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.

LOL BabyElefant keeps a cogent discussion flowing if one spells correctly.so importamt

But things do go wrong at birthing centres. I laboured at one, and had to be transferred to a CLU as DD was OP and refused to turn. Loads of upright active labour and pushing on all fours/supported squat/birthing stool with a MW who was dedicated to natural birth did nothing. DD refused to budge.

I had booked into a birthing centre on a hospital site, so the transfer was quick and easy. I would have been stressed out of my box if I had needed an ambulance transfer, and DD wasn't in distress. IIRC about 80% of the women admitted to the birthing centre actually delivered there. So 20% were transferred. That's a lot of women.

Look, I am in total agreement that when a pregnancy has complications, or high risk factors, then access to consultant led care may be necessary. I haven't heard anyone dispute that. I needed to have a C Section with dc2, and although I managed a VBAC with dc3, I wouldn't have pushed to even try to deliver at my local birthing centre because I knew it made sense to be near an operating theatre. But birthing centres are exceptionally safe. There has never been a death or poor outcome for any baby delivered in my local one (which is not true for our regional hospital. When I had my csection there, there was a mother who had just had a stillbirth).
I am talking about the millions of women who fit the description which I thankfully did with my first baby - straightforward pregnancy. It seems that quite a lot of them are somehow fed this myth that they will be 'safer' in a consultant led hospital, when this simply is not true. I'm not sure where this idea comes from - scaremongering, I guess, but is it the media? Other mothers? I'm not sure. After I had my first baby, I gave a few talks about the birth and bf at my local NCT group and some of the mums-to-be were genuinely surprised that as a first time mum I had given birth in the birthing centre! The assumption seemed to be that even though they had all had a tour round this wonderful birthing centre, even though they all raved about how fantastic it was, for some inexplicable reason, they wouldnt be able to deliver there! Now that's just illogical.
Sabire made an excellent point that if you start off with this lack of faith in your body, in the midwives who will be supporting you, then yes, you are more likely to go down the intervention route. I have friends who gave birth around the same time as me, who had absolutely straightforward pregnancies, yet went to the large hospital, felt adrift in the impersonal surroundings, not knowing any of the midwives, often hooked up to a monitor and left alone with occasional medics popping in and out. In contrast, I was supported by a midwife the entire time, only being left with my partner when I requested it. A lot of my friends found the experience quite scary (and yes, I know giving birth is scary anyway, but I mean the additional fear of being in a very medicalised, unfamiliar place). They then ended up with epidurals, many of them then needed forceps/ventouse... and ended up with the kind of birth they'd said they didnt want. And as sabire describes, although these women weren't happy with the experience, they ended up feeling 'oh well, that's the way it was, that must have been the kind of birth I needed.' It's simply not true. Many of these women were no different to me. They didnt need to end up with a medicalised birth - but often once you've gone down that route you lose faith in your instincts and just believe what the doctors have told you.
Of course, every woman should have the right to an informed choice about where she delivers. But having talked to many women who feel disempowered after the birth, as if they were just a slab of meat on a conveyer belt, it worries me that so many women fall for this myth that they can't have a natural birth.

I think that we're on the same side here.

I agree that being in a CLU in a big hospital does not give women the right support to labour naturally, and that not getting that support is a big factor in needing intervention. That's why I choose to have MW-led care in an environment designed for an active natural birth.

I also agree that birthing centres are safe.

But what I am saying is that I can understand that if there is any kind of distance between a birthing centre and a CLU that that would be a major factor in putting women off the birthing centre. It would have been for me.

LSCS are safer for babies compared to vaginal delivery
Vaginal deliveries are safer for mothers compared to LSCSs
Very simplified statement as there are always grey areas

But obviously with childbirth there are two lives to consider - mother and baby, both of equal human value.
And as vaginal delivery is safest overall taking both lives into account (except in cases where there is specific medical need) then it makes sense that this fact is publicised and acknowledged.

"So 20% were transferred. That's a lot of women"

I'm a homebirth rep for the NCT and meet many women who have booked/had homebirths.

I have met a lot of women who've transferred into hospital from home during labour, and do you know what - I have yet to meet one who feels that homebirth was a bad choice. They all say 'I'm so glad I spent most of that labour at home - it would have been MUCH worse if I'd gone into hospital at the beginning of that labour'. And they almost always plan a homebirth for their next baby!

Me personally - I had an obstetric emergency with my second who was born at home, and had two ambulances outside the house. Fortunately we were able to send them away again, but there was a moment in the labour when there were sirens going off and paramedics thundering up the stairs. I still went ahead and booked a homebirth with my third - I wasn't put off.

