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.

can i hijack and ask if i've a right to ask for an elective section if i had a crash section with a previous birth or will i be expected to try for a vbac.
When i see the consultant i would just rather say i'm going for a section rather than have to go into the reasons (his registrar's incompentence and risk taking during my previous labour)

Anecdotally, from the Childbirth threads, I would guess that you're much more likely to have a consultant who will encourage you to have another CS. It seems like consultants are very reluctant to recommend VBACs.

after my em section first time round the consultants encouraged me to have an elective witch and chips, though they would have allowed me to try for a VBAC if i had put my foot down. There were medical reasons involved though. if you feel strongly that you want one with your history i would have thought that was reasonable.

Witch&chips, how far along are you? Getting your MW or GP to refer you a sympathetic consultant is probably the most reassuring way forward. You can be referred to another conslt if s/he refuses. Crying a lot at everyone I met helped me and being referred to counselling waiting list looks good. Oddly enough though this pregnancy I have only seen what appear to be locum consultants who seem happy to sign anything you like!

Definitely order your traumatic notes, it's painful but helpful for working through it all, finding out why things went wrong. 5yrs on I can read mine without crying! You could also give a copy to your conslt if he's not playing ball. I've just been on an NCT Refresher Course for subsequent mums and I found it really educational. It's very different learning about labour when you can put yourself in the picture, and now I can see on my notes exactly what could have been done differently.

If going for a VB after traumatic birth, get referred to the consultant midwife. She will go through things with you and write you a birthplan that few will argue with (will also give your labour MW courage to stand up to interfering or inexperienced obstetricians .)

Thanks everybody am only 15 weeks today so long time to work things out.
Don't need my notes every mistake made during labour is still etched in my brain and still gives me that heartflutter you get when you stop your dc running into the road.

i know what you mean withandchips, actually it was a midwife who caused my ptbd and i still feel that way when i think of the event.

eh? I mean who caused my post natal traumatic stress thing.

C-sections cost many times more than vaginal deliveries. The NHS set target regarding rates of sections and a hospital will lose money if it performs too many c-sections compared to the target rate. Obstetricians will also be held to account. It is sadly naiive to think that economics do not come into the equation in NHS hospitals.

I'm late to this but it's a very interesting thread.

Unless it was medically necessary, I would never want surgical intervention purely and simply because I have a fear of operations! (I even risked my appendix rupturing in my early 20s, so scared was I of 'going under').

Out of interest, my SIL was born by cs (she was 10lbs and MIL was 2wks over) in 1964 but my dh was born VBAC in 1966.

Really interesting stuff, both the article and the thread. I guess I have covered the gambit. 4 normal deliveries, 2 with epidural, one with gas and one with no pain relief. one emergency c-section after labour and forceps and the last baby (6 weeks ago so it is fresh in my mind) was elective. What would I recommend, vaginal delivery all the way. Why, quicker recovery, more control over the process rather than strapped to a table, but the main reason is the recovery is so quick compared to a section. Emergency is the worse, the pain after was unbelievable and recovery (plus infection) was long and painful. I must say, the elective section was ok and I felt more in control as I knew what was happening but still stressful and I react to the medication they use so I was dizzy and vomiting for the first part of it. You do feel the baby being lifted out which is neat (although not painful, like a tooth being pulled after freezing) and you are just as happy when you see the baby but I had weeks of pain from the section followed by days after a vaginal delivery. You just get back on your feet quicker and can do more and feel like yourself quicker. Why did I elect, on medical advice because of the last section combined with my age (44). I just wanted the baby and myself to come through it ok. I think elective shoudl be an option for sure bu wouldn't be my first choice. I agree with the doctor's list based on my experience.

Healthy babe and Mum is the aim - regardless of route.

Have to agree that C section is v common amongst my friends,all for valid reasons though. Breech, fetal distress, obstructed labour etc.

I do hate the look of condescension given by women andmidwives who hear you had an elective section. No clue as to the reasons but happy to judge you and treat you like scum.

I loved the midwife who gave me such derision and said at my size, pushing a baby out would have been no problem. when she finally saw new arrival, proceeded to comment on the likelihood of a shoulder dystocia - still said I should have tried.

Some if us medics choose elective sections for very good reasons. On asking what the likelihood of me having a normal delivery after induction was, was told odds of about 20-30% and most likely would go to C section. I would have been stupid to have proceeded on that basis.

For those who doubt an elective section - have a heart problem, have been a type 1 diabetic since age of 10yrs, multiple miscarriages and previous abdo surgery, high BP, very large baby ( not DM related - just two giraffe like parents)

Each to their own and I have not one regret.

darthvader, an uncomplicated VB (no drugs, no epidural, no instruments) is the cheapest, followed by.......

elec CS
instrumental VB
emerg CS

only 1 in 10 women will have a 'natural' birth (no interventions)

really like it if someone could point me to data behind these rankings (look right to me but would like to see what lies behind them

I would be interested to know how much money is also spent postnatally on women who need repair operations, physiotherapy, debriefing and counselling. But then I have a vested interest as the hospital where I gave birth would have me down as a "success" - a VB, live mother and baby leave the hospital. And we've moved since, so they know nothing about the constant trips to the GP, two different gynaes, and all the counselling - and I'm still not right.

