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.

.. and I agree with Mrs Mattie that there's no need to 'encourage' c-sections amongst first time mums, but I do think they should be agreed to when requested by a woman who has done all her research.

Sadly, even with all the wonders of modern medicine, vaginal birth is a horrendous ordeal for a good many women. The fact that our bodies were 'designed' to do it is a total irrelevance as far as I'm concerned. Our bodies were also 'designed' to get cancer, but we sensibly use all the wonders of modern medicine to combat it. If some women wish to avoid vaginal birth, to force them into it because of some spurious 'natural' argument is just not acceptable.

I think Mrs Mattie is right that women with a fear of vaginal birth should be offered help and support BUT (and this is a big BUT) it should only be done at the same time as making it very clear to the woman involved that the choice is ultimately hers. This is a far cry from the way things are on the NHS at the moment, and the reason why I have chosen to go private, for my first baby, in order to ensure a elective caesarean.

I have a lifelong fear of vaginal birth. And I also think, rationally, that an elective caesarean will be the best option for me, both physically and mentally. I have had a lot of counselling and psychotherapy over the years, to deal with various anxiety issues, and I remain convinced that this is the case. I have also done a lot of research on the risks of elective caesareans, so am going into it completely with my eyes open.

The first time I got pregnant, I was so terrified about the prospect of vaginal birth that I went into complete meltdown, and I had an early miscarriage. My extreme stress may not have caused the miscarriage, but I will always feel that it did.

So with this pregnancy, I was simply unwilling to take the risk of having to 'fight my case' with midwives and consultants, and go through my pregnancy unsure of whether I would be able to deliver my baby in the way that I chose, and living in terror of an outcome that I feel could leave me in severe mental distress.

So I went private - which was not an easy decision for me, as we're not very rich, and as a matter of principle, I'm not a huge fan of private healthcare. But I felt I simply had no choice.

But to return to Mrs Mattie's original point, I would have been more than willing to undergo any amount of therapy and counselling and support from the NHS, IF AND ONLY IF I had been reassured that ultimately the decision was mine to make.

I have kept the fact that I am having an elective caesarean secret from most of my friends and acquaintances because so many people I know are so judgemental about this issue. Which I think is a real shame. Personally, I wouldn't want a vaginal birth but I would defend to the end another woman's right to have one if that is what she chose.

I think a lot of women need to be more sisterly in their approach to this issue.

but as far as i know, tokophobia is a recognised condition and the NHS would plan you a c.section ? is that not the case?

Why is it that people assume that if you want a csection it's because you're afraid of vaginal birth? Fear doesn't necessarily come into it and some women just don't want a vb and consider the risks of section to be (not less) but different from vb and more acceptable to them? There's nothing about vb that appeals to me and I was very happy with my section. I'm happy for anyone who wants a vb to give it a go but don't see why those of us who don't should be denied the choice of a section if thats what they prefer.

Lulu, I'm sure you're right, and I'm sure if I'd fought my case, I could eventually have got a c-section 'agreed' on the NHS. But I very much doubt (from what I've heard, someone correct me if I'm wrong) that any consultant would have agreed to this at the outset, and at the time I got pregnant the thought of months of uncertainty and even the thought of having to make my own case and have it 'approved' filled me with horror. I was so anxious about so many other aspects of the pregnancy already...

Part of me does regret this now and I like to think that if I ever get pregnant again, I will have more strength and knowledge to fight my corner on this. (In fact I would probably have to, as we couldn't afford to go private again anyway!) But I feel it's very wrong that women should have to 'fight', or break down and beg in front of a consultant. They should be given proper informed choice.

a c.section is more expensive in terms of resources and staff and beds than a vaginal birth, and the NHS does have finite resources, i thikn that is a big reason why a vaginal birth is the default mode of delivery. it is not just a 45 minute slot, you are on an antenatal ward, prepped, taken to theatre, you need aneasthatist, reg/obs to do the op, 2 midwives, scrub nurse etc etc. then 2 - 3 days in hospital. there can be a higher incidence of breathing difficulties which can mean a paeadiatrician is needed, possibly a stay in SCBU.

fine to want one, but i don;t thikn the nHS cna supply them on demand for jsut wanting one.

women have to fight for all sorts of things , such as a home birth or water birth, it is not just sections taht can be signled out as being difficult to arrange.

i agree it is awful that women do have to go through the stress of begging and pleading for their birht experience

Couldn't agree more with Chynah - different women consider different risks acceptable to them, and they should be the ones making that choice ultimately as they have to live with the results.

