C-sections 'a rational choice'

[AtheneNoctua]

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.

The thing is that the majority of people on MN who have electives have them for medical reasons. Most women on here have given birth on the NHS so it's not a choice at all really.

So I find it baffling and unpleasant when people have a go.

Yes it is different for the Beckhams of this world - but they are not that common especially on these boards.

So when people respond to posts like the OP about choice and start berating CS generally, they seem to forget that they are not talking to women who have made that choice or had the option to make that choice. They are talking to people who had CS as that is what the doctors said was the best decision.

For the same reason it annoys me when people say about cascade of intervention etc. I am sure to a certain extent it's true, but that is a question for the medical establishment and NHS, not for individual women. There seems to be an attitude in certain people of "well you let the induce you/give you drugs/etc and so what do you expect". the majority of women, especially first time round, will do as they are advised my medical professionals, to imply that they should have argued/been more vocal/known what was going to happen etc seems to overestimate the powers of the majority of women in labour. A doctor says that you should do X, or there is a risk to you/baby, most people do X. To then blame them for it is to me really very unfair.

I had a private elective cs. I still would more than likely have had one on the NHS should I have wanted one, because a) I have tokophobia as a result of seeing what happened when my sister was guilt tripped/pressured by midwives into having a vb when she had a breech baby (not pretty) and b) my baby was transverse.

It went brilliantly, I was extremely happy with it and I would have another in a heartbeat. I am not saying it would suit everyone. But it worked for me. Choice in childbirth, within reason. That's the answer.

I think that the point about the geographical specificities of the data concerning homebirths is interesting and pertinent. I agree that this could mean that these statistics are not applicable in the UK.

My and my baby's risk, then, when I chose the homebirth would be the same as any other birth in the UK (e.g. low risk of negative outcome). What I "introduced" to the risk was that I would be 10 mins away from emergency care. This risk, of course, would only be "applicable" if I entered the already statistically low category of births which develop negatively. Does that make sense?

blueshoes: To answer the charge that homebirths are more selfish for using up MW resources. That is extremely unfair.

The chaos in midwifery in the UK is not the responsibility of individual women.

To suggest that women who choose homebirth are selfish because they apparently monopolise resources is as illogical as implying that a terminally ill cancer patient ought to refuse expensive life-prolonging drugs because they're going to die anyway and the NHS is short of money.

Or, to be more relevant to this thread, that women should not be allowed elective CS as they are a strain on NHS funds. From remarks you have made, I can see that you are supporter of elective CS (as am I), so I'm sure you can now see the illogical nature of your biased remark about homebirth.

Sorry, BBBB - I didn't mean to annoy you by mentioning "cascade of intervention". I did so merely to illustrate the fact that determining whether a homebirth would've been more or less dangerous or had a different outcome to a hospital birth which ended in emCS is basically impossible and probably irrelevant.

I agree that the so-called "cascade of intervention" describes a series of circumstantially necessary events, which may or may not have been predicated on optimal/sup-optimal birthing conditions, none of which are the responsibility of individual women.

Penthsilia - I'm still on phone so can't link but if you search for the words "not statistically significant", you should find a thread on which we looked into these studies at length, and saw that elCS at or after 39 weeks does not change probability of resporatory problems or neonatal morbidity. So don't do CS too early is all.

I agree with the rest of what you said, by the way. It is about choice and what type of risks each person is comfortable taking, and little point in blaming others for making different choices. However, it is still clear that when in hospital you can refuse everything and effectively birth as if you were at home, butif an urgent need appears as you are birthing at home, you can't beam yourself up to a hospital.

Cote

I dont think you can say that giving birth at home, in your own envionment, with supportive midwife care is going to lead to exactly the same outcome as sitting in a hospital room 'refusing everything', with all the stress for the woman that will go along with that.

Hi Cote and miniCote.

I was under the impression that the article I linked to had suggested that the issues you mention had in fact been accounted for, and that there still remained an unexplainable 3x additional risk post-CS. But this is not entirely clear, so I am not prepared to make an argument of it!

You are right, though, that in those rare situations where immediate attention is required, homebirth is disastrous. I was prepared to take the small risk (as I saw it) that I would not be in that category; in addition, I estimated that other more likely unpleasant factors would be avoided if I stayed at home.

I do not believe that my choice makes me selfish; any more than anyone else's does.

what needs also to be borne in mind that unless there is a need for a crash section, there is usually a window of opportunity of 30 - 60 minutes to get a baby out by section.. which is also enough time to get bluelighted to hospital with theatre on standby

there are risks each and every way

i do think that it comes down to informed choice and the right support ante, intra and post partum

ladythompson, with a transverse baby and tokophobia i cannot imagine yu would have been refused a c.section on the NHS, indeed the only way to deliver a transverse baby is by secction

You can't assume that being in hospital = being able to get help much faster than if you were at home ten minutes or more away.

