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

If you think ive personally attacked you then report the post and get it removed.

oh and FWIW I didnt appreciate these statements:

'whereas an mention an op going wrong and 1) everyone will sympathise 2) you wont be embarrased'

and

'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'

just so you dont feel that youre the only one whose unhappy

you may be unhappy with my points mosschops but I didnt personally denigrate you to make them.

move on

Sorry, I have got a bit lost on this thread. Please can someone tell me if anyone has come up with the answer to the question "Why does the WHO use cs rates as a guide to maternal care"?

Its a really interesting subject isn't it. Its sounds appallingly high, so whats going on? Do we really need that many? If so, what has changed? I do think larger babies must be a factor but there's got to be more to it than that. I do wonder if infant mortality has gone down. Maybe in the 60's/80's more babies died? Have no statistics to back that up though. So maybe a higher c-section rate has lead to more live births?

My ds was an emcs. I was booked for a lovely water birth in our local birth centre but DS had other ideas. His growth started to slow down so they wanted to induce me, plus my blood pressure shot up. They tried for 6 long days and nights to get me into labour. It was a nightmare, 6 days on an antenatal ward with 3 other women, strict visiting hours, dodgy food, basically being bed bound due to high blood pressure and being woken up every 2 hours at night to have my blood pressure measured left me a total wreck by the time DS was here. I wanted to give the induction a chance and they literally tried everything they could to get me into labour but I do wonder if they left me too long before calling c-section. Even if they had got me into labour would I really have had the energy to birth naturally after 6 days of pre-labour? DS ended up spending 10 days in the NICU and I was an exhausted wreck. Hard to know whether he would have anyhow or whether his issues were made worse by my extremely long induction, certainly the paedirician seemed to think that it probably made his issues worse. One thing I am certain of though is that without a c-section DS would have come out a much poorlier baby or possibly have even been a still birth.

Oh and for the record I had a lovely emcs, staff were so friendly and within a few days I felt absolutely fine. Still desperate for a VBAC next time though, just hope my blood pressure doesn't shoot up again and they don't treat me like some high risk accident waiting to happen. I already know I can no longer have my water birth at the local birth centre

Wow the thread moved on in the time it took me to type that

Guys I honestly think you're talking cross purposes. There's "horror stories" for CS and VBs (especially EmCS) but most of us are broadly in agreement that general care needs to be improved.

I used to get really defensive about my ElCS ("elective" -ha!) because I had no choice. And then people would say "well you've got placenta previa so that's ok". Well how patronising is that? I felt like I had a disease or a disability and therefore had approval for a CS. Time has waned that feeling but I do like to annoy people with it now and again .
I think what I'm saying is that when things are raw - like a bad VB or CS experience - we can often read things into a post that aren't intended. I know I used to. And still do sometimes.

I agree with an earlier post that as a surgical procedure a CS mother gets more care than a VB mother. Just watching OBEM and the people left in the rooms to cope with contractions and gas and air and all that left me horrified. I was never left the whole day, from the walk to the theatre to the constant BP, medication etc checks. I think if maternity wards and labour units were staffed properly then a lot of these things would not happen.

Me too playingatmotherhood!

I take (very gentle!) issue with the word "appallingly". We're still trying to find out if 25% is A Bad Thing, and if so why.

Twittybangbang very interesting concept that surgeons are injuring you when they perform a c-section.

Personally I consider tearing all the way to the anus in vaginal birth an injury. Surgery is more of an incision.

Yes Shaz, I didn't nec mean it was appalling just that on the face of it it seems terribly high. But maybe it is high for a reason and yes is it such a bad thing? I do know I am sad my first birth was a c-section as it will effect my subsequent birth/births even though it was actually a positive experience for me.

Agreed playingatmotherhood. Despite me banging on about my positive C section (which it was) I do want to VBAC next time. Hoping they've invented underwater continuous monitoring by then!

(If you live in London, there is a hospital that does that - I don't!)

Just read about a survey from Teeside University - "one in six expectant women is now classed as dangerously overweight. The figure in England more than doubled from 7.6% in 1989 to 15.6% in 2007"
I wonder what the stats are regarding the incidence of CS amoungst these Mothers?
If these stats follow what is going on with the population overall (rising BMIs) then presumably they will carry on rising and, if linked to need for CS, then the CS rates will rise correspondingly?

gailforce1, no, I don't think anyone has come up with an answer to why the WHO uses CS rates as a guide to maternal care. Or if it does in the first place.

I've also had no luck trying to find out how/why the WHO got to their figure of 10-15 percent as an 'ideal' for CS rates.

This really bothers me. These debates often take as read that the CS rate is 'too high.' Are they? Too high for what??

I found this critique of the WHO's efforts to promote their ideal C-section rate -

skepticalob.blogspot.com/2009/07/whats-safest-c-section-rate-higher-than.html

The writer here discusses maternal and neonatal morbidity rates in relation to CS rates - and argues that according to the WHO's own data, "the average C-section rate for countries with low maternal and neonatal mortality is 22%". Not 10, or 15 percent.