I was speaking to a friend recently, who actually had a relatively 'easy' vaginal birth, but said that she would consider having a section next time, because she was so upset that she just felt nothing during sex anymore, well over a year later. And she was astonished that no midwife had ever mentioned this to her how frequent a side-effect of vaginal birth this was. Nor, in fact, had anyone outlined any of the other risks of vaginal birth. So the 'risk' discussion is usually all very much slanted in one direction.

Many people, of course, would prefer to take the risks of pelvic floor damage over the (much more unlikely, but potentially more serious) risks of surgery. Which is completely their call. But for these decisions to just be forced on women, who aren't given adequate information, as is the case now, is disgraceful, in my opinion.

pregnancy itself can and does cause damage to the pelvic floor. c.sections can damage teh bladder and bowel. there is a flipside to each and every point and i do agree that giving women the information to make an informed choice is vital.

"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"

Hmmmm. So pathological fear of birth is much more common among celebrities or wealthy women with private obstetricians? (a group much more likely to have elective sections)

At present women who have a clinical need of a c-section (for psychological or medical reasons) can have one on the NHS.

What clinical benefit is there for women in having a c-section if they have no medical or psychological need? Why should the NHS provide an expensive treatment where there is no proven benefit to mother or child and where a cheaper, clinically safer alternative is available (vaginal birth)?

Some celebrities may have a fear of vaginal birth, others may just prefer to risk the physical side-effects of a c-section than the physical side-effects of a VB. That is completely their choice, and it should be the choice of every woman.

Just out of interest, why do you think so many celebrities do choose elective c-section if it so obviously a riskier and worse clinical choice?

As has been debated earlier on this thread, so I won't repeat here, it is by no means conclusive that a vaginal birth is safer than an elective c-section for a healthy woman (and baby) with no other risks, carried out at 39/40 weeks.

"Some celebrities may have a fear of vaginal birth, others may just prefer to risk the physical side-effects of a c-section than the physical side-effects of a VB. That is completely their choice, and it should be the choice of every woman"

Not if providing it compromises the safety of other women and babies in a system where resources will always be finite. Even if the tax payer was willing to stump up huge amounts of extra cash to enable say - 50% instead of the current 25% of our female population to undergo major abdominal surgery, where would all the extra trained obstetricians come from? And midwives? And anaesthetists? And intensive care nurses? You can't just magic these people out of thin air.

"Just out of interest, why do you think so many celebrities do choose elective c-section if it so obviously a riskier and worse clinical choice?"

Low risk women who have a surgeon as the lead professional in managing their pregnancy and birth are more likely to choose a c-section, and more likely to have worse outcomes overall, than women who choose midwifery care. Surgeons promote surgery.

I should imagine that celebrities generally don't have to put up with much 'unpleasantness' in their day to day lives. Everything in their lives is scheduled to suit them - they don't have to wait for anything. I should imagine that most of them are pretty controlling. The lack of control around vaginal birth would be unbearable for a lot of women who are used to having what they want, when they want and how they want it. And the fact that they are always surrounded by people eager to tell them exactly what they want to hear.......

As for celebrities making rational, informed choices about surgery:
goodgrief

some slebs do have normal vaginal births, even homebirths

davina mccall has had 2 oe 3 homebirths

charlotte church has had 2 homebirhts

i am sure i read that pamela anderson did too

i thikn that nicole richie had a VB

so not all slebs, is it?

but i do think the unpredictability of birth would be an anethema to someone who is used to scheduling every minute of their life.

here

And Meryl Streep!

I can't imagine we would ever get to the point where 50% of women would choose a c-section for no medical reason - I'm sure I read on one of these threads recently that fewer than 3% of women would consider requesting a caesarean with no clear medical reason.

Saying 'resources are finite, so women who are horrified by the prospect of vaginal birth just have to lump it' is the wrong way to approach this, in my opinion. The right way would be: all women starting to fight for the right (and funding) for every woman to have her delivery of choice - with the usual caveat of understanding risks and benefits, and so on. This may be a far-fetched dream at the moment but it needn't be.

