Natural - v - Caesarean - a new thread

[JoolsToo]

sorry to be bossy but can we carry on here?

I'm for natural when possible

After all, the NHS has to foot the bill for all those psychiatric nurses and postnatal counselling!

Lots of interestinf posts here on a suject that is obvioulsy very near and dear to me. Interesting points about funding options. On the one hand, the NHS would certainly be of the view that they don't have any more money for funding maternity (I'm guessing but that is what I would expect them to say). But, as a few have posted what choice do we really have if all options are not presented equally (without penalty of additional fees). And also, if non medically necessary caesareans where to be charged for, should not the rule apply to all non medically necessary treatments on the NHS. What about fertility treatments? What about single jabs for the MMR? If caesareans are offere and charged for, then it seems o whole lot of other "optional" treatments should be too. And, then, that opens the door for the NHS to charge for their services.

Normally, I'm opposed to raising taxes for things that are run by the government (and that goes for any government) mostly because I don't trust a government to spend the money efficiently. But, I do feel strongly that people should have the ability to choose their medical care (maternity or otherwise).

Regarding the 'moral superiority' linked to feminism line, it is an interesting argument, but I think that the issue pre-dates the rise of feminism. There has always been a tradition of woment 'boasting' about what a hard time they had in childbirth, at least in my family. And my Mother is about as much a feminist as Ghengis Kahn!

I agree, I think the moral superiority line came way before feminism. Queen Victoria was roundly criticised for having pain relief in childbirth, primarily on religious grounds - God had decreed that women should suffer in childbirth because of Eve and the serpent, so what business did any woman, even the queen, have, to try and get round that?!

Caligula, I think it's important to point out that just as everyone'e experience of vaginal birth is different, so it is with c sections. The operation itself is quick, and painless due to medication, but the aftermath can be far from easy.

I admit I'm a touch sensitive about this - the day after my c section I didn't expect to be told I might need further surgery to cut out gangrene as they were struggling to keep an infection that had developed in my abdomen under control.

I have friends who had a really positive experience of cs and others, like me, who had a hellish experience.

hmb - but we must keep saying 'what a hard time we had' especially when the men are around

Excellent and thought provoking post Blu.
The hierarchy exists whether we like it or not. I'm pretty ok with my c-section but always use the phrase "ended up with.." if telling anyone.

The simple truth is that anyone who has a section has to somehow justify their position. Shame really, as it was hard enough as it was, without feeling like a failure as well. That said, if I don't feel like a failure, no one has the power to make me feel like one. So there and nuh.

Wickedwaterwitch - much further down this thread you mentioned the NICE guidelines re section v vbac - not sure if I'm looking at the right site but I can't see the info anywhere. Can you post a link or point me in the right direction please? TIA

Loads of interesting posts on here given my state at the moment I probably shouldn't be posting on here, one of my best friends' baby died this morning. She was 38 weeks 7lbs 6ozs and so far the reason she died was that the registrar preforming the op cut the placenta first and was inexperienced in preforming sections on women with placental previa. My friend has had 2 previous sections both due to placental abruption (both babies lived). This was supposed to be a routine operation.

To be honest I do not care want way my baby comes out as long as it's healthy. You do not look at a classroom of children and spot the ones who were "natural" births this whole competitive birth thing baffles me I was gutted when they told me I was too far along for an epidural, the whole process is horrendous IMO and it should be the womans informed choice.

sweetkitty, so very sorry to hear the baby didn't make it - I've been thinking about what happened ever since you posted about it yesterday. The family must be devastated.

sweetkitty what awful awful news but the right thing to post. I don't think any of us can even begin to think of what your friends must be feeling at the moment. It really brings it home that despite much more choice than ever (some informed some not, dependant on individual effort and the antenatal education provided in your area)despite the introduction of modern technology (like anything this brings positives and negatives) the priority has got to be in everybody's mind the health, safety and well-being of mum and baby...

Merlin, the NICE site is here I think I did a search to get the guidelines.

There have been some really interesting discussions here and a few things of you have had really awful experiences. This is my third and last (hopefully post on the thread. Regardless of the type of birth a woman opts for there should be no talk of charges. I get very fed up with the paternalistic "we know best" type attitude which seems so prevalent in maternity care today. IMO, as long as the Mum is fully informed then the choice of birth should be hers and hers alone. There are sometimes very good reasons to have a CS and sometimes there are good reasons not to. Likewise with active/natural/normal (delete as you like)birth.

