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

barkfox - thank you for putting what was in my head but was too shocked by mosschops attack to express.

I feel so saddened and upset by her behaviour but I wont be told to basically shut up by anyone.

sorry tittybangbang but this is a judgemental comment since Im neither overweight/obese nor older "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"

what i mean to illustrate by quoting that is I and lots of others who have chosen to have ELCS after traumatic VB are made to feel like we are nuts for wanting to to this avoid the trauma we suffered 1st time OR its becuase we must be fat/unfit or just a bit pathetic and "did we not realise labour is hard" type thing. Im not making this up! This is how I and lots of others are portrayed and I really cant see whats worse about a planned op as compared to a VB after encountering significant injury from the first VB?

Thats all Im saying - and saying that C sections can go wrong doesnt change it! I know they can but on balance id rather risk that than go through the last few years of crap related to my VB again

Sorry, this is such an obvious point, but it keeps cropping up -

tittybangbang, with all due respect, by your definition, ALL surgery is 'injury.'

You can argue that one to the hilt if you like! But I think that's rather an extreme view.

I take your point about cost of birth, although it's already been pointed out elsewhere that (a) we don't know the true cost of birth - aftercare is NEVER taken into account, so the cost of VB v CS remains essentially unknown, (b) there are SO MANY other places you could start to save money on the NHS before you get anywhere near childbirth! and (c) there are other birth choices that are 'expensive' as well as CS. Home births require individual attendance in a way that I know lots of women find attractive - but that's more costly than the way care is provided on a labour ward. Water birth units are more expensive than rooms with a bed. Epidurals cost something like £500 a pop, don't they?

If you really think "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", you're going to have to look at more than just CS's.

And forgive me, but your initial stance seemed to be frustration that you felt medicine as an institution was dictating too much how a mother should give birth - by being (in your view) too pro-CS. Now you're talking about denying a mother her individual 'wishes', or choice, for a particular birth experience.

I find that just as coercive, I'm afraid.

oops, cross post -

pinkmook, I've heard some very unsympathetic and judgemental comments directed at women who've chosen a ELCS after a traumatic VB. I think it's baffling and horrible, and utterly disrespectful.

Tittybangbang - You are being extemely judgemental. It is when women encounter attitudes like yours they feel like failures for even wanting to consider or having had a CS. This has been echoed by several women on this thread. Women should be supported in their choices.

An injury is caused by an accident! A CS is not an accident. When I had my vagina sliced open with a knife as a child, that is what I would call an injury! Not an experienced, prepared and qualified doctor making an incision to deliver my beautiful DC. You twist the facts to sound good in your own head.

In Canada you do NOT pay for giving birth. You pay for a set provincial health care premium each month to cover your healthcare whatever it may be.

People in the USA and Canada reject midwives because they do not feel that they are the safest option. I have a very good friend in Canada that is an OB/Gyn and she thinks that midwife led births are very risky, let alone a birth outside of a hospital. You do not know anything about the US or Canadian systems so stop making assumptions and comments based on something you know NOTHING about!

The USA also is a much bigger country then the UK with an exponentially bigger population. Any country with more people will have higher statistics then one with less people. There are also a HUGE number of factors that contribute to maternal and infant mortality, it is completely unreasonable to compare these to CS rates alone. The countries with the highest rates are those that do not have OB/Gyn's and have CS when required. This is the case with the top 50 countries on the list. Once again skewing details to suit your argument.

Really the COST argument again?? It is a very sad world when people such as yourself put a price on the emotional and physical health of a mother and child. Lives are worth saving!

If people want to have midwife births in hospitals, at home, in the forest with naked people dancing around they are fully entitled to do so provided they are fully aware of all of the risks. I don't begrudge anyone for their choice, you have done so repeatedly! By the same token if someone wants to have and ELCS and are fully aware of the risks then this is up to them and their healthcare provider. People like you need to get off of the self-rightgeous mother bashing train and leave people to make their decisions.

