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.

[KatieMiddleton]

Great post trust :)

[working9while5]

The cost of my anxiety to the NHS:
~ 3 GP visits before anxiety taken seriously
~ 9 visits to pregnancy support midwife
~ 2 obstetric consultant appts
~ Birth plan session with Supervisor of Midwives
~ 3 appts with Perinatal mental health consultant
~ 2 with Perinatal mental health psychiatrist
~ 2 with Perinatal mental health psychiatric nurse
~ 25 sessions CBT
~ 8 months of antidepressant medication

Hmmm. I wonder who could argue an elcs is more expensive...

[working9while5]

(And I might add here, I never wanted an elcs but the consistent warnings against it in the early stages and consultants etc terrifying me about risks really made my anxiety snowball... for no good reason).

[RedToothBrush]

working, just a quick question.

How long does a course of 25 CBT sessions take to complete. And how many did you have to have before it started to make a difference? I think its something thats worthwhile to know if trying to work out how to deal with this.

I think in some respects the need for help with anxiety needs to be a long term project along side fears with childbirth, rather than the birth being the target which seems to be the focus and the target.

A request for an ELCS is perhaps a separate sideshow and needs to be treated so. (If that makes sense).

[ByTheWay1]

How would people feel about ELCS if there were to be a proven link in the next few years between infant allergies and breathing complaints and CS birthing?

Anecdotal at the moment, it has been my experience - but I hear lots in the press about it lately too.. Lack of exposure to germs in the birth canal, lack of chest compression during birth... "probably" has some effect on the child's respiratory health.

Where do we put the balance point between mother and child?

[trustissues75]

I think from what I've read that the law has already put that balance point in place, bytheway - a woman isn't just a vessel and until that child is born it's the mother's wishes that prevail. I'm right there, right? Someone correct me if I'm not. If you start going down that path then the next thing we will see is women being basically imprisoned because the Dr's opinion (which can be highly subjective) is that her choices and decision are putting the child in danger...suddenly her body means nothing? That's a beyond messed up scenario. I've not read of any cases where the child's rights outweigh the mother's here in the UK but in the US I know of two separate cases - one where a woman was quite literally sectioned and dragged off to a hospital and strapped to the bed while they prepped her for a C-section and the other where the woman subsequently had her child (who was born healthy) taken off her by the authorities because she'd refused a procedure during labour and the Dr had deemed her as being a bad mother and called the social services - I don't know if she got her child back. That's a pretty slipper and scary slope to start on.

[RedToothBrush]

I think its a lot like the argument for breast feeding/formula feeding.

You are never going to be able to do 'The Best' thing in life for every decision for your child. You can only do the best within certain limitations and the best for your personal circumstances.

Plus I think that kind of research doesn't mean that you should reduce ELCS, if it is proven to be a link (and its is purely hypothesis at the moment). What it does, is establish how allergies are formed or how asthma is caused. From that, its a much smaller step to being able to actually 'cure' them.

It is a question of balance; and tbh I think only a woman has a good idea of how badly they will react, if they are forced against their will to have a VB. Bare in mind that this would also have implications for women who have a physical need for an ELCS too, so lets not go into 'guilt' territory. Its not fair. And a lot of women having an ELCS on mental health grounds will still argue that its not a 'choice' as such for them, anymore than it will be for a woman having an ELCS on the grounds of physical need. We need to establish that mental health needs are as valid as physical considerations and treat them with the sensitivity that also requires.

If you are armed with this information beforehand, then yes it maybe it will change a few minds. This will depend on just how big the relative risk will be too.

Besides, you can't make decisions based on things you don't know and a whole pile of what ifs.

What if I make the decision to not have an ELCS on the grounds that I suspect it might cause asthma. My child may or may not have asthma. And even if they do, then they might find a cure within 2 years of finding this link. And I could be left with deep psychological or physical problems as a result of this and that could have a huge impact on my life and the life of my child. No one has a crystal ball.

If I'm honest, the fact that the research so far, hasn't proved a stronger link, points to a lower relative risk if there is a risk there. I could be very wrong, but thats how I feel about it now.

There is no such thing as the perfect answer.

[ByTheWay1]

trust.. sorry - wasn't talking about the law - I know the mother's wishes prevail.... I was thinking about where we mums would put the balance...

