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

Rather a throughly medically supervised 'birth injury' on my bikini line than my bits being ripped to shreds by butchers (my brother's personal experience of a maternity ward as a houseman).

Titty, your ideal of a vaginal birth is so different from what women can expect in reality. Nice, but no use to me.

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

Sorry - that was me, I wasn't quoting from someone else's post.

The point I was making is that you have to provide appropriate care in an optimal environment to get the best outcomes. Women having C/S who have highly trained doctors, a well-equipped, clean operating theatre and good nursing care following surgery will have the best outcomes for surgery. Women who are trying to give birth in unfamiliar enviroments, accompanies by caregivers who are inexperienced with supporting mothers through normal physiological birth, women who don't have freedom of movement and are denied food in labour are not labouring under optimal conditions, and are therefore bound to have outcomes which are worse than they should be. I really think this needs to be acknowledged when we are comparing the outcomes for C/S and V/B.

Most C/S mothers have optimal care. Most V/B mothers don't.

"Titty, your ideal of a vaginal birth is so different from what women can expect in reality. Nice, but no use to me"

Well - it depends what kind of birth they're going for. In the UK the majority of mothers booking homebirths with midwifery care have straightforward labours followed by a spontaneous birth. The vast majority are very happy with their birth and of those who have had both hospital and homebirths, almost all prefer giving birth at home.

I chose optimal care for my V/B: homebirth, one to one care from a midwife I knew well, and I had a doula.

I wish all women had the option to be cared for in labour by someone they know and trust, in an environment which is supportive of normal birth.

titty, I do see your point there, about levels of support and care for VB - and it's actually v similar to blueshoes's post from a couple of pages back - "reducing the number of cs without improving the conditions in stretched maternity wards is arse-about-face."

That's one of the reasons I think reducing the whole debate to 'HIGH CS RATE BAD/LOW CS RATE GOOD' is unhelpful. A low CS rate isn't good if it is leaving women injured and traumatised after VB.

I also don't know (in response to someone else's point, I forget who, sorry) that it's true that women ARE well educated about the actual process and risks of VB in the UK.

A mate who gave birth last year (failure to progress, crash CS, again!) said she found out more about birth afterward than she did beforehand, while doing some research to 'make sense' of her experience. She said the NCT class she'd been to (while good in other respects) talked as if an intervention free birth with zero tearing/injury was 'the norm', rather than something which in practice a minority of women experience. She said if nothing else, she would have felt lucky if that had been her experience, rather than feeling a failure because it wasn't.

Not everyone wants a homebirth. I want to be in a hospital and chose the option that had the greatest likelihood of a safe birth for mother and baby ie cs.

I had two natural births, very big babies, 10 8 and 11 7 in hospital with no intervention and quite long labours 12 hrs+. My third boy was born last summer and was also huge 10 15 but was by emergency caesarian as I had a low placenta and haemorraged when my waters broke. I don't think they are militant in our local hospital, they just seem to want to put the woman's needs first.

Well titty - you have not experienced or lived in the USA or Canada, I have!

The doctors do care for you during your birth in Canada and they are NOT financially motivated. They are interested in the best interests of mother and baby and ultimately their safety. You may only see a consultant here in the UK if required but NOT in Canada. Don't make assumptions! Very few women in North America would even choose a midwife if the offered the choice.

"Midwives care for women throughout" Really?? Hmmm...in London on the NHS you are lucky to see the same midwife twice. In addition to this you are lucky to have a midwife in your room for the majority of your labour. I laboured here for 10 hours in an NHS hospital and saw a midwife twice!! Once to put a monitor on me, which ran out of paper and my DH removed and once to get a piece of equipement from the room that I was in for another room! Most of my London mum friends have very similar stories, unless they received private care. You are seriously mistaken if you think that this is the norm.

Where?, By Whom? - Time and time again midwives, antenatal classes, etc DO NOT tell women of the risks associated with a natural birth. Tears, instrumental births, Extremly painful inductions, etc. You only have to go on any mothers forum, website, to see that there are an overwhelming number of women who experience birth trauma in varying extremes. Furthermore if they become pregnant again feel pressured into further natural births by midwives and people judging them!

A CS incision is NOT an injury - definition of injury - any physical damage to the body caused by violence or accident or fracture - it is not this it is a carefully executed incision by a trained professional for the welfare of mother and baby.

"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." - There are also alot of countries in the world that do not offer the level of care that the USA/Canada/USA/Australia along with CS's and have very high mother and infant mortality rates.

