Are your children’s vaccines up to date?

Set a reminder

Please or to access all these features

Childbirth

Share experiences and get support around labour, birth and recovery.

Cesarean Birth Statistics

231 replies

iknowitsmadbutiwantit · 30/03/2010 01:43

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

OP posts:
Are your children’s vaccines up to date?
bellissima · 31/03/2010 18:30

And (before I shuddup) - agree totally that maternity services of all kinds in this country, whilst still generally safe, are in danger of becoming massively underfunded, particularly given the rise in the birth rate. I think that issue should be the main focus, not getting at each other over our birth choices. I chose to have sections but I am personally shocked at tales on here of women being whisked down for them because there's a bed shortage. Or of women labouring alone for hours - that would only increase the desire for a section amongst women who might actually prefer a VB - and that isn't a real choice at all.

barkfox · 31/03/2010 18:32

titty -

I've said this elsewhere, but it's worth repeating -

At my local A&E, at the weekends, over 70 percent of admissions are alcohol related. They all get treated for free on the NHS.

There are many, many areas where savings could be made before you get to the (very small) percentage of elective c-sections, or maternal request c-sections, to make an important distinction.

I'd like to see a much more holistic and realistic approach to the costs of childbirth. There is FAR more to take into account than 'on the day' costs, and I think it ends up being unnecessarily harsh on women if that is the only thing we take into account. Sending home traumatised injured women who have had a 'cheap' birth is not humane, and a false economy.

canucktraveler, one of your links, I think the one on social class and elective CS in the UK, says that the biggest indicator for C-section overall is maternal age (i.e older women were more likely to have them).

That struck a chord with me - anecdotally, so many friends in my age group (late 30s) have had labours that failed to progress, and then had emergency CS's. I do wonder if women in developed nations are having children later in life, and if that group is overall a bit less reproductively 'elastic' than younger women.

canucktraveler · 31/03/2010 18:44

Where have I said that women shouldn't have medical care if they need it in labour? - You said ? ?How many Obs/Gyn have experiencience in attending mothers throughout active labour, as a midwife does?? ?They provide medical care if it is needed? and ?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!? - OB/Gyn?s are medical doctors and provide full care for women in many countries including Canada. Many countries believe that Medically qualified doctors can be supported by OB nurses/midwives but that doctors should be providing the medical care. By your last statement you very clearly do not think women should have medical care!!!

"Lets let mothers suffer without pain relief"

Where have I said this? ? You said ? ?..that is birth which doesn't involve continuous monitoring, epidural analgesia? ? Women who want to have epidural analgesia are fully entitled to do so and any other thing that makes them comfortable in labour.

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

You said ? ?Well it is if they're involved in a disproportionate number of births which are physiologically abnormal!? ? Women should not suffer any emotional, physical or mental damage because a CS is ?physiologically abnormal?!.

Where have I said or implied that mothers should be denied the care they need to have the birth they want?
You said ? ?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.? ? In many countries OB/Gyns do care for women in normal labour furthermore in the UK one can also choose to pay for a OB/Gyn to care for them in a normal labour, it is consultant led care. This is there choice and you by your statement are denying women this choice.

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

You said ? ?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.? ? It is glaringly obvious that you think rates are too high and from the statement above you disagree.

FACT - Currently in the United States slightly more than one in seven women experiences complications during labor and delivery that are due to conditions existing prior to pregnancy; these include diabetes, pelvic abnormalities, hypertension, and infectious diseases. In addition, a variety of pathological conditions that develop during pregnancy (such as eclampsia and placenta praevia) are indications for surgical delivery. These problems can be life-threatening for both mother and baby, and in approximately forty percent of such cases cesarean section provides the safest solution.

"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.

Response: I have read and responded to your arguments. Your arguments are poor, furthermore I have provided statistics and studies that support my arguments. You are the one who is one sided and full of assumptions. I have made it clear time and time again that mothers can have ANY TYPE OF BIRTH THEY WISH, I do not judge this! I do not think that there is any problems with CS births, you very obcviously do. This is apparent not only to me but many, many other posters who have made comments to you.