Knowing how different my girls are now, I would have done anything I could to have not had a CS with DD1- just because the anecdotal evidence says it "might" have made a difference to my daughter's past, current and probable future health - that's all....

[RedToothBrush]

Besides, you can't make decisions based on things you don't know and a whole pile of what ifs.

Just to clarify, this is something you don't currently have any data for to assess.

It is slightly different to make what if decisions based on data you do have, which present the relative risk.

[RedToothBrush]

Hindsight is a wonderful thing though.

In hindsight you wouldn't get in the car that morning you are hit by a car and it kills you. Its still a risk that you calculate is worth taking to get to work though isn't it?

You can't live life with regrets like that. You do the best with the knowledge you have at any given moment.

[trustissues75]

I see where you're coming from, bytheway, and if that we're me, considering a procedure where there was good, solid, reliable and trustworthy evidence that that was the case I'd want to know so I could weigh it all up in my mind.

Chunderella - refused pain relief because of risks to baby..that's awful. I take it you mean the usual standard pain relief that's been used time and time again...what about the risks to baby (if they're going to take that stance) of a mother who is so and pain and so stressed out she suffers a sudden medical emergency? Or one who has such bad PTSD that she can't bond with her child because of it - and from what I gather there's plenty of information out there indicating that a baby's development is at least partly attributable to the early bonds it forms with its primary carers?

[bamboozled]

I don't think that many people understand the abuse the consultants get from the women and their partners who are fixed on NOT having a CS. An emergency CS is just that, an emergency, to save the life of mother and child, or prevent major damage being done to either one. at this stage, surely the years and years of training trump a few sessions with the NCT and anything any of us, however well educated we are, can research in the Internet. Obviously I am biased, because I live with one of these consultants who comes home tearing his hair out at the fight he has, before the EMCS, to actually do the EMCS.. But if people understood that emergency intervention is everyone's least preferable route of care, perhaps they would lay off the drs a bit. I know that this is a digression from the thread, but it's a point that needs to be made.
An elective CS is a totally different option, and here every woman should have the right to choose, with all the information given in an unbiased fashion, and make the decision that is appropriate for them, without being judged.

[RalucaV]

BytheWay,

me and my health are a perfect example of the opposite that this theory says. I was born by VB and I have multiple allergies verging on asthma (I am fighting not to develop it). I have had them since I was born the so called "natural" way. Every cold means weeks of sniffling and coughing.
My husband and my parents are the same way. I mean, isn't genetics rather then some germs from the birthing canal (that can be smeared on the baby after CS anyway)?

[trustissues75]

Oh and bytheway - please don't beat yourself up over this, you really really don't know if the CS actually did give your one daughter problems - there are a lot of theories out there with allergies, it's realy not worth beating yourself up over - you're doing your best and that's all anyone can ask of you.

[ByTheWay1]

thank you trust... (that was a lovely thing to say.... )

[RedToothBrush]

She's right. You shouldn't feel guilty for things you had no control over ultimately. They just 'happen'.

[LaVolcan]

Obviously I am biased, because I live with one of these consultants who comes home tearing his hair out at the fight he has, before the EMCS, to actually do the EMCS.. But if people understood that emergency intervention is everyone's least preferable route of care, perhaps they would lay off the drs a bit.

I suppose it is a digression but as you say, I think the point does need to be made. I often wonder though, how many of these EMCSs relate to failed inductions? Which in turn makes me wonder how necessary was the induction? I sigh inwardly when I hear someone say that they 'had' to be induced, had a long labour and it ended up in an EMCS. I wonder how many of these inductions were really necessary or were dictated to by a date on the calendar, and whether the woman would have had a perfectly straightforward VB if left alone? So in a way this is back to choice and being listened to - rather than 'we book you in for induction at 40+ 10/12/14/whatever' it would be nice if the pros and cons were offered. Sheila Kitzinger once said words to the effect that the protocols are a good servant but a bad master, and I think this is a point worth remembering.