Why would an elective cs cost the NHS less than an instrumental VB?

Im still watching this thread as want to see if there is anyone else but you mrstittlemouse who based on a real previous birth trauma is allowed an elective CS in subsequent pregnancies. I am going to test the water as soon as i get my first hospital appt ( am a bit worried about mentioning it to MW as im not sure how sympathetic they are ) except of course for your community one MTM - If it is indeed the case Highlander that an instumental VB is more expensive than an elective CS i dont get why they let so many women with potential complicatins go though a trial of labour? Surely it makes more sense to just plan ahead and get the baby out safely? I too would like to know the stats on the above as will make interesting reading ...

anagram i think because when you work out the cost of an instrumental vb you have to factor in the risk of having to do a crash section (v. costly + v.risky)

haven't read the whole thread but my current consultant has been fantastic.

My first birth was something of a nightmare with a 55 hour labour, following induction, an EMCS after failure to progress and a somewhat distressed, but luckily finally healthy baby.

When I saw my Obstetrician at about 16 weeks with this baby (my second) he was very open to whichever way I wanted to give birth. He talked me through the pros and cons of both options and left it with me to decide. I met him yesterday at 34 weeks, and have decided to go for Elective CS. Again he talked me through all the risks and advised me that if I went into labour naturally prior to the section, I can still decide at that point to try for the natural birth. I've felt really supported, informed and not at all co-erced throughout any of this process.

I would imagine that my instrumental birth was very expensive, as I had a MW with me for 12 hours of labour, then was transferred to a CLU, then had another 2.5 hours in the CLU, resulting in a ventouse delivery with 2 OBs, 2 anaethetists (sp?), 4 MWs, a paediatric team and possibly more people (I know that DH tried to work out how many and what they all did and gave up at 10). I was prep'd for an emergency CS (and almost had one, as DD was delivered on the last try).

Plus, as I say, all the other stuff that I needed afterwards, and now I come to think of it, all the extra appointments that I'm demanding now to try to stop it happening this time around (extra trips to the MW, GP, gynae and senior MW at the MLU so far - but I am going to push to see a consultant OB as well).

And of course that doesn't count the emotional cost of being in pain for so long, or being young (ish) and in a great marriage and having my sex life ruined.

It would have been a lot easier and simpler for them to have followed my bloody birth plan in the first place.

I'm late to this thread but I just wanted to add to the idea of a 'romantic' VB.

I think we need to focus a lot more on educating first time mums. Too many mums read the books, go to the NCT classes and just think,'I'm going to do this the natural way without drugs.'

I think it's indicitive of our need to be in control. We choose careers, we choose partners and thanks to contraception, we're now able to choose when we have a baby. Too many of us expect to extend that control into the labour ward. When it doesn't quite work out that way, we feel like failures which is ridiculous!

I think first time pg women need a 3-pronged 'attack' of education. (IMO,of course)

1. Understand the importance of being active and upright throughout pg and labour. Don't underestimate gravity. Don't get on the bed unless you absolutely have to etc. Don't sit on the sofa of an evening at 8mths pg slouching and eating dairy milk. Get up and go for a walk.

2. Understand and expect that option #1 will just not work for everyone! Some women need to be induced which often means being on the bed hooked up. Others will have stubborn bodies which just will not dialate. Still others will have stubborn babies who just will not move or turn or do what is expected of them.
   You may need intervention. This could be an assisted VB or a CS. This is ok and is being done for either your health,your babies or both. You have not failed You have just given birth another way. Think of it like the trains were on strike so you had to get a bus. A bit of a PITA and more inconvenient but you get there all the same!

3. The hard bit is yet to come. Women need to know that sleep deprivation is torture. That they'll look and feel like shit and everything will make them cry. Their relationship with their partners will suffer. After the initial euphoria, they will argue and bicker. They will need to work at it and it will be ok. If couples knew to expect this it would make things far easier.

THIS is what ante-natal classes should be about in my opinion.

baby's

agree with lulumama as usual

just like to add that i had an emergency cs (although it wasn't a big panic, all staff v relaxed) the surgeon cut my baby when she cut into me, so he had stitches around his eye when only a few minutes old. the hospital told me 2 in every 100 cs ends in a scarred baby, so am surprised this has not been mentioned.

am on stupid patientline system so pls excuse typos

am in hosp following a elective cs - except my choice was determined by illness. . Risks of cs are underestimated and pain afterwards rarely discussed.

have had to had some of my stomach muscles removed during the surgery and it will take upwards of a year to regrow them - if i ever do .

ALL birth is risky, but cs is not a light option. both you and your baby are more liable to be maimed or die with a cs - elective or not

WMMC! I was wondering how you were getting on. Sorry to hear your CS has had such complications. Hope you have a speedy recovery, and how is your new baby?

Great post!