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.

Yes true, I saw registrars sometimes, but they were good too. For anything important the registrar would get the consultant in.

If your consultant/registrar makes you feel ignored and out of control ask to see another one. After the midwives missed every sign of problems with my first baby I was very demanding and it really worked to my advantage. Despite terrible needle & hospital phobia I only have good memories of the births.

abbyfromoz Sun 03-Mar-13 19:20:31
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?

Perhaps you would like to both to READ the thread please. It is very clear you haven't bothered.

Abby...what exactly are you disagreeing with me about? I haven't told the OP any horror stories...I think she's witnessed enough of them herself and can understand her fears initially referenced to in her original post...and I may not have read all of this post in detail but I don't believe I've seen any horror stories on here. Perhaps you rmean Usher? I'm very glad your birth went extremely well, I'm very glad my forced hospital birth went extremely well too and I am certainly further towards the natural birth camp; however, I am very firmly in the informed choice camp which include ELCS and while I think you have the wrong poster, I will agree with her that it is not silly nor unwise to research statistics and explore all outcomes, which for some would include listening to poor outcomes from al kinds of birth.

abby I don't think positive stories help. That was you, not the OP.

They are not 'horror stories', they are experiences. Why should there be silence about things that go wrong? We should know and it should be acknowledged.

By the way i have done a lot of research in the area of childbirth and i strongly believe that fear is a major hindrance when it comes to failure to progress etc. i am not saying that it is the only reason- hence why I chose to go to a midwife run unit attached to the main hospital so that should there be complications i would be in safe hands. It's a very personal choice but i would encourage anyone to try for a natural birth unless there are medical concerns. Not trying to be haughty. Just trying to be encouraging as hearing success stories was the only thing that swapped my fear for hope!

trusttissues "Ushy...on the subject of unlucky...how much of this can be attributed to the cascade of intervention? "

Who knows ? My opinion is that the cascade of intervention is largely a myth. If you are having a difficult labour, you are probably going to want an epidural and the complications are more likely to lead to EMCS/instrumental delivery. What is chicken and what is egg is debatable. However, countries with the lowest intervention rates also have the highest maternal and infant mortality so that's where I am placing my bet.

ELCS avoids interventions cascading - you are virtually guaranteed just the one!

I appreciate not everyone might agree but where my baby and my life is concerned, I would prefer the decision maker to be me.

Sorry trust issues- my comment wasn't meant for you it was for ushy! Sorry i don't know why i read your name there.

Red...I'm sorry, but are you saying I haven't read the post? because I'm afraid you're wrong....I have skimmed parts but I have read a fair amount. What have I said that makes you fell the opposite? Is it because you mentioned the Cochrane library after I asked for where to get decent information from? I do know about the Cochrane library having used it as a student and for reasons I won't go into here I'm not entirely sure that can even be trusted these days. But that's my personal opinion.

No, it was directed at abbyfromoz not you trust.

Trustissues- definitely with you on researching outcomes- just feel sometimes listening to other people's experiences before having your own baby can make you feel a bit... Shocked! I remember a friend telling me every detail- how giving birth was so painful she wanted to just roll over and die. I was left gobsmacked and thought- crap if she felt like that how will i cope?! I think all she was looking for was sympathy an acknowledgment... But it did some serious damage. Not saying anyone in particular on here has done that! Was just a general comment to say don't take everything you hear as gospel... Including what i say

abbyfromoz will you stop patronising and have the courtesy to read the thread. I've already said this once. I will repeat myself until you do, if you continue to post the same old shit.

I don't think the cascade of intervention is a myth.

I am 100% sure that I was accelerated for no better reason than the labour ward was full, so the clock started ticking, the drip got turned up, I had a half effective epidural, and it ended in forceps.

It might have happened like that, if they hadn't been so impatient, but I am not convinced. Anecdote, as is often said, isn't data, but I have heard too many stories like that to make me think that the cascade of intervention causes the difficulty in a number of cases.

I see where you're coming from Abby, but the OP actually wants to hear all the sides to the debate from what I've read - just as I would. I remember people telling me |I was just working myself up - no, I really wasn't...listening to all sides and hearing the positive and negative from women who had experienced childbirth really did help me to ffeel more empowered....if I hadn't then when |I was faced with my ExH's fait acompli I probably would have crumbled and ended up at the hospital from hell that I was most certainly not wanting to go to.

