Why are so many women anti c-section?

[jivegirl]

Despite planning a peaceful waterbirth at home, I ended up having a very scary OP/ventouse delivery with my daugher nearly 2 years ago (delayed second stage, retained placenta, 3rd degree tear, plus internal tearing which had not healed after 6 months and required cauterising)

I have been offered a C-section and will see the consultant again to make my decision in just over a week. At present (35wks) bump is transverse, so the decision to have a section may yet be taken out of my hands. However part of me is secretly hoping the baby stays transverse so I don't have to justify having a section.

I can't understand why so many women seem to be anti-sections. It seems admitting a preference for a section is almost taboo.
I still get horrific flashbacks to delivering my daughter and can't think of anything worse than going through that again (my DP rates it as the most traumatic day of his life!! ) The thought of a calm, planned c-section sounds like bliss. Am I being naive?

I should also say that I will have excellent support from friends and family to help me cope with caring for an active toddler and a newborn in the weeks that follow - so I am sure I am luckier than many..

Would love to hear some opinions on this ladies!

ffs so now im crap at giving birth along with everything else!thanks

"Finally, I'm confused - if your only interest is in best outcomes for mothers in general, why did you ever bring financing into it?"

Because there's a finite pot of money and surely that money should be used to ensure that the largest number of women and babies get through birth in good health?

In my opinion using the money that's currently available to maternity services to increase the number of medically unnecessary c-sections for low risk mothers, while we continue with a system where the majority of women in labour are not getting one to one midwifery care is simply unsupportable.

If more money is to be made available to maternity services then that money should go to improve staffing on labour wards, as this will result in lower rates of emergency c-section - which is the most direct way to improve health outcomes for both women and babies.

I'm just so saddened that so many people think the answer to the challenges of labour amounts to this: just have a caesarean!

Is this your first baby? Have you got any experience of maternity care? I'm really interested that you think there are only two ways to make a difficult labour bearable: have a c-section, have an epidural. I know so many women who've had long, hard labours - myself included (I've had three difficult births) and I can tell you that the quality of care you get can make a HUGE difference in your ability to cope with pain, the way your labour progesses and to the way you feel about your birth afterwards.

You seem to think things like this are just incidental (or maybe you don't - you certainly don't say anything in any of your posts about them though) but they're not - they're central to women's experiences of birth. Yes - sometimes an epidural is the answer to a hard labour. But there are other responses as well which can make a huge difference in terms of clinical outcome and women's satisfaction with the birth - and sadly nobody seems to be arguing for these to be make available.

By the way - the most recent stats on epidural use I have are these:
21% of women who gave birth in the UK between 2002 - 2003 had an epidural 'during labour or at the time of the birth'. This reference is from the MIDIRS Informed Choice booklet, described as the 'gold standard' in NHS sponsored evidenced based patient information. 56% of the women who had an epidural also had their labours induced........

Of course I don't think there are only two ways to make a difficult labour bearable, why on earth would I opt for a birthing venue that tries everything to avoid those options, if I did? I'm not a masochist nor a psychic. Yet those are the two ways attacked in unison as a rule, and those I'm therefore seeking to defend. If people started to demonise home births/water pools in this thread I'd have a few things to say there, too - my concern is CHOICE, and for women to be supported in birthing in the way that suits them. I'm fully aware of how important quality of care is, I've expressed that clearly, over and over - but I don't think it's at all acceptable to seek to determine how other women should labour. And it's ridiculous to suggest that there's insufficient money for sections, and that's why vaginal delivery is suffering - all areas of maternity provision are underfunded at the moment and the answer is more money, not less choice.

That statistic is far more cheerful than the one I was given, which is (I checked!) the US figure. But I would also point out that women experiencing severe enough labours to need a spinal block are likelier therefore to require intervention, no? Which may further inflate the (undeniable and real) risks.

*I can tell you that the quality of care you get can make a HUGE difference in your ability to cope with pain, the way your labour progesses and to the way you feel about your birth afterwards.