Choo! Choo!

Dont know where you get you maternal mortality figures from but the USA is right behind the UK. Pretty good considering that they have a much better population.

www.nationmaster.com/graph/hea_mat_mor-health-maternal-mortality

barkfox its just so nice to hear other women basically "stand up for" (although thats a bit of a clumsy way of putting it but I cant think of another right now ) for this opinion as I so often feel maligned for feeling this way. So, thank you.

you are welcome, pinkmook.

(hugely off topic, but I think the way that some women are so horribly judgemental/dictatorial about other women's birth choices and experiences, whatever they are, is sooooo MASSIVELY unhelpful, and very depressing. I utterly, utterly loathe this idea that birth is a 'test' to be passed or failed. It's bullying nonsense, and the way some women perpetuate this by simply refusing to allow for the vast differences in experience and preferences we all have between us is just awful, and very damaging. There, end of off topic moan!)

I agree - I hadnt come across it as blatantly and personally directed before, more in general statements about C sections but its quite unbelieveable really that another woman would attack you for saying you choose CS over VB after traumtaic previous VB and daring to stick to your guns that just because an op has gone wrong doesnt mean that op is necessarily always bad - otherwise ALL ops would be looked down on and discouraged and thats not always the best course of action!!

Oh well!

"An injury is caused by an accident! A CS is not an accident."

The definition I gave of 'injury' is the dictionary definition and I'm afraid you are simply wrong.

"People in the USA and Canada reject midwives because they do not feel that they are the safest option. I have a very good friend in Canada that is an OB/Gyn and she thinks that midwife led births are very risky,"

Do you think most people living in a system where the vast majority of women have obstetric led care and where there is no culture or history of midwifery led care even understand what the differences are? Do they know what midwives do? Or what training they have? Somehow I don't think so. As for your obstetrician - did she support her belief that midwife led births are unsafe with reference to the FACTS on this issue, or did she just tell you that this is what she thought?

"The USA also is a much bigger country then the UK with an exponentially bigger population. Any country with more people will have higher statistics then one with less people."

Err. No. That's not how it works.

"The countries with the highest rates are those that do not have OB/Gyn's and have CS when required. This is the case with the top 50 countries on the list. Once again skewing details to suit your argument."

Oh come on, don't be silly. We all know that the countries where women are the most likely to die in childbirth are those where many women have little or no access to ANY form of antenatal care or to any sort of medical care - including that provided by qualified midwives. Did I really need to spell it out? Doesn't change the fact that in the maternal mortality statistics, the US does worse than the Netherlands, where nearly one in three babies is born at home with only a midwife in attendance.

"I don't begrudge anyone for their choice, you have done so repeatedly!"

Where have I 'begrudged' anyone anything on this thread?

" By the same token if someone wants to have and ELCS and are fully aware of the risks then this is up to them and their healthcare provider."

Yes - I'd agree with that. I don't think anything I've said up to this point would suggest I believe otherwise, except in the case of the NHS under our present system.

People like you need to get off of the self-rightgeous mother bashing train and leave people to make their decisions.

And I think women like you should stop being defensive about their birth choices. Nobody is judging you! Relax!

Canucktraveller - homebirths tend to be cheaper than hospital births because of their lower rates of complication for mother and baby, requiring medical input. You also have to remember that hospitals in the UK are aiming to provide one to one labour to mothers where ever they give birth.

tittybangbang yes people on this thread HAVE judged by others on this thread. And are judged in the iwder world or else why would the phrase "too posh to push" have gained popularity?

If a C section would can be described as an injury ten so must an episiotomy, forceps damage etc. Know which I'd rather have!

Yes titty your right, Lets return to pre-medicalised birth times.

