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Childbirth

Share experiences and get support around labour, birth and recovery.

C-sections 'a rational choice'

314 replies

AtheneNoctua · 20/05/2009 13:38

I couldn't agree more.

news.bbc.co.uk/1/hi/health/8057785.stm

That's no say everyone should have one. Just those who want to.

OP posts:
bigstripeytiger · 22/05/2009 22:57

I read your post, you said that your baby went into distress in labour and you had a crash CS.

I still cant answer your question, as I know nothing else about you, or the circumstances of your labour.

People need to make their own decisions, based on the best evidence availible to them, but taking into account their own circumstances and medical advice.

Sometimes I post information that I think might be interesting. Sorry if thats not good enough for you. I am still not going to speculate.

blueshoes · 22/05/2009 23:01

bigstripeytiger, don't trouble yourself 'speculating'. I am not particularly interested in the wishy washy vagueness of what you say.

bigstripeytiger · 22/05/2009 23:07

Fine, if you would rather seek concrete advice from some internet stranger about how you should have given birth, on the basis of the couple of lines of text you have typed then go right ahead...

blueshoes · 22/05/2009 23:11

I am not seeking advice from you, geez! I am pointing out how your statistics are useless in my situation.

bigstripeytiger · 22/05/2009 23:18

Statistics arent useless, but as I have been trying to point out you cant then use that information to tell people what they should specifically have done.
Ecological fallacy

bigstripeytiger · 22/05/2009 23:18

Statistics arent useless, but as I have been trying to point out you cant then use that information to tell people what they should specifically have done.
Ecological fallacy

charx · 23/05/2009 06:31

Just wanted to add that after my horrific 1st labour - where it all went eventually okay - but nearly so wrong there is no way i am having a vaginal delivery for this one due in 10days.

I'm in post traumatic stress counselling for delivery number 1 (I'm not crazy, highly strung or an irrational person - quite a tough cookie and matter of fact, but that whole experience did knock me right over).

I do agree with one of the earlier posts that having one to one MW (empathetic) support could reduce anxiety and lead to less stressful labouring. My own experience - never seen the same MW twice, MW (3rd one) during delivery told me she hated that particular shift and didn't want to be there.

For some reason - I still feel guilty about proceeding with Csection for this pregnancy - i think the badge of honour is bandied about too much out there. I'll admit to myself and my husband (and to you strangers!) that I'm totally wimping out. My 2nd might well be easier and quicker but I'm not going to take that chance. The impact on me and my marriage would be too much.

CoteDAzur · 23/05/2009 07:00

Obviously, the straight answer to blusleshoes is that if she were at home (i.e. slightly farther away from hospital facilities) her baby wouldn't have made it.

Stripey - I have one word for you: Riven. Look up her dd's story.

To each their own and all that, but it is not possible to deny that when birthing in a hospital you can refuse everything you don't want (epidural, sweeps, IVs etc) but when homebirthing, you can't materialize an operating theater or an NICU out of thin air in time of need.

If you are fine taking that risk, that is of course your prerogative. But it's silly to pretend the risk isn't there.

blueshoes · 23/05/2009 08:31

Thanks Cote, you have put it much more clearly that I. I did think of Riven's experience too.

twinmam · 23/05/2009 08:55

Charx - I don't think you should feel you are 'wimping out' at all. You have made a decision about what is right for you and your baby, quite rightly exercising your choice to do so. I'm sure a quivering wreck of a mother would be little use to your DCs if you were forced to endure the vaginal delivery you so fear. What happened to you in your first labour? Poor you

Not sure what I feel about the whole home birth v hospital birth thing that this thread has turned into. When I found out I was pg I planned to have a home birth (3 mins drive from hospital so it seemed not too terrifying a prospect if things went wrong). However, once we found out it was twins that possibility was removed, as much by my own choice as by the medical profession. I ended up having a c-section at 34 weeks - both babies breech and I was very ill with pre-eclampsia and cholestasis. Obv c-sec was the safest and best form of delivery for my little ones and for me. That said, in planning future, hopefully singleton births, I would still like as non-medicalised a birth as possible. A home birth would be out of the question I think because my health problems in first pg would rule that out.

Anyway, to get to the point of what I've been musing: don't all the things that have been said about the dangers of home births - no quick access to NICU, an operating theatre etc - also apply to midwife led units? This has crossed my mind recently in terms of my own experience and possible future DCs. We've now moved and our local hospital has a midwife led unit but there is a consultant led unit and NICU/SCBU etc in a hospital in the next town.

pmk1 · 23/05/2009 08:55

Stripey it's so obvious and clear what blueshoes is trying to explain to you! What are you not understanding?
Simple fact - with her dc's birth situation it would have gone as follows....

