I don't think "too posh to push" cs should be allowed on the NHS

[SoupDragon]

And by "too posh to push" I mean can't be ar$ed to do it "naturally, want to fit the birth into a busy schedule or want it early to avoid stretch marks. That kind of thing.

Obviously where there is a medical need (and by this I include maternal fear/distress where it can not be allayed beforehand} then yes, they should be provided by the NHS.

In the same way, I did not expect the NHS to provide me with a birthing pool, pay for the electricity and increased heating costs or provide me with food for my home waterbirth.

(yes, I know this will descend into popcorn and hard hats but I don't want to clutter up the other posters thread )

But there are lots of things that the NHS pay for that you might find undeserving if you knew about it. There are lot of things they should pay for and don't. ]
People have bunions removed when they can live perfectly well with them and they should have been wearing sensible shoes all along. I'm sure there are a myriad of things that are paid for that someone disagrees with.

agreed the figures are probably scued (sp?) somewhat, as even if you have a section for a breach baby it's classed as an elective section. But I do think that these "too posh to push" women exist.

I also think that consultants are more likely to advise a section nowadays because of the fear of litigation, although in the US it is much worse. When I was in labour with ds, he was back to back and I was pushing for 4 hours. one of the mws was a student and had worked in the US, she said that if I'd been over there I'd have been whisked off for an emergency section within half an hour of pushing if no baby had emerged.

i do know one friend who was too posh to push , definitely..no medical reason at all...and she admitted it,...so probably lots more who do and don't admit it...

i really believe if more time & effort was given to help women understand the natural physiological process of birth, how it works & why it works...and their natural fears were properly & sympathetically addressed.....the number of elective sections would fall....

Ahem. Do women really really have CS's for reasons to do with 'convenience'?

There have been women on MN who have felt very very strongly that they did not feel they could go through vaginal birth, and surely forcing woman (who may not be able to afford the fees) to go thorugh somethni which terrifies them, is psychologically horrific to them, is not at all a civillized thing to do?

I think the phrase 'too posh to push' has trivialised the issue.

But how do you know that these women are "too posh to push"? Have you read their medical records? Have you sat in on their appointments with their consultants?

It's mostly anecdotal claptrap.

My midwife said that "too posh to push" is a myth and she had never known of anyone having a c-section without a medical reason.

eg..woman's first labour ends in emergency c.s due to the baby turning and ending up stuck..or wrapped in the cord and needs to be born quickly....

that would not happen in a subsequent birth.....

.so what would be a medical reason then?

fear? yes...absolutely,,,but as i posted a bit earlier...if fears regarding birth were addressed properyl..the number of elective sections might be reduced....

and i am not advocated forcing women to give birth vaginally! but a trial of labour could be suggested more often than it is

i had an emergency c.s...as soon as i went for the booking in, the midwife said ' i take it you are going for another section?'

no medical reason asked for or suggested...just offered ...

i said no

I think elective C-section should be available (I'm American and we don't have the same funding issues as you). I don't think that women who just don't feel like laboring shouldn't automatically be given one, but I know three people that have had traumatic births leading to a C-section. Emergency sections are scary and for some women the choice to go straight to a C-section is better than the idea of laboring only to have another secion.

Here in the US most insurance companies don't cover VBACs. My sister inquired about one and was told that it was more expensive to make sure an anestesialogogist was on call for her than it would be to go for a C-section.

booking in for 2nd pregnancy obviously

but is a fear of vaginal birth really a valid reason? it is only because of advances in medicine that elective sections are available at all. 20 years ago you would have had no choice, if you got pregnant then you had to give birth, and a section was only available in case of an emergency. So are there millions of women from generations ago who have been scarred by having to give birth because they had no other choice? somehow I don't imagine there are.

since when have people been given caesareans on the NHS without a valid medical reason?

Bet this never, ever happens.

Northener, you have to watch the 'elective' 'emergency' terminology.

Ds was 'elective' in as much as I had planned it from early on in the PG....dd had been an 'emergency' c section. Are you sugesting that all women must have a Vbac or pay for the second?

As it happened I had a raft of great reasons for wanting a section, pre eclapsia, he was a footling breach and when I had the section the doctor doing it said I'd made an excellent choice since my scar was very fine, and would probably have ruptured.

But technically he was 'elective'.

I think it depends on your definition of "fear of vaginal birth". I had a birth that was so violent and horrific that I still have nightmares 4 years later. It left permanent mental scars. I think it's very difficult to make generalised judgements about what constitutes a "valid reason" - IMO massive psychological distress can actually affect the outcome of childbirth and impact the health of both mother and baby.

