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.

"By margoandjerry on Fri 11-Jul-08 21:07:50
Basically my consultant said that the order of safety is:

1. vaginal birth
2. elective section
3. forceps/ventouse
4. emergency section."

I am really interested in your consultant's basis for saying this, because from eerything else I know it is total baloney.
how can a ventouse delivery beless safe than an elective section? in terms of anaesthetic risk, risk of infection, risk to baby, risk to mother, any c section is bound to be riskier than a ventouse.
I would be very interested to see any kind of research, study, or even anecdotal evidence to the contrary

This IS interesting, isn't it?

I have a friend who is an obstet. and has had FIVE planned c-sections. The last couple ended up with a lot of bed-rest due to the risk of rupturing. I find it very interesting!

My DD3 was born 11 years ago and i still remember it all in minute detail unlike my first two births.
I was a little reluctant to post on this topic as i truly believe that women who are honest enough to admit that they would prefer an elective cesarean section are frowned upon. I suffered from gestational diabetes in each of my pregnancies making me a canditate for induction in all three of my pregnancies. The first two being at 38 weeks and my last one being at 37.

DD3 was induced in a busy ward where there werent enough staff and no one was taken down to the labour ward until the very last possible moment. As a consequence of this i was put in a small side room late at night (after two lots of prostin insertions) and my ex DH was sent the 30 odd miles home. At 5 in the morning the pain was more than i could bear and after frantically begging the MW to check me she agreed that indeed i was 'progressing nicely' - bear in mind bar the usual 1 hour of monitoring after the prostin i had no monitoring whatsoever and she took me downstairs to the labour ward. Once in the labour ward and with ex DH on the way i was in agony as is usual with childbirth but the when the exhausted (having been up all night doing emergency CS'S) anaesthetist tried to put my epidural in three times this really was the end of the line for me when it only worked down one side.

My waters broke and my newly arrived DH had to ring the bell frantically to get the MW as he was in there on his own with me and she got there just in time to see my DD's head out with the cord wrapped around her neck twice. DD came out far too quickly and no one was prepared for the consequences. I bled far too much and came within a hairs bredth of needing a blood transfusion but worse to come was DD next to me after delivery in her transparent cot and a MW asking me if i thought she looked like a funny colour? Well i had been up for 30 plus hours and had no idea but when the peadiatrician took her away and the next i knew she was having a lumbar puncture at only 4 hours old and in intensive care because of these cyanotic episodes it was enough for me to think that i was losing my newborn baby girl.

They discharged her after a week ( they discharged me the day i had her at 1 pm stating that they needed the beds ) and said they couldnt say exactly what was causing the episodes just that they stopped after 2 days and she seemed fine.My daughters birth was mismanaged horribly and I couldnt bond very well with her because of this for quite a long time. i had severe PND, something which i hadnt experienced before this episode. The reason i have posted this story is because i am so adamant that i want an elective CS this time. I know the risks and i also know that compared to the abject terror i will feel if i have to have another induced VB it is something that i will be asking for.

I know the NICE guidelines state that women should not be offered selective CS without a valid medical reason but i am nearly 9 weeks and right from my first appointment with the consultant i will be stating my wishes. I believe that every woman who is well informed enough should be entitled to make a decision as to the method she wishes to deliver her baby and i am very much hoping that after 11 years the medical proffesion will be sympathetic to this.

I have been looking into the possibility of privately having a CS but i also think that the cost will be prohibitive because from what i can see it is going to be 10k or over.
I do not after reading extensively about CS's think that they are especially more dangerous than VB's there will always be women on either side of the fence and i say to each their own i just know after my personal experience i want what i consider to be a 'safer' option for me and my baby.

I had planned on having no more children but upon meeting my wonderful soon to be husband who has no natural children himself i can think of no better thing ... I just hope that this experience is an altogether more positive one and that with enough discussion with the practioners who are looking after me in this pregnancy that I will be allowed a CS.

Agree with MonkeyTrousers. i think childbirth is romanticized. After preparing for my first birth with the NCT i was given, IMO, unrealistic expectations. It was lovely to feel empowered, ie, i can do without pain relief, no to epidurals, etc. but the reality of birth was so different, for me, and the let down and feeling of failure [having an emergency section after a long disastrous labour] was immense. This was not even talked about at the NCT. I do feel so grateful to the NHS for their care in the births of both of my children. Of course it is important for births not to be unnecessarily medicalised but it is equally important not to have unrealistic expectation of all birth experiences.

Agree 110% Ruty

Does anyone recall the marvellous debate we had a few years ago about the NCT outliving their usefulness? It was very thought-provoking.

"Of course it is important for births not to be unnecessarily medicalised but it is equally important not to have unrealistic expectation of all birth experiences"
or from another perspective, it is equally important not to be complacent and too accepting and passive about the care women receive in labour, and important to continue to campaign to ensure the treatment is the best possible treatment to enable them to birth well and without trauma.
and it is equally important not to underestimate the importance of a woman's birth experience to her experience of parenting and to her life afterwards.
i.e. it really matters. let's change it for the better, at am individual level (if possible) and/or at society level.

by the way, all the research strongly favours vaginal birth over a caesarean.
re the potential damage to the pelvic floor from instrumental deliveries, the harm can be minimised in different ways e.g. preferring a section to a late and a difficult instrumental delivery.