She concludes: - "There is simply no support for a C-section rate of 15%, since virtually none of the countries with low rates of maternal and neonatal mortality have a C-section rate of 15% or below, and most have rates that are far higher."

I know there are other issues to do with C-sections beyond maternal and neonatal mortality, but that seems a reasonable place to start. And obviously, taking one blogger's entry as gospel isn't sensible! but as I've said before, I'm struggling to find out background and info on the WHO's CS rate recommendations.

Playing - in the UK both the maternal and infant mortality rate fell throughout the second half of the twentieth century - quite sharply up to the mid-sixties and then rather more slowly after that. One reason for the fall from the 50s - mid sixties seems to have been greater access to blood transfusions (what saved my mother when she nearly died having my sister). The legalisation of abortion in the late sixties also had some effect as of course some maternal deaths before that date were the result of backstreet terminations. As to the 'large baby' argument then of course there are anecdotes on both sides. In my family small mothers and large babies have meant risky births, in others they have not. Let's not get into comparing hips and birth canal sizes! But one general statistic is certainly true - the Dutch have a higher rate of home births than most developed countries and it should also be noted that they also have amongst the tallest women in the world (if you don't believe me look it up - or take a trip!) - they are certainly not 5 foot 2 women who are giving birth to monster babies as easy as shelling peas. Their maternal mortality rate is a little lower than that of the UK but not really different to France or Belgium, where women tend to have far more medicalised deliveries.

(As before - most births of any kind in developed countries are safe and far, far, less risky than those in developing countries).

Obviously a very emotive issue. For the record, I laboured at home for 5 days before being admitted to hospital. Things didn't progress, the baby became distressed, and then I was whipped onto the hormone drip and epidural, before suffering a chaotic forceps delivery and 3rd degree tear. I was the only tear patient on the c-section ward (I was also in hospital for longer than the c-section patients), and was largely ignored by the midwives, so I guess that says something about the amount of care given to c-section versus vaginal trauma patients at my hospital.

I think what probably makes me most bitter now is the frequently expressed implication that those who have suffered traumatic births have somehow brought it upon themselves. That they haven't been sufficiently relaxed or confident, or done the right preparation. I was sooo geared up for a natural birth. I'd read all the books, done the NCT classes, prenatal yoga, birthing hypnotherapy, informed myself as much as I possibly could, I was brimming with confidence - and in the end I was done in by a large posterior baby that just couldn't progress. This was despite days and days at home bouncing on the birth ball, going for gentle walks, no pain relief (other than TENs), in my own environment etc. I'm still proud that I got through those 5 days myself, regardless of how things turned out. I also felt so let down by the midwives. I had utter faith in the lovely midwife led unit, but even once finally admitted, I was left completely alone for the duration, and even put in the pool far too early (which probably also stalled my labour with hindsight). I know that this was because they were horribly overstretched, but I just don't have the faith or trust required to put myself in their hands again.

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

Oh - are we playing straw man arguments now?

Where have I said that women shouldn't have medical care if they need it in labour?

"Lets let mothers suffer without pain relief"

Where have I said this?

"Lets let mothers suffer emotional, physical and mental damage"

Where have I said or implied that mothers should be denied the care they need to have the birth they want?

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

Where have I said that all c-sections are unnecessary and that it's more important to bring c-section rates down than to protect the health of women and children?

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

Who is suggesting this?

"You have judged enough."

No I haven't. I'm now going to judge you: you haven't read or understood any of the points I've made. I find your post bizarre. You've come out with a pile of nonsense - assumptions about my views on c-section that can't be justified by ANYTHING I've said here. For goodness sake - try responding to the argument rather than just going off half cocked and frothing at the mouth.

"Thank goodness the majority of qualified medical doctors do not share your views."

Well.....
From the National Sentinel Caesarean Section Audit Published on the RCOG website: "Obstetricians were also surveyed. Just over half (51%) thought their unit caesarean section rate was too high; the average rate considered too high was 20%.

" 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."

You do misunderstand me. The NHS is required to justify spending in terms of health outcomes. There are not enough midwives or the necessary resources right now to enable the majority of women to have healthy births, because they are unable to access one to one care in labour, and there are not enough consultants to go around. Increasing the rate of c-s by maternal request - if it was a significant increase - would put a very great strain on hospitals in terms of staffing and resources. The net result of a large increase in the numbers of elective sections for low risk mums would be that women who really need medical care - those with complex health issues and those who encounter emergencies in labour would be put in unnecessary danger. Unless they doubled or tripled the number of midwives and obstetricians working in the NHS overnight - which would be a difficult thing to achieve, don't you think?

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

There is nothing wrong with having surgery to save your life or your baby's. It's what every mother would do if she thought it was necessary. The points I have been making have been about the large number of c-sections done that even a large proportion of the medical profession (doctors and midwives) believe are avoidable.

