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.

Also, you do realise that your experience is not all women’s experience, right OP? If you look at the rates of mothers dying in childbirth over time, I’m sure that the mother mortality rate would decline in line with interventions.

I’d be dead if I hadn’t had medical intervention during labour with my first.

My best friend who is the healthiest, yogi, most nature-loving person I know, tried to have a home labour and the cord was wrapped around babies neck, she had to go for an emergency c-section. Thank god she was near a hospital. She blamed herself for ages as she had bought into all this ‘intervention is bad’ guff.

See how my and my friend’s experiences differ so much to yours and all that was involved really was bad luck? But also people have all kinds of reasons they may choose a certain type of labour and it’s their business alone.

@ilostmyhearttoastarshiptrouper I repeat - for subsequent births home birth is no less safe than having a baby in hospital. This is evidence-based.
Transversely, healthcare professionals, for a whole host of different reasons, can (and do) sometimes make choices of action which can also have negative consequences.

OP, why have you started this goady, judgemental, ignorant thread? As someone who claims to be engaged with “evidence,” you are remarkably silent in response to anyone who presents even the most basically nuanced view of any of this.

I repeat - for subsequent births home birth is no less safe than having a baby in hospital. This is evidence-based

I'm sure that would have been great comfort to me if my child had died following my cord prolapse.

@TwoUnderTwitTwoo It's not me who is ignorant here.

9/10 first time mothers will have some kind of graze, tear or episiotomy.

That's an absolutely not, hard pass from me

Isn’t it amazing how the OPs can research topics they approve of, and quote statistics, yet can’t employ the same powers of research when it comes to something they disapprove of and instead need to discuss it online?

@ilostmyhearttoastarshiptrouper And mine when my son's heart almost stopped because the so-called "professionals" prematurely broke my waters without informed consent. Maybe he wouldn't have suffered permanent hearing damage as a direct result.

@LorlieS who is ignorant here apart from you? Your posts show a profound lack of understanding of even the term “evidence,” never mind actual scientific literature; variation in local demographics; maternal, fetal or neonatal morbidity and mortality; confounding factors in the evidence you loosely refer to (but don’t cite); and a total disregard for the judgemental language you are using and its effects on past, present or future pregnant women.

What does “transversely” even mean in any logical argument? (In the sense of logic and mathematics, which I presume you were trying to emulate to make yourself sound more credible)

Are you an estate agent?

@TwoUnderTwitTwoo I don't think you like people who disagree with you.
What's your profession?!

Everyone is entitled to their opinion and I don’t dislike when people disagree with me. Opposing views are an essential starting point for reaching any nuanced conclusion, not just in maternity care but in all sorts of things (ethics and politics to name just two).

I dislike finding that I have been drawn into a disingenuous, bad faith argument.

I've got 5 children so naturally I'm an expert. I've had 5 different births. C-sections are on the increase because women are allowed to choose now. Induction is on the increase partly because women can choose them and also because they are recommended more frequently. When I was born my mum was induced at 40+14. When my 17 year old was born, the recommendation was to induce at 40+10 for being overdue. I think it's now 40+7 but I'm not sure. I know people being induced at term due to bring over 40, IVF baby, childcare reasons, previous quick birth. Induction is awful in most hospitals as there isn't enough staff so women are in limbo for days. I was induced at 9pm after being nil by mouth all day just in case. It was never going to go right like that but I couldn't be induced earlier because there wasn't space so despite having an infection which ended up turning into sepsis a few hours later I wasn't a priority. So many inductions end up as c-sections. I had a homebirth with my eldest and tried to have a homebirth with my 2nd. 3rd I could have had a homebirth but I was advised against it so I didn't. He was born in hospital while I was waiting to be induced. 4th was an elective section due to baby being in a weird position and 5th was an induction which went wrong and ended up as an emergency section. Personally I wouldn't opt for a homebirth now, even if I was low risk because I wouldn't trust an ambulance to get to me quick enough these days.

I think that what the OP consistently failed to understand in this thread is that women are often advised against home birth based on the risk factors. This alters the statistics considerably as the majority of women with any risk factor present will be in hospital for their births. Women are often moved into hospital during home births at the first sign of concern too. For any birth where there is a risk of complications, women will be advised to be in hospital because it is the SAFEST place for them to be. The problem is that sometimes complications arise during labour for which there was no clue during pregnancy. If that happens and you're at home, you have a problem.

I share your view, having given birth in similar. circumstances. I then chose an elcs for my second birth. I wasn't going to take the chance of a vaginal delivery and I'm grateful to have had that choice as I was genuinely terrified of going into labour again.

Unfortunately there are those, including some NCT leaders who will never empathise with or understand those of us that choose a section and will continue to bang on about the cascade of interventions etc etc whilst they seek to restrict a woman's right to choose a section. It's very regressive and I'm not sure exactly what you are trying to achieve?

@MissAtomicBomb1 I agree fully. The ultimate goal of a positive birth experience is a safe delivery of a healthy baby.

What the OP also doesn’t seem to appreciate is that people have different priorities. Some people aren’t bothered about intervention, that for some people even an emergency lscs would not be a bad outcome. That they will happily accept the risk of a cascade of intervention if it means that they are giving birth in an environment where they feel safer which for some women will be a hospital.

