Do women feel as if they're being told 'you shouldn't have a section'???

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Various organisations, including NCT, campaign for choice of place of birth and type of birth, and point to the rising caesarean section rate with concern. This is because the high numbers contrast with the likely figure of women and babies who need a section for medical reasons. It also reflects concern that on the whole, recovery after a section can be longer and more difficult. I don't think this is the equivalent of telling individual women they shouldn't have sections (clearly, the op is life saving for some, anyway), but this is how it seems to be interpreted. Comments?

Tinker's point is valid - the female docs I know who have done an obstetrics rotation would always go for c-section because they haven't seen any 'normal' births. GPs are a different matter, because they refer patients to midwives and do post-natal checks on women who have both sorts of deliveries.

Yes, but this was a professor of obstetrics referring to risk of damage - statistical risk. Not observational - and male! Though the article was co-written with a femal obstetrician. Pointed out that the risks in the NICE report were all caesarians versus all successful vaginal births, which of course includes all the emergency c-sections and all the c-sections carried out because of pre-existing risky conditions. They say - rightly - that a truer estimate of risk would be elective c-sections versus attempted vaginal birth. Also, re costs of c-sections, the rate of epilepsy is much higher in first borns than subsequent children and it is believed this is due to minor brain damage caused by the more difficult and prolonged first births. And the article didn't even cover that. They talked about the fact that babies born vaginally are at greater risk of problems than babies born by c-sections.

observer.guardian.co.uk/focus/story/0,6903,1208063,00.html

Thanks for that link, Aloha. Very interesting reading.

Oh Aloha, I know you are very pro-caesarian and I know it saved your life, but I've rarely seen a more biased and extreme account than the comment by these two obstetricians. The fact that caesarians save lives in some circumstances doesn't mean they are better than vaginal birth full stop.These surgeons are basically arguing that women are very badly designed for giving birth. Strange that the human race has survived to date then.
They fail to mention the risks of caesarians for babies, such as breathing difficulties ? an astonishing omission which is clearly deliberate.
Yes, a comparison between elective rather than emergency c-sections and vaginal birth would be of use, but their 'c-section is always safer than vaginal delivery' is so extreme it is ludicrous. And then they talk about making sure women are well-informed! I doubt very much that they give a well-balanced account to their patients if this is the sort of claptrap they spout.
As for epilepsy, it is a very rare condition ? more properly a set of symptoms ? which is very poorly understood and hard to diagnose. There is absolutely no evidence that vaginal birth is a common cause of epilepsy. Even the broadest definition would say fewer than 1 in 20 people have a single seizure at any point in their life from a variety of causes. Epilepsy is generally defined as a tendency to repeated seizures and at most 2 to 3 per cent of the population will ever, at some point in their lives, be treated with anti-epileptic drugs. Sometimes there is an identifiable cause, often there isn't. If vaginal delivery was a serious risk factor for epilepsy the incidence would be far higher. I'd bet my house that if you looked at relative risk, the association between epilepsy and any other activity such as eating carrots would be just as strong.

It isn't stange that the human race has survived to date since the majority of vaginal births will be unremarkable. However if you cannot exclude the fact that vaginal birth is aslo not without risk. Vaginal birth was the norm at the turn of the 19c and giving birth was more dangerous than being a miner ( the most dangerous occupation at that time)

And removing those individuals from the stats who have presented as emergency cases would seem to me to be a very sound scientific statagy, since these individuals may be presenting at the time of section with damage caused by prologed and unsucessful vaginal labour.

Regarding epilipsy, when I did some research on this in the 1980 the majority of cases had no know cause.The lifetime liklyhood of having a fit was 1 in 100 but of developing epilepsy was lower than this.

Agreed HMB but the obstetricians weren't saying 'the majority of vaginal births will be unremarkable' they were saying c-sections are safer, full stop. That's an outrageous statement which could uncessarily frighten pregnant women and suggest anyone going for a vaginal delivery is putting their baby at risk. They argue that c-sections are getting safer so are becoming a better bet than vaginal delivery. Well surgeons are also generally good at appendectomies but that doesn't mean a healthy person should have their appendix removed. If a woman wants a caesarian that's her choice (and obviously many are medically necessary) but I think it's appalling if these obstetricians are influencing their patients with these sort of extreme views.