I feel very strongly that a mother should have the safest and healthiest birth possible for her.

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

Actually fastest and greatest falls in maternal and infant mortality in the UK over the last century happened when antibiotics, the welfare state and universal health care was introduced, when the C-section rate in the UK was still under 5%. The majority of maternal deaths before this time were the result of perpeural fever and eclampsia. Good antenatal care, better infection control and good nutrition has made far, far more of a difference to maternal and infant mortality than the rocketing c-section rate.

Would also want to point out that the c-section rate in the UK has nearly doubled in the last decade alone, yet the stillbirth rate has remained stable at this time.

CS's used to be dangerous before an improvement in medical techniques - Here is a history explaining that:

www.nlm.nih.gov/exhibition/cesarean/part2.html

Here is a medical study of VB vs CS:

www.ncbi.nlm.nih.gov/pmc/articles/PMC1800583/?tool=pmcentrez

Here is a study on continuity of care affecting CS rates:

www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W7D-42RF0G5-5&_user=10&_coverDate=01%2F31%2F2001 &rdoc=1&fmt=high&orig=search&sort=d&docanchor=&view=c&acct=C000050221&version=1&urlVersion=0 &_userid=10&md5=879b99c9794fdbe75aa57fa10b4dd4a7

Here is a study on Social class and elective CS in the UK:

www.ncbi.nlm.nih.gov/pmc/articles/PMC421774/?tool=pmcentrez

A study to show that there are risks with a CS but they cannot be shown to be only related to a cs but may be from other confounding factors:

www.ncbi.nlm.nih.gov/pubmed/17267823

titty - I'm not sure to whom your comments are addressed because I really don't think I have judged or insulted you or anyone on here. My reading says that there was still a significant drop in maternal mortality after the introduction of the welfare state in the 40s - to the mid sixties and then a much gentler fall afterwards. And yes stillbirths are still far too high and I agree that maternal care, welfare and nutrition have probably got a lot to do with that (maternal and infant mortality here and in the US is shockingly higher in lower socio-economic groups).

Where I do take issue is that, as I and others have said before, if you want to save NHS money there are far easier targets than elective sections. I can't quite understand the focus on these as the big bad monster operation which must be reduced (as I've already said, before we even get onto drunk drivers etc try my probably totally unnecessary and apparently quite risky tonsillectomy - a rite of passage for lots of kids of my generation - I bet the phasing out of those has quietly saved a fortune and kids' lives). It rather saddens me, this focus by women on reducing a woman's choice. I think barkfox has highlighted a very interesting point in that it might be that most developing countries with a decently low maternal and infant mortality rate have a section rate rather higher than the WHO 'optimum'. And certainly even scare research like that recently in the Lancet (which came out with the fact that sections were riskier based on underlying figures of NO additional (yep zero) deaths in the sections studied) show more infant mortality in the VB cohort.

As before, to anyone about to give birth, discussions of different rates of maternal and infant mortality for birth method should not detract from the fact that giving birth in a developed country is generally very safe, however you do it!

"Surgery is more of an incision"

It's still an injury.

I don't see why you have such a problem admitting this.

"Personally I consider tearing all the way to the anus in vaginal birth an injury. Surgery is more of an incision".

Well yes - that is an injury too, and one that most people would want to avoid.

"Their maternal mortality rate is a little lower than that of the UK but not really different to France or Belgium, where women tend to have far more medicalised deliveries."

Their maternal mortality rate is similar to France or Belgium, but their maternal morbidity rate is much lower. Worth acknowledging, don't you think?

"Hoping they've invented underwater continuous monitoring by then!"

Why the bloody hell haven't they done this already? Surely it can't be that difficult!

Any clever engineers here who could address this issue?

Womankind would thank you if you could invent telemetric monitoring that could be used underwater!

And while I'm on the subject, why the buggery bollocks can't all hospitals offer telemetry for land births, if the technology exists?

(ok, ok - it's money I know, but I bet it would pay for itself soon enough!)

Bellisima, my comments were addressed to Canucktraveller.

I think you got splatted in the crossfire!

Quite. And the Dutch are amongst the tallest women in the world. fact.

(Not sure what you are banging on about to me with cut and pastes on incisions, anuses and injuries cos I didn't say anything about that or in those terms. Personally I would far rather have stitches across my lower abdomen than through my undercarriage (and with a nine pounder with a head circ on the top believe me I would have got the latter - as the paed who examined her said 'this could have been a bad outcome'. But in no way would I put forward my stitches preference as that of others.)

tittybangbang you may have hit on something there with telemetry etc. Are labouring mothers "left to it" because it's seen as natural and therefore easy? A bit like breastfeeding? So it's a case of "not all mothers need it therefore trust won't pay"? Hmmmmm.....

Okay sorry - cross posted! And am rushing to the oven tween posts to get grub massively healthy and nutritious food for the varms.