Lets let mothers suffer without pain relief

Lets let mothers suffer emotional, physical and mental damage

Lets allow mothers and babies to die because CS rates are too high

Lets allow mothers and babies to die so that money can be saved

Let tell mothers that it will all be ok and nothing bad will happen (oh, that's already done)

You have judged enough. Thank goodness the majority of qualified medical doctors do not share your views.

thought this was a thoughtful and balanced article on this subject

www.timesonline.co.uk/tol/news/uk/health/article551647.ece

tittybangbang, you quote another poster: -

" By the same token if someone wants to have and ELCS and are fully aware of the risks then this is up to them and their healthcare provider."

Then you say: -

"Yes - I'd agree with that. I don't think anything I've said up to this point would suggest I believe otherwise, except in the case of the NHS under our present system."

So... unless I misunderstand you...I'm realising you don't believe anyone is entitled to an elective CS on the NHS, whatever the reason.

If so - well, your views are your views. I couldn't disagree more.

Balanced information based on studies around the world;

The mortality rate for both Caesarian sections and vaginal birth, in the Western world, continues to drop steadily. In 2000, the mortality rate for Caesareans in the United States were 20 per 1,000,000. The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth. However, it is misleading to directly compare the mortality rates of vaginal and caesarean deliveries. Women with severe medical conditions, or higher-risk pregnancies, often require a Caesarean section which can distort the mortality figures.

A study published in the 13 February 2007 issue of the Canadian Medical Association Journal found that the absolute differences in severe maternal morbidity and mortality was small, but that the additional risk over vaginal delivery should be considered by women contemplating an elective caesarean delivery and by their physicians.

It is difficult to study the effects of caesarean sections because it can be difficult to separate out issues caused by the procedure itself versus issues caused by the conditions that require it. For example, a study published in the February 2007 issue of the journal Obstetrics and Gynecology found that women who had just one previous caesarean section were more likely to have problems with their second birth. Women who delivered their first child by Caesarean delivery had increased risks for malpresentation, placenta previa, antepartum hemorrhage, placenta accreta, prolonged labor, uterine rupture, preterm birth, low birth weight, and stillbirth in their second delivery. However, the authors conclude that some risks may be due to confounding factors related to the indication for the first caesarean, rather than due to the procedure itself.

Risks for the species
Child delivery has always been a great selective pressure for human females, due to the antagonism between bipedalism and the size of newborn's skull. By allowing women to not deliver babies from below, this selective pressure is highly reduced. This might result in an increase of the need for caesareans in future generations. Considering that caesereans have been practiced for several thousand years, the present relative high rate of caesareans can already be considered as the result of this.

Studies have shown that continuity of care with a known carer may significantly decrease the rate of Caesarean delivery but that there is also research that appears to show that there is no significant difference in caesarean rates when comparing midwife continuity care to conventional fragmented care.

The US National Institutes of Health says that rises in rates of caesarean sections are not, in isolation, a cause for concern, but may reflect changing reproductive patterns:

Some authors have proposed an ?ideal rate? of all cesarean deliveries (such as 15 percent) for a population. There is no consistency in this ideal rate, and artificial declarations of an ideal rate should be discouraged. Goals for achieving an optimal cesarean delivery rate should be based on maximizing the best possible maternal and neonatal outcomes, taking into account available medical and health resources and maternal preferences. Thus, optimal cesarean delivery rates will vary over time and across different populations according to individual and societal circumstances.

Nonetheless, some commentators are concerned by the rise and have tried to generate theories to explain it. Louise Silverton, deputy general-secretary of the Royal College of Midwives, says that not only has society?s tolerance for pain and illness been ?significantly reduced?, but also that women are scared of pain and think that if they have a caesarean there will be less, if any, pain. It is the opinion of Silverton and the Royal College of Midwives that ?women have lost their confidence in their ability to give birth."

