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

[tiktok]

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?

aloha, are you calling me a liar? i said my epidural didn't work - are you challenging that assertion?

you are doing exactly what you are accusing the nct of - supplying a highly selective view. my own view is that choice should be informed - that means being aware of the pros and cons of all the options. also agree with sd - don't see why c sections s/be avail. on nhs when not medically indicated, e.g. in your situation.

Mothers are allowed to opt for amnios or cvs during pg which carry a small but significant risk of miscarriage. A large number of mothers continue to smoke during pg despite the risks to the baby. An elective "by choice only" c/section is not an available option to me locally on the NHS. There are any number of reasons why I may wish to choose this, some of which will no doubt be thought to be trivial. Looking at my local hospital stats (for a woman of my age ), if I did not go for an elective c/section I would have only a 40% of a "normal" delivery, without forceps/ventouse/c-section etc (all of these being procedures which carry the risk of long-term damage). We have different attitudes to risk - we shouldn't prejudice against people on that basis. I'm not even sure that we should be putting everything down to a matter of cost, though that is unfortunately the way that the NHS is heading.

As Soupy says there are c/section horror stories as well as normal delivery horror stories. I think that we do need to consider that even ignoring electives some 10-15% of births would tend to need an emergency section as the safest outcome (if I've understood the WHO blurb correctly). Planning a normal birth doesn't mean that you get one: it is still a risky process. One person's view on those risks is different from anothers. Just it seems locally as if it is more socially acceptable to want the risks of a homebirth over a c/section.

Soupdragon, yes, I have only had a section birth. But even though I didn't go into my pregnancy planning a section, I will be totally honest and say I do have an absolute horror of vaginal birth and labour. Whenever I read the birth stories of hours and hours of pain, sliding around on blood and fluid, writhing about and bellowing and having to be dependent on strangers (ie midwives) for comfort and then pooing in your birthpool, it makes me recoil in revulsion. I do know other people find these tales profoundly moving (and people do enjoy these births which I totally accept but secretly find incomprehensible - sorry everyone), but they horrify me. So I was really pleased when I was told I had to have a section - no question about it. It was really important to me that I remained 'myself' throughout - ie not animalistic, which a lot of women seem to genuinely relish. I would have found anything else to be humiliating in the extreme. "Pulling at my innards" doesn't bother me at all - didn't see it, couldn't feel it! As for having the baby safely and painless lifted out of me via a tidy man-made, righ-size slit - I thought that was rather wonderful!
Also I had a friend whose baby died during a vaginal delivery that would probably have survived if given a cs - we all have our horror stories.
My favourite is when people say "giving birth is exhilarating - like running a marathon or swimming in an ice cold sea' and I think, 'But I'd hate to do either of those!".

Of course I wasn't calling you a liar BK. Why do you think I am? I wasn't referring to epidurals that don't work as pain relief (which must be horrific), I was referring to your comment about the 'risks' of epidurals - which I took to refer to the 'spiral of intervention' that MI mentioned. And I don't think my presentation of facts is misleading. I'll post the references if you like. There is no proof that epidurals themselves lead to more intervention, certainly no proof that they lead to caesarians, and the problems of analysing data are obvious.

TikTok: yes, I felt very strongly that the message I was being given was that a CS was the bogeyman of birth. The whole basis of our NCT class was 'avoid any intervention because the spiral could lead to A CEASARIAN'.
This was fine by me, breathing for England as DP inflated the pool in the front room, and I am very grateful for all the support for women who aim for a 'low-intervention' birth. But it gave me a completely prejudiced and erroneous view of the obstetrician and aneasthetist who eventually presided over a last minute epidural and tug'o'war style ventouse delivery. I expected them to be Hannibal Lecter type beings with no regard for women as individuals etc. In fact they were lovely, far more helpful than the MWs at that point (who had forgotten to remind me to pant rather than breathe during 2nd stage), and helped me get Ds out even tho' the Obs muttered 'this baby would have been a CS hours ago if you'd been in labour in hospital'.

In fact the 'no intervention' ethos was so strong amongst my MWs that no-one mentioned a GBS swab until it was well over 48 hours since my waters had broken, and didn't get the positive result until after DS was born. Had I been given the choice I DEFINATELY would have opted for accelaration or CS to avoid DS being on IV antibiotics.

Just to say that I see no reason to attach any value judgement whatsover to any woman's preferred appraoch to the birth of her baby.

Aloha: I did think that an epidural can lead to further intervention because the lack of sensation, and lack of mobility, interfere with pushing, relaxing perineum etc?

"giving birth is exhilarating - like running a marathon or swimming in an ice cold sea" No, it's like pooing a water melon

For me, the "natural" pain of natural birth is preferable to the perceived "inflicted" pain of a c-section. That's just how it's tied up in my mind of course but means that, for me, the thought of a c-section is terrifying and don't understand why someone would opt for one from choice. It doesn't bother me that they do opt for one but I don't understand it.

I remained myself throught both my labours/deliveries and I didn't get animalistic because that's not the sort of person I am.

Back towards the original questions though, I do think something should be done to curb the rise in unnecessary c-sections where they have come about through unnecessary intervention etc and could have been prevented through things like better positioning for the mother during labour etc. However, the blanket term "curbing the rise in c-section rate" is more likely to be viewed as saying women shouldn't have a section at all, which is wrong.

I think that in a prefect world everyone should be able to choose what kind of birth they want. While we wait for utopia to come about though, I think that we have to face facts, If someone's elective (other than on medical grounds) CS stops someone with MS or cancer getting expensive drugs then I'm afraid I think the right to the elective CS should be the first to go.

Hard choice though, but lets face it with a resource constrained NHS these are the choices that really do need to be taken all the time.

