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.

yes MNC MLP had an em CS and wished she hadn't
I see MLP bit difficult with the colleagues!

MLP, there is no right or wrong - it's an emotional argument. Dignity is just as mush up there as anything else.

Never mind the obs/midwife competitivness - there is a competitiveness among us all - pain/no pain, low weight/high weigtht, succesful b'f/not - etc

I think doctors have a greater understanding of the risks of the operation compared to the risks of a VB, because they perform the CS operation and know that, when it is elective (NOT emergency) there is a high high chance of everything going perfectly well. Why shouldn't it? It is a big op - but surgeons big ops all day, every day. They have got awfully good at it now. It isn't unchartered territory (like VB) or pioneering surgery.

Giving birth vaginally is somewhat like giving yourself a big op FGS!!! Just because it's been going on for thousands of years doesn't mean its the only way any more! We have the flipping technology, cavemen flipping didn't or I bet my last bone hair slide those cave women would have damn well begged for a CS!!!!

I'm confused as to how one might wish not to have an em-cs - what was the real alternative?

No one would want to have an emergency procedure, but we do know that the alternatives are grim, don't we?

Why does everyone think elective CS is without risk? It is a major abdominal operation and has huge risk compared with vaginal delivery.

I read that element of MLP's post incorrectly (must have been too busy typing "flipping" at the time )

mt - aimed at me? - I was being theoretical, in considering my birth experience, rather than saying I sat there looking at the CTG and thought, well, I;d really rather not go to theatre for a section, but if you insist...
If that makes it any clearer

Quite right Mears, elective CS is not without risk, but neither is VB yet people seem more loath to talk about the risks of VB.

Eg faecal incontinence - I had never heard of this (associated with pg) until I read some threads on here re sphincter damage following VB, the posters were obviously bravely baring themselves to a topic that must not be seen or heard usually.

Then I get the invitation to faecal research study with my green notes and it dawns on me that there are repercussions to VB going on that nobody ever really talks about openly.

We hear plenty about CS risks though.

Sometimes I wonder if we hear more about risks of CS and less about VB to stop more women wanting a CS which would obviously cost the NHS more money.

I think you are confusing the desires of the gov to cost contain within the public sector witht eh diseres of teh Docs/nurses/midwives to do thier job, well successfully with the best outcome for all and not end up in court.
I don't for one minute think that the Dr I see in hospital says well i wont give MNC a CS because it will save my dept 4,000 pounds they don't get to take it home
there is no bonus for not spending all the money!

Faecal incontinence can be assocaited with CS birth. Not many people seem to know that. The effects of pregnancy are wide reaching - despite of mode of delivery.

MT were you talking to me?
Wouldn't dream of putting words into mlp mouth
but what she said

I can spell sometimes sorry

Take your point 1dilemma but the NHS has a budget like any other organisation! They will budget for a certain amount of elective CSs per year and are probably "encouraged" (or pressured) to keep within the recommended limits.

Mears - accept that faecal incontinence can be associated with pregnancy per se but really, are the number of sufferers resulting from elective CS anything like the numbers resulting from a VB?

I know that bladders etc can get nicked by the surgeon's knife but there again - when the stats are done for CSs, how many studies lump both emergency and elective CSs together? I bet there is more chance of being nicked or some other such complication during an emerg CS!!!

If it happened during an elective the surgeon would have to prove it was unavoidable or else admit his work was substandard.

interesting info

MrsNC, you also have to weigh up the risks of C-section v. vaginal birth to the child. Clearly in an emergency or where there are medical reasons for a C-section there's no contest. But if you are choosing whether or not to have a planned section with no medical issues, then it's important to think about the impact on the baby.

Breathing difficulties, for instance, are more common in babies born by C-section. There are all sorts of factors, but I think it is true that even if you strip out all the obvious reasons such as babies being unwell anyway hence the C-section, or being born earlier, there is still a difference - it's though that the action of travelling down the birth canal helps the baby to take their first breath, IIRC. (Mears knows far more about this, obviously, and I'm sure she'll correct me if I've slipped up.)

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

Well, my mother is. She had two elective csections, one for my elder sister who was footling breech and one for me because the incision was vertical and VBAC not on offer in 1971.

She had a prolapse and pelvic floor problems post menopause despite having never gone into labour at all.

She had some sling-type surgery in her late 50s.

No hatrick, nothing as sophisticated as a conspiracy theory! Sorry if it came across like that, it was only that I presume there is a budget for these things.

Mears - my last post should have read as a question not a statement, forgot the ? at the end. (I was just wondering)

Caesrean section, even elective, is a risky business. Bladders are nicked - it is a known risk. Women do haemorrhage. I have seen it and seen the aftermath.

The impact of CS birth on future pregnancies cannot be ignored. Yes we need CS, but not at the current rate in developed countries.

I don't really think MNC is putting forward a conspiracy theory I think hse's just connected 2 things that aren't (can be easy to do on MN especially if you are the only one saying something)

I think most things about the NHS budget are so cumbersome that they do not even attempt to control them, but some things are micromanaged.
Drugs are very controlled, hospital budgets are generally out of control with a number of large teaching hosps being many millions in debt and money artifically 'swapped round' in some charade of one person paying the other
(note even if the cash does change hands I personally would rather we saved the money we spend employing people to do it and spent it on healthcare it's all coming from my taxes anyway!)

I'm a slow poster
i thought the comment to expat was something about men as in a man which didn't quite make sense to me

I've done one of each and I got over the normal birth a lot faster. My daughter is two next week and I still suffer because of my scar. I get labour type pains in it when I need the toilet or am over tired. I have to take things very gently with sex because it feels like it's going to split, if I move awkward I feel like I've sprained something. My back has been made a lot worse from the section because the muscles that were the problem are the ones that have to be cut through. I have to go up a size in jeans because they dig into my scar otherwise, I never really put the maternity jeans away because they're the only clothes I can comfortably wear. I was ill for a week from the anaesthetic and two weeks later I still couldn't walk to the NNU to my daughter.

Give me a normal birth any day!

As there are a lot of professionals in one place, can I ask if anyone knows about this...

I had to have an emergency section (31 weeks, footling breech, rapid progression with the drugs to stop it, bad back and heparin prevented an epidural) and apparently they didn't make the cut big enough so had to change direction to get her head out. I've been left with an upside down T and they just keep saying about this new one "elective section" with no explanation of why I need one. What are the risks with that shape scar? Am I totally out of the running to VBAC?

I know mears, but as a MW you will have surely also seen haemorrhaging from VBs too? Not trying to be facetious at all, just saying that any type of birth is not a simple process.

My friend's who's MW was very open to CS and I think, had my friend wanted one, the MW would have been happy to help.

Opinion will vary from doctor to doctor, hosp to hops, MW to MW etc - and woman to woman.

I am off to get some beauty sleep now (I don't half need it I have to say ) there has been some good, healthy and respectful debate here I feel and lots of food for thought...

Night all!

I don't know, Tinker, but my mother had a vertical incision with her first - it was 1967 and the baby was footling breech, so I'm not sure if the bikini cut was even offered then.

But she was not offered VBAC at all.

My sister had an EMCS first time round in 1993 and had a VBAC in 1997.