You seem to think things like this are just incidental (or maybe you don't - you certainly don't say anything in any of your posts about them though)*

I'm genuinely not trying to be rude here, but do you not read other people's posts properly? It's the second time you've averred that I have or have not said things, when that's simply untrue. I have REPEATEDLY mentioned quality of care, tlc, decent staffing and the birthing environment as vital, and why would I opt for the MLBU otherwise? (I'm not a great candidate for a homebirth, which I'd prefer from the familiar territory perspective.) Continuity of care, environment, and quality of care are sorely lacking for too many women in the NHS, and I completely agree with you, as I imagine most people would do, that emergency C sections necessitated by a distressed and anxious labouring mother being unable to progress (which are plainly different to planned in NOT being choices, and being far riskier) are costlier than providing excellent care from the off, besides being a lot more stressful and distressing for the woman concerned, and increasing her recovery time after she's already lost the benefit to a planned section - she's laboured already. It's the worst of both worlds. If more funds were made available, that cycle could be broken. However, that isn't what was being discussed in this thread - elective sections were - and a woman adamantly against a vaginal birth should be able to opt for an elective section, if that's her informed choice.

cheesesarnie, I don't actually think you were that poster? As I said, it was a direct quote. I just don't think that a body's ability to birth naturally/easily/with difficulty is any reflection on its owner - I mean, I'm asthmatic, I don't regard that as a failing in me, just that my lungs aren't too effective. I'm also chronically short-sighted - but that's not about who I am as a person, just how my eyes happen to be. It's great that I happen to live in a time and place where I can have an inhaler and contacts to deal with those physical traits. The ability to labour easily/naturally isn't any different, surely? I find the value-laden attitude to methods of birthing troubling, because it's creating a real psychological kicker for people if their births aren't easy, and they've already drawn a short straw in coping with a tougher physical experience.

Hear hear hatrick - everyone has an opinion and there is no grey area....I have to have a c-section due to my cervix being blocked my a football sized fibroid. at first I cried at the thought of not being able to give birth naturally and then thought...hang on a sec, the most important thing is that baby is delivered in the safest possible way...baby can't come out b/c my cervix is blocked and will not be able to dilate.....so I managed to find some peace within myself...and thought 40 years ago I sure as hell would not have been lucky enough to have access to all the medical procedures that exist today...from scanning to c-sections.
My bugbear are the men who insist on telling me whether I'm having a boy or girl based on the shape of my bump and whether or not I have had sickness, cravings etc!!!!!!!! GGrrrrrr!!!! :O

"And it's ridiculous to suggest that there's insufficient money for sections, and that's why vaginal delivery is suffering - all areas of maternity provision are underfunded at the moment and the answer is more money, not less choice"

It's not ridiculous at all. C-section rates have nearly DOUBLED in the last decade, and you can be damn sure that midwifery cover on wards hasn't kept pace. Women who have sections need additional care, particularly postnatally and it IS causing problems on the wards. Have you spent any time on a postnatal ward in a busy consultant led unit? Do you know what it's like? There'll be two midwives looking after masses of women, a good proportion of who'll need nursing care because they've had c-sections. Women who have had vaginal births get left to shift for themselves in this situation because staff have no time to help them with breastfeeding or anything else for that matter. And if midwives are working in theatre and on recovery then they can't be available on the wards.

At a purely theoretical level nobody should have any say in how a woman chooses to birth her baby other than herself, but we live in the real world with a centrally funded healthcare system. Care is always going to be rationed as long as the NHS exists in the form it does today. How much extra funding would maternity services have to be allocated to ensure that all women who wanted an elective section were given the choice? Seriously? And ensure that enough midwives were recruited into the NHS to provide the additional postnatal care these women would need? Plus all the additional midwives you'd need on labour wards to provide one to one care for non-caesarean mums (because you couldn't justify offering elective sections to low risk mums while not providing one to one care to everyone else). Oh yes - then there's the issue of obstetricians. At the moment there are SERIOUS problems within the NHS with providing apprpriate obstetric cover for maternity units as there aren't enough obstetricians to go around. You'd need hundreds more obstetricians and theatre staff, and anaesthetists.

