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.

Katie - please keep that soapbox. I rather liked that.

Thank you dita I hope you achieve your midwifery goal.

Katie loving the soapbox, keep it handy!

Redtooth (and others) seems my main areas of concern, which I've pointed out many times, still are being glossed over and the pain/time issue is still overtaking some responses. Thank you for reading and understanding the real reasons behind my concerns.

cakebaby,

congrats on your progress.

I'm sorry to get so vocal on your thread and I hope you'll get what you need and wish in the end

cakebaby, I find it so frustrating that the messages that several people have tried to get across repeatedly get missed by midwives (or want to be midwives) on here. It happens alot. They think they know it all, and as a result make assumptions rather than listen.

They are THE most crucial people to understand this gap between patients. If they don't start listening this problem will only continue to get worse I fear.

I sound like a broken record at times, but being able to put trust in HCPs and feel like they will actually be properly listened to are absolutely THE KEY.

EXACTLY my point - the 2nd paragraph of my original post. Fobbed off & not listened to. Just hear a perfectly reasonable inquiry as a potential difficult customer....and off they go with their stock answer browbeating.

I could not agree more, listening to people is the most important part of a midwifes role to me, everybody is different and everybody has there own needs, wants and desires and has the right to have these treated with respect.

Again I would say if you feel the midwife you have seen has not treated you with this respect then ask for another. I really hope you get the experience that you want.

Katie sadly I think this is true of many NHS services now. If you deviate from the pathway there is clearly something wrong with you, not the pathway is how it seems to go

But working, we are messing with their precious targets! How can they possibly give us good care if we don't comply. They can not measure success without having such black and white 'good' and 'bad' outcomes. We are not patients anymore, we are customers (yes I've seen that one lately) or given even worse titles.

dita, please make sure you read this thread in full and take on board the messages better than you seem to have as I find what you've posted is disappointing and contrary to what you've just said.

really? I am not a midwife I do however work in a hospital, and am currently on training programs where we are told again and again the patient is always right, should always be cared for, listened to and treated with respect. I have not actually read everyones responses only the op's (i was planning on coming and reading the whole thing tommorow when I have more time), I wanted to offer the op support or advice, it sounds to me like she has done a lot of research and knows what she wants. The targets may be the priorities for matron and higher but all the nurses I have come across care about what is best for the person in their care and that includes phsychologically as well as physically.

I hope that the midwives that are do not lose the values of all the fantastic people I have come across who are trying to be midwives, but I guess like with every system this does happen in some cases.
I promise I will read the thread completly.

Thank you dita. Thats the most I can ask of anyone. Just giving time and consideration, means a lot.

I always intend to stay out of these threads... getting sucked in though :)

I had an ELCS due to past medical history and increased risk of incontinence, particularly faecal incontinence which to be honest would be my worst nightmare. I had been told years ago after surgery that I should expect a CS if I ever had kids. My consultant also told me that a) an ELCS is now as safe as a VB and b) an extremely high number of female obstetricians have CSs, having seen the damage a bad VB can cause.

So I had an uncomplicated CS and have recovered well. I will say though that I found the initial recovery much more painful than I had expected (as a veteran of other apparently painful surgery which I found a breeze). It didn't help that I had the misfortune of having retained products and needed an ERPOC (D&C) 8 weeks after birth. Ironically this is slightly less common in women who CSs than VBs! :)

One thing - sorry to offend anyone but I won't mince my words here: the MWs were not my advocates. At all. Not only did some of them talk utter bollocks to me ('Of course you're not having afterpains, you don't get afterpains with a first baby!' ) I found them generally sneering and 'serves you right' when I was in severe pain afterwards. Second night after DD's birth when I hadn't slept in 48 hours, had totally overdone it and was in agony it was a lovely male doctor who came to my rescue - gave me a strong painkiller and a sleeping tablet, sent DD to nursery to be looked after by MW with catsbum mouth to allow me to get a few hours of sleep. If you want a CS it will be a doctor who grants it and who will probably understand your reasons, probably more so than a MW.

A few months on and I am totally back to normal. My scar is minute and I have no problems at all 'down below'. The initial few weeks of pain were shit at the time but totally worth it. It also didn't prevent me BFing DD, something which was important to me.

Sorry this is such an essay but I really hope you get the birth you want. As long as you are prepared to accept the risks (which are minimal) then push for the ELCS if that's what you want.

A couple of points to add to the lively debate:

1. My experience of midwives/Drs when I got an ELCS for my 2nd birth was different to Angelicos. My booking in midwife completely understood the trauma of my 1st birth and immediately arranged consultant referral without me asking, an antenatal midwife accelerated my 2nd opinion consultant appointment after I ended up in tears trying to answer a simple "how are you?". My initial consultant was utterly dismissive of my request, didn't listen to my concerns (and as a result misrecorded them in my notes) and was very selective in giving me information on risk to suit his agenda. The midwives on the post-natal ward on the other hand were wonderfully caring (unlike after my 1st birth) and despite being short-staffed one even took the time out to ask me about my ELCS choice and LISTEN to me, for a long time. I honestly couldn't have enjoyed my hospital stay more! I was offered access to whatever pain relief I needed and offered help with the baby should I need a rest!

