Natural - v - Caesarean - a new thread

[JoolsToo]

sorry to be bossy but can we carry on here?

I'm for natural when possible

Uwila because home births tend to have fewer problems, they have fewer interventions (which cost money) and are far less likely to end up in an emergency caesarean (which costs money). Plus you have midwives who are actually using their skills, instead of recording readings from machines, as Amanda was saying earlier. And if all mw's were confident to officiate at homebirths, then they?d be more confident in a hospital scenario as well ? which might mean that the labours in hospital were less likely to end in intervention.

But you must be right that the cost of providing a midwife at home to all individuals who want one must be higher than a production line in hospital. If the production line starts ending up with loads of caesareans though, with the potential problems that they have (every time you have one the risk of damage which then has to be fixed is slightly higher than last time) the cost may even out ? don?t know if anyone has actually done the sums! But even if it?s higher, it?s about paying for women?s choices ? just as the caesarean option is. I?m all in favour of the taxpayer paying for both, but you already know how free I am with the taxpayer?s money!

Last figures I saw were:

£450 for an uncomplicated homebirth.
£800-£1600 for hospital delivery depending on type of birth
£2000+ for a caesarean - emergencies costing far more than planned, elective CS.

Can't remember where I got these from though. I saw them in the last few weeks though.

Blimey!

So a hb is cheaper even though 2 mw's have to be sent out and aren't therefore available to run around among 20 women on the ward?

Amazing.

Like I said - not sure where the figures came from.
Probably due to the fact that homebirths are often shorter and less likely to take up the time other births do. Usually the second midwife only comes once birth is well on the way. The only time I did any different was when I helped my last client birth - in a field, under a bender where all her previous children (3) had been born. It was dark and cold so 2 of us went from the start.

Seems like we are all intelligent enough to make our own minds up. We have the choice, lets be gateful for that.

amanda - does the cost for hospital birth include the post-natal care element?

Am I missing something here? Do people really believe that cost is an issue when all we all want is the safe delivery of our bundle, however it arrives. |If you get the birth you want does it matter whether it was more or less expensive than someone else's choice?

wanda, it matters to policy makers, who decide what choices we have.

But does it matter to us? Seems like some people are using it to back their own case and I'm not sure that makes sense. But then I have had three large galsses of chardonnay and not a lot makes sense then.

That would be glasses rather than galsses of course

No, I think we are just discussing it because the point was raised that the NHS is reluctant to support home births because of the cost. And then I wondered why this would cost them more.

And oh yes, I think the cost of post natal in hospital should definitely be worked into the equation.

And also further operations etc. needed afterwards, in later years - bladder ops, prolapse corrections, hysterectomies etc., which were related to childbirth. Not sure how good the data is in terms of how much correlation there is between type of delivery and later health problems, but I'm always worried by how many older women have prolapsed wombs, bladder problems, etc., and wonder if that's a joy to come. But if there is a link, then it should also be worked into the cost equation.

Something else struck me - Amanda, in a field, under a bender? What's a bender?

I'll try to answer the questions re my friend as far as I know they told her at 20 week scan she had a low lying placenta at the front, she was having a planned CS if she managed to get to 38 weeks as her previous 2 births were placental abruptions. They said they were not worried about the placenta as it usually moves out the way??? She had a number of complications during this pregnancy including a number of bleeds from the placenta, diabetes and severe backache (caused by her first CS). She had been admitted to hospital a number of times during this pregnancy was having weekly scan and was seeing the consultant every week.

Their main concern was the diabetes and the size of the baby estimated to be over 9lbs. She was haivng pre labour pains for over 2 weeks prior to her planned CS and had begged the docs to deliver her early they were reluctant due to immature lungs in the baby, they were trying to get her to go into spontaneous labour as this would send a signal to mature the babies lungs.

Anyway the scans focused on the babies growth not on the position of the placenta. On the day of the op the usual consultant was on holiday so the registrar took over she was unskilled in placenta previa CS's. She had to call the consultant in to deliver the baby as she was having difficulty the consultant had to dive in unscrubbed and pull the baby out as it had been 20 mins (I believe it should only take 5) apparently there was a lot of blood on the operating floor. The baby was wrapped up and handed to her DH, they were told she was having difficulty maintaining her temperature so was placed under a thermal blanket (don't know the correct term) her Apgars were 5 on arrival and 8 later (is it 5 mins after) it was only when she started grunting that my friends DH asked for the paediatrician who looked after there other children that they thought something might be wrong. It transpired that she had lost 60% of her blood and was rushed to NICU for a transfusion. This was 2 and a bit hours after she was born.