I’m hoping to undertake my PhD on birth environment, it’s a complicated subject. It’s not as simple as home birth is good and a hospital birth some sterile, awful environment. So we talk about increasing oxytocin and decreasing adrenaline in order to have effective contractions, but the same birth environment will not produce the same hormones for different women.

theres a lot which can be done in hospitals to improve the physical environment. Continuity of care will help women feel safer. There’s a lot to be said for side by side midwifery led units with quick access to the obstetric ward if necessary . But the main issue which remains is intervention and I think this starts before labour even commences. I genuinely don’t know what the answer is. We need women and babies to be safe, we need better individualised care, we need women to be involved in decision making as we need to know what their priorities are….we need more staff for this to happen. But there are many times when intervention is probably needed to ensure safety. Of course afterwards you can never say for 100% that without the intervention there would have been a bad outcome. But I’ve sat in enough serious case reviews to know that when something is missed and intervention doesn’t occur it can lead to babies and women dying.

I just want to add that a lot of women are going for an elective c section for their second birth because they were treated so poorly/ had such a bad experience for their first. You can’t vilify them for wanted a more controlled experience for their baby’s and their own sense of safety. Perhaps if more women had a better first birth experience there would be fewer elective c sections. That’s on hospital maternity provisions and midwives, not on birthing mothers.

Yes this ^

My experience of hospital birth, for known risks, was poor and I would probably have gone for a future caesarian to get round the risks rather than hope the staff available know what they are doing on the day, or that the required facilities were actually available.

Preference would be for enough listening and knowledgeable staff though, either in a hospital or at home.

This isn't strictly true in terms of the research as the birthplace study being referred to only related to low risk pregnancies anyway.

"The main findings relate to healthy women with straightforward pregnancies who meet the NICE intrapartum care guideline criteria for a ‘low risk’ birth."

The widespread study was done in 2012 and found that birth is generally very safe, and homebirth is just as safe for baby and actually safer for mum on a macro level. Clearly there will be individual circumstances where people can say that if they were at home their situation would have been adverse, however on the other hand some hospital births with adverse outcomes may have been much better at home indicated by the fact that the study finds no discernible difference.

The home birth midwives are very highly trained, and you have much more individualised 1:1 care (and in later labour, 2 dedicated midwives) which will lead to good outcomes.

The findings from the study are linked below:

www.npeu.ox.ac.uk/assets/downloads/birthplace/Birthplace-key-findings.pdf

Not expecting to change minds of those who seem to think home birth is dangerous and irresponsible but the evidence is there! It's also something the NHS supports and even encourages, and if it were that dangerous I don't see that being the case.

My local trust has around 25-30% c section rate, so the OPs 50% is very high compared with that (which I think was the whole point of the post)

Sorry I think the study Year was wrong, not 2012 maybe 2006

@scrunchmum Exactly. The rate for our local Trust is very high, and most definitely not anywhere near the ideal.

Taken from University College London Hospitals website:

About 1 in 4 women have a caesarean section in the UK. Most experts agree that this is too many:
Vaginal birth is much safer than a caesarean
section for most women and babies, but
sometimes a caesarean section is the only safe option, for example when the baby is
positioned side-to-side in the belly (transverse lie) or the placenta is covering the cervix (placenta praevia).

As for staffing ratios re home and hospital births I couldn't agree more and I know which I personally felt the safest with. My baby was born height of lockdown and all face-to-face NHS care was pulled. There were no blood pressure checks, no fundal height measurements taken, literally nothing. It was at this point I realised this was unacceptable and looked for alternative home birth care away from NHS. My care was second to none with my midwife visiting weekly for as long as was needed.

Also throughout my labour (very lengthy) I had a 1:1 midwife with me at all times and then two midwives as labour progressed. That certainly wasn't my experience in hospital because of course there just isn't the number of staff to offer that.

Ok Lorlies, slow clap for you? “Experts” and “safer” are completely subjective on the experience of the woman receiving care. Are you trying to be goady at this point? The only thing that matters is healthy mum healthy baby. You got that without a c section, someone else gets it with. There are no gold stars for one way or the other in the 21st century.

With my dd2, my midwife was right there in the room when my baby's heartbeat slowed and stopped. She pressed the panic button and within seconds there were 5/6 others in the room whose speedy response and quick transfer to the operating theatre saved her life. I was given general anaesthetic in the operating theatre and had one midwife literally holding the cord inside me to prevent it being trapped and stopping the oxygen flow to my baby. She was born by crash section very quickly after that. There is absolutely no way that this would have been an option if it required an ambulance transfer- just no way.
It was brutal and painful and in no way a beautiful, gentle experience. Despite this, I had no post natal depression, no issues breastfeeding and had an instant bond with my baby (when I woke up) who had spent the first hour of her life in the arms of her dad. It was probably about the most intervention there would ever be in a birth but had the very best outcome. In fact, my dd2 had less issues (higher APGAR score, no jaundice etc) than DD1 who had a completely natural birth.

I've requested a c-section because I'm having twins. Though it is possible to have twins vaginally, I have no desire to try.

I also have no issues with interventions, all I care about is that baby/babies are born safely.