You made your choice for a home VB with midwife and Doula and had a positive outcome and you are satisfied. That is fine.

I had a CS with a Consultant in the UK. I recovered very quickly had a healthy happy baby and a positive outcome.

EVERY woman has a choice!!!! It is not up to you or me or anyone else to decide what is best for them. It is up to the woman and her doctor. Stop judging others decisions. I don't judge you or any other woman for having a normal birth.

oh my god shouldn't have read this thread, i'm scheduled for a vb and i'm now fucking terrified. i understand people who had a cs are glad as it went well and they're safe but perhaps they should think a bit when posting on the childbirth topic. i'm sitting here crying becuase of the overwhelming negative info on vb. what am i supposed to do now?

canucktraveler - I want to stand up and give you a roujnd of applause - its all very well for people like tittybangbang to extol the virtues of VB but a home birth is not for everyone (if Id had home birth IM quite sure my DS would have been in mortal danger as well as me) and I certainly cant afford a doula!

Its an idealised version of childbirth thats a nice idea but not the reality and if the alternative is a very bad VB experience (as Ive already had) give me C section any day of the week!

An arbitrary decision that CS rates should be lower based on nothing but believeing that VB is the "IDEAL" is pointless - REALITY IS, A CS is better than a badly managed VB!!

Ask my husband who had to try and help me through and understand the injury I recieved when I didnt understand what had happened to me because no one wanted to admit (in the medical prfession) that m experience was anything other than normal, or that we cant have sex for 2.5 yrs without pain and the loss of intimacy and distance that caused in my marriage, or why I became so depressed because I felt like a big freak/failure for having so m any problems afterwards, not being able to poo properly without pain for months and months, crawling on my hands and knees because the pain between my legs was so bad, ending up in A&E after the stiches split (after Id already stopped having visits from the midwife - so no one knew) and an abcess dveelpoed on the split, screaming in agony and sweating with pain. Try telling it to my son who didnt understand why his mother was a shell of a person that could barely function but got no help from anyone. Try telling me that 2.5 ears after that VB, a week before my wedding I had to take myself off to a family planning clinic in order to access a gyneacologist becuase my GP had a look and "couldnt see any problems, all looks normal to me" when I t;ld of the pain i suffered and my inability to have intercourse, then having to use vaginal dilators to try an d stretch the scarred mess back to something usuable. Tell me VB is better and I'll tell you to dream on. C section for me.

Rara - I chose ELCSs. A couple of my friends did. Most of my friends had hospital VBs and a couple had very successful home births. The majority of births in this country are perfectly safe for mother and child. I think that some ante-natal classes do downplay the things that can happen during birth (though mine didn't) but the message on this thread is to do the research and also maybe to be a bit assertive about the kind of birth YOU (not the doctors, not me, and not anyone else on here) want. If you don't want an epidural then be assertive, but if you do then also be assertive. And of course when push comes to shove (literally!) things might not happen exactly the way you want it and that's when it also helps to have done the research and be assertive (maybe with your birthing partner) eg over forceps or whatever. It's also important to realise that you are allowed to change your mind.

This thread is about caesarians so that's why people are giving opinions. But I think you will find that most of us who chose sections ourselves are completely in support of choice for others.

I would echo what bellissima says - I am fully in support of choice for others but that does not mean pretending these things dont happen.

As bellissima says, I was under the impression that epidural, forceps monitored labour (i.e confined to bed lay on back) were all fine and would cause me no prolems. I wish Id know that if Id refused forceps Id have had a c section and therefore had the choice to try labour out but ultimately when it didnt work out in my case, have c section and avoid the years of trauma ive had. Women should be allowed to speak up about their experiences because no one did when i had DS and the shock of what happened and the isolation i felt were as bad as the physical stuff so i dont think its fair to say we should "be careful what we say" we are only speaking the truth of our own experiences.

pinkmook my story is almost a complete opposite to yours.
I had 2 VB's totally normal, recovered as usual.
Followed by an EMCS with no.3, a complete burst abdomen, holding the covering of the bowel in my hands screaming for an ambulance, re admission to hospital, unable to walk for weeks, serious infection, re-opening of wound again, continuing problems with bowel, ongoing pain and PTSD.
IMHO C section is not the easy option I have suffered far worse than I could ever imagine from this, I would have 200 VB's rather than one c section.

Just because your cs was better than your VB does not mean its the better option.

What works for one woman will not work for another, indeed what birth is for one baby can be different for each one you have.