1. I know the discussion has almost been derailed by references to CBT so I'll try to keep this brief: My anxiety was coming from being [potentially] denied the birth I wanted. I perfectly understood the statistics and the relative chances of various "things going wrong" for both VB and ELCS. So far as I was concerned, no amount of counselling was going to change those relative risks, they are fact. I had made an informed decision and wanted my choice supported. Therapy was not going to change that.

herethere I'll mug you for your lovely MWs next time round! :) I wish my MWs had been like that :( Although in fairness the community midwife I saw at booking appt was lovely and referred me to consultant due to medical history. However she had had 2 CSs herself due to med history and was therefore v sympathetic.

I hope this doesn't sound too harsh - which means it's likely to...but if you're so afraid of giving birth why have you decided to get pregnant? And why didn't you save up for the cost of having a C-section if you knew that would be what you wanted? Surely you know that the NHS doesn't just dole out proceedures at the request of a patient?

I'm very sorry you're so frightened (and CS comes with it's own set of problems - pregnancy and birth is a risk and always has been) I don't mean to diminish your fear because it's obviously very real but I'm finding it hard to understand why you didn't get your ducks in a row before you chose to get pregnant.

Disclaimer: I'm assuming this pregnancy was a choice form your introduction about putting off getting pregnant until now for many reasons - mainly fear.

On a possibly more helpful note - have you considered home birth? A lot of the horrors you seem to have heard about could well have been down to the cascade o intervention so often seen in hospitals...not to mention midwives being so over worked and overstretched it makes it more likely to miss things as they're rushing about between the three+ women they're watching over in labour...at home you've got a midwife who is with you all the way along - something going wrong is much more likely to be spotted quicker.

On the other hand - if there is a real medical reason (not a number-crunching for the NHS reason, but a real valid benefits outweighs risks reason) for you needing an ELCS then that would be your best option - but just wanting to go for an ELCS because of fear is possibly foolish because you could well be actually putting yourself at more risk with ending up with a horror story for friends, family and co-workers.

" but if you're so afraid of giving birth why have you decided to get pregnant? "

Hm, maybe because she actually wants to have children just like all the other women that get pregnant?

I postpone getting pregnant to higher age too for different reasons, but one of them is that then there will be less hussle to get ELCS. Maternal age is one of big risk factors for VB. So it is also a good argument to get ELCS.

Ffs trustissues RTFT. Your condescending posts just demonstrate you have not read the op's posts (or the other posts) and given any thought to what she has actually written. It is rude to make such offensive comments without taking the care to read and think about what the op has written.

My apologies for you if you have read everything and still think that is an acceptable thing to write.

trustissues75 Sun 03-Mar-13 07:00:46
I hope this doesn't sound too harsh - which means it's likely to...but if you're so afraid of giving birth why have you decided to get pregnant? And why didn't you save up for the cost of having a C-section if you knew that would be what you wanted?

Yes that is too harsh. I was in denial about wanting children for many years. I married my DH making that very clear. I spent years wishing that I was infertile so that the decision would be taken away from me, and so that I didn't have to face up to how I felt deep down under everything.

Then my body clock went off and everyone around me started having babies and I utterly can not bare it. My fear does not stop me wanting to have a child despite every fibre of my being trying to do that. It does not go away and isn't a switch that you can turn on or off. I find comments like your incredibly naive and ignorant.

Its ruining my life tbh. I can not stand to be in the same room as pregnant women. Everyone anyone asks 'when' are you going to have kids I am at a lost to know what to say and usually end up saying 'its a long story' or 'its complicated' and leave it at that and people tend to back off. I can't be around women who've just had kids as I can't cope with it. It makes me angry, upset, jealous, frustrated, weak, and feel less of a woman and a freak.

But I know I'm not. I know there are women like me and this a lot more common than people realise. I know this because women are starting to talk about this and break the taboo. I know this because there is a limited amount of research that is starting to come out which shows patterns in women who have birth fear or ask for an ELCS. I am not a freak - I am not unique. I share common characteristics with other women which have been identified by scientists. This means that people can be trained to identify these and to be trained to recognise what causes the most distress and ways can be found to assist me and to over come these problems.

As for paying for this. Apart from NICE doing a cost analysis over this which said that cost was not a reasonable grounds for denying a CS because of costs of complications and costs of dealing with mental health, theres also a couple of other very crucial problems to 'saving for an ELCS'.