Of course what would be even better is if the NHS used the resources it has more efficiently so that everyone's needs and wants can be met. But as I said whilst we wait for utopia...

Soapbox, does that mean all women should be encouraged towards the cheapest birth option? Or merely the most common?

i had my first section as i had no choice in the matter, baby was in distress at 33 weeks and couldnt be born any other way. I definatly wanted a normal birth for the second but it didnt turn out that way. I had been in pain for days, my waters had broken and my contractions still werent going anywhere 18 hours later. I was told i wasnt in proper labour and couldnt have any pain relief (well it felt like agony to me)then the baby's heart rate started to deccelerate during contractions. They said they would put me on a drip to get things moving and take me down to theatre if things got any worse but i went to pieces and asked for another section. I was in a lot of pain, frightened, no-one examined me, no-one seemed to be bothered at all and i felt i couldnt trust the doctors to keep a good enough eye on us. Who knows if i did the right thing? i didnt want it to become an emergency. So in affect, i would be one of the women who chose a section. Not everyone's reasons are the same and ive actually felt a failure because of it ever since. Its not what i wanted at all.

Well if put on the spot I think my priorities would be:

1.safe for mother and baby
2. as painfree as possible (so drugs avail on request)
3.cost
4. free choice as to CS or vag birth.

So I guess I am saying cheapest but within constraints of safety and pain.

Of course I respect choice in birth. Just because I find something personally horrific doesn't mean I think it is morally wrong. I'd hate anyone to think I was criticising anyone else's birth choice. I do think the money argument is a bit spurious. Should we ban epidurals and gas and air and birthing pools and birth centres and scans - that would also save lots of money. The NCT is always campaigning for MORE money to be spent on childbirth...except in this one small area. Hmmm.
I know the NCT says as a certain truth that if you have an epidural you are much more likely to have - horrors! - a c-sectionn (as a result), but there is no evidence for this at all.

You can have poor maternity care, or bad luck, that leads to awful vaginal birth experiences. Ditto ceasarean sections. All anyone can do is read as much as possible (if they want to - some people don't) and weigh up what is important to you.

For instance, having a caesarean increases the risk of the stillbirth of the next child (Lancet. 2004 Jan 31;363(9406):402) - and that is after all other factors have been accounted for. The section itself and not the mother's socio-economic status, her tendency to a small pelvis or whatever seems to increase the risk. It still means your next baby is overwhelmingly likely to be healthy. But if you have a dreadful fear of stillbirth (maybe you have had a previous stillbirth) then you need to know this, so you can weigh it up.

This is what I mean by counselling women - telling them facts, accepting that some facts mean more to some women than others, and not bullshi**ing them.

Well, Tiktok, that is just one study - I think the NCT are very selective on studies themselves (as in breech birth and c-sections) and my friend's stillbirth was directly linked to vaginal birth.

How do you determine "safety"? Do you only look at fatalities, or do you look at other issues? Who decides what the "safer" of two outcomes would be? Say you had a 50% chance of a 2nd degree tear or a 25% chance of a 3rd degree tear - which is the "safer" outcome for the mother?

Doesn't having something like safety as the main factor mean that birth opions are put firmly back with "professionals" and not with women...

And also for Aloha, you have ignored the wonderful birth stories with natural deliveries and concentrated on the worst, given your profound horror of natural birth, yet continuously champion c sections... I have never writhed on any blood and mucous nor run any marathons or found it exhilarating, I found it hard but manageable and overwhelmingly fulfilling, I also got up and had a bath 30 mins after wards and went home an hour after that. To me that is worth so much more than the risk of a c section...
Statistics show.......
that c sections are safest?? do not think so

Well as to the safety issue I think I'm talking about births that are safe for mother and baby and by that I mean, unlikely to result in long term pain or disability for both. Fatalities would of course come into that consideration.

Yes I think that does involve the professionals to inform the mother as to what is the safest option for her taking into account all her history.

IMO any intervention that results in having to spend longer on the post-natal ward eating NHS food is a very serious health risk indeed.

Forgot to say. As to the question about the 2nd v 3rd degree tear. Wouldn't count it at all. Short term discomfort - and I speak as someone who has had one of each!

And in any case it is not possible to micromanage the birth process to that extent. Usually the deteminant of a tear is so far into the birth process that the decision as to how the baby is born is already made. You can't exactly say at the point of crowning 'Oh dear she's heading for a 3rd degree tear, shove it back up and take her down to theatre' can you

Aloha

You may think that the issue of money is spurious but the fact is that the money has to come from somewhere.

In fact probably the bigger issue is resources, our hospitals probably don't have enough theatre facilities, surgeons and staff to meet the needs of everyone who may want a CS on demand. Or do you think you are not winning many people over to the CS option

kiwisbird, most births are wonderful - this is about whether campaigning for better options of birth leads to the attitude that women shouldn't have c/sections if they want them. Yes we need to campaign on behalf of those who had uneccessary c-sections and didn't want that. But if someone is happy and content and informed about her birth plan, then why deny her the available options be it homebirth, waterbirth or elective c-section.

aloha, i must apologise, i went off on one there. actually i agree with you, i don't think the "cascade of intervention" case has been made conclusively - but it is worth bearing in mind.

i specifically meant that the risk of an epidural not actually working should be considered a "risk" of the procedure, and one that women should be made aware of. i thought you were challenging me on that - but reading back you weren't at all, so i don't know why i thought so actually

Bossykate - I also had an epidural that didn't work. As you say it is a big shock. I had one area in my hip that wasn't covered and it was horrendously painful.

It happened again with my second child, but this time the anaethetist was back in like a shot and topped it up and repositioned it. Worked perfectly then, but for the half an hour it took to re-take I thought I was in for another horrid time!

my second one didn't work either it was a very frightening experience.