I absolutely agree that I'm glad that I spent my long labour in a supportive environment and encouraged to be upright and active. As soon as I arrived at the CLU I was put flat on my back and a monitor was attached and it was agony.

But what I'm saying is that for a lot of women the distance between home or the birthing centre and the CLU is a big issue. People on here are wondering why women don't want to go to the lovely birthing centre (or have a home birth) and I reckon that that's a big part of the answer. Not that they think that they can't do it, just that if they are one of the large minority that have problems that they don't want the stress of a long transfer when they are in labour and things are going wrong.

I know people who say exactly the same sabire - that even where they've had to transfer to hospital during a home birth, they don't regret the time spent at home, and will often decide on home for next time around

'But what I'm saying is that for a lot of women the distance between home or the birthing centre and the CLU is a big issue. People on here are wondering why women don't want to go to the lovely birthing centre (or have a home birth) and I reckon that that's a big part of the answer. Not that they think that they can't do it, just that if they are one of the large minority that have problems that they don't want the stress of a long transfer when they are in labour and things are going wrong.'

Nail on head! Maternity services are cut back even further and it's called 'centralisation'.

In our area, the CLU is a ferry crossing and a journey on an A road away.

It's about 60 very long miles. It takes me nearly 2 hours to get there and requires car-ferry-train.

If something goes wrong in the local birthing unit, which is still 14 miles away, you will have to be choppered across.

And we're pretty close!

This is the CLU for an area encompassing about 100 miles west of here as well.

And yes, we are still on the mainland. The actual coast to go onto the islands is a good 70 miles west of here.

I agree expat. If the unit near me had been full there was no way that I was going to go to the other birthing centre in the area - they had completely closed down any CLU or emergency paed facilities there. Leaving only one CLU for miles and miles around.

A friend was refused entry to that CLU (it was full) and had to travel by car to the next city. It was her second child and the journey was not fun knowing that second deliveries are generally so quick.

Thanks MLP. Personally I don?t think it will be an elective, they?re giving me a gel to try and stop me going into labour again, but I got the impression they don?t see it will delay it by much. I worry that it will be another rush job (I don?t mean that in a bad way, I had the hospital director ? called back from half way across the car park on his way home ? no less and I know he did a good job, but there was an urgency as I had started to deliver a foot and the drugs weren?t stopping my labour) and will be along the same lines as last time. I think the reason I?m so interested in the difference is if I am in premature labour I and we?re not facing a footling I?d rather not be rushed off for a GA at last minute when the drugs haven?t worked not knowing if it could be avoided. The GA screwed my head up, I still feel like I?m babysitting Tink till her mother comes for her, I can?t bond with her because I?m looking over my shoulder for her mother all the time (I am seeing someone to help me with that and other things I should point out) I think MmeBovary has explained it well, I wasn?t there. The fact I?ve only just gotten over my fear of needles to self-inject and have extra blood tests does slightly come into it?

?If they ever do decide to offer elective sections on demand, I think we should all insist that those of us who wouldn't want one be offered the money to spend on the services an independent midwife instead!?

It is a shame they don?t have the same budget for every labour so that those women with a normal labour have everything they need.

who could have access to food and drink in the delivery suite, rather than having to disappear off to find it, or bring a packed lunch

lol I was begging for food, they said no in case they needed to operate, I asked for water as my mouth was so dry my throat hurt ( maybe that added to the problems I had afterwards) they still said no. My partner went to get something from the shop and call Mum, came back with a mars bar and a drink and insisted on drinking and eating standing next to me! I went mad and he laughed!

FairyMum, I know a lady whose baby?s bottom was nicked during a section. They didn?t say anything about it to the parents and it took granddad yelling at them that the baby was ill 12 hours later to get the baby moved to the unit. The unit weren?t told why the baby was sent there, they didn?t do a blood transfusion the baby desperately needed and the baby died. I know a lot of stories of mothers and babies hurt or worse during a CS. When you use baby loss forums and IRL groups you learn so many ways that babies can die, it?s heartbreaking. I bet I could beat you on the insensitive comments! I have one obstetrician who insists on making as many as possible every time I see her and that is a lot! I was rather disappointed at my booking in that it was her I was seeing.

The birthing centre near me is actually part of the hospital, so women are encouraged to use it, even if you don?t the labour rooms in the delivery suite are still very good (I?m told, have skipped over them slightly before) with a birth pool, beds that allow you to take any position etc. I had a MW with me the whole time I was in the delivery suite and she talked me through each contraction.