Due to the blood loss she suffered kidney then liver failure then eventually heart failure as well as 2 bleeds in her brain. The docs have admitted that if she was taken to NICU straight away they may have saved her life.

What I want to know is why after all those scan they did not know the position of the placenta? Do they always go in blind? and why when the saw the massive blood loss and the fact they had cut through the placenta was she immediately not taken to NICU?

Sorry if I have scared anyone it's not my intention I don't know about procedures etc

Amanda, thanks for that stuff about de skilling midwives, interesting. I've looked up these stats before, home birth definitely costs less than hospital birth, I don't think the NHS disputes that. Caligula, a bender is a tent type thing, like they had at Stonehenge and other festivals like this

In the end it is a matter for discussion between the parents and the medical staff taking into account the individual circumstances and the best interests of mother and baby.

I was in in labour for 24 hours with my DS - in Germany they don't believe in inducing slow progression, or in rushing to give a CS. It was touch and go at about 22 hours whether I would have a CS as DS's heartbeat was dipping with the contractions, but I had a great doctor and he finally manipulated DS so he could come down. I will always be grateful to the Dr for telling the MW - no - we will wait a little longer. I had a fairly minor episiotomy which healed very quickly and enabled me to be with my DS who was transferred to a different hospital as he was premmie.

I am 22 weeks now and hoping for another vag birth, but especially after bubbles story will be watching the CTG very carefully for signs of distress and will not resist a CS if it is the best for my baby. To ensure that my judgement in this matter is not clouded I will be as drug free as absolutely possible and be sure that my Dr knows what I want ahead of time.

I have a friend here who had such a traumatic and damaging forceps delivery that she will be taking the option of CS for her next baby, and I can fully understand responding to such a traumatic experience in this way.

Thank you for sharing that story sweetkitty. Although very sad even just to read, the information is of course valuable. As mentioned before, I too was told that I had a low lying placenta. I will most certainly be asking questions about how long it should take to get the baby out, who will be performing the op and so on...

My deepest sympathies to your friend.

Just a follow on to what AussieSim said. I didn't find that drugs clouded my brain during my labors. In my case it was the pain and exhaustion (and I have an extremely high pain threshold). However, I had my mother with me and I was completely confident that she could make the right choices for me if necessary. And for my VBAC I also had a midwife whom I trusted (and who did end up having to bully the consultants into stitching up my ripped labia...they were going to just leave it in two pieces). I think it's really important that you have someone with you that you trust to make those kind of decisions (or someone who can push the mw's and consultants when necessary). And that person isn't always your partner no matter how loving they are. In my case my dh was there and supportive but would not have been any use at all in any decisions as he is pretty useless when it comes to doctors (thinks if he lies to them and does't tell them where it hurts, they'll be more likely to make it better..men!).

By the way, if anyone has time to look them up. I'd be curious to know what the cs stats are for countries where it is routine to do them electively (I think in brazil that's the case). And also, the usa has a relatively high cs rate, but doesn't have nhs or midwives to blame..wonder why? Is it because there is a shortage of obgyn's or perhaps it's just less acceptable for women to die in childbirth nowadays, or is it as we discussed before, the increasing average age of mothers? I'm very curious about all of this. I also wonder if the quoted "danger" of a cs is still an accurate one. Medicine technology has advanced quite a bit...maybe they're still taking into account cs's done under old methods?

i always understood that the high rate of CS in the USA was partly due to the litigation-averseness of US Gyns

Haven't had time to read whole thread (am meant to be working ) but just wanted to say to sweetkitty how sad I am for your friend. What happened to her is just unthinkably awful. In answer to some of your questions (and only going from my own experience - I'm not a doctor), I think that her consultant should really have been fully aware of the position of her placenta. I had placenta praevia with dd1, and had repeated scans to check exactly where it was before I had my cs. I had my dd at 36 weeks (planned), because I kept bleeding and had been in hospital for 9 weeks by then. In the time I was in hospital I must have had at least 4 or 5 scans. I wasn't told at 20 weeks that my placenta was low (hospital policy not to comment on it) and I would question the wisdom of that, because, knowing what I know now about how serious placenta praevia CAN be, I'd want to have another scan to be sure that everything was OK before I went into labour - even though in most cases there's no problem. This is exactly what happened with dd2. I insisted on being told where the placenta was at 20 weeks, and - on being told it was low - insisted on a 2nd scan at 34 weeks just to check it had moved. Everything was fine and I had a successful VBAC. Going back to the initial point of the thread... I'd have a natural birth any day if I could. But a cs is not 'second best' when it is necessary for medical reasons.

