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 think the problem is that some midwifes now see themselves as opposed to consultants rather than working with them. My mother was a midwife and she would not have dreamed of contradicting the consultant - which some may say was a problem in those days. However the pendulum has swung too far in the other direction with midwifes, often with little experience or training, just spouting out cliches about natural deliveres - I had two but so what...

As a pregnant woman, though, it does make it hard - who are you meant to listen to? Who are you meant to believe? I agree there may be areas where the pendulum has swung too far towards a MW v. consultant battleground, but that doesn't mean consultants are always right either.

When considering the statistics, though, it is worth remembering that as soon as you have an induction you are knocked out of the "straightforward vaginal birth" group and about 20% of women are induced - yet some women do have a "normal" vaginal birth after induction. Lies, damn lies...

I thought the statement abou tbirth being a 'natural' process but also that it is quite natural for women to die in childbirth was the crux of it actually andf cut through the pc crap that dogs this debate.

Giving birth is probably the most risky thing we will do and a lot of us pre the NHS just wouldn't have made it. I'm all for live and let live re this issue and am not on either side, but think the romanticism of childbirth is a bit risky - the romance comes after, when you have made it, by luck or otherwise.

If I even have another (and after my first expereince) I will be choosing an elective cs, simply becasue I want to minimise the risk of not being here to bring nmy kids up.

when I was having DS, the anaesthetist in the delivery suite said that the reason so many doctors themselves have elective
c sections is due to dealing with an unrepresentative selection of women having babies.

If you are a doctor in the delivery suite, for instance, you don't see the home birth that didn't require intervention or assistance, and in my opinion, have a distorted view of child birth as a doctor only tends to get involved in complicated caes?

it's a healthy dialectic - they rub along and probably bring out the best in each other. If either side (midwives or obs) were complacent giving birth would probly be even more risky.

UI think we should be thankful for the fact they rub along - not get along - that's what makes it work, it's not the problem at all!

You know that you stand a better chance of a vaginal delivery if your interventions are kept to a minimum.
So if your delivery progresses along the right time line, all well and good, but if things start going wrong, you end up heading off down the interventional line, with augemntation, ventouse/forceps and then Em LSCS.
So I hoped for a vaginal delivery based on an interventionally low labour, but if anything started to deviate from the straightforward, then to opt for a LSCS at an earlier point rather than later on after hours of failing to progress/failed forceps etc

MT - it may be healthy for the MWs and obs, but is it healthy for the mothers? Does friction bring out the best or the worst? Complacency isn't good, but neither is overt disagreement. If you're getting contradictory advice from your MW and your obs, who are you supposed to believe?

I wonder how many women are given augmentation and/or interventions because of a "failure to progress at our designated rate" rather than a true "failure to progress".

I guess that kind of sums it up Darrell. A good approach is probably as you say, avoid induction, avoid epidural and give yourself the best chance of a non medicalised straightforward birth. It can't always be like this, but I can't help feeling that if more women were empowered to avoid interventions as possible, then the csection rate would decrease

There is an ob on here who had a homebirth quite recently I thought from what she was saying.

THIS ARTICLE IS ABOUT TIME TOO!

(Rant warning ):

At last a chink of light. I have seen umpteen threads on here completely trouncing anyone who dared to suggest they may want an elective caesarian. The amount of self-righteous vaginal birthers on MN is incredible, full of quotes/statistics/information purporting that caesarians are the work of the devil.

How many mothers do have fanjo/sex/incontinence problems after a VB? HOW MANY ADMIT TO IT??! Would your best mate tell you if she leaked poo after giving birth to her last baby 5 years ago? No, doubt it. So the myth that VBs are all sweetness and light, (conveniently forgetting the amount that end in an emergency caesarian of course) persists.

And perhaps the undercover stuff like incontinence stays undercover because caesarians are more FLIPPING EXPENSIVE than VBs.