I personally have much more problem with an NHS which tells women on the one hand that they cannot have a homebirth because lack of funding means there are not enough midwives. Yet on the other hand has a CS rate approaching 25%. Sadly, with every year that passes more and more midwives lose skills that may have enabled a Mum to have a safe vaginal birth - these Mums now end up with CS because nobody is confident or skilled enough to manage variations of normality. I know of one midwife who will deliver twins and breech babies at home - she has so much understanding and knowledge about how labour works and the mechanics of birth. She has never lost a baby - sometimes the Mum ends up in hospital for actual delivery - the skill is in recognising when this is necessary. This midwife is approaching retirement and her skills will then be lost. Sad. I know that if I had twins or my baby was breech I'd want to be in hospital but surely I have a right to expect a midwife and doctor who understand the birth process and the mechanics of birth. If they don't then I would just be another statistic in the emergency CS figures. An extreme example I know but this loss of skill applies right across the board - even to seemingly simple skills. So instead of being "with woman" (the definition of "midwife") she/he is simply a notekeeper and fetal heart trace interpreter. Nothing wrong in either of those things but when they take undue precedence over supporting the mother then we all lose out. This is why I left midwifery - Mums don't get the support they need, medical interference interrupts the flow of normal labour, the baby suffers as a result (even though he/she is often born healthy and well, the midwife doesn't seem to care for the Mum but is instead intent on her notekeeping and the fetal heart trace which ALWAYS shows some minor abnormalities in labour, she frets, calls the doctor, the Mum worries .....and I'm rambling now. Just feel that sometimes women are treated as no more than vehicles (and faulty ones at that)for the baby. The baby IS important but so is the Mum and I think the NHS has lost that somewhere along the line. Hopefully, in the future I'll train as a doula so that the balance can be redressed. Can't think why the NHS doesn't employ them.

Oh yes so very very terrible. Can I ask what how why this happened? I have a low placenta in the front, They expect it to rise up out of the way by birth. But, I have wondered what they do when/if the placenta is in the front and in the way of the planned incision. Does this often happen?

Oh gosh, how devastating. I think it's easy to take for granted the horrible horrible things other people go through and forget these things still happen even in today's modern medical world. I've read so many sad stories on her in the last few days, I just don't know how some people can get up in the morning.

Thanks for sharing the story, though. It is good to know what happens to real people rather than just discuss statistics.

uwila, in theory, once the lower segment of the womb begins to develop, the upper segment grows upwards taking the placenta with it. The caesarean incision is into the lower segment (bikini line) so the placenta should not be an issue even if it's at the front as long as it is in the upper segment. The biggest problems occur when it is occluding the neck of the womb which sounds like what aloha had first time round.

Mandy

Thanks Amanda. But what I'm wondering is what they do if it does not move up out of the way. It was noted as being low at 20 weeks, and I know that in most casses the lower uterus stretches and it moves up and all is well. But, hypothetically (or possibly not) what would happen if it does not move up? Can they perform a caesarean if the placent is covering the area they intend to cut? Do they cut somewhere else? Can they somehow detach the placenta before they cut? Does this mean Caesarean is not an option?

Sorry to bombard you with questions. I had forgotten that you used to be a midwife. Do you know the answers? I of course plan to ask all of these questions of the consultant when I see her at week 36. But it would be really nice if I knew a bit more about it before week 36.

Hi uwila, I've never actually seen this be a problem but I imagine that they would have an portable ultrasound scanner in theatre to ensure that they did not cut anywhere they shouldn't. The lower edge of the placenta can cope with the trauma of being cut providing they deliver the baby quickly. Which is not usually a problem once the womb is open. They would always have a paediatrician around in theatre as well for this type of delivery. Not sure what happened to sweetkitty's friend - sounds just horrendous and as if some questions need answering.

Mandy

Thanks www - must be my pregnancy brain, but done several searches and can't find anything on vbac v section!!

Merlin, try a search on the RCOG site, it was a huge Adobe file, sorry I can't be more use than that!

Good points Amanda, particularly on the de-skilling of midwives versus cash. If more money were spent on ensuring that midwives had the skills and confidence to do home-births (and recognise when a hospital was needed) they would have more fulfilling jobs, mothers would have more genuine choices and the NHS's spending on maternity would be more effective.

Life could be so simple!

Oh, and the caesarean rate would go down!

I'm a bit confused (or rather naive I suppose) about this cost issue regarding home births. I mean you are in your own home, with all of your own supplies (bath, water, towels, etc.). Seems you would be saving on hospital facilities. Surely the cost of calling out the midwife is not more than you are saving... or is it?

Pardon my ignorance. I never have (and never will) considered a home birth. But, I'm all for people who want one having the choice.

Just don't really understand the cost issue for the NHS.

Uwila - no time to read this thread but saw your post about what do they do if the placenta is where they want to cut. Happened to me 2 weeks ago (birth announcement coming up ). They call in all their top experts (most of whom stand around "just in case"). Then they cut through till they can see the uterus. Then they stand around for a bit discussing what is best to do. Then they cut the uterus, cut up the placenta, and get the baby out, very quickly. Then they make sure you are not haemorrhaging. Then they breathe a sigh of relief.

A placenta completely covering the cervix at 36 weeks happens 1 in 2000 pregnancies, and I guess half of those are at the front? Each cs doubles your chances of it happening next time though.

RIght, so I should:
1- expect to be on the table for some time and
2- take comfort in knowing so many experts will be there.

Thanks for your input. What hospital were you at?

LOL happymerryberries, at gritted teeth birth stories - and interesting point, Caligula, about Queen Vic, and the curse of eve. I agree that adds a whole extra layer of the history of subtext to birth. I think for me, the difference is that after the 'invention' of the feminist active birth movement, suddenly birth wouldn't be horrendous or a curse any more. We would breathe and perch on our ethnic birthing stools and sing 'I am woman' and it would be a bit uncomfortable - but nothing to worry about for the true sister!

Uwila - I think homebirth is 'expensive' because you have 2 midwives looking after you and you alone (one of the benefits!). They have to be available to be called out - whereas in hospital - as Aloha so cruelly experienced, midwives share themselves out (or not) amongst how ever many women there are labouring.