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.

How on earth did they do blood pressures or dip urine if no face to face antenatal care? I know for sure here the antenatal checks carried on face to face.

@CormorantStrikesBack I was very fortunate in that I had savings to pay for an IM. She was exceptional and only one of few midwives I trusted implicitly. Not "bound" by NHS policies meant she could be fully patient-focused. I never once felt pressured and always felt listened to. Sadly this hadn't been the case with my other deliveries.

@CormorantStrikesBack And this is where it gets scary. They didn't. They called you up and said "Are you swollen anywhere?" Say what?!!!! No BP checks, no urine checks, no fundal height measurements, no listening in to baby. Nothing. All over phone with no option for F2F.
I still can't believe the risks taken.

Epidurals are safe and are used often for pain relief during labour. The risks are minimal.

That was good enough for me.

@SouthLondonMum22 Have you heard of Cascade of Intervention?

There is a risk giving birth - having an epidural makes minimal difference. It wouldn’t be offered if there was a problem having it. DH, a doctor and my consultant were happy with my choice.
No way was I giving birth without an epidural. I would have done the same if I’d decided on another baby.

@Parker231 I'd be interested to hear a view from midwives on this?

Yes.

I don't believe interventions are the devil. I didn't care how my baby got out as long as we were both healthy and safe.

Induction, epidural, both healthy and safe. Job done.

@SouthLondonMum22 All interventions carry risk.

So does giving birth. There's a risk no matter what.

The risks are small and the benefits outweighed those small risks for me.

That’s so sad. I used to be a Supervisor of Midwives back when they were a thing and specialised in supporting women having the birth they wanted outside of guidelines. So I’d meet them antenatally, go through everything, draw up a birth plan, document it in her notes, tell her consultant what was happening. It’s all about informed choice. It’s quite a progressive trust I guess. We had/have an Induction specialist midwife and the doctors have to run all none post dates inductions past her. She will also meet with the woman to discuss their plan of care.

@SouthLondonMum22 The benefits not feeling pain in labour?

I was happy with the expert opinions of the consultant and anaesthetist.

That is shocking

All interventions carry risk

Interventions also save lives but the OP seems determined to ignore that fact.

@Parker231 Are midwives not experts then? There are a number on this thread I think so hoping they can share their experiences re epidural labours as I imagine they've seen many births.

@ilostmyhearttoastarshiptrouper Sure, but an epidural taken to minimise pain isn't about saving lives is it?

That was the big benefit, as well as it making me feel more relaxed.

Similar as to when I take pain relief in any other situation such as at the dentist.

@SouthLondonMum22 But the two aren't really comparable (unless you're pregnant during a dental appt?)

I’d fully agree if a woman wants an early epidural she should get one as long as she understands the implications regarding her mobility, monitoring, higher chance of instrumental, etc.

I believe the most recent evidence says it doesn’t increase the risk of em lscs however I find that hard to believe.

I remember the bad old days of the early 2000s with the “epidural wars” where if your woman wanted an epidural and you used to tell the coordinator she’d tell you to get back in the room and support your woman more 🙈. I also used to do birth debrief sessions with women traumatised by being declined epidurals. Thankfully things have changed.

It’s not just about saving lives though. Some women genuinely have ptsd from labour. Including from the pain and being denied pain relief.

I have never met a post natal woman who has regretted an epidural. Maybe the odd one who says oh maybe I could have managed a bit longer, but not genuine regret. But I’ve met plenty who regretted not having one as they weren’t “allowed “ one or there wasn’t time.

The risks are minimal in both cases, including to the baby when we are talking about a woman in labour.

I had no desire to be in pain if I didn't have to be.

Sure they are experts but I didn’t consult with a midwife before deciding on having an epidural. It was a safe procedure and ensured that I wasn’t in pain. In fact I slept incredibly well.

This.

The population demographic will also be a factor or I expect this rate varies significantly between trusts