There was only ONE midwife on duty for seven women in labour at my hospital (and I was on the allegedly midwife-LED unit). Across the corridor, on the traditional hospital ward, the ratio was the same.

I chose that m/w led unit because it was in a leading acute hospital (with tertiary neonatal intensive care) and just through a set of doors to the hospital ward.

Actually I was probably in more danger there than I would have been at home, with a midwife paying attention and a choice of three acute hospitals within a 5 min ambulance ride should anything have gone wrong. (In London.)

As it was, I got away with a third-degree tear. Had anything more serious affected ds, we could well have been in real trouble.

And that is not a one-off - community midwives later told me it is common at that hospital (St Thomas's). Had a reputation for being 'lucky' as they hadn't managed to kill anyone, despite understaffing.

Maternity services have been underfunded for decades, despite a climbing birth rate. Recipe for disaster, even if women do choose hospital births because they assume they are 'safer'.

Stripey - No need to stress, just say no. In my (very recent) experience, it's quite easy.

We might decide to induce you, so eat nothing.
"No" (shortly followed by gulping down sandwich in fridge)

Here's the steroid injection to mature your baby's lungs, show us your bum.
"No" (and there was no induction at 37 weeks)

Etc etc

I'm guessing they wil be happy to see m my back as I leave

Penth: "To suggest that women who choose homebirth are selfish because they apparently monopolise resources is as illogical as implying that a terminally ill cancer patient ought to refuse expensive life-prolonging drugs because they're going to die anyway and the NHS is short of money."

I never used the word 'selfish' in relation to the monopolisation of midwife's time in homebirth. That is not what I said at all. I was merely pointing out that the BJOG study pre-supposed the availability of well-trained midwives in a homebirth - which is not likely to apply in the UK as there are not even enough midwives for hospital births much less midwives to release for home births.

Of course women are not responsible for the inadequate care in maternity services. As you have pointed out, I chose an elective which enabled me to bag what I considered a quality care for myself. And I would do it again if necessary.

Illogical as it may be, NHS (rightly or wrongly) directs staff resources towards surgical births, rather than midwife-led births. So to get the care I wanted, I opted for a surgical birth. I won't opt for a home birth because I cannot get comfortable with the safety issues as I don't live close enough to a hospital with adequate maternity services/SCBU for a safe transfer. But that is just me. In hindsight, I was 'lucky' to be in hospital when dd needed it.

edam, dd was born at St Thomas' too, coincidentally - by crash section.

I totally agree that maternity services are woefully underfunded. Hence if I had chosen VBAC, I would have brought in a doula (to get care and attention) and gone to the private wing of a fully equipped maternity hospital with excellent NICU/SCBU (St Thomas' being one of them).

I am not surprised by the lack of midwives you described. The post-natal ward was horrendously understaffed with rude nurses to boot.

But in the case of a transfer, it is not the availability of midwives I am concerned with, it is the surgical team - which at St Thomas' sprang into action to deliver my dd within 11 minutes. I don't know whether dd would have got away as lightly as she did if I had to wait for an ambulance and get stuck in London traffic and had to be wheeled up to theatre. If it was my local hospital (and not St Thomas), they were turning women away at the door, and they could not cope with the numbers.

Very few people would have the choice of maternity hospitals within 5 minutes that you did, in any case.

True - I just happened to live in between St Thomas's, George's and Chelsea & Westminster.

Apologies, blueshoes. Indeed, you did not say that women who choose homebirths are selfish. I, obviously quite wrongly, was under the impression that you did, or that this was what you intended to imply. I realise now that I conflated the following remark which you made:

"I'd like to think I am quite selfless to choose a elective in a hospital, whereby I take more of the risk on myself, than a home birth, where my unborn baby takes more of the risk because I want an intact perineum and a wonderful birth experience."

and another that you made:

"and in UK, the serious issue of whether we even have enough midwives to release for homebirth, when hospital births are already overstretched"

with an earlier remark which I remembered, made in fact by pmk1, which heavily implies that homebirthing is selfish from all points of view, even seeming to conclude that the crap nature of NHS maternity care is down to homebirthing (thought this is not entirely clear):

"One could argue that that is slightly selfish that the needs of the mother with a warm and fuzzy midwife are met, but potentially not the baby? And also, when a midwife is attending your homebirth, she can't be attending to another women in the next room keeping in mind the labour could go on for hours and hours?
Also, don't forget, in the early part of the last century, women campaigned tirelessly for the right to give birth in a hospital due to the attendant risks of homebirths. I'm anticipating you will argue that they are all community midwives, therefore that is all they do, however one cannot deny that one midwife looking after 3 women in a hospital is a far more efficient use of her time? Perhaps this is why the care is so crap within NHS.... but anyway, if you thought of all those things"

FWIW, my midwives were community midwives, so I'm not quite sure where on the "selfish", "taking-midwives-from-women-in-hospitals", part of the spectrum I fall onto. Probably somewhere near all those pesky women who selfishly insist on elective CS and use up so much more money than my relatively low-cost homebirth.

