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.

Well it's either that or an Independent MW. And no... you're not silly!

I met some lovely midwives at my ante-natal checks and remember thinking I would love to have them at the birth. Sadly, you just don't know. I admit to having a real problem with the whole profession after my experiences. At my last booking-in appointment, the midwive laughed when I tpold her how many miscarriages I had had and said. She said "you are very persistent, aren't you?" and giggled. Very funny! Anyway, ignore my rants or I will never stop

Fark me Fairy, that's extraordinary. Some people really shouldn't be allowed out should they?

Hmmm, the IVF mums that I know (including me) certainly wanted and most of us got a normal VB...I guess it must partly depend on why you needed IVF in the first place. At least for 1/3 of us male factor rather than female factor is the issue...

Anyway digression from the point of the thread over, I think that there are risks with VB or CS and my issue is that these are understood so the adult woman can make an informed decision about what she wants. Neither is right or wrong but you should know what you are getting into.

I had a an energency c section as opposed to the planned one (not exactly elective but 2 weeks earlier). Long story but I had polyhydramious and a breech baby. My experiemce was that when you are expected to have a c-section no-one tells you the risks. When they don't want you to have one they do - scary! I ended up with worst of both scenarios. Full labour then emergency c-section. It took me a long time to get over the fact I wasb't "there" when my dd was born. If I did it again I would not risk a VBAC in case that happened again. If I was a dcotor and had seen such scenarios I think I'd undetand if they made the same decision.....

My understanding is that hospital is happy as long as mother and baby leave alive. They don't care as much what happens to the mother's body in the process

MW and obs and Gynae are recommended to provide least invasive mode of birth.this is not only safe but is cost effective

hence choice can consist of
Home Birth
Birthing centre
labour ward
birth plan and analgesia preferences

but obviously everyone wants live birth, live mummy

I would have gone for home birth if I'd been brave enough!! I did the next best thing (birthing centre) which was fab. Interestingly though, most women in my NCT class booked themselves into the big teaching hospital 25 miles away, even though we have the loveliest birthing centre on the doorstep. Safety record at the birthing centre is 100%, and the atmosphere is lovely - individual rooms, very homely, lovely midwives, continuity of care and no doctors around!! I found it interesting that despite all this, so many women opted for the more medicalised route. This was at the point of booking, so months before giving birth, so it wasnt because of any complications. It made me wonder if despite all the evidence of the birthing centre providing really safe, positive birth experiences, a lot of mums just have this irrational feeling that a big hospital with doctors and anaesthetists must be safer?? It's a shame, because a number of these small midwife led units are in danger of being closed down, and if more women used them it would make them more viable.

but birthing centres have specific no contraindications exclusionary policiy eg
no elevated BP,
no medical complications,
low risk pregnancy and anticipate a low risk labour and birth e.g. no previous medical or obstetric problems
do not want to have an epidural in labour

fwiw i would was delighted to be umder consultant lead care.my pg the the mw were diffident and poor practitioners

Yes, birthing centres do not accept women who have certain complications/conditions. But the point I was making is that all bar one of us in my NCT class fitted this description - we were all low risk apart from one woman with raised BP, yet only two of us in the class booked into the birthing centre! Your experience was obviously different scottishmummy, but in my area, the birthing centre is renowned for excellent midwives (competition for jobs there is fierce - it is what the midwives aspire to). There is excellent continuity of care: the team of midwives is small; you know the midwife who is delivering you. The safety record is 100%. The rooms are clean and homely. Visiting hours are unrestricted. In contrast, the big hospital is understaffed, care after the birth is really poor, bf rates are lower, generally a lot of women who give birth there are not happy with their experience. And that's what I find interesting: it's as though despite the evidence of the birthing centre being a much more positive experience, so many women seem to hold onto this irrational feeling that a big hospital + doctors = better. When it so clearly isnt.

Just to add that I had a csection with dc2 and a VBAC with dc3, so I only got to use the birthing centre for my first birth. The other two were at the big hospital. So I've had experience of both. The birthing centre was way better.I would have loved to have had all my births there, but obviously a cs was not possible and VBAC was too high risk. I just find it sad that a lot of women feel this pressure, from whatever, source, that big hospitals 'must' be preferable.

