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.

my red cardigan,

Bit of a generalization that all couples will argue and bicker after birth - and that sleep deprivation is torture. Only if you don't share it, imo

My partner and I share the sleepless nights. I pump and he does a few nights and I get some sleep and then vice versa. Both of us agree that it takes a few nights to make a difference.

But we are both in professions where we are used to working for long stretches and doing night shifts!

All my friends who have had elective c sections were happy with their decision. An emergency c-section is another matter....

I think that "genes" can have a big impact on birth. There was a very bad history in my family, but I knew that all the births were either in the generation above me (the horrible shave and enema on arrival in hospital, stirrups, routine episiotomy etc.) or recent but medicalised (because there was a problem with the Mum or the pregnancy). So there was no way for me to know whether it was the circumstances of the delivery. As it was, I did have the same problems that the other women in my family had. Which makes me think that the "family pelvis" causes persistent OP. We already have the family photos showing the lovely enormous square heads of all the babies!

Mrs TM- I'm sorry you've had such a hard time trying to find a sympathetic ear and someone who can help.

You are right about how we often don't find out the long-term impact of our interventions, especially at registrar level when we rotate through different units regularly. It's only really at Consultant level that we come across women in their subsequent pregnancies with a very different interpretation of events from that depicted in the notes. Of course some women are so traumatised they choose to avoid a further pregnancy and never cross our paths again. All I can say is that there is a growing recognition of this and most units now have a birth afterthoughts service where you can go back at any time to discuss events during labour and delivery no matter how long ago it was. I think a lot of women find the additional explanation and information very helpful, but of course that doesn't help with ongoing physical problems.

Scar tissue is difficult to deal with as I'm sure you've been told as further surgery obviously causes more scarring, but I wouldn't rule it out completely. I would also consider something like psychosexual counselling, not because 'it's all in your head', but I think they can be very helpful in lending that sympathetic ear and also providing practical advice on overcoming loss of libido secondary to pain.

Maristela- I'm sorry to hear about your experience too. That must have been truly terrifying and the kind of event that can lead to post-traumatic stress disorder, also being increasingly recognised as a 'birth outcome'.

I still beleive that vaginal birth is safest and that anyone pregnant reading this thread should try and retain a sense of perspective however difficult that may be in the face of such terrble experiences.

Believe!!

I think it is very difficult for many because of that missing element of control that goes with all childbirth, regardless of the mode of delivery. Have a VB and things can go wrong, have a csection and things can go wrong.

I struggle with this even now, approaching the third birth, especially as DD1 has such marked dyspraxia (more than likely inherited, as her father, paternal uncle and paternal grandfather have it as well).

Thank you. I'm glad that at least it's starting to be recognised as a problem. Just as in your experience, my notes don't really reflect my experience. For example, there was no mention of why I was given an episiotomy as according to the OBs it never happened. So there is no mention as to why it is so big (all the way up my vagina almost to my cervix and completely destroying my G spot). My notes were written "in retrospect", so even though they say that I didn't want an instrumental delivery ("until I was told about the risks of CS" - which was nonsense, I already knew about them, I was just bullied into signing the consent form for instrumental) - there was nothing about the OB acknowledging that I didn't want an episiotomy or telling me that he (the senior doctor) would do the repair if I tore. I feel like taking a sodding dictaphone with me to my next delivery.

Regarding the psychosexual stuff - I know that this isn't the cause of the problem, and it's very insulting to be told by doctors that they know my vagina better than me. You're right that it did become an issue in the end, because let's face it, if you do something and it causes you pain, it's difficult to keep doing it and not have a psychological reaction to it! But either way, there was no help offered at all - just "it's all in your head - go away and stop bothering us".

MrsTM, it's experiences like yours that make women frightened of VB. I'm sorry you had such an awful time.

Ilovemydog, if adding a newborn into the dynamics of your marriage didn't affect it in any way then I'm amazed. The vast majority of couple find that in the early days they bicker and snap at each other for no realreason other than the fact that they're nervous and exhausted.

We shared nights too. Even though I was BF, DH woke and rubbed my back or cuddled me and just was very supportive generally. That didn't stop me feeling that being woken 4 times a night was akin to torture. You get use to it but in the beginning it is horrendous. Every mum I've ever met feels the same. You must be very unusual.

Thank you. I sometimes feel awkward posting here and wonder if there should be a separate board for those preparing to go through labour and those recovering from it. I know that before I had DD1 that I would have been clued to the "recovering from" board though.

Highlander - can I ask where you got your information from re pricing and delivery rates?

Recently (last couple of years) the financing in the NHS has changed to work through "Payments by Results". Every procedure has been assigned a tariff based on the cost of giving this procedure to the "average" patient, and these tariffs are what the PCT receives for completing that procedure. For deliveries in the 2008-2009 period, costs are:

Normal Delivery w/o cc: £996
Normal Delivery w cc: £996
Assisted Delivery w/o cc: £1,422
Assisted Delivery w cc: £2,029
Caesarean Section w/o cc: 2,198
Caesarean Section w cc: 3,077

These tariffs include a stay in hospital of variable length (varying with procedure), so 3 days for a normal delivery, 15 days for a CS with complications. As of this year, homebirths are included and priced the same as normal deliveries.

The complete list of tariffs and guidance notes is availble to download here.

www.birthchoiceuk.com/ calculated average statistics for women in England based on 1998 data from the Department of Health. They found 46.5% of women acheived a "normal vaginal birth", where a "normal vaginal birth" was considered as one where labour starts naturally, had no anaesthesia (GA, spinal or epidural), did not have a CS (planned or emergency), did not have an instrumental delivery and did not have an episiotomy.

I think that also highlights some of the problems. I have a scientific background, and as such I would like to be given advice based on good quality research. However, that automatically introduces a time delay while that research gets published, and then a further delay before it can (hopefully) influence NICE guidelines. Can any of the obs that are around give any insight into what the situation is regarding following the guidelines? In general and more specifically when new research suggests they are no longer best practice?

Risk is so difficult to quantify in part, I think, because it can be presented in so many different ways. Risk based on an individual Dr's experience, risk based on societal perception, risk based on the experience of an individual's friends, risk based on research... In theory research should give the answer, but even then unless the criteria of the study are understood the risks may be misrepresented.

I don't think elective sections are wrong per se as long as the choice to have an elective is truly informed. Vaginal births can be wonderful, and I was very fortunate to have a good experience, but they can also be truly traumatic experiences and my heart goes out to the women where it all goes wrong. But similarly, there are no garuntees that a CS (elective or otherwise) will be straightforward and problem free.

tangle that was very interesting post!
i wondered if anyone could help me here