"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." ? This is a complete and utter contradiction! Under pressure or not the safety and well-being of mother and baby should ALWAYS come first. You have brought up the cost issue a multitude of times, it is SAD.

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."

This is you not reading the thread correctly ? You need to respond to another poster not me

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

This is you not reading the thread correctly ? You need to respond to another poster not me

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.

FACT - While there is sound reason to believe that cesarean section has been employed too frequently in some societies during the last two or three decades, the operation clearly changes the outcome favorably for a significant percentage of women and babies. In our society now women may be afraid of the pain of childbirth, but they do not expect it to kill them. Such could not be said of many women as late as the nineteenth century. Moreover, most women now expect their babies to survive birth. These are modern assumptions and ones that cesarean section has helped to promulgate. An operation that virtually always resulted in a dead woman and dead fetus now almost always results in a living mother and baby -- a transformation as significant to the women and families involved as to the medical profession.

ealey · 31/03/2010 18:46

I completely agree with your point about underfunding bellissima, and would go further and argue that pregnant/labouring women are often treated too dismissively and without sufficient respect. I am probably the kind of woman you mention who in an ideal world would like to believe that a non-traumatic natural birth is achievable, but just doesn't have enough faith in the system to risk it again. Which leaves the elcs, which while scary, is at least relatively predictable and non-chaotic. I appreciate that this is not a good enough reason for elcs for many people, but when you've been on the wrong end of chaotic care and suffered the consequences it's very seductive!

tittybangbang · 31/03/2010 18:48

"There are many, many areas where savings could be made before you get to the (very small) percentage of elective c-sections, or maternal request c-sections, to make an important distinction."

Look - I agree that more money should be found for maternity services. But you can't magic qualified midwives and consultants out of thin air!

"Sending home traumatised injured women who have had a 'cheap' birth is not humane, and a false economy."

I agree - but one of the cheapest ways to increase the number of normal births and decrease the number of traumatised women is simply to increase midwife numbers and have more facilities for caseloading and for out of hospital birth. Personally I think that midwives should also be a bit more consistent in passing on the NICE recommendations on c-section to women - telling them that one of the very few things they can do to reduce their risk of needing an emergency c-section is to have a doula or female birth supporter attending their labour.

"I do wonder if women in developed nations are having children later in life, and if that group is overall a bit less reproductively 'elastic' than younger women".

There is no doubt that as a rule older first time mums have harder labours. Not sure it's about how 'elastic' they are reproductively though!

barkfox · 31/03/2010 19:02

Should have added -

The poster trying to clarify whether titty was against all elective CS on the NHS was me.

I'm actually still not clear about that. I think she is opposed to it. Her response to me was to say that a large increase in the number of elective sections in low risk mums (and why would that happen?) would be to jeopardise those women who 'really' need medical care - "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?"

Well, indeed. I'm afraid I think that's a little patronising. I haven't proposed either a large increase in maternal request c-sections, or a magical overnight increase in staff. And I think it's worth pointing out that if there was a significant jump in requests/demands for homebirths, there'd be an increased demand on the number of midwives, too. I would support the right of women to choose homebirths if that's what they wanted, though.

[as an aside, I found while googling about WHO c-section stats that there is some support for denying women epidurals in the UK - or making them pay for them as they constitute a 'luxury' rather than a 'need.' That's scared me, and I disagree with it completely - but I guess if you're someone who wants to limit maternal choice because of cost, then there's something else to target.]

tittybangbang · 31/03/2010 19:06

"By your last statement you very clearly do not think women should have medical care!!!"

If mothers don't need doctors involvement in the birth then they probably are better off without it! (given the mass or research showing that low risk women under obstetric care have worse outcomes for birth than low risk women cared for by midwives).