I am pg and when I received my green notes I was also invited to take place in a research study for faecal incontinence taking place during and after my pregnancy!!! Doesn't that say there are problems on a wider scale than people would like to admit?

Ahem. Being pg I am also somewhat occasionally

... ratty

but incontinence doesn't always happen, however, with assisted deliveries.

i had a forceps delivery with DD1.

i never had any incontinence aside from the normal, temporary variety that i also had with DD2, an uncomplicated vaginal delivery.

i never tore along the scar.

i had a graze with DD2.

One of the things that does concern me that is blurred in the article as in many discussions is that all interventions seem to be lumped together. I had a successful induction although I hope that 2nd time around I can avoid the need for one, just because I was very unhappy with being wired up to machines for so long. I did also need ventouse assistance but it was successful and my stitches etc healed ok.

The article doesn't even mention stats for ventouse, but I don't believe either that or forceps when they're successful are on the level of a caesarian.

If you have cable or satellite TV, there's a fascinating series on Discovery Home and Health about 3 American female doctors who work delivering babies, the level of intervention there is very clearly much higher than here.

My cousin's DW is still very poorly after having a CS 10 weeks ago. The wound ruptured, got infected
I've had 3 vaginal births and never suffered like she has.

I am happy that you have not experienced any long-lasting problems but can you imagine how awful it would be if you did.

Not saying that everyone will get incontinence from a VB, just that after-problems such as this, dodgy-stitched fanjos etc etc could be on a far more wider scale than most of us know, because the symptoms are so humiliating. Plus there is pressure to achieve the perfect birth/baby/partner/life these days, who wants to ruin the myth to their mates/family?

I bet most people who post on MN with their physical problems from giving birth DO NOT go round telling even close friends half of what they happily share on MN.

I had an emergency section. I am an obstetrician. I really really wish I'd had a normal delivery for myself but at the end of the day I am like any other mum - a healthy baby is what counts. I am going to stop wittering in case I end up outing myself. But I do know of two colleagues who had elective sections, and I think it is about dignity in the unit you work in more than anything else. Rightly or wrongly.

mlp can't they go elsewhere?

At the risk of outing myself - if you work at a tertiary centre with huge respect for your colleagues - you don't want to go elsewhere.

Sorry for your cousin's DW Sazisi . Yes CS is major abdominal surgery, but VB is major abdominal trauma. Fact is there is no easy way of giving birth and my main bugbear is those who only see the fluffy romance of a VB and refuse to accept/discuss the things that can go wrong with your fanjo/waterworks/pooworks etc resulting from a VB.

It really is a game of luck I think and that's why every woman should be entitled to make her own informed choice. Nobody can say how any birth will turn out because each is unique, so those who are so very pro VB are almost, what are the words I am searching for, responsible for propogating the myth that all VBs are airy-fairy experiences.

Fine to say your own VB was good/bad etc but straying onto difficult territory in more ways than one are those who trumpet about how good VBs are in general, should they be held responsible if someone else takes their word for it and then has a terrible time?: because you can be an expert on your own birth but not someone else's proposed birth.

I read it and found it really interesting.I have friends who are midwives and doctors, including consultant obstetricians. The key to it all is that doctors tend not to get involved until it gets a bit hairy. So they tend to see what can go wrong before, during and the aftermath. midwives on the other hand see a higher % of problem-free births and would argue why have a major operation if you don't have to. Still not sure what the answer is, but suspect more midwives opt for natural births than doctors. for very obvious reasons.

A very good point MLP re dignity.

But still can't help point out that you had an elective caesarian because a healthy baby is what counts. Can only conclude from your post that there is more chance of getting that from an elective caesarian than a VB...

You're not post-men though expat, that was the point I think

I really think this is a false argument. Yes Tangle, I do think the current system works - it's only through dissent that things progress - I think thjat something 'we' forget in our want for all things harmonious

As a midwife I have seen more problems associated with caesarean section. I have seen women require hysterectomy after elective caesean section so please do not assume that CS is the safer option. All surgery carries risk.