I realise that not everyone want to hear everything...you didn't want to hear it an that was your choice, but for some people listening to the good and the bad does help.

LaVolcan, is that a true cascade of intervention or a pure lack of resources?

Was it the lack of resources to blame, or the actual intervention. The different is important to know and understand.

What I can say about the cascade of intervention theory is that it is alive and kicking in the USA too and trust me when I say they have completely no shortages of resources over there...my hospital was like a bloody hotel (own kitchen, own double bed, own extra bed and pull out bed for children and hubby to sty overnight, absoloutly everything you could think of provided for and a plethora of options for what you wanted) based on the fact that the USA runs the opposite way, they want to make as much money as possible, could it be that there is a cascade of intervention. Speaking rom personal experience I actually ended up with an epidural which has been shown to start of a cascade in some studies...I went from 3-10cm in less than 15 minutes and the only thing that went wrong was my DC went into a bit o a shock for it being so fast....so who knows?

Sorry red... I can see you don't like being ignored.

The OP and several others including myself have said several times its about being respected and not having people make assumptions, which you did and just how frustrating it is.

Its been stated numerous times on this thread that 'mental attitude' and 'faith in your body' is not in the thought process of some women and they have other ways of assessing what birth is right for them.

It is not just about 'horror stories' etc.

Have just read this v interesting thread (in several instalments!) Absolutely agree that individual choice must be paramount. My personal experience perhaps approached fear from the opposite direction - I was terrified of CS. I would of course have agreed without hesitation had the baby been at risk, but was incredibly fearful of the prospect. Had someone decided for me that as VB carries some risks to the mother, it would not be an option and I would therefore have to have a CS I would have been angry and distressed so completely understand why someone who was refused an ELCS on the basis it carries some risks to the mother would feel the same. It would be wonderful if we were all treated as competent adults who could assess the different risks associated with each type of birth and decide which set of risks we felt most comfortable with given our individual circumstances.

I also totally agree with the extra effort that is required to deviate from the 'norm'. The pride I feel about my hb is not really to do with the birth itself (that would be daft, as good positioning/lack of complications is just a matter of pot luck and any birth is a wonderful achievement irrespective of mode) but more to do with the fact I was persistant in asking mws about my options, getting request for hb processed, organising a pool etc. I'd imagine that there might be a similar sense of achievement in arranging an ELCS if there had been resistance but it really shouldn't have to be like this.

Good luck OP - I really hope everything goes well for you.

Wow... Some nasty here

RedToothBrush - given the way it was so procedure driven, I felt sure that it was a cascade of intervention.

Makes sense. Once you have reach X point then Y happens. With no room for flexibility?

Abby, I think that's a little unfair - it's a highly charged debate for many, the right to choose. I was fierce about everyone leaving me the eff alone and letting me get on with it because of my fear of degradation and over-intervention but when it came down to it I found the pain excruciating, far too much to bear and I was only at 3 cms and I'd done hypnobirthing too! Your friend told you that it was so painful she wanted to die - that isn't something to just be brushed off. It is like that for some women. I'm choosing HB again, but that is because I seriously do not trust hospitals and because I dilated so suddenly |I worry I'll be en route to the MLU and end up in what I have been informed is the most dangerous scenario - an unassisted roadside birth - but I do worry I won't be able to take the pain because, rankly, it was, for me, bloody awful (I'm hoping that being made to be somewhere I had reservations of being contributted to the pain because I couldn't relax at all) but am willing to try because I believe MW's at home are more likely to be more imaginative in solutions for various scenarios - I hope I'm not woefully overshooting in my expectations - but just because you found it bearable doesn't mean everyone will and phobias are real as are womens rights to not being treated like complete and utter children - that's something that has always made me mad. Some of the women on here have come to the conclusion that an ELCS is their only option I they want to have children and since there isn't a cost issue argument then why shouldn't women choose that - it's got it's own set of problems and I personally wouldn't choose it given my own medical history - but why is it such an issue to get one if it's not draining the NHS?