Is that clearer?

"Where have I said this? ? You said ? ?..that is birth which doesn't involve continuous monitoring, epidural analgesia? ? Women who want to have epidural analgesia are fully entitled to do so and any other thing that makes them comfortable in labour."

Of course they are. Where have I suggested otherwise? But the fact remains that as the majority of epidural deliveries are augmented by oxytocics, are supine births, and often involve instruments and episiotomies, they are not physiologically normal births, and therefore more likely to result in other interventions and birth injuries.

"FACT - Currently in the United States slightly more than one in seven women experiences complications during labor and delivery that are due to conditions existing prior to pregnancy; these include diabetes, pelvic abnormalities, hypertension, and infectious diseases. These problems can be life-threatening for both mother and baby, and in approximately forty percent of such cases cesarean section provides the safest solution."

Again - I really don't see the point you're making here. Of course c-section is the best (and sometimes the only) option in some instances. I'm not denying that. As for the 40% - well I think that's arguable. By the way, my own extended family of 4 women (me and my SIL's) involves one type one diabetic, one hypertensive and obese first time mother of 36, one mother with gestational diabetes and a history of macrosomic babies (me), and another 'elderly primigravida' who becomes hypertensive towards the end of each of her pregnancies. 12 babies between us, including two over 10lbs and 5 over 9lbs. No c/s. No babies in special care. Maybe that's where I get my confidence that the majority of even high risk women can deliver without surgery, given good quality care.

OK - I'll finish by spelling it out: I am not anti necessary c-s and I'm heartily delighted and grateful to live in a society where it's available to those mothers who need it.

I don't think we need to continue with this 'you think all mothers should give birth in a paddyfield and chew through their own umblical cord' nonsense, so please resist the silly accusations that I am cruel and stupid enough to want mothers and babies to die in childbirth in order to reduce the c/s rate. I have also said nothing at all about women being denied epidurals.

"This is a complete and utter contradiction! Under pressure or not the safety and well-being of mother and baby should ALWAYS come first. You have brought up the cost issue a multitude of times, it is SAD".

Look, I've said it before and I'll say it again. We only have a certain number of midwives and consultants, and they need to be used to save the largest number of lives. Offering elective c/s to low risk mother by maternal request would result in more deaths - there simply would not be enough medical care to go around. Even with our 24% c/s rate we have a major problem in some hospitals with consultant cover. How on earth could we keep women and babies safe with the same number of medics and operating theatres, but with perhaps double the number of c/s?

tittybangbang · 31/03/2010 19:08

Sorry - want to add that in the private healthcare system there is lots of spare capacity - which is why it is so expensive. There is almost no spare capacity in the NHS, which is why per head it is one of the best value health care systems in the world (if not always the nicest or the most efficient for patients).

foxytocin · 31/03/2010 19:12

""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.

*drivingmissdaisy" a group of midwives in the late 20th century in the United States have done exactly what Canuck described in the quote.

The midwives at the Farm have had well over 2,000 births and counting in the last 30 years. Every single birth which they have attended from the early ones in the back of old school buses when they were traveling hippies to their birthing center set up in the backwoods of Tennessee have been meticulously documented.

Their C/s rate is somewhere around 1%. the do not turn away women for any of the 'high risk' reasons which birthing centers normally refuse women. Their statistical success would be the envy of the most prestigious maternity units in the world bar none. These midwives are doing something right and the medical community have much to learn from them if they wish to stop and listen without many of their preconceived notions.

go have a google for them and read around.

barkfox · 31/03/2010 19:15

Argh - cross post, sorry -

titty, could you clarify something for me pls?

On the one hand you say in respect of elective C-sections that "you can't magic qualified midwives and consultants out of thin air!"

But then in the same post you say, in terms of increasing the number of normal births and reducing trauma: - "one of the cheapest ways to increase the number of normal births and decrease the number of traumatised women is simply to increase midwife numbers and have more facilities for caseloading and for out of hospital birth."