[bamboozled]

I think the problem with that is that a placenta doesn't have the capability to support a baby in-utero indefinitely... It will break down and then the baby will be compromised, and this is very difficult to monitor, hence the need for induction. Obviously there are women who have refused induction and gone +17 days etc, but there are also the women who have had terrible outcomes because of placental failure... It's not a risk worth taking in my opinion. If you've spent 40 plus weeks growing a baby, not eating blue cheese, not drinking, not taking ibuprofen etc, why gamble at the end..

[janey1234]

Exactly bamboozled - especially given that as maternal age increases, the placenta deteriorates more quickly - and the risk of stillbirth increases. Part of the reason I will be requesting an ELCS...

[LaVolcan]

I presume that there must be women who have suffered placental failure before the hospital's declared induction date occurs? This is really just a request that women are treated as individuals and given the proper information on which to make a decision.

[working9while5]

Oh and I was born by elcs (consultant about to go on holiday ) and have asthma but I don't blame my mother for it! Asthma can be a pain in the arse, but unless you are one of the very unlucky few for whom it is really disabling, it is that and nothing more (and yes, I've been in intensive care).

Redtoothbrush, dead right about theray needing to be a project "alongside" vs a "route to".

I started CBT when ds2 was 4 weeks old, and have had it weekly (with some holiday breaks etc) until quite recently. I have four sessions left. In some ways, I don't think it actually would have been effective for me without the Mindfulness - because a lot of the "cognitive answer" was about tolerating uncertainty (no shit!) but how do you do that? As you eloquently put above, your experiences can bring fears that defy logic.

Mindfulness is more about meeting those fears and learning to see them as fear, and to sort of hold that fear if it makes sense? In the beginning mindfulness was very overwhelming because I sort of had this whooshing of anxiety/racing thoughts and just sitting them without needing to do something with it e.g. reason it/research it/find a solution to it. Mindfulness usually is an 8 week course, 2 hours a week and you are expected to practice 30mins to 45 mins a day. So probably potentially faster...? The two complemented eachoether well because the CBT helped me work out the sometimes weird and wonderful beliefs I had picked up about birth (even though I was post birth it was still useful to work out where the anxiety had come from!) and the Mindfulness helped me know I could manage my current fear differently without always needing to DO something e.g. read/research/solve the problem (which often made it worse).


I couldn't put a timescale on the CBT really, there were various moments where things clicked. One was where I started to realise just how terrified I was of the experience of being overwhelmed and in pain and of being judged for that. I was actually more afraid of being judged than of the pain or even being powerless, which I would never have guessed. Included in this was the fear of not being heard when I was in pain, but also that it would "wrong" to be in pain when others had things so much worse in life (good old Catholic upbringing there!). I had a lot of shame about that too. I also had this bizarre fear that if my baby died it would be my fault for not being thankful enough for being pregnant in the first place. Again, only got there through a lot of talking!

If I had to boil it down, therapy works because someone listens without judging. The quality of the therapy is going to be more about you feeling that your fears are heard and accepted rather than the method of it etc... though I think CBT probably appeals to people like us who are essentially very rational and sceptical of woo etc. Mindfulness seems (to me) to work by helping you realise that your fears are not you, and that you can feel afraid without being overwhelmed and distraught because of your fear? Does that many ANY sense? It's probably slightly different for everyone. Mindfulness is the sort of thing that is impossible to explain, you can only realise what it is when you try it out a bit.

I think dealing with the anxiety has been very freeing for me as a person and really you are right, that has nothing to do with the birth, though I would never have probably realised I was anxious without the birth iyswim. Would have described myself as laid back rather than a worrier, very rational etc etc... but everyone has some fears that hold them back I think, and it definitely has been great to begin to deal with it.

[bamboozled]

Yes, obviously, but the risk increases as the days past due date increases. The problem is that the camps are SO divided, those that don't want intervention generally don't want the medical stats either, 'it's my body, I know best' - and in fact are doing a huge disservice to the women that want to have the proper information before making up their minds. It just muddies the water. If we were told that the car seat we wanted to buy to bring our new born home in, was not guaranteed to save their lives in a crash, but that this other one definitely would, there's a rats chance in hell that we would buy the one with a speculative outcome.

[bamboozled]

Sorry Working,, that was replying to LaVolcan. I'm not sure if I explained that properly either .
Also, Cakebaby, sorry, in no way is this meant to offend or upset you.