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.

Ah, it's Philip Steer. This is his stock-in-trade; he loves being a controversialist and he loves advocating CS. When I worked in maternity services I was always coming across him pushing maternal choice caesarean.

And then - as luck would have it - he became my obstetrician! As I was having midwifery-led care I only saw him once, after I had a bad 20 week scan. After he'd finished delivering the bad news he cheerfully said, "Now, while you're here, let's just sort out the delivery. At your age, you are running double the risk of stillbirth. So why don't we put you down for an elective section at 38 weeks?"

I was not pleased: not only was his timing lousy, but I happened to know that his 'double the risk', while technically correct, in fact means a doubling of risk from 1 to 2%. I thought this was a really dishonest way of persuading a healthy woman to have an unnecessary CS, and no wonder his hospital has such high section rates if they're just routinely offering them to older women (I was 40).

I did get off my high horse just a little when I ended up having a prolonged back labour, failure to progress, foetal distress and emergency CS at 40 weeks . But just a little: I still think that he won't be happy till CS rates are approaching Brazilian levels (I mean CS rates in Brazil, not the level of your Brazilian IYSWIM).

I thought the c-section causes infertility thing was a myth. I understand that if the egg tries to implant on the scar it will probably fail. But, beyond that, I thought that no cause and effect had been validated.

What do you know that I don't, Mears? Is there an establishe cause and effect or is it just a positive correlation? So, for example, older women are more likely to have sections and older women are more likely to be having their last child sort of thing.

I've had a hospital birth, a home water birth and a planned c section.

My c-section was divine, and I 'get it' now - why people would choose it.

However, they were all simply a means to an end.
I thought I was a die hard hippy dippy earth mother but have come around to informed choice.

"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."

That is slightly misleading though. Eg the reason for an increased incidence of complications leading to serious outcomes (eg maternal death) isn't necessarily because of a cs. An emcs is usually performed because of real risk to the mother and/or baby during a vaginal delivery - if the cs wasn't performed the outcome of the birth might have been the same. And the majority of cases of course a cs is the thing that saves the life of mother/baby.

I would be interested to see stats comparing the outcomes from complication-free vaginal delivery vs elective cs. Other than a lengthened recovery rate from the cs, afaik the risks to the health of the baby are pretty much on a par.

Agree with Athena about the risks to future fertility. Scarring inside the uterus may affect it, but scarring outside (eg between uterus and bladder) is unlikely to. Don't quite understand why ectopic pg should be more of a risk either - the fallopian tubes aren't touched during cs.

I see that Athene made my point much more succinctly in her post of 19:17

I think a lot of sloppy statistics are always thrown about in this argument about cs being 'riskier'. Some of the 'risks' involved in caesareans are, whilst undoubtedly serious, completely 'fixable', and then there also are the risks of vaginal births which - while rare - can be catastrophic. So I would like to see women given all the actual statistics and then allowed to choose for themselves.

And all this debate about who'd prefer what has lost sight of Athena's/the article's original point which was just: women should be able to make an informed choice to have a c-section. I can't see how anyone can argue with this, and I think women should be up in arms to defend this cause - regardless of whether they themselves would personally want a c-section. There's plenty of things I choose not to do myself, but that doesn't mean others shouldn't have the right to choose it. The 'cost to the NHS' argument is just not good enough. And nor is the 'childbirth is natural, women shouldn't be able to request a major operation' argument. Epidurals aren't 'natural', and neither is gas and air come to that - should women who want those also have to pay for them?

pmk1 yes in that order!... emerg c/s, VBAC, VBAC (twin 1)and crash c section (twin 2), elect c/s. No 5 was a happy unplanned baby...I was terrified of the c/s all the way through... thought I would bleed to death. Luckily the elective was fine but I would have much rather given birth naturally but VBAC2 was not an option for me for various reasons.

fattipuffs I could hold my babies after the c/ss (except the crash one as I was wired to machines for a while and very ill and one baby was in NICU) but I couldn't physically get up and get my crying baby without a midwife etc. Took me a while to be able to pull to sitting and lift baby out of cot.

OMG, you had a vaginal birth AND a crash section on the same day?!?!?!

double ouch

yes it was a nightmare scenario and definately double ouch.. but I am just glad we are all OK, that's the main thing!

I really hate these comparisons! And however much people think sections are BAD we do live in the 21st century and why should anyone have to endure a labour if they don't wish to? I wanted a baby not a birth experience and was totally happy with my elective.

Most of the comparisons are an 'good' vaginal birth against a statistic for C Section which includes all emergency ones - they are never just referring to a 'good' elective section. Therefore there is no real comparison and although a section is risky for mum an elective a term is no more risky for baby than enduring a labour and possible distress/complications. And as for mum - you only have to read the numerous posts on pelvis floor and stitches to realise it doesn't always go so well!

And does a C Section really cost more? A VB needs how many hours of attention whearas a section is done in 45 minutes. Also does the VB 'price' take into account any corrective surgery/phisio needed? plus for every VB there is a theatre team waitin in the wings even if they are not required (they don't just ring a surgeon up when he/she is required). Plus every VB that needs intervention or ends in emergency section would definitely be more costly.

I've never understood why women are so defensive of their own choices re childbirth and so aggressive towards others when their choices differ. It's as if we can't be happy unless everyone does the same as us. How my baby was born is a tiny part of his life and of our relationship. I'll save my guilt for what happens from here on in.

