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.

CS even!

Mears - what do you mean about an increase in infertility?

Research has shown that women who have had a CS delivery are statistically more likely to have problems conceiving again. If you 'google' it you will get lots of information on it.

Infertility is a known risk of caesarean section.
Somewhere in the NICE guidelines it says that there is a 46% higher chance of a woman having no more children if she has a CS than a vaginal delivery. That is significant.

I feel very strongly that women should be aware of this before opting for a section, and I wonder how many are. I had no choice but to have my EMCS, but it has led to no end of problems with ttc number 2; 3 losses last year, at least 2 of which were ectopic, and it is thought most likely that scarring from my CS caused damage to my tube and led to the ectopics. I find it hard to believe that any woman wanting more than one child would knowingly gamble her fertility to have elective surgery.

Haven't heard that before. Not that it's relevant to me, but interesting.

Interesting website, thanks for the link - though a bit alarming to read that the risks of cs include an increased risk of in-utero DEATH (in capitals, no less) to subsequent babies

"lets fact all the "advice" a pregnant woman gets in this country is very much slanted toward natural is good and surgery is bad"

Advice is slanted towards encouraging women to do whatever results in better health outcomes for mothers and babies.

At the moment the best available evidence points to vaginal birth being a safer option for most women. And that's despite the fact that we have a system where many, many women attempting to birth vaginally are getting suboptimal and sometimes substandard care.

If women attempting to birth vaginally got the sort of care that has been proven to result in the best outcomes for mums and babies (ie, one to one midwifery care from a known caregiver in a environment which is supportive of active birth) then the argument would be even more heavily weighted in favour of vaginal birth being the safest and healthiest option for most mums.

"But women should be allowed to look at the risks on each side (and there are very serious, though fortunately unlikely in this country, risks on both sides) and then decide for themselves. Make no mistake - this would be the case if men had to give birth!"

We do have free access to the evidence. You only need to have a look at the RCOG website - there are clear, evidence based guidelines on caesearean birth there that enable women to weigh up the risks and benefits of vaginal vs c-section birth. here

I'd certainly argue for c-sections on demand if there was enough money in the system to also provide women birthing vaginally with one to one care in labour. But it's hard to argue for women to be given an option which would definitely result in more maternal deaths and serious morbidity, particularly if resources had to be directed away from anywhere else, as this would put mothers attempting vaginal births at increased risk.

By the way - it isn't really logical to talk about 'cutting costs for the NHS' by restricting access to elective sections, anymore than it's logical to say refusing to extend access to rhinoplasty for people with no medical need is 'cutting costs'. Those services have never been available because clinically there is no argument them.

Athene - the comparisons you make (with depression and smoking induced illness) don't make sense. The role of the NHS is to prevent and treat disease and ill health through health promotion and through clinical treatment - and that's it.

Fattipuffs - one of my friends experienced placenta percreta in a pregnancy following two cs. This is when your placenta grows through your c-section scar. In her case it attached itself to her bowel.

She spent 3 months in hospital and nearly died during the operation to birth her baby. She lost a lot of blood and she had to have a hysterectomy. Then she was sent home on strong drugs to shrink her placenta, which had to be left in place until it could be removed at a later date with more complex surgery.

I suspect placental problems in future pregnancies are something very few women think about when they are contemplating c/s.

MrsHappy, sorry to hear about your misfortunes, however, I feel you really can't compare an Emergency CS with an Elective, as in an emerg the primary aim is to eleviate foetal distress by delivering the baby as quickly as possible with little thought to care and attention when entering the abdomen / uterus, as such, there is bound to be increased complication rate with an Emergency procedure - regardless of what type of emergency procedure. The whole point of elective surgery is that it is just that - elected, planned, and therefore risks (which of course there still will be) are minimised. I feel there are just as many if not more risks to a natural birth when there is failure to progress, and or any other complications that will lead to an emergency CS.

You're not right, PMK1. Although my section was classed as an emcs there was no foetal distress or hurry. The cs happened because the baby was stuck and the consultant was able to take her time getting the baby out. In many ways it was no different to an elective. Abdominal scarring happens because you've had abdominal surgery, not because of a careless or hurried surgeon.

THat is not entirely true pmk1.

An emergency CS does not mean that there is little attention paid when entering the abdomen. There are very few 'emergency' emergency caesrean sections which need to be done at great speed to 'save' the baby. An emergency CS is one that is done in labour for a variety of reasons that do not require speed.

As a midwife I have seen many elective and emergency caesarean sections. I have seen women with elective CS need hysterectomy and admission to intensive care. No matter how you dres it up, it is major abdominal surgery.

I had an elective c-section 4 months ago(i wouldn't say eelective right enough, little one was breech and she wouldnt turn). I really dont know why people would want to choose to have a CS, i completely lost the bond with my baby and now suffering bad PND. I hated the fact i had a date and a time to have my baby and when she was bron she was held up over a curtain covering my bottom half then took away !! CS should only be an option for emergencys or in my case for breech babies.

Birth is the most natural thing in the world, why would anyone want to choose not to take that path if they had the choice !!

And i was never told about the chance of fertility problems after a CS which i am not happy about and will start to research it just now

Mrshappy your case was obviously one of the good experiences as a result of an Emergency. More often than not, an Emergency CS is not a situation where the surgeon can take his or her time, and as name suggests, it is just that - an emergency, and hurried, therefore future complications are more likely after such, which is what I am referring to.
There are always going to be stories about "the person that nearly died from the CS" - that's because no one ever talks about the easy non complicated one - it's boring... People also talk about the dangerous natural births.....they are the one's that result in the emergency CS (which gets talked about!)
Anyway, I'm glad there are many people against the elective CS, otherwise mine may have been refused!