Firstly, not every pregnancy is planned. If you end up pregnant and without enough money in the bank, what do you do?
Secondly, there's logistics. The only private maternity units in the UK are ALL located in London/SE. That means for someone like me who lives 4hrs drive or 2 and a half hours by train away from the nearest place that this simply isn't an option. You can not have a CS in a standard private hospital.
I am lead to believe that it may be possible to have a private CS in an NHS hospital, however the process is even more difficult and even people in the profession don't know anything about it. It has been asked about it on here numerous times, and I've tried to do some research into it, but there is absolutely nothing out there about how to do it. And it still means you will be in an NHS hospital being given ante-natal care by midwives who may be 'in need of retraining' shall we say.
Thirdly there's the cost and planning and time it takes to raise the funds. It costs £10k - £20k in general to have a private birth from what I gather. It would take us years to raise that kind of cash. Years I haven't got as I'm 34, close on 35 now. Its taken me years to get to the point I'm at. Others, won't have that long.

In all honesty, if there was somewhere close enough to me, that would allow me to give birth in the way I wanted, I'd probably beg, steal or borrow the money in whatever way I could. But the truth is, there just isn't.

Which leaves me with just two options. Getting support from the NHS or having no children. Why shouldn't I get help from the NHS? Because its not to your taste or because its politically unacceptable and frowned on by society despite all the evidence says "actually there's nothing wrong with this". Not when even NICE have made a point of saying that cost isn't an issue for this particular health care problem.

I'd rather say to you - if you are so ignorant, why don't you educate yourself and find out what the real story is, rather than being judgmental?

As for homebirth.

Perhaps you'd like to read the thread?!

Or perhaps you'd like to read up on the success rate of homebirths for first time mothers over 35 and then get back to us all with what you find.

Redtoothbrush, I think you were on some of my threads about this a year or so ago. I think it is really sad it is ruining your life. What is it that would help, I'm confused? Is it that you want a guarantee of a maternal request elcs? Surely with such a severe phobia this could be agreed ahead of time? The perinatal mental health service in our area does preconception appointments, surely a plan could be made? Do you also have fear of pregnancy, I know some women do?

Also here there.. the op is very much about anxiety and not merely about relative merits of elcs. The first answer to anxiety about birth isn't always going to be elcs, though it is a very sensible rational choice for many and should be supported for women. Yet the op was about anxiety to do with hospitals and loss of control rather than the risks of vb per se. If someone posted here saying they had read the research and on balance felt that an elcs was safer than vb for their circumstances, then I wouldn't have posted about cbt. Talking about cbt as the NICE recommended talking therapy to anxiety in terms of MY experience of anxiety does not constitute a 'derailment'. I actually am confused as to how an elcs could be the sole way of dealing with anxiety about being in a hospital being fobbed off and not listened to as this may come with any hospital experience. An elcs isn't going to resolve that underlying fear which may be an issue in future hospitalizations of the op, her partner, her child etc. I don't see how anyone can categorically say a nice recommended evidence based treatment isn't for them before even trying it. I also find it funny that NICE is waved about as best practice when it suits but I am being 'evangelical' and 'derailing' for suggesting an overpowering fear of hospitals rooted in personal experience might be best dealt with via the evidence based intervention for that type of fear vs just automatically requesting a surgery that will involve a hospital stay. The elcs sounds like a good option clinically it I don't see how it will resolve fear of hospitals!

Katiemiddleton - condescending? Okay, I personally don't think so at all...and pleasem don't make apologies or me, that's terribly condescending.

OP - rudeness was not on my agenda at all, and I haven't read all of the post - there's an awful lot to read there.I just don't understand why you didn't make sure you could go private and elect a C-section if this was planned. I really am sorry you're so afraid - I had lots of ears about my last birth and almost zero trust in hospitals, and I have lots of fears about this one later this year too, but to expect what I eel is a medically unnecessary procedure just because you want one and to get it on the NHS is a little bit unfair. Sorry, but I do think that.

I suggested homebirth if it was an option or you because you mentioned your extreme fear of hospitals.

Redtoothbrush - I'm well aware not every pregnancy is planned - I wasn't making a blanket statement, but trying to put it in the context o what the OP had originally written - she'd put off pregnancy for years, mainly because of her very real fear of it all, so obviously knew that actually giving birth in hospital would be a huge stumbling block, and understandably so, you can't just wish fear away, but my point was that knowing this why would she expect her planned pregnancy to be accommodated because of a condition that she knew was going to be an issue?

I also dont' think there is anything wrong at all with electing to have a C section - its your body, your birth - I completely support that, but expecting that on an overstretched budget that we all pay into is not fair unless there is medical need.

And please, there is no need to be rude - calling someone ignorant who politely said what they thought is, incredibly, rude.

trustissues,

here goes the money argument again, although it has been proved many times that it is based in mythology rather than fact.
It has nothing to do with budgets, it has to do with misogyny, outdated ideology of midwives and misery-loves-company attitude of many women (including this thread) guilt-tripping other women.