Do you think there's a cat in hells chance of politicians voting for additional funds for this scenario? Especially if the result of the increase in elective sections would at a national level be more new mothers ending up in intensive care beds, or worse...... Higher cost, worse outcomes. Who's going to vote for that?

Basically what I'm saying that in the real world you can get as cross as you like, but the scenario of elective c-sections on the NHS for all low risk mums who want one is simply not going to happen.

Also qually - your analogy about asthma is a bit of a problem for me. The vast majority of women in this country who have babies have nothing whatsoever wrong with their bodies that would make birth impossible or especially difficult for them, including the majority of those who end up in theatre.

As for your comments about "value-laden attitudes" to birth, again - who here is turning this into a moral issue? Who? Is anyone here implying that those women who have easy labours are superior in some way to those of us who have difficult labours? You are the one who is raising this spectre, nobody else here seems to be attaching these sorts of judgements to women's experiences of labour.

As to your other point - well sorry if I overlooked earlier comments you'd made about the quality of care itself - I haven't read right back through this thread and was simply responding to that particular post, in which you don't say anything about the really important issues such as one to one care in labour or caseloading.

I think it's ridiculous to suggest that the answer to chronic underfunding is to deny women undergoing one of the most gruelling and dangerous times of their lives the freedom to choose an option they're more comfortable with. The answer is to fund better and allocate resources better from elsewhere in the NHS, because maternity care often seems to be like mental health/sexual health; a Cinderella service, without enough ring-fenced funding, and that's unacceptable, no? There are all sorts of areas in the NHS where rationing could be applied with greater or lesser controversy, but labouring women seems a pretty awful place to start.

I also don't think it's especially relevant to argue funding because most sections for a first birth aren't elective, are they? They're emergency. The best advice is that you recover faster from a natural birth and require less intervention, so most women want to try for a natural birth first time. However, my GP was quite clear that my trust support all birth choices, from elective sections (with risks and downsides carefully explained) to home births (likewise). Nobody's said anything against any option, just given the info. So in my experience, women do have the choice. (Incidentally, women under my midwifery team have breast-feeding advice provided by a specialist who visits you in hospital and at home, and mothers who've had vaginal births in hospital are encouraged to return home asap - within hours - and be cared for there by their families, and the midwifery team who saw to their antenatal care - bliss, as far as I'm concerned, and surely helpful to hospital midwives? So perhaps there are ways to lighten the load on hospital staff without compromising care. Though I also note that our Trust doesn't provide certain tests, such as nuchal fold, so maybe their focus on care in and after labour is funded that way. Who knows.) Most choose to try for as natural as they can, because they know it's generally safer. Some don't, for their own reasons, and I think that should be respected. I do appreciate I'm lucky; in my GP still offering antenatal care; in my midwifery team; and in my hospital, where even pretty high risk women are encouraged to try for a natural birth in the MWLBU if that's what they want - or allowed an elective section. It's just that the former is apparently a lot more common as a request from first timers.

The vast majority of women in this country who have babies have nothing whatsoever wrong with their bodies that would make birth impossible or especially difficult for them, including the majority of those who end up in theatre.

I do find it hard to believe that the NHS staff have a habit of recommending emergency sections to women who don't need them. I DO agree that some women's labour experience is so awful that they are inhibited from labouring well, and thus become too tired/discouraged to progress, and better care could help in preventing their ever ending up in theatre; I don't believe that most staff are cavalier about emergency sections, and further, nor do I believe that a section is a failure. I just can't see why a CS is a disaster if mother and child are safe and well and mother recovers reasonably quickly - that's surely the most important thing? Over-reliance is clearly less than ideal - but so is throwing the baby out with the bathwater. Why is a section automatically a bad thing?

