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.

[Sioda]

She said more than that Jesse - you're choosing to read selectively. And not being dead is hardly the only important thing in life. How about not being permanently injured, incontinent, needing reconstructive surgery? How about having a baby who is not brain-damaged or disabled by a birth injury? A mother who doesn't cry her way through the baby years with PND thanks to a horrific birth experience? All of those things happen every day. So yes it does bloody matter. Don't be so flippant.

[blueshoes]

"It doesnt matter as long as you all end up alive"

Jesse, I have to say that is bullocks for all the reasons Sioda gave.

[cakebaby]

Hi ladies, thank you for all your posts, it's turning out to be a very thought provoking journey!

Fortunately I am accustomed to research so have quickly been able to draw salient points from data secured and see through the polished statistics!

So I am carefully a perusing the literature and drawing to a preliminary conclusion, of course, subject to change further down the line when one door shuts behind me and another is slammed in my face!

My loathing of hospitals comes from seeing my mother confined to a bed, dying and the overwhelming feeling amongst family was that she was being left the get on with it quietly & 'nature will take it's course'. I know it's a different set of circs but this is my perfect nightmare.

Couple this residual fear with my advanced maternal age (apparently), the fact that I only plan to have one child,have already been told I am likely to be induced early as 'that's what tends to happen' with those 40+ at edd, associated increase in use of instruments and the published risks in their use, I think I am leaning towards an elcs request.

Of course I have also factored in health risks to me & baby, at birth and thereafter. Not least, witnessing my dh grandchild struggle with a birth brain injury leaving physical disabilities which has had an indescribable effect on all involved.

I know this will not be everyone's conclusion, and this is not intended to judge anyone else's decisions, but one thing I have learned through research is that one size does not fit all! Which incidentally seems at odds with the mw's comment last week about inducing women over a certain age....just compounds my thoughts that in some NHS trusts, expectant ladies are treated as a herd!

[RedToothBrush]

When I see people post stuff like Jesse, I do wonder what planet they are on.

"It doesn't matter as long as you all end up alive."

We will never change poor healthcare and abuses of dignity and respect with attitudes like that.

[RedToothBrush]

I also have to say that given the stats on first time mothers over 35 needing assistance (either induction or intervention) and the stats on first time mothers who have a home birth, that saying a homebirth was the 'only way', isn't particularly realistic and perhaps misleading.

What happens when a homebirth isn't possible or she has to be transfered? The chances of this are extremely high.

[Shagmundfreud]

"CS is often discussed simultaneously as appalling surgery"

Are you sure you didn't read 'abdominal' as 'appalling'?

I've never seen anyone describe a planned c/s as 'appalling' or anything like it on this board or anywhere else.

"How about not being permanently injured, incontinent, needing reconstructive surgery?"

With respect - women who have c/s sometimes need reconstructive surgery, have incontinence problems or end up with a serious bowel injury. A friend of mine needed a hysterectomy and bowel surgery after her placenta grew through her scar tissue from a previous c/s. Really, it worries me how little the risks of surgery are mentioned on this board in comparison to the risks of v/b. It's almost as if it's seen as the risk free option and I don't know any other major procedure which is seen in this way.

But I would agree with all the posts here lamenting the lack of control that women have over their birth choices on the NHS, whatever they are. It really is awful, and is getting worse. It's also the inconsistency of it all as well - the postcode lottery in full force.

[ByTheWay1]

Since when do you get the option on the NHS ??? This is seriously "medicalising" a natural process..

an ELCS is not risk free - for either mother or baby...bladders can get cut (not as rare as seems to be made out on here), babies can get cut, can suffer allergies and chest infections more throughout their lives and the implications for future fertility and birthing problems can be huge. Please do not think of ELCS as an "easy" option.

