Cesarean Birth Statistics

[iknowitsmadbutiwantit]

Hi.
I am not currently pregnant (unfortunately)(dd and ds already), but my sister is and we have had some interesting conversations recently. One of these concerned the alarming figures I read somewhere that 1 in 4 women in America have cesareans. Imagine our suprise, when we checked out the national birth statistics in Great Britain! A 25% cesarean rate is not uncommon in this country either! My local hospital, Colchester General, has cesarean statistics of 25 - 28% depending on where you research. I personally know of someone who was told she would have to have a cesarean if the maternity ward was short staffed!
Do these figures worry anyone else? or is it just us? Id be interested to hear other peoples opinions. x

Totally agree Shaz - and amazing how many medical staff (or their wives) have them - the GP who encouraged me, the anaethetist's wife, the registrar friend of mine....hmmm.

Yep, one of the midwives had had 3! She was a good one for info.

there is nothing wrong with an ELCS if the mother is fully informed of the risks and she chooses to opt for it with the support of her carer.
Nothing wrong with it at all.

my consultant also had 3 sections and told me she would never choose to have a VB.

When surveyed in both the UK and USA the overwhelming majority of OB/Gyn's would choose and ELCS.

exactly canucktraveler, i don't need anymore info than that lol!

Its like a head chef telling you not to have the fish lol

Can anyone tell me why the WHO is so obsessed with CS rates and using these as some sort of "guide to care"? Is it also equally interested in with maternal birth injuries?
I think that it is very misleading for prospective patients just to look at the hospital's cs rates. I would want to look at use of ventose/forceps/induction/epidurals and what long term damage and on-going care women required after giving birth there. I would also be interested to see what the rates of PND were and would be looking at all these factors. (Me, overly inquisitive??)!
With regard to the cost of csections to the NHS it must never be forgotten that in Maternity you are always dealing with TWO lives - just how does anyone propose to put a price on them?

Gailforce

Amen!

Whenever I hear the US c-section rate being trotted out disapprovingly, it's usually in the context of them being so fearful of litigation. Which rather begs the question, just why would they be being sued if their section rate wasn't so high? Presumably because of preventable damage to mother and/or baby? Would this really be a preferable alternative?

ealey - Excellent point!!

Totally agree, gailforce1.

I'm not exactly sure what just looking at the CS rate of an individual hospital tells anyone, in the absence of any other info.

There seems to be a HUGE amount of info about other aspects of labour and birth which just aren't as easily available, if at all (levels of intervention like ventouse and forceps, as gailforce1 says).

There's also something deeply misleading about the 'cost per birth' argument that's used for CS's. Where does the cost of a mid forceps birth that causes long term physical damage to a mother show up?? Not on the hospital balance sheet. What about the cost of treating incontinence that may be a problem years after the birth, or surgical repairs, or physio treatment? What about women who need counselling after traumatic births? again, that gets paid for somewhere along the line - just not on the day you have your baby. The truth is that we don't actually know exactly how much birth costs.

(I do wonder, and this is just a private theory! how much our expectations of what constitutes an acceptable life for a woman after childbirth has changed over time. Anecdotally, I can think of women my grandmother's generation who were 'never right' after birth, and who seemed to have lived with levels of incontinence that I'm not sure would be considered 'acceptable' now. Let alone had more sex/more babies.)

All that aside - I've never had it explained to me why the WHO think the figure of 1 in 10 is 'right'. They must have their reasons. Genuine question - does anyone know how they arrived at that specific figure....?

Reallytired Tue 30-Mar-10 12:56:59

"Childbirth is not as dangerous as some people make out, otherwise the human race would be extinct."

Errhhmmm...the survival of a species does not depend on the majority of females surviving the reproductive years. In prehistoric times, life expectancy rates are believed to have been about 35 years (which meant that an awful lot of people died much younger)- not what we would consider acceptable today, but quite adequate to ensure the survival of the species.

Agree totally with gailforce and barkfox.

I recovered quickly from my emcs, and opted for elcs the second time round, after a research. I opted for elcs rather than VBAC because I was not satisfied due to the lack of info on instrumental vaginal births gone wrong. The elcs did what it said on the tin. Perfect.