And the little stat I posted about subsequent risk of stillbirth after a section is never mentioned - see ref below. It's all part of the equation.

I must admit, I read the Obs piece about C-sections and it did give me the willies a bit. I'm all for pple who want c-sections to be able to at least ask for them and get them, but to hear 2 medics saying that basically sections are safer..........where does that leave the rest of us? I've had 2 very long births.....ds1 I couldn't even put a time on.......a week I think and the second 15 hours 1st stage. I really worried about the effect on them. I'm not bothered about the pain, but if c-sections are really safer, then I think thats really scary. I think they should be careful what they say.

Forgot to say that I'm about 33 weeks, and yes it has frightened me.....I'd put up with any amount of pain but if it is endangering my child, I'll be first in the queue for a section as anyone would I think.........

why do they not instead look at c sections in women who DON'T want them, rather than those that do, to choose a section is obviously thought out and evaluated so comes under the birth empowering choice theme that all parenting organsiations including the NCT should stand up for.
Much better to target the figures in women who through a badly managed induction process (drip happy hospitals) end up with unwanted and often traumatic emergency c sections, the worst of both worlds, a long agonising drawn out labour with little progress, a distressed baby, and then a hasty section thereafter. That experience of labour will lead to the next delivery being an (elective) section as well probably, as the experience of what labour is like is distorted.
Can you tell this is the bee in my bonnet?
LOL

Er, why is it 'extreme' and 'ludicrous' to say that a section is safer for babies than vaginal birth?? I would guess a Professor of Obstetrics who is also the chairman of the Royal College of Obstetricians and Gynaecologists scientific advisory committee would actually be pretty well placed to know what he is talking about. I do not think it is 'outrageous' to say what he, who is after all, extremely well qualified, believes to be true. After all, the number of times I have been told about the terrible risks of dying with a c-section blah blah blah and nobody says, oh, that's just scare mongering. It seems totally taboo to say anything positive about sections. And yes, we are very badly designed for childbirth. Human evolution has favoured the upright stance - hence narrow pelvises - and big brains - hence large heads. Clearly these two are not very compatible when it comes to birth. On holiday in France last year we went to a museum of stone age man, where I saw a stone age female pelvis, which looked like an open, shallow bowl, and the skull of a stone age baby, which was tiny. I would guess birth then was a more straightforward affair. We are now designed to have a certain death rate in human females during the birth process - and that is not taking into account the factors that Fisk mentioned, for example older mothers and bigger babies.

And of course, Kiwisbird is right - why on earth the emphasis on banning the small number of maternal choice sections instead of making changes that might reduce the number of sections where women don't want them? Is it because of some kind of strange morality where women should suffer the 'punishment' of labour? Or is it solely financial?

I do find it baffling that when someone says sections are dangerous nobody describes that as extreme or ludicrous....

being upright worked well for me!!! delivered both mine standing and it took less time than an episode of casualty, with less blood
and an intact perineum too...
natural non intervention birth is the norm in most cases I think recent figures put vaginal deliveries with no complications at about 60%
which is fabulous news.
C sections are invasive and not without risk, however on balance in some situations undoubtedly they will be "safer" because of the risk factors that lead to the decision to perform the section.
To say overall that sections are safer is dangerous and untrue, regardless of whomevers proclaimations.

kiwisbird, I'm sorry but I honestly think Professor Nicholas Fisk is a bit more qualified than you to say whether sections or vaginal births are safer for babies.

Also, when I say upright stance, I do not mean during birth - I mean the fact that we as a species stand upright on two legs, rather than bent over - our pelvis has to be narrow for that to be achievable. Yet our big brains mean bigger heads. I think you don't have to be particularly smart to work out that smaller, narrower female pelvises and bigger foetal heads are not developments designed to make birth easier or safer.

Ooooohh so true
do you not think that if this was true it would not be hidden away on some onderous link in a newspaper and that some kind of national or international guideline might be drawn up to ask us all the RAISE the level of c sections nationwide...
why concentrate on ONE opinion by a minority than by centuries of evidence?
Because it was safe and great for you?
One of my best friends mothers died as a result of a c section... I know its all relative though.

