Caesarean for "stupid" reasons?

[GloriaInEleusis]

Following on from this thread, I just wondered how many people have caesareans for stupid reasons?

I've had two, one crash and one planned. Neither was for a stupid reason.

Gloria you say 'Vaginal birth has plenty of risks and I for one am not prepared to take them. I think a section is safer. And that's my choice.'
Is it though??Should some mothers be able to request a CS when in other hospitals they can't???It isn't always 'your choice' whether to have a CS or not, and most of the time it is taken out of our hands.

" birth is a natural act, which we are females were designed to do vaginally.

society and the medicalisation of childbirth has turned this natural act into one of supposed 'extrme risks' and fear."

alot of things are a natural act, that doesn't automaticlaly make them the best option in all cases. One of the striking things about being human rather than just clever chimps is that we have the ability to look past our physical evolution to use tools to give us other choices and options.

I dont' think that its soceity that has turned childbirth into extreme risks and fear, I think by the time we had finally got over the risk of dying in childbirth or losing a child (which was still very much a risk for our granparents) we had a whole new set of quite real worries and risks to do with giving birth. Knowing so much more about birth defects, risks of going into hospital (MSR etc) lack of support structures in extended fmaily so a very real risk of going into labour unexpectedly surrounded by strangers etc etc.

I agree that childbirth doesn't in itself need to be medicalised - thats why i wanted a homebirth cos I wasn't ill just pregnant!
However that isn't to say that it isn't scary - fgs if nothing else you are CREATING A NEW LIFE! and if that doesn't scare the F* out of you maybe you shouldn't be giving birth!

I mean this is a new person, and given all the bollocks that is pushed at mums-to-be about how your actions/ thoughts/ emotions etc etc affect your baby from preconception onwards you might be forgiven for thinking that this was an incredibly important moment and if you dont' do it exactly right you will screw up this persons life forever.

So where do I sit? I think that childbirth is basically a messy, painful affair and the best option is to get it over with as quickly and safely as possible in each individual case for woman and child(ren). There's no point in suffering pain, there's no medals for bravery or refusing safe drugs etc, the whole point is to get a live healthy baby at the end of it and all the guff about transcendant birth experiences just sets women up for dissapointment. Its nasty brutish and all too frequently NOT short!

Prunie, you wrote: "Once we had got nutrition and healthcare sorted to an appreciable degree, the health of mothers improved such that childbirth became much safer than it had been when hygiene, communicable disease and above all poor health were the main factors in maternal and perinatal death."

I am curious about your stats. Is Margorie Tew saying that now that with improved hygiene, communicable disease and poor health (the main causes of death in childbirth in olden times), it is safer to give birth at home/GP unit than in a hospital?

Do the studies take into account the fact that the risky cases tend to end up in hospital and the low risk cases go for homebirth. I agree that hospitals are not the ideal environment to give birth in (bright lights, monitors, bl__dy internals and all), but I find it difficult to believe that medical interventions have not played a part in saving lives.

Also, live birth and live mother is great. But it is also important that a birth does not result in permanent injury and long term pain to baby (eg CP) and mother (eg incontinence). Do home births measure that?

You might have to check with your dh

It is victorian. Elective sections are available on the NHS if you know are determined and willing to jump through a few hoops. You might have to change your GP or even consultant. But it's possible.

Now, I've never requested one just cause I felt like never occurred to me. But, after I hadd DD by a crash section and then discovered two others from my antenatal class had asked for sections I must admit I did think think "now why didn't I think of that?!?!?!" Next time round I requested on on the basis that I had already had one and was prepared to take the risk of another emergency section not to mention the risk of the scar tearing. Now I realise some people think those risks are minimal and are prepared to take them. That's fine, but not for me.

That is precisely what she does say - or rather what the cold stats say (they are not my stats, I didn't collect and analyse them, I'm only reporting!).
She is unequivocal that the assumption that hospitalisation and interventions lead to increased safety for mother and baby is not at all borne out by the statistics, and indeed that the opposite is the case, if we are going by figures. She points out that eg the RCOG have deliberately suppressed the stats and that she had to work hard to get hold of them, as well.
As for which data precisely are being looked at: there are a few problems with the classification (this was the thrust of our evening conversation yesterday )e.g. in that in some cases a planned home birth that transfers to hospital can be classed as a home birth or a hospital birth - I am poised to read further and get more into that as it is a very important point (otherwise, all home births would be safe, and that is patently not the case).

She does go into risk assessment and is very clear that for all levels of risk, the picture is one of consultant-led units being riskier than the home in terms of mortality.
I absolutely see your point about morbidity though - interesting and to be investigated.