The lack of info around injuries caused by botched vaginal births is criminal. You only have to go on mn to read about these cases, and how these women's physical and emotional needs are not adequately met.

Reducing the number of cs without improving the conditions in stretched maternity wards is arse-about-face.

I wonder if the large percentage of c-sections is because of women opting for epidurals whilst in labour? This can slow the labour and then bring on other problems.

I'm due to have an ELCS later this year following a fourth degree tear after a 5 hour second stage which ended in a forceps delivery.

I've stopped telling people that I'm having an ELCS because of the instant disapproval the majority give me. I shouldn't have to justify it, I'm having it for solid medical reasons of not wanting to be left with double incontinence. I know it's not an easy option, but for me it's the better one.

Thank goodness there's a choice - and for some women it is the better choice (though you'd be daft to take abdominal surgery lightly). We always hear people standing up for choice in home birth, waterbirth, drug free birth etc. an ELCS is also a valid choice for individuals to make with their midwife/consultant.

BTW, I only had gas and air during my last labour (not through choice!), so it wasn't the pain relief, it was DD's positioning.

Cakeywakey - forgive my ignorance but wasnt 5 hours a very long second stage? I thought that I had read on another thread about a maximum amount of time and cannot remember how long it was but not 5 hours. You said that you only had gas and air but not through choice - what did you request?

"Totally agree Shaz - and amazing how many medical staff (or their wives) have them - the GP who encouraged me, the anaethetist's wife, the registrar friend of mine....hmmm"

And yet midwives are more likely than the general public to opt for a homebirth or for low tech care in a midwife led unit for their own births. Maybe it's because they see the full range of births - being involved in both complicated and uncomplicated deliveries. Doctors really have very little involvement in normal birth, so you'd expect their perspective of risk to be distorted when it comes to making decisions about their own birth choices.

Whenever I hear the US c-section rate being trotted out disapprovingly, it's usually in the context of them being so fearful of litigation. Which rather begs the question, just why would they be being sued if their section rate wasn't so high? Presumably because of preventable damage to mother and/or baby?"

Because a medic can deliberately inflict a very serious birth injury on a woman - a cs incision - and she will never be able to prove that the doctor wasn't preventing worse injury to her or her baby, even though all the evidence bears out the view that the a very large propotion of c/s's are preventable.

I find it amazing that doctors involved in the large numbers of low risk births in the US ending in CS can believe they are upholding their hippocratic oath to 'do no harm' when there is such a mass of evidence that low risk women cared for by midwives have vastly better outcomes in childbirth.

I think I've come up with an anti C section argument this morning!

Eight months after the slice, I was doing Jackknives (like sit ups but evil) on Wii Fit and now my stomach feels very odd.

Doctors do see the worst effects of vaginal births gone wrong though - the risks and effects of which are not adequately disclosed to the public.

Which is the reason why I chose my lovely elective cs.

tittybangbang - I come from Canada, in almost all provinces midwives are not allowed to practice. Your care is by a OB/Gyn so they attend the full range of births. It is the same in the USA. Their perspective is not distorted. They have a stronger medical education and are able to handle every eventuality that a midwife cannot. Midwives cannot do CS's doctors can do it all, so it is midwives that often have the distorted view!

A CS incision is NOT a very serious birth injury on a woman! It is surgery yes, and with surgery there are risks, however with a planned surgery and an experienced doctor these risks are minimal. There are many, many risks associated with VB as well and funnily enough these are rarely discussed with mothers. Mothers are always told 'it will be ok', 'it's natural'. Many mother are not OK and they are traumatised emotionally and physically after a VB and then expected to endure this again because of pressure placed upon them from midwives and other holier than thou mothers.

Doctors are absolutely upholding the hippocratic oath, they are helping mothers and babies to enter the world SAFELY.

What you do with your body is during pregnancy is a choice between you and your doctor.

Gailforce, yes 5 hours is apparently a rather long time. DD was well on the way, just awkwardly positioned. I think they wanted to give me as much time as possible to get her out myself, but in the end I was just too exhausted to carry on. They did try ventouse first but couldn't get a good grip.

I only had gas and air as I was seven cm by the time we got to the delivery room, so it was too late for any other pain relief apparently - I'd have been happy to consider anything! - not that it would have ultimately made a difference.