I have just looked at the childbirth connection link provided by mears. I have to say it is not exactly unbiased. There is definitely an underlying agenda that says section is bad and natural is good. It brushed over some of the disadvantages of vagnial birth and exaggerates some of the disadvantages of a section. For example:
Emotional well-being of mothers: A woman who has a cesarean section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth.

I believe that all of the pro natural propaganda (such as the link at hand) not only contributes but causes a woman trauma about her birth. If the NHS would lay it all out on the line and educate women about sections as a matter of course than woman would not be so shocked when they end up having one. I have had two sections. One crash and one elective. And I was not traumatised by either. I have never suffered from PND. But, then, I didn't relly mind having sections. The first one came as a surprise, but after God only knows how many hours of failed induction I was actually quite happy about being knocked out.

Re the fertility thing, see , for example, this, and 10.1 of www.nice.org.uk/nicemedia/pdf/CG013fullguideline.pdf, although both recognise that the figures don't filter out women who choose not to have more children, so further study required etc.

The Ectopic Pregnancy Trust records previous cs as a risk factor for ectopics. The reasoning is apparently that all that poking around can lead to the formation of scar tissue e.g. between the uterus and tubes (just as it might between uterus and bladder). Or might lead to infections which also cause scarring, although of course you are given that great big shot of antibiotics in a section.

Anyway, I don't have that big an issue with elective cs provided that the risks are fully explained. I just get the impression from conversations with friends that they sometimes aren't and if that is the case I think that women should be fully informed before going for elective surgery. Beyond that I couldn't care less really.

These statistics don't really support the conclusions being drawn here. Maybe it is due to age of the mother as the older the mother the more likely a caesarean. And also because she is older maybe she doesn't want more children because of increased risk of birth defects.

Also, perhaps people who don't plan to have more children are more likely to have a caesarean. So, perhaps thes areticles have got their cause and effect the wrong way round.

I could go on with endless maybes.

I have listen to Professor James Walker speak of the risk to future pregnancy caused by caearean section. He was emphasising that women are not made aware of this when encouraged to have an elective CS for breech presentation for example.
guardian article here to summarise

I personally do not have any objection to women making the choice for elective caesrean section - I just think they should know all the facts. It is not an easy option without risk.

And another not so unbiased piece of literature.

I think Victoria Beckham or Liz Hurley are celebrity advocates of sections. Do they go aroound advocating for caesareans? Not that I know of. And, wasn't Victoria Beckham's first section unplanned? I could be wrong. I'm not an expert on VB's birth choices.

Informed decisions are good. But they should be equally informed on vaginal delivery and caesareans. It doesn't mean tell everyone the worst stuff about caesareans and sugar coat the vaginal birth stories.

AtheneNoctua - I cannot easily find the research paper so used the article to demonstrate it is out there. I have no interest about what celebrities think about CS. Infact I think VB had a CS first time due to breech but it is neither here nor there.

A single elective cs is undoubtedly a fairly safe procedure in a normal weight mum.

The major risks come when she has her second and subsequent pregnancies. The risk of major blood loss and hysterectomy after a second or third section is far higher than the risk of someone with a comparable number of births who hasn't had sections.

I personally think it is not worth the risk unless there is a good reason to have a cs and would only have one myself if it was absolutely necessary.

I thoroughly object to elective sections (when there is no obvious need - psychological or physical) there are women having their lives, and their babies lives put in jeopardy by a shortage of midwives and the lack of one to one care.

Once we have proper staffing on the labour wards and on postnatal wards, then we can look to increasing the rates of elective sections. It'll be expensive - we'll need more intensive care beds to start with......

Sorry - should have read: I thoroughly object to elective sections being offered on the NHS when there is no obvious need - (psychological or physical) while there are women having their lives, and their babies lives put in jeopardy by a shortage of midwives and the lack of one to one care

I get very annoyed with this idea that advocating natural births means that you reject "modern medicine" and medical advances. It's a way of making people look irratational and of discrediting their argument.

I have just read the link that Mears posted and am now really worried. I am having issues ttc number 2 after em-cs with ds 20 months ago. I got over the trauma after hypnotherapy but about 10 months of trying has elicted only a miscarriage so far.

why anyone would want to have an operation at the same time as having a child is beyond me (I've had 2 sections, for medical reasons)

Modern medicine is great. I wouldn't be here now if it wasn't for intervention and neither would my babies. I have had two c-sections and I bloody loved my last one and will never give birth any other way if I ever have any more children.

However, I do think it's totally barmy and pretty bloody sad that first time mums with no complications in their pregnancy should be encouraged to 'choose' c-section as an 'option'. Surely, with all the wonders of modern medicine, we should be focusing on helping women give birth in the way they were designed to as safely and happily as possible? Not advocating major surgery as routine...

But Gabygirl, no woman would ever request a caesarean without either a physical or a psychological need - she will either do it because she wishes to avoid certain physical risks of a vaginal birth (and this should be entirely her choice), or she will do it because of a serious fear of vaginal birth. And to deny a woman a caesarean for either of these reasons is not only cruel, but treating them like children/idiots.

'Whilst there is a shortage of midwives' just doesn't stand up as an argument. As I've said earlier, why not, in that case, save money on anaesthetists and refuse all women epidurals? There are plenty of costs that the NHS could be cut rather than refusing intelligent and informed women elective caesareans. Why not start with the ridiculousness of giving wealthy pregnant women £190 for no reason whatsoever?

But why is the fear of childbirth not dealt with in a gentler and more positive way? It's not patronising to suggest to a woman scared of vaginal birth that maybe, with the right support, she can manage it? I just don't understand the idea that a c-section is an easy option. Madness.