[RedToothBrush]

ByTheWay1 Wed 27-Feb-13 11:17:16
Since when do you get the option on the NHS ??? This is seriously "medicalising" a natural process..

a) since its been recognised by NICE that it is cost effective and that cost should not be used as a reason not to grant an C-S
b) since C-S has been shown to be helpful to people suffering from anxiety - some women would rather terminate a pregnancy rather than go through a VB
c) since recognising that birth fear is a very real condition and can have negative effects whilst in labour which effectively can cause the natural process to not actually work.
d) since women have 'unnaturally' put off giving birth to an age that nature didn't intend.
e) since evidence based studies have shown that there are different risks associated with a VB and a CS. Women, quite rightly, are no longer are willing to blindly accept that a VB does not carry risks and want to make an informed decision about which risks are of more concern to them.

HTH

[RedToothBrush]

babies can get cut

They can. But then scalp and cranial injuries happen with a vacuum or forceps delivery too.

In fact an NHS report from 2004 said that of the 5400 babies that had scalp injuries NONE - not one - was related to a planned CS.

So whilst an ELCS isn't risk free and it could happen, its one risk that I would be far far less worried about than some of the others and I would be far far more concerned about if I were having a VB.

But there you go...

[ByTheWay1]

I do know that birth fear is a very real psychological condition, and that yes, ELCS can help in these circumstances, however, I do think that sometimes giving birth naturally seems to be demonised by some and if there was not all this talk of just go and have an ELCS as if it was a walk in the park, more resources would be used for helping women with mild anxiety. Who isn't anxious about giving birth?- that is also natural.

Soon it will be risky giving birth naturally in the daytime, because the doctors are all occupied with ELCS... then it will become the norm and we will have lost the battle to keep any midwife led birthing units open.

[MyDarlingClementine]

Bytheway,

I think resources issues is something to lobby the gov about - we have apparently needlessly lost 50million pounds after some failed railway deal, due to error in a government dept.

Directing venom there to them that hold the purse strings is rather more appropriate that insinuating that a lady who wants an ELC is going to make it risky for a woman to labour on another ward due to a lack of doctors.

You need to be lobbying for more resources to be directed to maternity care.

[ByTheWay1]

I have been lobbying.... locally and nationally - and if that outs me so be it...

but the powers that be seem to think we all want to give birth in faceless maternity wings in large centralised hospitals, where you don't see the same midwife twice rather than at our local midwife led units - because more and more people campaign for surgical birth to be freely available.....

a single woman wanting surgical intervention in her child's birth is not going to make it risky, but the ever growing numbers might.....

[shallweshop]

Redtoothbrush - I agree entirely with your post and your point (c) particularly affected me. After suffering recurrent miscarriage and an ectopic pregnancy I was anxious about every aspect of pregnancy and utterly terrified about giving birth as I truly did not have faith in myself to deliver my baby safely. I really wanted a c-section but after lots of talking/coaxing by my midwife, I agreed to try a vaginal birth. I was induced just after my due date (again due to anxiety and just wanting baby out safely) and the induction process went on for 3 days - endless internal examinations and sleepless nights - after which I was still no further forward and the c-section was eventually carried out.

I am convinced that my extreme anxiety was preventing me from going into labour. I entered motherhood feeling exhausted and a complete failure. My midwife was lovely and I think she felt she was doing the right thing by pressuring me into giving birth naturally but, with hindsight, I am not sure it was in my case. I had an elective c-section with DS and it was a much calmer, more pleasurable experience. I recovered well and was up and about the day after both sections.

[RedToothBrush]

Lets blame women with anxiety for closing birthing units. Yeah good one that. Cos its their fault. They are selfish. Lets put even more blame and guilt on women with a problem and potential mental health issue.

Do you know the figures on how many women suffer from what is classed as 'extreme' anxiety? Its been put at between 1 in 6 and 1 in 10 by several different studies. So that isn't a small number, yet you are suggesting that most people who are asking about ELCS only have 'mild' anxiety.

No its far easier to dismiss anxiety as 'mild' and belittle and bully women by saying they aren't as anxious as they are making out and hold counselling up as the solution to this.

It just means that counselling ends up being a tool by which to try and silence women voicing perfectly understandable and legitimate concerns, which are based on the conclusions of evidence based studies and not on solely on emotional and irrational fears. It treats women like children.

Counselling does not stop certain complications. And if its is a certain complication that someone fears most... This type of attitude is not helpful to women; some women DO NOT WANT counselling. They do not NEED counselling. It is damaging to the purpose of counselling to use it in this way and effectively FORCE it on women. It means it becomes untrusted. And its a waste of resources too.