(all this to blueshoes)

When I say all levels of risk, I mean that - not all types of risk. We are talking stats here after all.

oh fgs, why, why, why why do these debates rage on??

if you want to deliver via VB - knock yourself out.
you want a homebirth - well done you.
elective cs for medical reasons - fab!
elective cs because you want one - go nuts!

as long as mother and baby are happy and healthy...who cares?? freedom of choice is the way forward and no one should be judged based on the mode of delivery they choose.

oh and i add. have just had elective cs on medical grounds. was such a positive experience, would not hesitate to have one again (if i am blessed enough to fall pregnant again) - even if it wasnt medically necessary.
guess that falls into the category of stupid reasons and also means i shouldnt even consider falling pregnant again according to some mnetters.

dal21 - the debates rage on for the same reason as any other important issue affecting people and society! And I would say that in terms of importance, giving birth to a new life is up there with other fairly important things!
The whole point is that any kind of freedowm of choice has to be balanced with other factors - the impact on others:
eg should a mother be allowed to choose a CS for non-medical reasons when statistically it is less safe than VB? It's actually a moral issue isn't it? Also, a CS costs more than a VB - should a woman be able to request one given that the money comes out of the public purse? I'm not giving any simple answers, just explaining why actually these ARE issues which should be up for public debate.
Personally, I find Prunie's post really interesting - showing that home and GP unit births are statistically safer than large hospitals. Yes, some people will have tragic anecdotal evidence of the homebirth that went wrong etc but you can't deny the facts which are that home and GP units are safer. And I think all women have a right to know these facts, because I also agree with the post which said childbirth has become so far removed from a natural process that many women honestly don't believe they can do it. I was quite shocked at my NCT antenatal class to come across a number of women whose STARTING point was that they were going to need an epidural for labour. I don't feel that's about women exercising choice - it's about a lack of information and understanding which actually disempowers women.

prunie, thanks. I think I get you, not just

Good point about hospital transfers of home births. If every home transfer to a hospital is classified as a hospital birth, then this buggers the hospital figures because they end up having to pick up the pieces of a home birth with complications. If a transfer from home is still classified as a home birth, then the home birth figures get the benefit of life-saving interventions in the hospital without the hospital being credited for it. Either way, the hospital figures get buggered in relation to home births.

I had an elective second time around because I was utterly terrified of labour and midwives after my first attempt.
At the time I felt I could not have mentally survived another traumatic labour and did not want to leave my DH, toddler and new baby to cope with out me. My GP and (specially chosen) consultant were very helpful although my first time had been a crash CSec so that makes a difference. But as anyone who's had a traumatic birth knows, the next time you HAVE to feel in control and for me that meant no midwives.

If we are going to base things on how much they cost the public purse, then let's do away with IVF treatments. Completely medically unecessary and expensive to boot.

Chibi - of course cost has to be a factor!! It doesn't mean it's the only factor on which it's based, but it has to be one of them. You raise the issue of IVF - well, that's a good case in point! Should we do away with it completely? Should everybody who has difficulty conceiving be offered unlimited IVF? Or do we opt for somewhere on the spectrum - ie: a certain number of IVF attempts paid for on the NHS? There are many situations where there are grey areas and C Sections can be one of them. If a woman doesn't have a medical need for a c section, then it's entirely reasonable that various factors are weighed up - money being one, mental health of the woman another, possible risk to child another etc etc

inthegutter - fair point on the debate front.

what i dont like about these or other debates is when they turn into bashing people for the choices they make. i am an intelligent indiviudal and when VB was being bought into question as the safest mode of delivery - I read up the facts. all risks were pointed out and explained - of both vb and csection. the fact that it was such a great experience means I am more than happy to do it again.

morally - yes, many points are up for debate. along with should smokers be treated on the NHS, should alcoholics, should drug addicts.....

but some of the more sweeping/ extreme one sided statements made on threads like this really get my back up.

The Tew figures remind me of Disraeli's famous quote "lies, lies and damned statistics".

If you look at any graph comparing infant/maternal death rates over the past 100 years alongside the Caesarean rate over the past 100 years, the first goes down hugely and the other goes up hugely. Is anyone seriously suggesting that these two factors are unrelated?

This is a hugely privileged moment in time in maternal history. We can't control everything 100% but we are so much more fortunate than those who went before us. This will no doubt provoke some people (and I don't mean to be rude), but I really do think that there is too much "naval gazing" on this section of MN, possibly linked to modern women's unrealistically high expectations combined with doulas' vested interest in natural childbirth. IMO a debt of gratitude is owed to the doctors and medical intervention in general.

Hmm. I think you're confusing correlation and causality.

I think the disconnect comes from talking about birth in terms of social trend, and birth as the intensely personal experience that it is, whichever way the baby comes out.
Whatever the figures, each one of us will never forget our births, and we each bring our own set of circumstances, fears, hopes, our past to it - that's unquantifiable, really.
Sweeping statements about what's morally better are never going to be accurate or pleasant or useful.
I am passionate that we need better information, though, and way more support than many of us get.