I saw my consultant at 26 weeks, and told her there and then that I would prefer to have a C-Section. She tried to scare me out of it, but if you want one, there is nothing they can do. It's your baby-you do it your way.
I did do a lot of research before the op, and it proves to be very slightly safer.

The reason I opted for one, is I was an emergency c-section. My mother never dialated, after days and days(small pelvis) The doctors in those days put pressure on her to wait for natural, which would have proved fatal.

I told my consultant I was too scared as I didn't want the same thing to happen.
I started with contractions 38 weeks, and they still kept me waiting(to try and prove me wrong)for 2 days, without any food and 1 little cup of water to drink(incase I DID need the op)

Just as I thought, I wasn't dialating, and I ended up having my op.
It was brilliant though, I was awake. They let me watch them pull her out.
As a result of having nothing to eat and drink, my blood pressure was up and down, and that took longer to get over than the actual op!

Wow! this is a big discussion that i missed because I was in hospital after the birth of my ds by cs! I had been thinking of starting a thread on this subject because I need to get my feelings after having cs off my chest and wanted to know of other people feel the same or have similar experience.

It wasn't planned, but I had been told that it could be necessary so I had time to let it sink in and realise that the important thing was for my baby to be born safely and me to be healthy again afterwards. IT was a shock though when things weren't going right during labour and I had to have one.

I don't care about the discussion as to whether css are given too easily and are on the increase, or whether people should be able to chose etc... they are a fact of modern life that we are priveledged to have available to us (for whatever reason we have them).

I thought cs was an 'easy option' for 'posh' people and I am disappointed about the lack of information and warning about the fact that it is major surgery and takes time to recover from.

I found the whole procedure absolutely terrifying.

I had a local anaesthetic which left my arms too numb to hold my baby when he was first brought to me and my breasts too numb to feel him when he was first put on my breast.

I could only watch out of the corner of my eye when he was weighed, dressed, tests etc for the first time.

I was in so much pain after that when I was told I should get out of bed it took 2 people a very very long time to get me out of bed, walk me (bent double) to the bathroom so I could sit down to wash and clean my teeth.

The first night I was so doped up on pain killers that I fell asleep very deeply, dh (who stayed overnight with us) told me how wonderful it was to lay awake all night watching our little boy.

By the end of the second day I was in tears because I didn't know how it felt to care for my baby, was feeling too unwell to focus on him and didn't feel that I had bonded with him at all. dh did everything (except feed him) and was telling me how much he loved him and how wonderful he was etc... I just didn't have the same feeling, I didn't know him, didn't know what he looked like naked or how his belly button looked when it was first cut (small things maybe but to me important things I missed).

It took me until the 4th day after to manage to stand long enough to change my baby and bath him for the first time.

I couldn't laugh for several days as it was too painful - and I laugh a lot usually.

No sport for 3 months! Sport was a HUGE part of my life before I got pregnant. I am really looking forward to putting my running shoes back on again! It would have probably been a few weeks with a natural birht not months!

...and someone on MNet said that after a cs you are not insured to drive for 6 weeks!!!!!

No soaking in the bath for 6 weeks!

I expect to have some numbness probably forever around the scar.

I am very lucky, no complications with the op or the wound and after almost 3 weeks feel very well. I had excellent medical care and am very confident that it was the right thing to do to go ahead with a cs.

I am also lucky that I have no problems with bfeeding so have the choice to do so.

I don't mind the scar and have a beautiful, happy healthy baby which I probably wouldn't have had if it wasn't for a cs (maybe I would also not have survived). But if there is a next time I would like to join the priviledged group of women who know what it is like to give birth naturally -to me it is somehow one of the mysteries and miracles of life.

Leogaela, I am surprised at some of the advice that was given to you post c section. Were you told no sport for 3 months? I was told that I could do pretty much what I wanted after the 6 week check up. In fact I started an aquarobics class the same day. I wasn't told to avoid soaking in the bath either. I also cheked with my insurance company and was told I was clear to drive from 4 weeks.

Leogala

have to emphasise after your 6 week check you can do anything you want (you may have to be careful with sit-ups to begin with but that's to do with pregnancy not csection)

driving for 6 weeks is a fallacy too, check with your insurers, mine told me when I felt ok to drive I was insured

of course you can have baths

numbness fades to the scar only

am angry at your appalling advice

meaning appallimg advice you have been given