FWIW my local hospital has a CS rate of 27.1% but they are the major university hospital for the area so take all high risk births tbere which I imagine bumps up their figures

oh and FWIW I was given the choice with my EMCS between trying synto or going for EMCS, after an 'off the record' chat with a senior MW I opted for the EMCS. Having been through my notes, and despite all the problems Ive had since I know I made the right decision for ds2, he would not have survived synto

Good for you mosschops but it doesnt change the fact that insisting VB's are better then ELCS is the right thing to do. The point I and others have tried to make is it seems people want to bring down cs rates when all the other attendant issues re: induction, one to one care haven't been addressed first and people making comments like

You had an EMCS I am talking about ELCS

"I suppose that women survived in 1960s who would have died in the past. They are now becoming granmothers. Natural selection would have prevented. The daughters of these women are also genetically prepositioned to find labour hard. Also there are more obsese and older women giving birth"
the impression I get is people think CS's are or overweight, lazy, soft people. NOT the case.

Excuse me, I wasnt being rude in my post I was just telling my story, as you did, so not sure why I get a 'good for you'

The FACT is that VB is better than a CS. A CS is major abdominal surgery that alone carries risks with anaesthetic, damage to bladder/bowel, infection etc.. A normal VB carries none of these risks.
However as I said, this is not the same for all women in all cases, for me 2 VB's were best in those circumstances and then an EMCS was best for me in the last birth.

EMCS or ELCS its still major surgery that carries risks

and just as an aside Im willing to bet that people around you, health professionals, family, etc had much more of an understanding/sympathy for you having had such a traumatic situation arise from an operation rather than a "normal" birth.

Like someone else said there are risks associated with any birth whether VB or CS and as Canucktraveler says "Time and time again you read the boards on here and elsewhere about horrendous natural birth expericences. I would say that the majority of mothers that have a planned CS (as opposed to a emergent CS) have good birth experience"

well excuse me but i wasnt being rude either! How is saying good for you rude!

actually the health professionals had never seen what happened to me before, they all stuck together and sang the same story and I am now persuing legal action against the trust for medical negligence after having to see a private consultant to get an honest answer.

Why do you think people have more sympathy for those that have had a traumatic section than a traumatic VB? Surely trauma is trauma no matter how it happens.

And my EMCS was a great experience, but the resulting trauma after that was not!

mosschops30 - I am sorry to hear about the trauma that you experienced in your 3rd birth. That sounds horrible! . I hope that there wasn't negligence involved in your case and I hope that you get it sorted out.

A CS is major abdominal surgery, I do not disagree with that. However I donot believe that there is a quantifiable difference between a doctor making a carefully executed incision in the abdomen or a midwife making an incision from your vagina to your anus. Or Forceps ripping and tearing through your uterus.

For the sake of sounding like a broken record women should be explained ALL the risks in whatever option they choose (VB or CS).

of course trauma is trauma but its a little hard to explain the vaginal trauma as its, y'know, a private area and normally discussed at length with people whereas an mention an op going wrong and 1) everyone will sympathise 2) you wont be embarrased

as other on here have said "And I agree with others that I have heard far more traumatic VB stories than ELCS stories. The latter is, of course, major surgery (although not usually under general anaesthetic, unlike the tonsillectomy I had as a child of the wisdom teeth removal in my 20s - both of which I have now been told by doctor friends were risky and probably unnecessary operations). If you wish to keep down NHS costs there are far easier targets in the form of injured drunk drivers, the obese, smokers and so forth (all of which are separate debates)."

and

"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."

Your surgery went wrong - thats terrible, but what has that to do with the issue we are talking about that rates of c sections have underlying reasons and a blanket policy of saying they are BAD is wrong ??

pinkmook I can tell you that lying on the bed holding my bowel in my hands thinking I was about to die was not embarrassing but absolutely terrifying.

As its clear you are so bitter about this, and only like the sound of your own drum banging I'll bow out and let you continue to only listen to yourself!

thank you 'canuk' I agree with most of what you say, but I dont think it should be a choice ante-natal. Things go wrong with both we accept that the minute we get pg. Its not right but it does happen

wow - mosschops you are so incredibly rude i hardly know where to start. I did not start any of the ing nor attack you personally as you have just done to me so quite how I'm in the wrong for wanting to be heard above the people saying C sections are always wrong i dont quite understand.

I said your experience was terrible but repeat the point (which you seem unable to answer) what has an operation going wrong got to do with the point discussed here that C sections are not (blanket policy) a bad thing?

