High rates of intervention?

[LorlieS]

The C-Section rate is 40-something percent in my local NHS Trust. This seems remarkably high when considering labour and birth are in essence natural processes? Why might it be? What are rates like nationally I wonder?

I've had 8 pregnancies and 3 births. First birth - hospital induction (in hindsight should have declined). Second birth - "normal" delivery in hospital. Third birth (decade after second!) - "normal" delivery at home with no intervention (no internal exams, natural delivery of placenta etc) with an Independent Midwife.

@ilostmyhearttoastarshiptrouper I was (slightly sarcastically) answering the question in the OP about why the rates are 'high' (if they are). I am a massive fan of medical intervention, which is the reason why DD6.5 is sleeping soundly next door and I didn't bleed to death.

@Hotpinkangel19 My first two (hospital) births were not positive experiences; the second one most definitely not so.
That's totally fair enough - so important to be in an environment you feel safe in.

Have a read of saving babies lives version1,2 and 3. The 'National ambition' to reduce still births and perinatal mortality/morbidity. It does acknowledge intervention rates have risen but still birth and brain injury are reducing. Like someone else has commented, maternity units used to place huge emphasis on reducing their c/s rates. But brain injury and stillbirth and neonatal deaths for each hospital weren't 'published' or judged. It's a very tricky time in maternity care. Huge time spent on recruitment and retention as midwife numbers still continue to drop. Sad times.

www.england.nhs.uk/publication/saving-babies-lives-version-three/

@ChrisPackhamsYellowFleece And likewise, for reasons similar to your own and also based on research, I am a "massive fan" of the "hands off" and only medical interventions when necessary approach.

intervention rates have risen but still birth and brain injury are reducing

Who could have guessed...

I am a "massive fan" of the "hands off" and only medical interventions when necessary approach

And what if the time scale of the "necessary" is minutes? Then what?

OP, it sounds as though you have made up your mind before posting here anyway, so why ask a bunch of mumsnetters who you are so much more knowledgable than, instead of asking your local maternity unit and then reporting back to us?

Anyway, as you refer repeatedly to evidence around home births and various methods of delivery, then I presume that you are scientifically literate enough to explain to everyone else here what the many confounding factors are in many of the cited papers about home birth and can also explain to us which specific cohort of patients are likely to do well with home birth and therefore why your local unit may have higher than average C section rates?

As you can see from posts here, never mind your own extensive “research”, maternity care is as complex and varied as the many women who deliver their babies by whatever method is deemed appropriate by her and her maternity team.

Good for you. So, to each their own, and leave it there? You clearly wouldn’t like it if somebody else interfered in your choices so why are you querying what other people do or feel is necessary for them?

I’ve seen a few threads like this - the OP has a home birth or two and is suddenly ‘interested’ in why other women haven’t had the wonderful experience they have. I don’t think it’s a true interest, I think it’s a bit voyeuristic and so they have a reason to have a little boast.

It’s quite unkind, in my opinion. Just be glad of your own experiences and let other women do what is right for them.

It’s really important to look at the statistics. The increase in instrumental births and sections isn’t really delivering improved outcomes for babies or mothers. There are huge differences between trusts and units with statistically similar intakes or between similar groups. I am concerned that we are not tracking impact on women’s long term health and the impact on the early days of parenting. I absolutely support elective sections and whatever women want and need but all care should be evidence based and appropriately resourced not a set of practices agenda driven or designed to mitigate against understaffing and fears of litigation.

https://www.irishexaminer.com/news/arid-41267860.html#:~:text=An%20analysis%20of%20HSE%20data,between%2040%25%20and%2049%25.

The rates are high in ireland too. I saw this article recently.

From the article: The WHO said in 2021: “As countries increase their caesarean section rates up to 10%, maternal and neonatal mortality decrease.
“However, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates.”

@LorlieS Research? Ah, you're a qualified obstetrician conducting a literature review, no doubt for a reputable scientific journal. That puts a different complexion on it.

@Naptrappedmummy Not at all. It isn't me on here condemning other women for their choices based on misinformation. It isn't me saying their choices are risky and dangerous (again not evidence-based).
I am saying I think all women should of course make their own choices but based on true facts and evidence.
But there is nothing wrong with questioning the stats, of asking the questions.
Same for parenting choices.
It's why I've bedshared with all three of mine from birth, to give an example.

@ChrisPackhamsYellowFleece Are you? If so, I warmly invite you to look at the work and research-based evidence of Dr Sara Wickham (although I'm sure you've probably heard of her already) 😀

I'm with you OP, this is a staggeringly high c section rate. Absolutely fine of course if there are valid reasons for each woman and I know women who have chosen c section and good for them for making the right choice for them

However I also know of 2 women who:

1. Had a traumatic 1st birth vaginally and opted for a c section 2nd time round
2. In hindsight felt they were pushed into a c section during labour and wished they were given more time to progress naturally (and with a second pregnancy will opt for a VBAC if possible)

I don't think maternity services have served either of these women well.

@Lovetheriff Absolutely. This is absolutely it.

OP, you are strongly inferring that women who have had intervention could have avoided that if they had made their decisions based on “true facts and evidence” (which you have still not presented and I remain unconvinced you understand what “evidence” means in the scientific community).

You are perfectly entitled to your opinion but pretending that you are not condemning women for their “misinformation” is, at best, disingenuous.

What an absolutely absurd thing to say, that you would never have another hospital birth. So if you were in labour at home, the baby was stuck or you were bleeding to death, you would refuse to go?

I mean I suppose litigation fear can improve practise but it’s a fucking low bar and until the staffing issues are better resolved then it’s hard to see proper sustained improvements.

This.

@ChristmasCustard I would avoid hospital unless my home birth IM advised otherwise. I trusted her to make that call.
But by the by as can't have any more now anyway.

@grumpycow1 Referring to home birth being "dangerous" and "risky" is misinformation. Fact.

I would avoid hospital unless my home birth IM advised otherwise

You've not responded to my points about time OP. When childbirth starts to go wrong, it can do so quickly and with little time to respond. What then? Do you just risk potential brain damage or death in pursuit of a lovely experience?

That's not what you said though is it? You said 'I'm not having any more children with 100% certainty but if I was I would never again have another hospital birth'.

I don't see the word 'unless' there. Changing your tune now aren't you?

@LorlieS Can you please respond to either of my previous posts? You seemed disingenuous to begin with but now you are veering on dangerous, stating “fact” when in fact (!) you have failed to convince me that you have any understanding of complex maternity care, variation in local demographics or confounding factors in statistics of the sorts of things you are discussing here. Personal experience is anecdote, not “evidence.”

I am very happy that you have had positive, complication free births without any trauma and of course that is what every woman wishes for as she goes through the profound experience of bringing life forth.

@LorlieS No, I'm not. Just a person who understands the difference between being an expert on something and having an internet connection.