise. Perhaps i was 'lucky' but don't you think the OP needs to hear some positive stories?

Sorry i meant ushy.