Only 26% of trusts fully follow elective c-section procedure

[WhereIsBlueRabbit]

I suspect this article from the BBC website confirms people's experiences here:

Women 'being denied Caesarean choice' www.bbc.co.uk/news/health-45245489

In short, only 26% of trusts fully follow the NICE guidelines around elective sections and 15% have a policy of denying them outright.

Our hospital is on that shit list and it’s entirely unfair.
We haven’t got a written policy but every single woman who has requested a caesarean in the past 10years has been able to have one.
Some have seen a second consultant, some have seen psychotherapy. However each woman has had individualised care and has chosen the birth appropriate for her.
(Consultant obstetrician and labour ward lead at a hospital on the list printed above)

I had a previous traumatic induction and delivery and wanted an elcs. My trust is shown as green, however when it came down to it, they didn't really follow the guidelines at all, although I did get a section agreed for 41 weeks. As it was, DD had suspected IUGR and they wanted to deliver early, I flat out refused another induction and had a semi elective section in the end.

I've seen 4 different midwives and 1 registrar on this pregnancy. I'm astounded by the difference in attitude between this hospital and the one I had DS at. At this hospital trust I've been asking for a c section from 7 weeks and everyone I have seen has stated categorically that whilst I have good medical reasons for wanting one they aren't necessary and c section on request is perfectly fine. Compared to my last trust where even those with significant medical need we put through hoop after hoop!

Women should be trusted to use the information and make an informed decision that is best for them.

Wow. This took off while I was at work! Thanks to @warmsunny for the clicky link and to the ever-knowledgeable @RedToothBrush for the story behind the headline.

What gets me is that, as other posters pointed out, these things are not transparent. Sure, I get that a straightforward vaginal delivery is cheaper. It's what I originally wanted for myself. (I ended up with an induction and EMCS.) But that's if it's straightforward. If it's not, then there's the cost of interventions, aftercare, potentially corrective surgery in some cases, and goodness knows what else.

I agree with other posters who point out that this is not just about mental health issues. There are many women who have a preference for a CS for reasons other than mental health and it seems really fucking patronising to effectively be patting them on the arm saying "there there, are you worried it's going to hurt?"

The problem is all those complications won’t be paid for out of the maternity budget.

Each dept, infact each ward is run like it’s own little business empire with its own budget. If labour ward need to beg a box of paracetamol from the postnatal ward that box will be written on the board in the p/n ward and not be rubbed off until labour ward has replaced it. It’s that level of penny pinching.

Any aftercare from complications such as incontinence or corrective surgery will be nothing to do with maternity finance wise. So the Head of Midwfery will be happy because it doesn’t come out his/her budget.

Nobody seems to have the brains to realise somebody needs to look at the bigger picture overall.

Saying that the majority of vaginal births will not incur such costs/complications so overall it would still be cheaper.

The nhs is run by accountants not doctors.

And I see women who are obviously stressed trying to come up with any reason why they shouldn’t have a vaginal delivery and they shouldn’t be under that pressure.

I remember one woman who came to see the consultant who told him that her mother had had a difficult birth and so had her sister and that difficult births ran in the family and she therefore medically thought she needed a section. The consultant spent some time genuinely thinking this was her concern so quite rightly spent some time trying to explain that a relatives experience has no bearing on how hers will be.

The woman is getting more upset. Consultant in the end says “of course if you just want a section anyway, that’s fine”.

We could have saved 15 minutes and a few tears if we were able to just openly say if you want one, have one.

It does worry me though if we had such an open policy the CCG might click that they’re footing the bill and clamp down.

The consultant spent some time genuinely thinking this was her concern so quite rightly spent some time trying to explain that a relatives experience has no bearing on how hers will be.

Genuine question, slightly off topic but, can a tendency for difficult births not run in the family then? I ask because I have a similar experience of my mother and aunts all having difficult births. I inherited their agonising period pains too and opted for a section partly out of anxiety and partly due to just wanting one as after researching it I thought it the better choice.

I’m curious if my families history is just coincidence, which would seem odd but then it’s a small sample size and so could be purely random!

I’m very disheartened by all the comments on other websites/social media where the vast majority of people seem to be completely against maternal request CS.

Most of the comments are along the lines of ‘Why do women think a planned CS is the easy option? It’s significantly more dangerous for mother and baby, and is double the cost of a vaginal birth’

Most of this simply isn’t true. The vast majority of women KNOW it isn’t going to be ‘the easy way out’, it’s completely insulting and talks about women like they’re completely stupid and are trying to choose something they don’t understand. Then again, I guess this outlook works on the basis that women can’t be trusted to make decisions about their own bodies.

Secondly, the ‘significantly’ riskier claim isn’t exactly true either. It’s complex and depends on each woman’s individual circumstances. Vaginal birth comes with its own set of risks. Vaginal birth can also lead to emergency caesarean. Some women will realise that they have a 50% chance of an EMCS if they are induced (based on their age or other factors) so may want an ELCS based on avoiding an emergency section. Some women will see that they have a high chance of a serious tear etc

Then the cost issue... what good is it comparing it to a straightforward VB? Then everyone quoting that women choosing ELCS are costing double? They’re not. Some of them actually SAVE the NHS money for the forceps birth or EMCS they never had. When you add it together it evens out that an elective section definitely does not cost double.