I agree with you harpsi but the problem is getting a CS instead of a difficult instrumental birth. That was my birth plan, but my wishes were trodden into the floor at that late stage of labour and I was forced to have an instrumental. Plus I was given an episiotomy without my consent, and then lied to abour it. That's why I think a lot of the CS issues are down to control.

CoteDAzur, Sorry if my message was misleading! Yeah, the anesthesiologist administers the epidural in the UK. But .... (and there are lots of threads about this), you have to request one through the midwife, unless it's a c-section of course. In the case of a low-risk vaginal birth, the midwife can decide to deny your request for pain relief. That may be because of lack of resources or for other reasons (she doesn't think you need it, she is overworked, she wants to play solitaire on her computer, etc). She is the gate-keeper.

In some countries, the law protects your rights regarding pain relief during childbirth. Not so in the UK.

RosiePosey, I am really sorry for you and I hope you get what you want. You need to be insistent and informed, and then they usually listen to you. The ought to, after what youhave been through.

I've just read the whole of this thread, lots of interesting stuff on here, but I was surprised to see Mears (who is an excellent poster and for whom I have the greatest respect) get annoyed that people were saying CSs were without risk, as they carry 'a huge risk' in comparison to VBs. I know Mears is a professional but if she is talking about maternal death, which I think she is,

a) there's a difference in the figures between an elective and an emergency CS and I think this is highly significant (ie, the former is safer)

b) A CS carries double the risk of maternal death than a run of the mill VB, yes, BUT maternal death in today's Britain is, thank God, a tiny tiny number. Even twice a tiny tiny number is still...a tiny tiny number.

'it is equally important not to be complacent and too accepting and passive about the care women receive in labour, and important to continue to campaign to ensure the treatment is the best possible treatment to enable them to birth well and without trauma.' Of course, agree harpsi.

'by the way, all the research strongly favours vaginal birth over a caesarean.' Is this statistical evidence or other research? I mean, of course statistically vaginal birth is safer, but it may not be the safest route for some individual cases.

I am with you too Ruty; there were three other mums at my NCT class and we all agreed that basically we felt we were given unrealistic expectations of birth and that it was somewhat romanticised. As the one of the group who had a traumatic birth, when we went to our 'bring your baby' good bye session, I felt a definite second class citizen as she sat on the floor listening adoringly to tales of natural childbirth but - ooh - didn't get round to me and my baby!!! And no this isn't paranoia, the mums commented to me afterward "she didn't want to talk to you, did she!"

Of course this is only one experience of one teacher but it's clearly not an isolated experience judging by this thread.

oh that's awful HG, as if your birth experience is less valid or something. I ould have told her anyway!

Rosieposey - I meant to add that I explained my traumatic previous birth to my community midwife and she immediately offered me an elective section if I wanted one. So there are definitely professionals out there who are very sensitive to the issue. The fact that I've been offered a CS has also meant that I've felt free to consider vaginal birth without having to worry about being forced into one.

Fascinating & measured thread, have read it all with great interest, thank you. The 'All-things-'natural'-are always best Mullahs' romanticising VB make me sick. Many are simply not interested in a discussion.
I'm PG with #1 at 35 and set on CS after lots of research. DH and I both grew up with family members damaged during VB - and yes, we do know there are no guarantees in life and disability can strike anyone at any time - but the (rare) risks of VB has kind of scared our families & us, at the risk of sounding dramatic.
My CS wish got stronger after a long frank conversation with our then GP (trained as OB) before we TTC. GP is convinced CS the best choice for 1st time mothers at my age and told me 'not to get upset if labour ended in emergency CS'.

Sadly we don't live in his area any more. How on earth does a 1st timer get an elective CS? It seems hopeless.
Sorry about the essay but I've never really shared this before.

I am having an elective section this time, already had two emergency sections one afetr a 36hr labour and the other because my scar ruptured. I am having an elective section as both my previous births were so traumatic I never want to do that again.

I was made to feel like I 'failed' at giving birth, with comments from the MW's like 'at least you have a heathly baby even you if didn't get to give birth'

Had I had any stregth left I could have quite easily punched them.

Rosieposie, I've been there, it's called Post Natal Post Traumatic Stress Disorder, often misdiagnosed as PND. When I had my 2nd baby I saw my GP for checkups (had developed phobia of midwives), got him to refer me to different hospital (had panic attack on trying to revisit that one) and consultant of my choice (I phoned their Birth Afterthoughts and asked for the name of a softy one who wouldn't push VBAC.) At 21wks I met him and he booked me in there and then which was so hugely reassuring I cried all over him! My elective at 39w was actually quite fun and cured me completely. HTH.

Forgot to add, my birth plan and maternity notes were very clear that I could not tolerate a VBAC ('my life, sanity and family depend up on me having a caesarean...' kindathing). The hospital's notes were obviously similarly clear (my GP must have written a wonderful referral letter) - it was quite amusing seeing people read them, and pussyfoot around me.