Hospital Birth: dc gets the immediate care to make it with equipment and doctors at hand

Home Birth: baby wouldn't have made it

Hmmm yeah, real toughy - are you saying you still don't know which one is safer????

Dress up the safety of a home birth as much as you want, the cold hard facts are the obvious two possible outcomes above... I know which one I'd think is safer!

it's not complicated!!

bigstripeytiger · 23/05/2009 10:00

What you dont seem to be understanding is that when you do studies comparing the outcomes for large numbers of babies and mums, there isnt a difference.

There will be some babies who would be better off being born in hospital and some who would be better off being born at home.

Overall, the risk of the baby dying or ending up in NICU after home or hospiatal birth is the same.

Logically you would expect that being in hospital would be helpful wouldnt you?
But the evidence is that for low risk women as a group being in hospital doesnt alter the risk.
So for every baby who you think has its life saved by speedy access to medical care, then there must be another baby who dies as a result of being in hospital. Unpalatable, but otherwise the risk would be higher at home wouldnt it? Not the same.

Of course if you would rather chuck all the research evidence aside thats fine. Maybe you could drop the editor of the BJOG a line and let them know they neednt bother publishing any more research on this area when a quick browse on mumsnet would suffice.

Or we could be asking why the risk isnt lower in hospital when all logic says it should be.

blueshoes · 23/05/2009 10:12

stripey, let's say the BJOG is the gospel truth on the fact that the risk of a baby dying or being admitted to hospital is the same whether you give birth in hospital or at home.

But that is it. It does not study the seriousness of the outcome should such a risk materialise.

So what you consistently fail to understand or acknowledge is that if a mother is already IN the hospital where speedy intervention is needed, that the outcome to the baby is going to be much better than if a transfer needed to be arranged first.

Risk is same, but outcome is better for hospital birth if risk materialises. Geddit?

edam · 23/05/2009 10:15

But if stripey is right that the risk of the baby dying is the SAME for home or hospital birth, your argument fails. Yes, common sense suggests hospital would be safer should anything go wrong, but the evidence says, surprisingly, that is not in fact the case.

Penthesileia · 23/05/2009 10:24

Ok, here I am again. Embarrassing U-turn, and return to thread...

blueshoes: If I have understood your story correctly, you had an emCs. Is that right? Forgive me if I have misunderstood your situation. If so, undoubtedly, the CS saved your LO's life; and also there is the very strong likelihood that had your labour proceeded as it did while you were at home and you were not transferred swiftly enough to hospital, your baby would have died. CS certainly saved your baby's life, thank god.

I don't know how quickly your situation changed, but if I may, I would point out that lots of births which end in emCs began at home, and the MWs attending recognised that the birth was not proceeding properly and got the mother and baby to hospital in time. I know 2 women for whom this was true. As I said, however, I don't know how swiftly your situation deteriorated, so can't speculate on whether if you had started out at home you could have got to hospital in time.

Anyway, thank goodness you and your LO made it.

Let me reiterate: elective CS is a valid and rational choice for women to make for themselves.

Also, clearly, emCS are remarkable, live-saving operations, for mother and child. To argue against someone who has come through such an experience that a homebirth would've had a better outcome is ridiculous, insensitive, and impossible to prove.

I must say, however, that to use Riven's example here is a little tasteless. I'm sure that Riven asks herself often "what if", and speculating or implying on this thread that had she been at hospital her DD's outcome would've been different is very cruel.

I would also ask politely that the posters suggesting that homebirth is riskier than hospital birth, and using blueshoes' LO and Riven's LO as examples to prove their case, stand back from their argument. Of course, in these statistically reasonably rare occasions, to be stuck at home away from hospital is dangerous. But these are not the best births to hold up against homebirth, and you know it. It is also worth pointing out that there is much discussion about the so-called "cascade of intervention" leading to emCS which often complicates the picture, and leads, in hindsight, to people's conclusions that a homebirth, in their circumstances, would've been dangerous.

Obviously, the risk of something going catastrophically and tragically wrong can sway one's perception of risk; particuarly when considering birth, which is such a massive and life-changing event; and considering our profound love and care for the LO we are carrying and want to deliver safely.

But this can be a "wrong" perception (I put it in speechmarks, because I think that it's not wrong exactly, rather how the individual organises the information available to them, and makes a choice for themselves).

Do you refuse to drive because there is a statistical risk that you might die in a car crash? I doubt it. You judge that the convenience of driving outweighs your risk of being in a fatal accident. Please don't say, well, re: CS, I'm thinking about the baby; presumably you drive with your DC in the car too? Thus exposing them to risk?...