Elective Caesarean section safest form of childbirth BMJ23 November 2007

Sir,

I have a total of 23 years Obstetric experience in the UK, 13 years as a Consultant in a large maternity unit and with 2 years full-time research in perinatal mortality statistics during training. Villar and Colleagues (BMJ 2007;335:1025 (17 November), oi:10.1136/bmj.39363.706956.55 (published 30 October 2007) present data from South America showing that elective Caearean delivery (El CD) is associated with a 1.66 fold increase in risk of neonatal death in cephalic presentation (table 3). This is a worrying statistic for any women deciding the best mode of birth for her baby, and would suggest that a vaginal birth is safer for the baby than El CD.

To estimate this risk for a UK Population I have analysed the comprehensive dataset collected by the Confidential Enquiry for Maternal and Child Health (CMACH), with very different results. During the period 1995 to 2006 there were 780,370 total births in the West Midlands region of England. During that time there were a total of 4054 neonatal deaths (up to 28 days), of which 176 were following El CD. Of these 111 were caused by lethal congenital malformations and an additional 50 were due to prematurity. Amongst this massive cohort there were only 15 deaths following El CD after 37 weeks, with a neonatal mortality rate for El CD at term in normally formed infants of 0.19 per thousand (one in 5,263), compared to the headline figure of 7.7 per thousand (one in 130) presented in your paper. A difference of more than 40 fold. In my opinion the paper, and associated editorial gives the false impression that El CD is a cause of neonatal death. The fact is that elective caesarean section at term is a very safe method of birth for the baby, and is safer (for the baby) than planning vaginal birth. The presentation of data in this way gives me no confidence that the morbidity data, which is much more difficult to quantify, is accurate and unbiased.

I suspect that the vast majority of these cases are in fact deliveries associated with prematurity and other obstetric problems. In my opinion the WHO and BMJ have joined together to present a completely false statistic for the risk associated with El CD, and this has not been picked up or corrected by either the peer review process or the associated editorial.

It is regretable that the false impression given has been widely reported and disseminated, but the true mortality rates - which are well collected and reported for all UK deaths through CMACH are not given the same prominence.

Yours sincerely

Mike Wyldes MA FRCOG
Consultant Obstetrician
Clinical Lead for Labour Wards at Heart of England Foundation Trust

Data from West Midlands Perinatal Institute, CMACH Regional data collector.

Competing interests: Obstetrician in NHS and Private Practice in UK]]there is no absolute consenus amongst doctors about use of C section either. in this this month BMJ

Oh I didn't see rosetip's post.
Just a mo.

Rosetip - I think the statistics are a bit more complex than 'infant/maternal death rates go down/csections go up'!!!!
I don't think anyone on this thread is seriously suggesting that csections are always a bad thing. I had one myself: it was necessary to save DC2s life. But that doesn't follow that we are 'privileged'to have high tech births/medical interventions. Many women end up feeling that giving birth has been a dehumanising experience precisely BECAUSE of interventions. Someone also mentioned earlier the 'cascade of interventions' which is well documented eg statistically you are MORE likely to end up with an instrumental birth if you have an epidural. That's a fact. A csection is statistically more risky than a straightforward VB. That's a fact. I don't see what's naval gazing about recognising that.

rosetip all I can say is that someone who a) has access to the real figures; and b) is trained to analyse those figures is saying that the figures for maternal and perinatal death would be even lower than they have been, had it not become the norm to deliver in a obstetrician-led unit (by whatever method).
Of course we need to keep in mind that modern obstetrics has its place. The thrust of the argument is whereas medicine has helped a thousandfold interms of disease, where childbirth is concerned, there has been an appreciable, measurable negative outcome (statisticaly speaking) with increasing medical interventions.

Of course caesareans have saved lives, I don't think anyone is suggesting otherwise. But there is a point where an increasing Caesarean rate does not result in decreased perinatal mortality, but does result in increased morbidity. Interventions have their place, but their overuse is damaging to mothers and babies.

There are a number of places around the world including The Farm midwifery practice and a centre in NY, the name of which I can't remember , where they have consistently low CS rates and low perinatal and maternal mortality and morbidity. Why on earth aren't the NHS trying to emulate them?

inthegutter, actually this month BMJ 23/nov/2007 "The fact is that elective caesarean section at term is a very safe method of birth for the baby, and is safer (for the baby) than planning vaginal birth."

author Mike Wyldes MA FRCOG
Consultant Obstetrician
Clinical Lead for Labour Wards at Heart of England Foundation Trust

that is the thing, clinical opinion and statistics can vary and C section is not necessarily a bad thing

and scottishmummy, I'm sure there are plenty of articles which would argue the exact opposite! See Prunie and Daisymoos last posts!