I only mentioned the G&A because of Boulder's post that perhaps epidurals were a potential factor in high CS rates. Sometimes intervention is unavoidable.

Doctors also know how hospitals work and the variability in the quality of care by midwives, which can sometimes be shocking.

Why would they want to submit themselves or their wives to that under-resourced random system when an elective in a theatre is so much more controlled and result relatively certain to both mother and baby.

Sorry to ask again (I've tried googling to find a link, and haven't managed it) -

Why is it that the WHO have decided that 1 in 10 is an 'acceptable' c-section rate? And what is it they are taking into account there?

As someone else has mentioned, how important do they think preventing maternal injury is?

Before we get too eager to condemn surgical obstetric intervention in the Western world, this link might provide some food for thought -

www.womenatrisk.org.uk/vm1.html

It's about women who suffer vaginal fistula during childbirth in developing countries. Miserable reading.

"so they attend the full range of births". #

How many Obs/Gyn have experiencience in attending mothers throughout active labour, as a midwife does? How many Obs/Gyn have extensive experience of normal physiological birth - that is birth which doesn't involve continuous monitoring, epidural analgesia, oxytocics, synthetic opioids, amniotomy, episiotomy and instruments? My understanding is 'doctors involvement in the birth' amounts to overseeing the management of labour and catching the baby.

"Their perspective is not distorted".

Well it is if they're involved in a disproportionate number of births which are physiologically abnormal!

"They have a stronger medical education and are able to handle every eventuality that a midwife cannot. Midwives cannot do CS's doctors can do it all, so it is midwives that often have the distorted view!"

Midwives attend C/S's and accompany women through the event. They also care for women throughout normal labour. Doctors don't do this. They provide medical care if it's needed. What other role could they possibly have in normal birth? The majority of births would take place quite happily and healthily without any involvement from a doctor. Their skills are in sorting out problems in childbirth, not facilitating normal birth. And the evidence for that is the higher CS rates found in women who choose obstetric care for pregnancy and birth than similar women who are cared for primarily by midwives.

"A CS incision is NOT a very serious birth injury on a woman!"

Errr - it's a 10cm incision through muscle, fat and your internal organs. It requires the involvement of highly trained medical specialists, leaves a permanent scar and takes weeks to heal. It puts the mother at risk of scar rupture and placenta praevia in subsequent pregnancies. It is a major birth injury!

"There are many, many risks associated with VB as well and funnily enough these are rarely discussed with mothers. Mothers are always told 'it will be ok', 'it's natural'."

Where? By whom?

Women in the UK generally know that the majority of women giving birth will perineal damage, sometimes serious damage requiring surgical repair. They are also aware of the high rates of emergency c/s.

"Many mother are not OK and they are traumatised emotionally and physically after a VB and then expected to endure this again because of pressure placed upon them from midwives and other holier than thou mothers".

I'm not suprised so many women have traumatic vaginal births, when you consider the way labour is so often managed in medical envinments.

If you herd healthy women wanting to have vaginal births into unfamiliar, sterile environments, surround them with strangers, hamper their mobility and give them lots of drugs which distort the normal hormal cascade of labour, then you are going to get the sort of outcomes which we see regularly discussed on this board: high rates of 'failure to progress' resulting in emcs, long and painful labours, instrumental deliveries, knackered pelvic floors, episiotomies, and babies that won't breastfeed. Well - quelle surprise!

"If you performed C/S in a barn with staff who were poorly trained you'd get appalling outcomes".

"Doctors are absolutely upholding the hippocratic oath, they are helping mothers and babies to enter the world SAFELY".

How can they if they are not able to help more women to birth their babies safely without needing major surgery? There are countries with half the C/S rates of the US which have better perinatal mortality. And I'm sure within the US and Canada there are hugely varying rates in C/S between different hospitals, dealing with the same sort of demographic. This is also true in the UK. Some hospitals have much lower c/s rates than others, even taking into variations in demographics.

"What you do with your body is during pregnancy is a choice between you and your doctor"

But when your doctor has a vested financial interest in you needing major surgery, and little experience in normal physiological birth then really - you have to ask yourself how much choice as to how your labour is managed you actually have.