How rude to speak to someone who has gone through years of emttional and physical trauma so dismissivley as to say "and only like the sound of your own drum banging I'll bow out and let you continue to only listen to yourself!"

At least Im able t discuss it without deliberatley insulting people.

"The FACT is that VB is better than a CS"

I don't think I would put it that way.

I don't think you can easily assign compartive values to CS and VB.

I'd encourage anyone who's confused about this issue to have a look at the guidelines on the RCOG website - they're very helpful.

here

FWIW, and this is off-topic a bit, sorry - I think it is hard for women who've had difficult VBs, and suffered injury, to express their experiences freely, AND I also think they often risk an unsympathetic reaction.

Talking about pain/issues with an abdominal operation is more acceptable territory IME than talking about things like incontinence and sexual difficulties.

But there are also odd attitudes that crops up around vaginal birth injury - from 'ugh, why do you have to talk about disgusting stuff' to 'it's all a Natural process, anything you've suffered is Natural, so stop moaning about it.'

With CS's, I have heard the old 'you've got a healthy baby abnd that's all that matters' line, as a way of dismissing any unhappy experiences the mother has had - BUT, I think there is a basic acceptance that major abdominal surgery is a big deal, and mothers who've had CS's have more 'permission' to discuss trauma and injury.

I don't think asking people who've been through traumatic experiences to 'be careful' what they say helps, tbh. Suffering in silence isn't a great way to go about things.

"Very few women in North America would even choose a midwife if the offered the choice".

Women receiving good quality midwifery care in Europe have lower rates of maternal and infant mortality and morbidity than low risk women being delivered by medics in the USA and Canada. If women in the USA and Canada reject midwifery care it's probably because a) they are unware of this fact b) there is no culture of midwife led birth where they are so they simply don't understand what they are rejecting and c) because they've been raised to see all birth as medical emergencies requiring the input of surgeons, (which is what obstetricians basically are).

"Midwives care for women throughout" Really?? Most of my London mum friends have very similar stories, unless they received private care. You are seriously mistaken if you think that this is the norm."

No - one to one care and continuous care from the same midwife are not the norm here, though midwives, doctors and mothers feel it should be so. It's very much a postcode lottery. But it's what we are aiming for and what we believe is safest for women and babies. You can't compare apples and pears. It's pointless comparing an expensive, doctor led birth in a private medical facility with a birth in an NHS maternity unit which is understaffed. On the other hand, in London £5K will buy you wrap around maternity care from one experienced independent midwife throughout your entire pregnancy, all your scans and blood tests, two midwives for your birth and a month's worth of postnatal visits. Would this compare favourably with what you paid for your maternity care in Canada? (I personally only paid my midwife £1800 - but it was 'mates rates'. The standard package for full private midwifery care in London is about £3500 for the full shebang).

"A CS incision is NOT an injury - definition of injury - any physical damage to the body caused by violence or accident or fracture - it is not this it is a carefully executed incision by a trained professional for the welfare of mother and baby."

Well, here's another definition of the word 'Injury':

"Damage or harm done to or suffered by a person or thing" considerable injury to the campaign.
"A particular form of hurt, damage, or loss: a leg injury".

I think you could call a large cut to your stomach and one of your internal organs 'damage' or 'harm', don't you?

And if the mother undergoing cs could have safely had her baby vaginally (as most mothers having c/s could were they given optimal care during pregnancy and in labour, according to the World Health Organisation) then you'd have to surmise that it's an avoidable injury.

"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." - There are also alot of countries in the world that do not offer the level of care that the USA/Canada/USA/Australia along with CS's and have very high mother and infant mortality rates"

And your point is? The USA spends more money per mother than any other country in the world but is 37th in the maternal mortality stakes. How can you be defending its system of maternity care?

"EVERY woman has a choice!!!! It is not up to you or me or anyone else to decide what is best for them. It is up to the woman and her doctor. Stop judging others decisions. I don't judge you or any other woman for having a normal birth."

Sorry - I haven't seen any 'judging' going on here . This isn't a moral issue! (not for mothers anyway. I'd argue that the medical establishment has something to answer for though).

And nobody is arguing that women shouldn't be the primary agents when it comes to deciding how they want to have their babies. (although this is a complicated issue in the UK because of finite sums of money avaible to spend on maternity care - there's a good argument that the health and safety of mothers and babies as a group must be prioritised above the wishes of the mother for a particular birth experience, if it is hugely expensive and medically unjustifiable).