Anyone got any chill pills?

I'm eagerly awaiting the new govt guidelines on reverting back to 4 legged walking...

What are the centuries of evidence though? Vaginal birth is a risky activity, historically. And has traditionally been greatly feared. Yes, of course the human race has survived, but many women have died. We've survived plagues and endless hideous, incurable diseases too. Doesn't mean they are safe or good for us. I'm not saying vaginal birth is as dangerous as a disease, but saying we've survived it is NOT the same as saying it is perfectly safe. And it's not one opinion. More than half of obstetricians agree with him. You may not agree with him, but he is one of the world's most qualified doctors in the field so I do think his opinion cannot be dismissed as 'ludicrous'.

Wrote this before reading the last few posts and, if you can get them to me virtually, I think I urgently need some of your pills SoupDragon.
In response to your point aloha, I think it must be partly because women who have had sections are seen to have had births, which must be "second best". We've avoided the pain and the effort of natural birth and therefore must be taking risks with our babies, i.e. selfish modern mothers, putting themselves first. Sections are OK if we're biological failures (chip on shoulder, me?) in the first place but not as a rational choice. All tied up with the Eve thing I think.
Also, while the increased mortality/morbidity stats have become well known and accepted, there's little awareness that they're looked at in a cock eyed way as Fisk (and you) point out.
As to why its tucked away in the middle of the paper - perhaps reading the MMR stuff on here has made me cynical, but possibly it might have something to do with the undeniable fact that coming out in favour of sections is hardly politically correct at the moment.
Have to say that I personally didn't find the article particularly biased, or indeed positive. For me, it depressingly confirmed that despite being a complete science idiot, I can nevertheless make some sense of medical articles on pub med. I'd gathered that the biggest risk that would affect me was that of placental problems in a later pregnancy and this was emphasised in the Observer article. I had my (unplanned and almost certainly a very good idea) section at 22 and ds's sheer fantasticness () has persuaded that I'd probably like a few more children over the course of the next 20 years but, although I'm always cheered by janh and zippy's lovely examples of multiple sections, I really really don't want a hysterectomy in my 20s
Anyway enough moaning. Btw, completely agree with your earlier post about avoiding unneccessary sections that women don't want kiwisbird - you've hit the nail on the head for me.

I can dismiss him as ludicrous if I so choose, thats the joy of free speech
I can appreciate that medical controlling of birth can increase the unpredictability of birth adn many other things too, I mean should all women have mastectomies to avoid getting breast cancer? That would be safer too, so it is all in context, I guess if vaginal birth was really that dangerous then it would be only sensible to look at birth as risky thing.
It might well be safer never to have kids at all!
I am biased and I know, because I have had 2 superb, easy and fulfilling birth experiences, as did my mother and all of my immediate relations.
I just wonder about the sense of promoting a view that cutting a woman open to deliver a baby under anaesthesia and miedication, can be "safer" than a physiological process in the majority of cases, I appreciate again, that in indentifiable cases it is safer to perform a section. And I think it is ok for women to choose a section if they so desire, but to be properly informed of the risks * there are several*
Neither way is guaranteed to be perfect or free of risk, but it can be managed on an individual basis. Rather than by a generalising opinion, however medically fluent and esteemed that opinion is.

God know what I'm on about in that last sentence, meant that I agreed with your point Kiwisbird

I think that we all accept that the risks of maternal death, while small in both vaginal births and sections, are increased with a section. However, although I don't have access to absolutely every piece of research (and, anecdotally and irrelevantly, just like you knew a lady who died after her section, I know someone whose baby died in early labour and I worked for a lady who had severe cerebral palsy after her breech birth went wrong) why is it impossible that a section 'could' be safer for the baby in terms of death and serious disability than a vaginal birth (bearing in mind that unfortunately they're not all as pleasant as yours). Is it just that its unnatural? After all lots of natural things are dangerous.

Doesn't it all only mean that c-section is safer than v-birth for those for whom it is medically necessary? Which is obvious. I think, Aloha, that women "historically" used to die from childbirth because of infections (now easily treated by antibiotics)rather than the actual birth process.