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.

I know and it's true. But equally the rite of passage types, ante-natal women and friends and so on do get into your brain. Maybe they need to understand that their job is done, the natural birth message is out there, now let's just all relax...

I am normally very practical and can't quite understand why i have this feeling of ought. It's so unlike me, I'm usually very decisive...

It will all pan out in the end though, I'm sure

Thanks penthe.

I never went to ante-natal classes, so was not exposed to any of this smugness opinion before I had DD. I arrived at my own prejudices all by myself. It pays to be a hermit.

Oh, and, just a personal thought. I was lurking on Jackmama's thread about women who don't find labour too bad, and at one point she saluted these women. Now, theoretically, that's me. I basically found my labour and birth pretty easy. I was lucky. But for exactly that reason, I don't necessarily feel that I have any right to claim it as a rite of passage. I didn't suffer enough. I'm far more "impressed" by stories of long labours and heroic recoveries. Go figure.

Anyway. Night night for now. I'm off to watch Garth Merenghi on 4oD.

BBBB, when deciding whether or not to go VBAC, I also had the feeling of 'ought'. And I went for 2 VBAC clinics with senior midwives and they looked at my records and I fired questions at them about statistics and chances of successful VBAC.

In the end, I opted for the devil I know: elective cs, which went smoothly.

Once I booked the date, I felt so light and relieved and put the birth right out of my mind - I knew it would be alright. Contrast that with my first birth when I was sitting on my birthball and practising breathing techniques and doing perineal massages. Still ended up in em cs.

oooh garth merenghi - just went to 4od to check it wasn't ones I hadn't seen! Top choice... Are you watching the conchords? I've got to catch up with the new series...

Must admit i am kind of heading in that direction blueshoes. The fact that i am hoping they will say I have placenta praevia (sp) and therefore have to have a section says a lot I think...

BigBellasBeerBelly I had the feeling I ought to try for my first one, I was TERRIFIED of labour but thought it was something I should do so I did hypnobirthing and made sure I was well informed and that my DH knew exactly what I wanted to happen and how. In the end I had an EMCS as DS was discovered to be footling breech when I was at 8cm. Whilst now having been thru some labour I am not as terrified about the prospect I have decided that I have tried but next time i am just going to opt for an elective c/s from the word go. Now, having had one child, I don't get the whole must push it out thru my vagina to be a real woman or to bond with my baby properly.

Thanks Libra

I think we have pretty much come to a decision today, I have an appointment week after next so will see if their stating that I can choose and can change my mind at any time is really true!

So baby may be here sooner rather than later [cripes]...

I don't know, that BBC article just left an extremely unpleasant taste in my mouth.

On the one hand I feel incredibly grateful that I live in a place and time where a C-section is an option during an emergency.

On the other hand I always think its silly to compare vaginal birth today with "how it used to be" or with women in third world countries, where those women don't receive adequate nutrition and hygiene in hospitals may be suspect.

hecter has met this guy and he basically tried to frighten her into have a C-section. He sounds like a man on a mission, with his own agenda and issues.

TO be honest he sounds a little bit pissed off that the female body can do the job of birthing babies so extremely well. It sounds like he would prefer to believe in the myth that the female body is defunct and needs him, ready and waiting with his scalpel, to save the day.
Vaginal birth is extremely efficient, especially if the woman refuses pain medication, such as epidural. Yes, its true, there are times when a C-section is necessary, no-one is disputing that. BUt to say that it is "female macho" to want to do things how they are meant to be done, smacks of womb envy to me...

Hi BBBB Snap

I'm also trying to decide about an el c/s or not.

Saw the registrar today and booked in for 25 June, but actually just keeping my options open. Baby is currently lying oblique and hoping she stays that way so there is no decision to be made

What gets me is that all the doctors and midwives I've seen have said that VB would be better (but I can have a c/s if I insist).

I want a cs; I'm petrified that if I try for a VB I'll freak out when I go into labour and/or end up with another instrumental delivery or em c/s. But the unanimity of medical opinion is getting to me (despite none of them being able to put together an argument that I can follow; c/s would be at 39 weeks so no increased risk to the baby).