"I should imagine that celebrities generally don't have to put up with much 'unpleasantness' in their day to day lives"

So is this an admission that c-sections are a pleasanter experience? I thought they were more dangerous, risky and so on... ;-) As Lulu says, it's a myth that all slebs have c-sections, so I think it's hugely unfair to belittle those that do as being spoilt control freaks - we don't know any of them, and they may very well have their own perfectly valid reasons for making this choice.

I thkn the NHS should and does provide elective sections for women with phyiscal reasons they cannot give birth vaginally or it would be too high risk.

and for women with tokophobia, although i do think that it would be great for women to be offered counselling, and maybe a doula too support them emotionally , regardless of whether they had a VB or c.s

"I can't imagine we would ever get to the point where 50% of women would choose a c-section for no medical reason - I'm sure I read on one of these threads recently that fewer than 3% of women would consider requesting a caesarean with no clear medical reason."

I quote:
"Among developing countries, Brazil has one of the highest rates of caesarean sections in the world. In the public health network, the rate reaches 35%, while in private hospitals the rate approaches 80%"

So - c-section rates can sky-rocket when women are able to choose surgery.

"Saying 'resources are finite, so women who are horrified by the prospect of vaginal birth just have to lump it' is the wrong way to approach this, in my opinion. "

You can approach it any way you like but the facts are this: the health service is under huge, and growing financial strain. We have an aging population, and a population which is rapidly becoming more obese. There will NEVER be money under our present 'free at the point of use' system for medically unjustifiable, and expensive treatments.

They are more risky.

But they are also generally uncomplicated, and don't usually involve a woman having to endure hours of extreme pain which can be hard to alleviate, unlike vaginal birth.

I have to say anyone who chooses major surgery without good reason should pay for the operation themselves.

I thought the idea is that women should have CHOICE whether that choice be homebirth, VBAC, epidural, activebirth, waterbirth etc? Some of these options cost more than others but are deemed acceptable but CS is not? Surely it's just a choice like any of the others that a well informed woman should be able to make.

Also if cost is such an important factor I bet my (purely elective no medical reason) CS cost a lot less than some poor womens failed attempt at VB (and possible repair/therapy afterwards) - and don't forget the theatre team would have been on standby for her whatever just in case she needed a CS they aren't suddely hired for specific jobs.

There is evidence to suggest that in some cases (aware its mostly due to luck)if a woman is afraid of labor she is more likely to end with a emergency c section surely that after 20 hours of natural labor would cost more than a elective section. I had a vb but personally think women should be told the risks and if they still want a section then their reasons must be important and they should be allowed. Only wondering why does a section cost more when it takes less than 1 hour and many vb mean you need 20 to 30 hours of care from mw, consultant,epidural man and pharmacist. Not disputing it costs more I just thought it was cheaper for a section for some reason.

Because a section requires a tema of doctors (who are generally more expensive than midwives, nurses, etc.) to all be there with their undivided attention.

For VB, they pool a whole bunch of women and have the less qualified (and lower paid) staff (mis)managing the whole lot.

"There is evidence to suggest that in some cases (aware its mostly due to luck)if a woman is afraid of labor she is more likely to end with a emergency c section surely that after 20 hours of natural labor would cost more than a elective section"

Almost all women are afraid of labour in some capacity. Rightly so - it bloody hurts.

Women who have a disabling fear of labour generally have access to elective sections on the NHS.

How likely you are to end up with a c-section in labour isn't 'mostly due to luck' I would say. The c-section rate has doubled in the past decade or so, and yet the stillbirth rate hasn't fallen signficantly in that time. Are women more 'unlucky' now with their labours or is the high number of c-sections down to the culture of our maternity system?

Would also point out that having a doula or a homebirth seems to greatly cut your risk of needing a c-section. Or is it that low risk women who go into hospital to give birth are doubly unlucky compared to women giving birth at home?

Thanks athene I never knew that. Personally am scared stiff of the thought of someone slicing me open and would only allow if I had no other choice, and cant imagine why someone would choose this so assume they must have a good reason.

I would agree gaby in alot of cases c sections do seem medically unecessary. In some luck does seem to play a factor though. I think counseling should be offered prior to elective section being granted but I don't think women should have to pay for a section.