Are C-section given to frequently? Yes. Here they are 25% of births. Which to me seems high. Most of them are probably elective. Here there is a discussion of doctors that do it too often. The problem is that doctors and insurance providers have to be on the same page. The doctor can recommend it, but that doesn't mean that the insurance will cover it. A good friend wants to have a VBAC, and she knows the odds of one being needed again are low, but if her insurance company says no she doesn't have a choice.

bet there are, wannabe.

You only have to look at the number of awful experiences people post on MN to wonder how many other women feel the same.

SD - I agree with you (and did on the other thread). I was probably an 'odd' case as I was offered a c section for vague medical reasons (not really needed!) and I decided I didn't want one. I would much rather recover quicker after the birth than have to recover from major abdominal surgery too!

I am sure there are women in RL who are too posh to push - they prob don't publicise it! Tbh though it prob is more a 'celeb' thing - those women who can 'afford' a quick tummy tuck at the same time, have a nanny on hand 24 hr day and a chaffeur (so don't need to worry about not being able to drive) etc!

Greensleeves - I will happily pay taxes to contribute to women like you having a CS next time if that is what they need for their emotional well-being.

Most women, given the facts and information about vaginal birth and CS, will absorb their natural fear and decide against a CS - given that it is an operation, etc. That must be true: most women do feel aprehensive, or afraid, and yet most women do not ask for a CS, If someone feels they still want a CS - then the woman should be the 'decider'. Not other people 'diagnosing' whether her feelings are valid or not.

To answer Southeastastra....I've had various bits of private medicine over the years, and all of the consultants I've seen have been practising in the NHS as well as having a private practice.

Not sure about the Private Hospitals re births, but I am using th private maternity unit at my hospital, and have the same OB I was allocated on the NHS last pregnancy. I haven't asked her, but my feeling is that she would not do an elective unless she felt it was in mother and baby's best interest privately, nor would she refuse an elective section on the NHS if she felt the mother was too terrified to cope vaginally. But then, I trust her.

Can't say the same for a different private OB I had when pg with dd, who wanted to section me the minute he clapped eyes on me (12 weeks pg) based on his own anxiety and preference to surgery over delivering babies! I think there are a LOT of individual decisions made in spite of guidelines....

I think that's an excellent post, Blu.

As it happens, I did weigh up the options and have ds2 vaginally, and it was a much better experience - but I was very close to panicking and saying "No, I can't do this", the memories of ds1's birth and its horrendous aftermath made it a very marginal decision for me. I think it's vital that women in that position have choices and a degree of control over what happens to them. I genuinely believe that fear on that scale can affect the physiological outcome for mother and baby.

I believe a fear of vaginal birth is a valid reason but efforts should be made to allay those fears rather than just going for cs. I think a prior cs is a valid reason for a repeat cs but I also think that VBAC should be put forward as a valid option rather than being the second choice it appears to be in a lot of areas. I'm not advocating that women be forced to give birth naturally with no pain relief.

I also don't believe that any what I define as Too Posh to Push sections happen on the NHS, they would be private. I also don't beleive they shoud be available but some people argue they should.

I don't think that smoking related stuff should be treated on the NHS unless the patient makes an undertaking to stop smoking for the rest of their life. They should be given every help available to make this quitting successful. Ditto for other health problems caused by lack of exercise, diet etc. Drug addicts? No, they shouldn't be helped unless they are committed to quitting and they should get every help to aid them in quitting. People should get the treatment, of course they should, but the cause of their problem should be corrected too to help prevent further health problems. Otherwise what is the point?? Why throw money at someone to heal them of a particular ailment if they're just going to get it again? But this isn't really linked to c-section at all, it's just a tangent

This is just my opinion. I don't think c-section is a "lesser" birth or think women who have had them are failures though.

I think fear is being thrown around too often. There is the normal fear that everyone has, but my sil spent 13 hours pushing after 24 hours in labor. At the sixth hours she begged for someone to help her. She begged for the vacuum or forceps. The midwives just thought she didn't take pain well. They took her epidural out and when they put it back in for her section it was misplaced and she felt the incision on half her body. She was so drugged up afterwards and so exhausted that she doesn't remember her son's first day on Earth. In her case an elective C-section for her next baby would give her the opportunity to enjoy her childs birth.

And agree with Greensleeves and Blu. If only women were consistently offered support/opportunity to talk through and process their fears before such decisions were made. How on earth can the woman, OR the consulant, make an informed decision without a bit of that?!

Yes, a bit of 'counselling' would cost the NHS a few quid - but not a lot compared to some of the cockups that result from lack of info/discussion maybe....

I was offered a section just because of an em section during first labour. That was wrong IMO.