Anyway, good luck, hope it all goes well for you

"Maybe they need to understand that their job is done, the natural birth message is out there, now let's just all relax... "

Yes - it's really 'out there' to the point that more than a quarter of all births are surgical now.

If women thought it mattered that the c-section rate was so high, we might make more of a fuss that our maternity services are organised in such a way that large numbers of women are having c-sections that they might have avoided had they had better care.

But of course if you think it doesn't matter how you have a baby - that there are no benefits to having a baby in the physiological way (even for mothers who are physically able to birth a healthy baby vaginally) then why bother pressing for change?

"I wish someone would go in and overhaul the whole thing. People say birth is too medicalised"

Well, it's not 'people' saying that birth is too medicalised, it's major health organisations like the WHO and the RCM and even the RCOG who say it. There have been huge rises in the amount of intervention that women are having in the past 20 years, without a corresponding fall in rates of stillbirth and neonatal morbidity.

"- which is presumably another reason that the natural way is pushed, but as that is a reality for so few women"

The 'natural way' is pushed because normal birth is healthiest for mums and babies. And yes, the fact that so few women achieve normal births is scandalous. Women and babies are being damaged unnecessarily by our birthing culture. I just don't think the answer is 'let's not talk about the benefits of physiological birth or how best to achieve one (which are basically - have an active birth, avoid epidurals and try to stay away from consultant led units) because it makes women who have loads of interventions in their births feel bad.

"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."

Well - maybe if they understood that it's not their bodies which have let them down, but the system within which they have had to give birth, they might feel differently about it. However, if you want women to understand this, they have to understand the hormonal underpinnings of physiological birth and how our system of care militates against it. Sadly there are many people out there who see this as 'natural birth clap-trap' and propaganda.

"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."

Blueshoes - current research seems to show that babies born at home are less likely to need resucitation or a trip to SCBU, and more likely to breastfeed successfully than babies born to low risk mothers in hospital. I personally chose a homebirth with my second because I simply wanted to get through the birth with the least possible damage to me and my baby. It had nothing to do with wanting a 'wonderful experience'. For me birth is something to be got through, not something to 'enjoy' (though I don't deny that as one of those pesky 'rites of passage types' I also feel that there were huge rewards at a personal level through taking charge of my birth in this way).

This is one issue where public interest does not necessarily overlap with individual interest.

"This is one issue where public interest does not necessarily overlap with individual interest".

In a state funded healthcare system where resources are rationed than it is nonsense to say this. Resources will always be limited within the NHS. Maternal choice C-sections would eat up limited resources, leaving mothers attempting to birth vaginally at increased risk of poor outcomes caused by a lack of midwifery and obstetric care.

IMO any additional resources that are put into maternity care should be directed towards improving health outcomes for mothers and babies, as this is the most important thing. At present the most direct way to do this is to provide more one to one midwifery care and better consultant cover on wards, not hugely increase the number of unnecessary operations done in the NHS.

It only sounds like "nonsense" because you misunderstood. I didn't say NHS should pay for all elCSs. I said the drive for more natural births and less CSs doesn't necessarily overlap with individual interests.

I am obviously referring to cases where women are being pushed towards VBs although carrying big babies or are high risk for big tears. Individual pros and cons need to have more weight in discussing a woman's birth options than the desire to minimise overall CS rates.

Another example: It would be rational for an individual to immediately have a course of general spectrum antibiotics after an episiotomy or CS. But this can't be encouraged because on a big enough scale, this would lead to more AB resistant bacteria. Conflicting individual ve public interests.

"I am obviously referring to cases where women are being pushed towards VBs although carrying big babies or are high risk for big tears. Individual pros and cons need to have more weight in discussing a woman's birth options than the desire to minimise overall CS rates."

But these things are assessed on the basis of the needs of the individual. Women carrying big babies or those with previous bad tears are referred to consultants, who discuss the risks and the benefits of vb vs cs. However, doctors have to provide evidence based recommendations. If the research suggests that outcomes for cs are poorer, or no better for women in these situations (all other things being considered), then how can they make a blanket recommendation that c/s is the way to go?

As far as I'm concerned, when it comes to childbirth, the interests of the individual don't conflict with the interests of society as a whole. The best outcome for the individual and for society is the largest number of women possible giving birth with the fewest injuries and complications to themselves and their babies.