Most of the comments are along the lines of ‘Why do women think a planned CS is the easy option? It’s significantly more dangerous for mother and baby, and is double the cost of a vaginal birth’

This is such bullshit, statistically babies are safer in ELCS and there’s some evidence women are also safer.

But people are unwilling to realise a vaginal birth isn’t always the best choice!

Also both times I have been offered induction the risks of that were not outlined in the same way. My hospitals EMCS rate is nearly 50% for first time mums being induced. And out of the rest a much higher proportion of instrumental birth.

C section is the safest mode of delivery for a baby. Depending on what studies you look at it is either slightly more risky or very similar in terms of risks for the mother.

Genuine question, slightly off topic but, can a tendency for difficult births not run in the family then?

No statistical evidence to suggest so, no.

Other factors are much more likely to influence where its a difficult birth.

Oxford university trust also don’t class a previous c-section as good enough reason alone for an ELCS so many women have to attempt a Vbac with no choice otherwise.

Oxford are utterly draconian. I've not heard a good word.

Note here: Oxford have a private wing which doesn't have a clinical problem with ELCS if someone is paying for them.

The conflict of interest here, is glaring.

I'm just about to embark on this. Just found out I'm pregnant following a missed miscarriage with my first earlier in the year.

I'm 39, and before we even started down this route I did acres of research on pregnancy and birth as I have a phobia of all things medical. It took me 10 years to step into a GP surgery but over the past five years with help I've been trying to learn to cope and manage the fear.

During my research it became clear to me that the information on birth and risks of both vaginal and c-section births is poor and often difficult to find. Vaginal birth info is often glossed over ("most women tear" but no easy to find/understand detail on how badly, how likely dependent on age, the long term consequences etc) for fear of scaring women it seems, and c-section data is often muddled, including emergency outcomes with electives which are clearly two very different situations. There's also a lack of information and understanding around instrumental births and long term risks of those (I for one would not consent to forceps or ventouse).

For someone like me who shakes and panics simply walking into a hospital building you'd think I'd want to avoid all medical intervention, but actually my in depth research has taught me that I want the exact opposite. I want a calm, planned, controlled (as much as is possible) birth that k can prepare for. My mental health would not cope with having to make informed decisions when I'm in extreme pain giving birth. I also want to minimise any long term issues because frankly after I've had this baby I do not want to have to go back repeatedly and be messed with because giving birth vaginally has damaged me.

I'm really hoping that they will say that if that's still what I want after I've spoken to all the people they want me to, and jumped through the hoops that my request will be granted.

Birthrights have been so helpful to me, and I'm hoping I won't need them from here on in, but if I do I know they'll be an amazing support.

I’m so happy that my hospital (Brighton) agreed mine so readily. I agree with @RedToothBrush (amazing posts by the way, thank you for the stats on cost) about that ‘maternal request’ term. That what the consultant wrote on my paperwork and I found it strangely upsetting (even though I completely think it should be available by simple request). I agonised over my decision to ask for one and worry about people’s reactions. I’ve already heard lots of ‘too posh to push’ type attitudes in my NCT group. To be fair though they aren’t aware I’m having one, I like to think they wouldn’t be so bloody rude if they did...! So those 2 words made me feel really useless. I was so please when in my next midwife appointment she noted, in large letters ringed in red, that I was having ELCS due to tokophobia linked to PTSD.

@RedToothBrush thank you for some really informative posts, I'm usually pretty good at taking the press with a pinch of salt but your posts led me to the actual report and I'm shocked at how much some articles have missed the point. Also the mis reporting on costs is pretty appalling.

I've also realised how extremely lucky I am to be under my local Trust (one of the 'green' ones), I have requested a section this time as had an emcs last time after undiagnosed breech and although not as physically traumatic as others, shook my faith in midwives and the feeling of lost control is something I don't want to experience again. I had anxiety but will admit it's not tokophobia, I just want to retain control. My consultant was brilliant - I had done my research and stated that for my mental health, the 34% risk of a vbac going to emcs anyway (that's the figure for my hospital) was too high, and she immediately agreed to the section. It never occurred to me that, having researched risks and knowing my own mind, they could turn me down (though I had been warned they might). I'm horrified it could and would happen to others. I'd encourage everyone to research and write lists of their own personal pros and cons - but sadly it seems not even that guarantees anything. Why aren't women trusted to make their own medical decisions in this one instance.

Yes, there's quite a strong cultural bias against ELCS through choice. Toxic soup of ignorance, misogyny, misunderstanding of evolution, natural fallacy and parroting crap like outdated and always bullshit anyway WHO targets.

I wonder how often hospitals are failing to comply with their legal duty as set out in Montgomery v Lanarkshire?

Yes, there's quite a strong cultural bias against ELCS through choice.

I’ve noticed this. Yet there isn’t this attitude to other choices within medical settings. I reckon because ELCS or not only affects women!