Interesting, and if I'd known then what I know now, I would have opted for an elective cesarean.

I was three days in labour - induced, augmented and intervened - totally managed - and then had a senior registrar chop me up from post to pillar in three minutes flat to deliver my baby (who was whisked away and I never saw her - she's fine now...but).

I'm still in pain 4 years later, and I have serious abdominal adhesions, a numb abdomen, a huge disfiguring 12 inch scar, and endometrial tissue has escaped into the layers of my womb muscle, so periods are excruciating. My sex life is ruined also.

elective or as Janet Balaskas says 'active ceserians' may well be the way to go for a lot of women. I think every woman should be respected and supported in her choice of how to give birth.

So sorry to hear this, Zazen. You poor thing. What a ghastly time you have had. I wish these things didn't happen - traumatic em-cs, traumatic VBs - one hears about too many of them. It makes me feel despairing, but I am not really sure what the answer is. If I said 'more elective caesarians', I know for a fact a lot of people would disagree with me, but...

I must say that if I'd known before giving birth I could end up with major birth injuries I'd have gone for a planned c-section even if it meant selling my house to pay for it. I had horrendous third degree tears which are still taking months to get over, endless problems with stitches and infections and the possibility of having to have further surgery to repair damage. I'd rather have had a c-section than the risk of faecal incontinence which may affect me in 5/10 years time after the lifetime of my repair is almost over. Explaining to friends/relatives how badly hurt you are "down there" is awkward at least with a c-section you can talk about it and visiting the doctors isnt as a horrendous experience when you have to lie there with numerous people looking at your butchered private bits.

just agreeing with honoria. Our NCT teacher only got mums with the most 'ideal' & 'natural' births to talk to the class. .

Well im glad i posted now as to be honest i really didnt know of any women who in my experience were able to secure the guarantee of an elective cesearean from a sympathetic Consultant. Its been so long since DD3's birth that ive forgotten how the system works and i felt that if i mentioned what happened last time it would take an awful lot of persausion on my part to get anybody to even listen to me never mind take me seriously.

Can someone clear this up for me? I was told by someone that my notes for each birth are actually kept in the hospital where you deliver, my last one shall remain nameless incase anyone on this thread is going to deliver there (im sure its fine now as this was 11 years ago) but i am now living in Wiltshire and will have my baby at the Great Western hospital in Swindon. Does this mean that they have no access to notes on my previous birth at the other hospital because obviously it would be great if they did?

mrstittlemouse I am glad to hear the community midwife respected your wishes and that there was no worry on your part because at least you had a choice in your method of having your baby - this gives me a lot of hope for the next few weeks and what i thought was going to be a battle perhaps isnt going to be. My poor DP is being so good about this and understands how scared i am and said whatever it took as long and the baby and i were safe we would find the money for private care if needs be but i dont think that this is realistic as i have said financially for us nor do i think it is fair as it should be a possibility on the NHS. I can really sympathise with the poster who said she would sell her house rather than consider the hell of the terrible birth that she had a second time round.

Buckets I have had someone tell me this too that it probably wasnt PND but was post traumatic stress disorder, certainly my behaviour was not normal and My little girl and I's relationship suffered greatly for some time ( years ) afterward.Even though the hospital werent able to admit responsibility they knew good and well her awful birth and subsequent cyanotic episodes could have well been avoided had they just induced a few less people that day ( oh i forgot to mention the woman three beds up from me that kept saying she needed to push and was ignored as they said it was too soon - she went to the toilet and started crowning )

I feel much better having seen all the posts which indicate that it IS possible to find practitioners who will be understanding to my feelings. I was also wondering if you get alloted a consultant at your local hospital and they wont listen or negate your feelings is it possible to find an obstetrician that is? Never sure about choice as this is the NHS and whilst i believe and trust in it greatly i am worried that i am not going to be able to get anyone to listen to me Basically if i have problems at my local hospital does anyone know if i will be able to go somewhere else to hopefully find a consultant who will at least consider my situation rather than writing me off as i have had three previous VB's? Any advice greatly appreciated

rosieposey - I was all set for a battle and took my DH with me for my first MW appointment. I think that it helped that I had already arranged for counselling with my GP - they knew that it really was a problem. My community MW has also "cherry picked" which consultant I'll see if I chose to meet up with one.

I'm right at the end of the second trimester and still haven't decided how I'll give birth, but I'm getting all the info that I can and meeting with as many people as I can. I actually phoned the birthing centre today and they were very sympathetic. It's a very small unit too, so hopefully less chance of getting forgotten and ignored.

Good luck to both of us.

I have to see a consultant and will definately be under the hospital because of the gestational diabetes i always get just am worried that the one i get will not listen or be dismissive.

mrstittlemouse i guess the first person that i should talk about it too is the midwife when she books me in ( not sure if she then refers me on to the hospital for GTT's and blood checks ect ) but i will talk to her about it and hopefully she will know or be able to give me an idea of what my chances are of getting the elective CS, you sound like you have it all sorted and whichever method of delivery you choose im sure it will be the right choice for you - thanks for the advice