Is anyone here implying that those women who have easy labours are superior in some way to those of us who have difficult labours?

Not if they birth naturally, but yes, if they opt for a section. I'm afraid many of your comments have read that way - including your comment that you think you "did brilliantly" not to choose a section, but to birth a long and very difficult labour naturally. Great for you, but I think ALL women who give birth, by whatever means, have done brilliantly. The method isn't relevant to that achievement.

"I think it's ridiculous to suggest that the answer to chronic underfunding is to deny women undergoing one of the most gruelling and dangerous times of their lives the freedom to choose an option they're more comfortable with."

At the moment women who have a medical need for c-section are offered one - including first time mums who are phobic about birth and women who have had previous traumatic births. Outside of these criteria the NHS has NEVER as a general rule offered elective sections for healthy low risk women, so it's not a case that the lack of provision of elective sections is now an 'answer to chronic underfunding'.

You are arguing for a RADICAL change which goes against all the principles underpinning current provision of treatment within the NHS. You are arguing for healthy women to be offered expensive and unnecessary treatment that will put them at additional risk of serious injury and death because they feel more 'comfortable' with the idea. Where else is this principle applied within the NHS - that patients be offered a treatment which actually puts their health at additional risk, when there are no pressing psychological or other health issues to be considered?

"So in my experience, women do have the choice."

You mean all women are told at their booking visit that they have a free option to choose whether to labour or whether to opt for c-section? I very much doubt that your trust freely offers c-sections on demand to any low risk mother who wants one simply because she finds the idea of it 'more comfortable' than the idea of giving birth vaginally. If it does it's the only trust in the country that's currently doing this!

"I do find it hard to believe that the NHS staff have a habit of recommending emergency sections to women who don't need them"

I've made the point several times on this thread that the staff involved in the care of women in labour are IN NO WAY CAVALIER about c-section and would NEVER suggest it unless they felt it was in the best interests of the mother and baby. The point I was actually making in the post you refer to is that when things go wrong in labour it's not usually because there is something fundamentally 'wrong' with the woman's body! It's more often down to the position of the baby, cord/placental issues, and fetal distress. Yes, true the majority of emergency c-sections are for 'failure to progress', but the fact that this seems about half as likely to happen to you if you opt for a homebirth seems to point to flagging labours and exhaustion often having more to do with birth environment and care during labour than the faulty physiology of individual labouring women.

"nor do I believe that a section is a failure. I just can't see why a CS is a disaster if mother and child are safe and well and mother recovers reasonably quickly - that's surely the most important thing?"

If a c-section is necessary to ensure a healthy birth, then it's a triumph for both mother and baby.

But given that a proportion of c-sections are probably avoidable with better care ..... the thought that there are many new mums who are going home each week with their babies after having had unnecessary major surgery - doesn't that matter too? Isn't THAT something we should be raising our voices about?

"including your comment that you think you "did brilliantly" not to choose a section, but to birth a long and very difficult labour naturally."

You were critical of me earlier for not having read your posts accurately but you have done exactly the same to mine. I did NOT say 'I did brilliantly NOT TO CHOOSE a section'. A section was never on the cards. I said I did brilliantly in my labour - meaning I coped with a very difficult experience in a way I felt proud of. I'm not taking anything away from ANYONE in saying that so why the need to be such a tight arse about it? I'm not commenting on other people's births - only on my own.

I did really 'badly' in with my 'difficult experience' of labour. Due to the trauma of the extreme pain I suffered a kind of PSTD and have acquired several quite crippling new phobias, including severe claustrophobia and a phobia of dentists that means I currently have a huge tooth rotting in my head but I am physically unable to open my mouth to let a dentist treat it. I begged for a caesarean.

Oh - ok.

Apologies to everyone I've offended by talking about the positive aspects of a difficult labour.

Sorry Vivace if you saw my comment as some sort of judgement on your horrible experience.

I'm off to bed.