You didn't annoy me penthe

It's just one of the things I notice is mentioned a lot, at ante natal classes and on here. Sort of "of course you don't want x, because that will lead to y, and then z will happen and the sky will fall in".

But of course if a doctor comes and says "we need to do x for the safety of you baby" the vast majority of women just say "ok".

I wonder if so many women have more positive second births as they know what they don't want - usually based on the previous time. There was a thread on here and second births were raved about, whether they were VB, VBAC or elective. I wonder if the woman feels more in control second time round. Don't remember what people said about emcs either!

Phew.

Yes, I'm sure an element of "been there, done that" does come into play with second births.

I think control is a huge part of a positive birth experience (control within reason, of course). Many of the unhappy stories I've read on MN seem to have as a defining feature the woman's sense that control was taken away from her (doctors/midwives didn't listen or believe her; requests for pain-relief were refused, etc.).

I guess that's what I meant earlier about why some people are anti-CS: perhaps there is an element of envy, since an elective CS seems to be a much more controlled and controllable birth, and ultimately, this is what women want to experience.

Which brings us back full circle - earlier people were saying that the possible bad things which can happen with a VB are not really mentioned.

For eg no-one in our ante-natal classes (NHS or NCT) mentioned episiotomy (sp?) although it is very common. So when the buggers come at you with a pair of scissors (i think? - not actuallt had one) it must have come as a terrible terrible shock.

That sort of thing can only lead to the woman feeling out of control. It is said they don't want to scare women too much - but better scare them now and let them know what may happen than let them find out when they're at their most vulnerable.

I entirely agree that women ought to be informed, or inform themselves, of the, sometimes extremely serious, possible risks of VB, just as much as they are about CS.

I suspect one of the reasons there is a general conspiracy of silence (as I think you called it before) is because we are, still, so hung-up about our genitalia and sexual organs and talking about them is still so taboo.

I think women should be informed TBH, if they make the effort to go to ante natal classes.

Ours was all "it's not discomfort, it's pain", epidural bad, BF dead easy and best to avoid all pain relief due to it leading onto other things. Induction and CS not really mentioned.

I wish someone would go in and overhaul the whole thing. People say birth is too medicalised - which is presumably another reason that the natural way is pushed, but as that is a reality for so few women, it would make sense to talk about what really could/will happen rather than the best case scenario which gets endlessly trotted out.

Then women who had it easy would feel of so extra wonderful, and women who had a bad time/interventions would be able to feel more philosophical about it. the current system generates a lot of women who feel they have done it wrong, that their bodies have let them down and so on. i know women who feel like this and it is so sad.

penthe there is a message for you in chat

BBBB" "But of course if a doctor comes and says "we need to do x for the safety of you baby" the vast majority of women just say "ok"."

Very good point, BBBB.

It is all very well to say that women can always refuse intervention but the reality is that health professionals can easily scare women into any intervention by saying the baby is at risk. That is one of the reasons I opted for an elective. There is not enough real control or choice in a vaginal birth, whether it is support, environment or intervention.

This thread is really interesting as I'm in the process of deciding what to do myself this time - although it's looking like it may be taken out of my hands - 34 week scan yesterday showed placenta 2 mm away from "cut off" for CS and stonking great baby. In a way I hope that teh placenta is too low so that the decision is taken away from me. It's such a tough one.

It does sound like a difficult decision. Best of luck in figuring out what you want to do.

I understand exactly what you mean about wanting the decision to be taken away: my placenta was low-lying at my 20wk scan (common, I believe), so I was rescanned at 32 weeks (by which time it had moved). In the intervening weeks, I was partly hoping that I would be told I would need a CS. This was mainly because I think I only knew one person in my immediate circle of female friends and acquaintances who hadn't had an emCS after a lengthy labour. (My local hospital has a higher than average CS/emCS rate.) I was adamant that I didn't want to labour horribly for hours, only to end in an emCS.

In the end, and after thinking long and hard about it, I opted for the homebirth, among other reasons, to try to minimise the possibility of an emCS or instrumental VB.

it is tough...

And of course I found my last emcs very easy and recovered well and BF and everything was great.

There is this feeling that you somehow ought to try though...

I have really been enjoying this thread though. MN seems to be having much calmer discussions about emotive subjects at the moment. It's a lovely change

FWIW, I don't think you should waste time feeling you ought to try. Try what, exactly? Haven't you already "tried" enough, getting through your pregnancy, etc.? What's the "glory" in "trying"? As I mentioned earlier in the thread, I think that women should be able to construct as strong a narrative about their CS (em or elective) in terms of "rite of passage" as a VB. Actually, WRT this issue, I'm often very moved by people's CS birth stories when they describe how peaceful their birth was, and how smoothly it all went. Sounds like a nice thing to me.