Far better to actually LISTEN to what women are saying, and the reasons behind why they want ELCS (many of which involve resourcing) instead of blaming them for taking resources from others and actually SOLVING some of the problems properly.

[MillieTom]

The problem with vaginal births is that you tend only to hear the horrific stories. Maybe it would be useful to speak to those with a more positive experience to give you a balanced viewpoint. Just try to focus on birth being a normal process. Hypno birthing may be really useful to help with relaxation in pregnancy and beyond.

[PeoniesPlease]

Yes, all maternity services desperately need better funding so that women are able to make positive choices according to their own clinical needs, preferences and concerns. It should not be a question of deciding that your own preferred method of birth is the only "correct" one, and then campaigning to undermine the options of women who don't make the same choices as you. We should all be campaigning for better funding for all types of birth - why is this even something which needs to be said, ffs?

[RedToothBrush]

Just try to focus on birth being a normal process.

For what percentage of women is it not a 'normal' process though? Its not a small percentage. I despite the use of the word 'normal' when it comes to birth as it sets up anyone who doesn't have an experience that isn't within that definition as being 'abnormal' and perhaps a failure if they fail to achieve it.

Horrific stories are not uncommon; because that is the reality! Why are we not prepared to talk about the reality and instead we have to rose tint it and show an equally distorted picture.

A balanced viewpoint, involves honestly recognising and talking about 'when things go wrong' as well as when things go right. All this 'normalisation' of birth that is currently being encouraged seeks to not confront this reality and is morally reprehensible in my view.

Especially when you are over 35 and all these generalised figures that are shoved in your face, can give a lot of false promise. It would be better to break down these figures and target other groups. And the truth is, it tends to be older women who are asking for ELCS, knowing this. Why? Is this really so wrong?

[PeoniesPlease]

Agree with absolutely everything RedToothBrush says.

The fact is that planned vb has a number of outcomes, only one of which is what some people like to call "normal birth." Some people find the risk of complications during a planned vb unacceptable to them and so want to choose an ELCS, having looked at the risks inherent in that too.

That is a valid choice and I don't think women should be having to cast aspersions on their own mental health, go through needless expensive counselling, and beg midwives/consultants in order to have their wishes respected.

[Sioda]

Shagmund I didn't say or imply that those things only happen with VB's. My point was that each individual has to consider which mode of birth is best for them and the outcomes I listed are simply some of the ones to take into account.

Sharing anecdotes as a way of illustrating the risk of surgery is really unethical. It's the responsibility ultimately of the medical profession to check that any individual woman understands the risks of a caesarean. When they explain risk, they don't use anecdotes, or at least they shouldn't. They should describe the risks in terms of how many women X will happen to out of 10,000 or whatever. Simply describing one outcome tells women nothing about how likely it is to actually happen to them. Apart from which, every woman planning a VB is at risk of your friend's outcome, unless they intend to refuse an EMCS under all circumstances. It's a risk of birth, not of ELCS.

No one describes CS as risk free, as you well know. Equally there is no point in people outlining the risks and benefits of CS vs. VB here on every single post of the dozens who ask about this. The NICE guidelines are there for people to look at for themselves and they're as good as we've got at the moment in terms of objective evidence.

ByTheWay Ignorant l and irresponsible lobbyists like you are following in a long line of tradition of ignorant middle class women telling the rest of us what's best for us. Participating in politics carries responsibility and you need to acquire some.

Millie I know you're trying to help but what about the women who decided they would do the 'thinking positive'/'won't listen to negative stories' + hypnobirthing and found that they were shocked and traumatised when they found labour and birth much more painful and exhausting than they expected, or found themselves with a serious birth injury and long recovery period (whether VB or CS)? They'll tell you that they wish they had been better prepared for the things that could go wrong or that they might need extra pain relief etc. Thinking positive is a popular fad right now but sometimes it's actually not the best idea. As for normality, lots of things are normal. Death and pain and suffering are normal processes. It's not a good yardstick for decision making is it?

[Sioda]

Ignorant and sorry ...