BUT big hospital + doctors CAN be better- esp clinically acute situation fwiw Yes i would rather be closer to dr's, and specialist care

The birthing centre does sound lovely but nobody knows that their birth is the one that turns into an emergency. Plenty of stories on here re emergency cs's performed in the blink of an eye, obviously this could not happen at the birthing centre.

Of course that's why they only accept low-risk pregnancies, to minimise the chances of an emergency case, however anything can happen in a labour situation.

I would love the birthing centre if I knew for a fact I would not need the services of a large hospital. However nobody does know this in advance.

But birthing centres would not exist if they didnt have a safety record that is exemplary. When you think of some of the heart rending stories in the media, of mothers dying in childbirth, or that baby who was crushed by forceps ... where did they happen? Large consultant led hospitals. Emergency situations are extremely rare. Usually there are warning signs in advance if things are going wrong. The fact is, midwife led units for low risk pregnancies are an extremely safe option, possibly statistically safer than consultant led care. Home births also have an excellent safety record. I am not talking about high risk situations. Once I had had a CSection, I accepted the fact that my VBAC needed to be near an operating theatre in case of emergency (though thankfully I managed a natural birth). But in a low risk situation - no contest. A good midwife and a good birthing centre can make for an empowering experience, as well as a safe birth.

yes a safety record with low intervention no obstetric complication no epidural.not all births follow such a path hence need for medics

"a lot of mums just have this irrational feeling that a big hospital with doctors and anaesthetists must be safer??"

Yes - they say 'well, better be in a consultant led unit so I can have an epidural if I need one. And whaddayouknow - they DO need one!

Epidurals are the answer to hospital births: take yourself into an environment which is completely unconducive to normal labour, then spend ages afterwards wondering why it all went wrong. Arrive at the conclusion that your body is a disaster when it comes to giving birth and thank god for modern medicine.

"Plenty of stories on here re emergency cs's performed in the blink of an eye, obviously this could not happen at the birthing centre."

So logically you'd expect the thousands of mums and babies who birth in these centres and at home to have higher mortality and morbidity rates than low risk mothers birthing in consultant led units wouldn't you?

Except this doesn't seem to be the case. Go figure!

And what's more - low risk women birthing in consultant led units are actually more likely to end up in theatre and their babies in special care than mums and babies who birth at home or in birth centres. Go figure again!

"but birthing centres have specific no contraindications exclusionary policiy eg
no elevated BP,
no medical complications,
low risk pregnancy and anticipate a low risk labour and birth e.g. no previous medical or obstetric problems"

Our local birth centre has strict criteria, but regularly 'bend' the rules to admit women who feel very strongly that they want to birth there. They sometimes take vbac mums and others with medical issues.

"fwiw i would was delighted to be umder consultant lead care.my pg the the mw were diffident and poor practitioners"

What consultant led care actually amounts to in our local CLU is being admitted to the labour ward, being put on a monitor and then being ignored for hours, unless things start to go wrong, in which case they call in the obstetricians. It's still the midwives who are with you throughout labour, unless you are having major problems, in which case the obs become involved.

flattered you cut and paste my narrative!what is your point then

mw present throughout labour!sadly this is not the norm due to under staffing, pressure on staff,high bed occupancy rates etc

Sabine, do you have any proof there are lower mortality and morbidity rates in birthing centres or is it your assumption? Just saying "this doesn't seem to be the case" is a little vague. If you have firm stats/proof to back up your statement I for one would take birthing centres more seriously. Chance to convert someone here!!

Findtheriver: good points however your comment: "When you think of some of the heart rending stories in the media, of mothers dying in childbirth, or that baby who was crushed by forceps ... where did they happen? Large consultant led hospitals." These include high and low risk pregnancies, whereas the birthing centres cherry-pick the least complicated pregnancies, so there are less that can go wrong.

It's not just you scottishmummy, Sabine cut and pasted my post too (preens)

where is best place to find cs stats?everyone on here always quotes them and id like info on a 4th cs,find some stuff but not alot.

Thanks for pointing that out, hartick!

This doesn't surprise me at all. When I was pg with DS1, I desperately wanted a c-section (as I was too scared to give birth). All the midwives and doctors in the hospital were telling me not to, that VBs were much safer, risk of infection/haemorrage with CS, etc, for hours.

But when I asked them, "How did you have your children?" every.single.one of them said that, in fact, they'd had C-sections.