To return to the discussion of elective CS, rather than emCS, which is a different matter, I think, it is worth pointing out that it does carry a risk to the baby, regardless of what blueshoes implied in her swipe against selfish homebirthers. This article for instance refers to a study which suggests that neonatal mortality is nearly 3 times higher in elective CS than VB (although, for both, that risk is still very, very low).

However, as many debates (about ff, weaning, etc.) on MN show, statistical results are not necessarily good motivators for individual actions and choices; lots and lots of factors come into play when we make our decisions.

As I said before (god, I'm boring myself now ), women should be able to choose their manner of birth and be fully supported in their choices. They should not be berated for so doing; nor for any bad consequences.

Apologies for this long post. I hate arguing about such sensitive matters, and it has bothered me all night (sad git that I am), that my choice is perceived as selfish by some, when "statistically" (guffaw) I believe it to have been a safe one, and certainly no riskier, given my profile, than a hospital birth (VB or CS). I do not consider women who choose CS or VB in hospital to be selfish. I would ask that people who criticise homebirthing be more considerate, please. (Although, fair play to you if you've been smugged all over by a RL homebirther. Then you can let rip. ).

I thank you...

Lulumama · 23/05/2009 10:43

yes homebirth can result in catastrophe

so can hospital birht

homebirths are not unmonitored. if there is a hint that things are not going well, teh woman will be transferred in, by ambulance. there is often more than enough time to get a woman to the hospital, things don;t tend to go wrong catastropically in an instant.

saying ;my baby would have died/i would have died, is not really an arguemnt agaisnt homebirth or vagianl birth for all...

many many more babies are born safely at home / hospital than not

just because some babies are better off being born by c.s , it does not mean that other women are stupid or irrepsonsible for choosing a homebirth or VB in hospital#

most posters have beenreally careful not to be judegy aboout c.s, but it seems to be ok to imply homebirthers/vaginal birthers are being stupid and careless

BigBellasBeerBelly · 23/05/2009 10:44

Hello penthe

Just looked at the BJOG link and note that it is based in the netherlands, with some 60% of women opting for homebirth and 40% hospital.

So homebirth is a much more common option in the netherlands.

That may mean that the results would not be the same in the UK - as our homebirth rate is much lower - so the people attending them may not be as experienced etc. We also don't know how far the average Dutch person is from their nearest hospital, what their procedures are etc etc. Or even how they define low risk.

Not saying that our results would be different, simply that it does not necessarily follow that what is true in one european country will be true in another. Too many different factors.

BigBellasBeerBelly · 23/05/2009 10:45

Oh penthe the was for you, the comments following were not!

BigBellasBeerBelly · 23/05/2009 10:47

TBH lulu I there have been some posters who have been pretty damn harsh about CS.

For one of these sorts of threads I think things have gone remarkably well!

Lulumama · 23/05/2009 10:51

you are right, it has gone well,bar the odd sarky comment!

Penthesileia · 23/05/2009 10:53

I agree, BBBB. I do think that elective CS gets short shrift on MN. I'm not entirely sure why, though: envy? resentment? misplaced sense of duty to educate seemingly uninformed women who choose CS?

I also wonder whether women are jealous of other's women's decision to choose CS because it takes the birthing process out of their hands, so-to-speak, and offers a modicum of greater control over what is seen as, essentially, an uncontrollable event. I'm not putting that very well, I know, and I mean no offence to either side. I'm just reflecting, for instance, on the ire showered on celebrities who choose CS: in their cases, they clearly are perceived to have more control over their births, by virtue of their wealth (can easily afford an elective CS), and thus provoke anger.

I'm not, I must emphasise, suggesting that CS or VB is "better", by mentioning these things. Just trying to understand why elective CS does attract such criticism (even if implied, or dressed up as "information").

Penthesileia · 23/05/2009 10:56

other's??? Ooops.

Also, I imagine that elective CS attracts negative attention because it is - sometimes rightly, sometimes wrongly - perceived as being symptomatic of the (over-) medicalisation of birth, and the negative influence of doctors who choose or encourage CS for factors other than what's best for the mother (e.g. time; convenience; fear of litigation, etc.).

Penthesileia · 23/05/2009 10:59

Criticism of women for having emCS is clearly just bonkers, obviously.

blueshoes · 23/05/2009 11:04

BBBB, you are absolutely right about considering the differences between Netherlands and UK: I am copying from the BJOG link:

"Conclusion: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system."

Exactly your point about the training of midwives (and in UK, the serious issue of whether we even have enough midwives to release for homebirth, when hospital births are already overstretched) and the speed of transportation, a point I had also made.

Lies, damn lies and statistics.

blueshoes · 23/05/2009 11:06

I agree with penth that it is inappropriate for me to mention Riven. Riven, if you are watching, please accept my sincere apologies.

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