Silverton's analysis is controversial. Dr Maggie Blott, a consultant obstetrician at University College Hospital, London and then a Royal College of Obstetricians and Gynaecologists (RCOG) spokeswoman on caesareans (and Vice President of the RCOG), responded: 'There isn't any evidence to support Louise Silverton's view that increasingly pain-averse women are pushing up the caesarean rate. There's an undercurrent that caesarean sections are a bad thing, but they can be life-saving

pinkmook, fyi, my MIL had 5 babies in the 60's. Every one of them was over 9 lbs and she never had a single incision. Her most difficult birth was DH's who from the sounds of things had shoulder dystocia but all are alive and well.

she is only 5ft 1 and at the time didn't weight much more than 8 stones.

All were home births. all were with midwife led.

I am 7.5 stones, small hips, small frame, had an 8lb baby with no pain relief (the midwives arrived 5 minutes after it was all over) at home. (not bragging, just showing that for your anecdote there are others out there which state the opposite of the point you are trying to make).

A. 1 to 1 care through out labour by a person with very good knowledge of births (midwife, doula, traditional birth attendant)
B. mother's positioning,
C. location - a place where she is familiar and feels mentally, by this i mean subconsiously, not rationally secure, and can exercise control has a lot to do with how she will cope during birthing.

The trauma suffered by many women during natural labour, many of them ending in assisted deliveries or c/s is symptomatic of the lack or limitations of the 3 points outlined above.

It doesn't mean that c/s are better or worse, it means that we have to re-evaluate the care women receive when they go into labour. In order to bring down the rates of PND, PTSD, birth injuries and death to mother and babies and finally, C/s rates.

This is an odd thread, I didn't know cesarean births were bad or somehow lesser than 'natural' or 'normal' births.

Wow, I suddenly feel second class - but at least I'm alive, and my baby is also alive and healthy - not dead or brain damaged - and my bits are intact - we didn't go for my baby being removed by vacuum suction or by metal hands, as forceps are sometimes described!.

I really can't understand what's wrong with 25% or more of the population having their babies removed surgically through the abdomen wall - major abdominal surgery on the day your baby is born is not a decision taken lightly - ut most women do have some surgical intervention anyway.

So what's the big deal? What is this really thread about?

We really need to reevaluate whet we are talking about - before surgical and other interventions, millions of babies and mothers died in childbirth.

What's so bad about having surgery to save lives? Would you refuse other life saving surgery? Just because of a statistic?

Interesting post foxytocin and I agree with the last paragraph especially, however I never said I was an expert I - along with others on this thread - wondered if rising birthweight could affect things. My consultant however disagrees with you that my size/babies weight WAS an issue - and thats why they have fully supported a c section for me second time around. Who am I to say who's right or wrong? your mum/my consultant? Its very hard to say whether your mother has a smaller frame/birth canal than me since I havent seen her nor you me. But I understand your point

"Lets return to pre-medicalised birth times". You've hit the nail on the head Canuck. With the attitudes displayed towards assisted births I really fear this is where we're heading and then of course once that happens there will be demands for a return to intervention.

mosschops - yes it does upset and sadden me because its a vulnerable topic for me, I had flash backs and suffered mentally for a long time afterwards - not sure I need to "man up" about this?

I think it is you who sounds bitter right now but I dont wish to encourage you on this further as you seem to think insulting me is OK.

yeah join the club, I am having treatment for PTSD at the moment. Oh but yours is worse because it was a VB trauma right????

Maybe this is a vulnerable topic for us both so can I suggest we ignore each others posts and get on with the thread

im very sorry about your experiences mosschops. But I have not personall attacked you by saying you should "man up" "get out more" that you are bitter, self centered or any of the other things you have aimed at me.

I dont wish to get into a competition over whose trauma was worse AT ALL. In fact I dont think I ever suggested anything of that nature.

Im sorry for your experiences but please dont talk to me in that way - it goes beyond the realms of discussion (even heated discussion)

My point is, and always has been, I dont see why C sections are seen as - blanket policy - bad.