One thing that I find very interesting in this discussion is the issue of pain, which seems to be somewhat absent. Safety of mother & child are not the only criteria for women giving birth. Historically, women have always, ALWAYS tried to find ways to not have so much pain in labour. It's only a very small percentage of women who labour without pain, & it seems that it's always been that way. I was recently reading a very interesting book 'Birth a history' by Tina Cassidy. In the past methods of pain relief included really horrific concoctions- and dangerous too- and yet lots of women would try to get their hands on them. Understandably, in my opinion, as they just didn't want to be in pain if they could avoid it. Also, historically the different churches (eg Catholic church) though pain relief was immoral & women should labour in pain (the idea of Eve's curse and all that). Today there is a relatively safe method of pain relief- an epidural. OK, it does have some minuses, but far fewer than the horrible anaesthetics that were given in the past. What I'm saying is that I suspect many women go for the option of hospitals or even elective sections because of the issue of pain, and not only because of the issue of safety, although of course that's important too. And I don't see why pain should be brushed off so quickly as an issue, as I often find happens in certain discussions. I even had a similar experience recently when I went to hospital to ask the midwives some questions about labour (I'm 37+2 today). When I asked when I should go into hospital, in their opinion, in order to increase my chances of getting an epidural in time, all 3 of them smiled kind of smugly & went on to lecture me about how epidurals are not the best option, pain in labour is not the same as other pain blah blah blah. I was made to feel like a child to be honest! I've made my birth choices & will have a doula with me to help & support me & DP... & I feel that this attitude of some midwives really does not help. Pain should be acknowledged & women should not be made to feel like wimps when they choose to have pain relief, as long as they know the pros & cons. In my book, & after the research I've done, the cons of an epidural seem to me less than having to deal with my fear of pain...

Anyway. Just wrote all this because I feel there is obviously a big tug of war between midwives & doctors & we women are often caught in the middle. We should be encouraged to make our choices, & helped to make the best of those particular choices, that's what I feel. Even if that means an elective caesarean for some (although it wouldn't be my first preference)... I would like to see more information, more support, more respect, and less 'too posh to push' comments which are condescending & only serve to make women feel inadequate & like failures.

Maria 2007 -- I agree with you about the pain angle. But if epidurals were widely available in the UK (as for example, in France, Spain, the US, and etc), many midwives would be out of a job. It's not in their best interest to give you honest information about epidurals. Same with professional home birth promoters (some of which are very active on mumsnet) and NCT.

There is a desperate shortage of midwives in the UK - how can you say that more medical interventions and anaesthetics would mean we needed fewer midwives here?

I think the main problem in this country is that obstetrics is such a 'cinderella' service in terms of resources. I'm a doctor (not an obstetrician) who's seen enough complications during my training to put me off a home birth although I know this is not backed up statistically. I had a short intense hospital birth with gas and air and a Ventouse and it was pretty horrific but basically fine and am still planning a second VB hopefully in the birthing centre of our local DGH obstetric ward. Last time i laboured in the bath at home and was fully dilated on admission. This time i hope to use the birth pool-but there are only two so chances are they may well be occupied. My ideal birth situation would be a hospital attached birthing centre with clean comfortable relaxing rooms all with birth pools and en-suite bathrooms plenty of one to one midwife care and back up experienced obstetricians and anaesthetists available around the clock on site. I think this is a happy medium which would accommodate a lot if not all women's expectations of childbirth.

Why is the general experience of an 'NHS' birth so far far removed from this??? We (mothers) make up a large percentage of the population and the workforce. Can Mumsnet/women generally not try to put maternity services at the top of the agenda of both political parties?

The specialist I saw for years after a horrendous 4th degree tear confided that all the women on her team would choose c-section over forceps.

Midwives have a monopoly on childbirth in this country. Not true elsewhere. In the US, an anesthesiologist administers the epidural - obstetrics nurses assist.

Who administers epidural in the UK?

Don't say it's the midwives! >

An epidural would be administered by an anaesthesiologist in the UK.

LadyG - I agree with so much of what you say. The One Mother One Midwife campaign is geared towards acheiving a lot of what you suggest.

An anaesthetist sets up and administers the epidural here, not midwives.

cross-post, sorry!

Oh good. Anagram's post seemed to suggest otherwise.

here is another article which i found interesting. www.guardian.co.uk/society/2004/may/02/health.politics1

This is the head ob where I had my section.

My setion was a fantastic experience which was a pleasant surprise after being told I would be incapacitated for weeks!

Nothing in the world could induce (pardon the pun) me to have a vaginal birth next time after hearing about my friends' pretty bloody horrifying experiences.