Jackie, I think many women would want to take that path of CS for many reasons. I know a situation of a child being resented after a natural birth due to the complications following it, and many other stories similar also involving the husbands etc if you get my drift.
mears, I understand now, as I know Midwives have very.. ahem... strong opinions.
Anyway, not trying to ruffle any feathers or get biffy, just putting my views out there, and I respect others for having theirs

I'm not medically trained but I thought that although statistical evidence supports the conclusion that women who deliver by caesarean are less likely to have future pregnancies, this has not yet been linked to infertility caused by the procedure. It could also be caused by the women in question being too traumatised by the whole birth experience to go through another pregnancy - perhaps in the scary experiend of an ems cs?

www.library.nhs.uk/rss/newsAndRssArticle.aspx?uri=www.library.nhs.uk/resources/?id=96108

I've read through this thread with much interest as I'm debating whether to go through vbac or elective c/s in 6 weeks' time.

I lean towards an elective c/s but I'm tormented by the guilt re bonding, the health of the baby and generally feeling lazy. I feel that there is pressure on women who choose an elective c/s to feel guilty about their decision. Speaking for myself, this article has given me some relief from the guilt - so I'm pleased it was written.

Let us not forget that a positive correlation does not establish cause and effect. When a vaginal birth goes wrong and ends in a section those statistics go into the section category when actually the sections was the solution not the problem.

I had an emergency section, a crash c section and an elective section (and 2 natural births)...

emergency c/s...not that hurried, time for spinal..staightforward but hard recovery and post op pain for a year.

crash c/s..baby out in minutes, general anaesthetic..hurried op to save baby..massive blood loss...in recovery started internal bleeding...back to theatre..repair of ruptured artery..very ill in high dependency, baby in special care..very long recovery

elective c/s...straightforward..epidural..baby OK, me OK, but long painful recovery

In contrast my natural births were a fab experience even with bad tears I got over them so much quicker. I also hated not being able to pick up my own baby

Chocoholic "I feel that there is pressure on women who choose an elective c/s to feel guilty about their decision. Speaking for myself, this article has given me some relief from the guilt - so I'm pleased it was written."

Well said. That could be me writing that - though I don't feel guilty for the reasons you do, more that my leaning towards an elective cs is frowned upon.

Yes of course there are risks with any surgery, but there are also risks with vaginal childbirth. Particularly VBAC, which could include uterine rupture plus all the usual tearing, prolapse, incontinence etc.

Re. the scarring - this could happen equally with removal of the placenta following vaginal childbirth. Uterine/abdominal scarring (and risks such as placenta accreta) can happen with any trauma.

Of my friends with children, I'd say it's 50/50 for vaginal/cs delivery, and I have never heard any of them say they regret a cs (whether emergency or elective). In fact two of them have said the cs births were much better.

The thing that puts me off trying for a vaginal delivery this time is a repeat of the 30 hour labour during which I threw up from beginning to end. I was simply relieved to have ds delivered, I couldn't care less how he arrived.

Jellybeans, why could you not pick up your baby? I did this after emcs within an hour.

Fattipuffs - people tend to be loyal to their birth choices, if their baby is OK and they had reasonable care (which women who have a c-section are more likely to have had).

"Yes of course there are risks with any surgery, but there are also risks with vaginal childbirth. "

Nobody is arguing that vaginal birth is without risk, so this is a slightly pointless argument. The issue surrounds the comparative risk of serious bad outcomes, ie maternal and infant death and serious injury in the current pregnancy and in future births. There is no doubt that c/s is more likely to result in death and serious morbidity than vaginal birth.

"Re. the scarring - this could happen equally with removal of the placenta following vaginal childbirth. Uterine/abdominal scarring (and risks such as placenta accreta) can happen with any trauma."

Uterine rupture and serious scarring is vanishingly rare, except in women who've had uterine surgery.

And yes - there are many things that can cause abdominal trauma, such as ectopic pregnancy. However, most of them are not inflicted unnecessarily and by maternal choice.

Jellybeans!!! Geeez!!!! In that order??? You weren't put off then? I'm really impressed!!
Well said Fattipuffs

EachPeach that's not what I said - of course it should be free for those who need it, I just think if it's not necessary perhaps those who prefer it ought to pay themselves. I had a home birth booked with the NHS and had to pay for my own birth pool - they weren't going to provide me with one, and why should they? It greatly improved my birth experience but I know it wasn't necessary.

When I first got pregnant I assumed I'd have a natural delivery - why not? Isn't that how it works?

DS1 - breech - elective section. Up and about next day, felt normal after a couple of weeks.

DD1 - let's go with the flow and see what happens. Emergency section at 36 weeks after waters broke and failure to dilate. DD1 week in scbu but we BF and i bounced back again after a few weeks.

I am happy with my births (was a bit at the mum who told me it must be weird to have had DS1 taken from my body. No weirder than having squeezed him out of my fanjo thank you very much) but it took well over a year to get pregnant with DC3. Could be age, could be c-sections.

I would like a c-section for this birth but then I know it's my last birth. I think the important thing is not to get too attached to one idea of what will happen and then you won't be disappointed or feel like you've failed. You can hope for a natural delivery and try to give yourself the best chance of having one but so much is beyond our control.