Interesting article in the guardian about obstetricians going for elective c-sections

[FairyMum]

www.guardian.co.uk/society/2008/jul/11/nhs.health1

This is interesting. My neighbour is an obstetrician who was very adament that her DD
should have an elective c-section. I also have two friedns who are GPs who both had elective c-sections privately and
say they would not even entertain the idea of a vaginal birth.

I put this in chat as well...thought it might be too off putting for anyone who might not have gone through childbirth yet!
It made me shudder

Oh yes. Sorry, didn't think of that.

The female obstetricians I know have all had vaginal births.

Obstetricians never see normality so it isn't surprising that some may want elective CS when they always see the interventions (and also do the interventions).

I remember one male obstetrician being very moved witnessing a waterbirth - he didn't realise birth could be so lovely

I know an obstetrician who is having a homebirth

I think obstetricians can have a warped view of what birth is like.

They never see people like me give birth.

On an anecdotal level, I saw a wide range of deliveries whilst training (with all kinds of complications) and had an elective LSCS for breech and then a VBAC perfectly safely.
I tell you, i'd take the vaginal delivery every time.
And I think I know Dr Abigail Fry (waves), maybe she's a mumsnetter.

I had a vaginal birth on the ward where I had previously worked as an obstetric doctor. Several of my friends have had their babies the same. None have had an elective section as contrary to popular belief most obstetricians know exactly the risks involved in a section and wouldn't want one unless it was necessary.

For me, I was quite happy to labour at home and deliver under midwife care BUT having seen numerous 'normal' deliveries aswell as complications of many sorts - I could not have relaxed without the knowledge that there was an anaesthetist, fully equipped theatre, neonatal unit, obstetricians and paediatricians down the corridoor if needed.

As it happens I was fine but baby stopped breathing afterwards. Thanks to the lovely paediatricians he is now fine.

We do have a slightly anxious view of birth (I wouldn't say warped in the same way i wouldn't say midwives have a warped view although they don't have the same degree of involvement when things do go wrong). Birth can be wonderful and natural and yes it can be fine - but it can also be scary and things can go wrong. You have to know what risks you are willing to take - which ones are important to you. I was happy to accept tears, pain (didn't have epidural) and the possibility of forceps/ventouse being needed. I wasn't prepared to accept death or disability for myself or my child for any preventable reason. We are all different.

Mums who are obstetricians are women first and foremost. Of course they will have been emotionally affected by their constant exposure to dysfunctional labours and poor outcomes. The mind/body connection is so important in childbirth, frankly I'm amazed any of them manage to have normal vaginal births at all.

ummadam - I didn't think it was that common for HP's to choose to birth in the units they work in. It must have been a strange experience!

My freind is an anaethetist (sp?) and has had 3 elective C-Sections and is always telling everyone to do the same BUT she has no pain threshold whatsoever and is a complete wimp and because of her job tends to see the labours that have gone wrong and require emergency C-sections etc. I have lots of GP and other doctor friends and they have all opted for natural births.

This is not an interesting article, it's a bad article scarmongering. I do not know one female doctor who would choose a ceasarean over a vaginal birth for themselves, however all female doctors I know would choose to give birth in hospital or at least a MLU attached to a hospital because of the complications they can see because of their jobs.

"Consultant obstetrician Virginia Beckett also puts it plainly: "When I was 14 weeks pregnant I dealt with 12 stillbirths in one 24-hour shift."

Well if the natural average is 11 per day I am definitely steering clear of which ever hospital she works at.

be interesting to know, in contrast, what proportion of midwives, opted for the c/s route

Sabire - it was very strange! but also kind of reassuring as I knew the unit, their procedures, who I trusted and who I didn't. Having spent so many days and nights there working it was a bit like a home from home for me anyway

I had a c-section first time because ds was breech. I hope(d) that next time I will be able to have a natural delivery as statistics demonstrate that it is the safest method but then I read this article and I start to wonder...

I know it is scarmongering but I do sometimes think well at least with an elective c-section you know what to expect (most of the time).

reethi96 - don't think about it too much now (ie don't worry) but discuss VBAC (vaginal birth after caesarean) with your consultant nearer the time. Ask them to go through your previous notes (there will be notes on the operation that will be useful) and help you come up with an individual plan that is right in YOUR situation. VBAC's can work really well and as you have never had the opportunity to labour, how your body will manage is an unknown - it might do really well! You can always have a "trial of scar" ie see how you get on and then have a semi-emergency section (ie one that is done straight away but not in a panic because something is wrong). Your consultant at the time is the best person to advise you (and TBH I've not met one yet that would advise an operation without good reason).

That makes sense ummadam. Thanks.

in the article in the newspaper it was 2 still births in her shift not 12!

I am hoping for vbac and that article thoroughly depressed me....

I worked in a women's clinic attached to a large county hospital with a Level 1 trauma unit. About 70% of the OBs and resident OBs were female. Of those who had children, the only ones who had csections had them for reasons like emergency or breech.

The director had three vaginal births herself.

She attributed a lot of the post-menopausal problems women presented with - prolapses, pelvic floor issues and the like - to lack of education about the importance of exercising teh pelvic floor and lifestyle issues (obesity, sedentary lifestyle, smoking and drinking too much) and too many hysterectomies.

idontbelieveit, the article states

"Consultant obstetrician Virginia Beckett also puts it plainly: "When I was 14 weeks pregnant I dealt with 12 stillbirths in one 24-hour shift. You can imagine that might skew your view of how to manage your labour."

However please ignore the article don't let it depress you I honestly don't think it represents what female doctors think - why would my friends need to be PC with me and say they want vaginal births when they don't?

But the survey in that feature says 32% which means that most obs/gyns don't prefer an elective c-section. Even despite the bad labours they see.

I thought the article was very interesting as it was the only time I've ever seen the risks expressed in the way they were presented to me.

Basically my consultant said that the order of safety is:

1. vaginal birth
2. elective section
3. forceps/ventouse
4. emergency section.

But of 100 women aiming for option number one, only 50 would end up with option number one and 50 would end up with options 3 or 4. So if you aim for the safest route you have are just as likely to end up with the least safe route as you are to end up with the safest route.

So it seemed logical to me to opt for number 2: the second safest, and be sure of getting the second safest.

I wanted ES for various reasons but that was the number one reason. I was quite pleased to see this way of thinking set out int he article because it's not written about very often in this way.

This is not an attempt to argue my case to anyone by the way - just setting out what my thinking was.

Interesting margoandjerry. However, you are giving very raw statistics here. I'm sure the reality is far more complex eg of those 50 women who don't end up with option number one, what are the reasons why? I am sure the statistics would show that if you go for a natural birth, ie minimum of pain relief, and using non invasive pain relief where possible (water, breathing, keeping mobile etc) then you are more likely to have a successful vaginal birth without interventions. I would imagine that a large percentage of that 50 women who dont get the normal vaginal delivery have opted for the epidural route, which does make further interventions more likely.
So in other words, if you are keen to try to achieve option 1, the safest option, you are probably best off aiming for a natural birth, without epidural. A lot of women find this preferable to skipping option 1 and going straight for the elective section

I agree with the article; when it mentions divisions between midwives and obstetricians I know have direct experience of it.

With my first, when struggling to deliver, the senior midwife aggressively shooed out the doctor who had come to help as the baby was starting to be get distressed & I was in shock. I was informed I didn't want the doctor but actually I bloody did! Later learnt from my community mw they'd broken guidelines and long term physical and mental health issues directly resulted from their dogmatic belief that a natural delivery is so much better than an interventionist one

2nd time round I was pushed form pillar to post between consultant and midwives for the duration of most of my pg regarding the kind of delivery I should have. My consultant was balanced and measured; some of the mws were imo totally fixated on a natural delivery at all costs. I felt they had a personal battle going on against the consultant team and the long term picture for my health wasn't often considered.

If I had a third pg I would have an ec like a shot.

yes I agree findtheriver.

If I had been going for option 1, I do buy the argument that you can maximimse your chances by going for minimal intervention of any kind and seeking midwive led care and all that.

I do think that is the case.

For me though, I was always very interested in the EC option and that just firmed it up for me. Even more so when DD had the cord wrapped twice around her neck so we would have been in em section territory anyway.

It was just nice for me to read something so close to my rationale.

"the minimum of pain relief" - ie none (not my choice) - is what made the birth of my daughter so utterly desolate and appalling and gave me panic attacks afterwards where I felt as if I was being nailed in my coffin whenever I closed my eyes so I literally was too afraid to sleep.
Personally, I think it's shit, and give me a caesarean any day of the week. I would take a consultant over a midwife similarly.
We are all different and have different experiences.