It reads as if you are using the difficulty of increasing staffing levels as a reason to deny women elective CS's - but then arguing it would be easy to increase midwife numbers to allow for more homebirths.

Maybe I've misread this.

(There is a very interesting thread a few pages back about homebirths being suspended in East Sussex due to MW shortages. I don't have any strong views on this myself, but there were suprisingly strong views on 'entitlement' to a home birth when maternity services were under extreme pressure. It is worth a read if only to see issues of cost and choice discussed, for once, not in the context of c-sections....]

tittybangbang · 31/03/2010 19:18

"I do not think that there is any problems with CS births, you very obcviously do"

Err, am I missing the obvious here? If elective c/s results in higher rates of death and serious injury to women, and to babies in subsequent births than v/b (which it does, according to the RCOG) surely a) women should be made aware of this b) women should be offered the best possible care if they wish to have a vaginal birth so that the risk of an emergency cs is reduced and c) public funded and cash limited health systems which put the health of mother and child as a first priority should approach the idea of offering elective c/s on demand to low risk mothers with caution?

That's all I'm arguing.

Oh, and that like the majority of doctors and midwives I feel the c/s rate could be safely reduced.

Nowt controversial about any of this is there?

Amazing how easily some of you get your knickers (and your ideas) in a twist over this issue.

barkfox · 31/03/2010 19:25

Total aside -

Why, when the question of elective CS comes up, do some people assume that if it was available 'on request', then simply everyone would be rushing to have it, and the CS rates would at least double??

That seems an odd assumption! Don't most women want a VB? (I don't, but I've always assumed I'm in a very small minority.)

It just seems that we rarely discuss the maternal request situation in terms of what it actually IS, in reality - more in terms of alarmist fictional scenarios.

I fully support a woman's right to choose what kind of birth she wants, in as far as she is able (there's always going to be a fair bit we can't control). But I'm not seriously entertaining an immediate future where women, if permitted, are beating down the doors of CLU's to get their elective sections.

Am I missing something?

tittybangbang · 31/03/2010 19:30

"But then in the same post you say, in terms of increasing the number of normal births and reducing trauma: - "one of the cheapest ways to increase the number of normal births and decrease the number of traumatised women is simply to increase midwife numbers and have more facilities for caseloading and for out of hospital birth."

Whatever the purpose, you can't magic midwives out of thin air. The sad fact is that there are many, many, many qualified midwives in the UK who are either not working in maternity, have let their registrations lapse, or are working very part-time because they simply cannot stand the birth culture in so many UK hospitals at the moment. Did you know that although there are about 10 applicants for every place on a midwifery degree, in many colleges over 30% of students drop out because they can't cope with what they are doing in hospital. And many who do graduate don't go on to work as midwives. It's truly shocking. Many midwives are completely demoralised with what's happening to mothers in hospitals across the UK at the moment - they feel it's a complete betrayal of everything they believe in.

Offering midwives the chance to work as most of them want - to be able to establish relationships with the women they're looking after, to provide one to one care in labour, to have the time to talk to women during antenatal appointments, to do more homebirths - these things would draw many thousands of midwives back into the NHS, because they'd be able to give women the sort of care they know they need.

Offering them the chance to come back and catheterise, canulate and set up drips for large number of healthy women for c/s wouldn't have the same draw somehow.

barkfox · 31/03/2010 19:36

titty - where are these "large number of healthy women" having CS's? (see my previous post...)

And tbh, I want a midwife who supports my birth choices, and who supports me whatever happens, rather than one who is only interested in a particular kind of birth that they personally find rewarding or acceptable.

tittybangbang · 31/03/2010 19:43

"It just seems that we rarely discuss the maternal request situation in terms of what it actually IS, in reality - more in terms of alarmist fictional scenarios."

There are private hospitals in Brazil where the elective rates are over 80%. In Italy c/s rates of over 40% are not unusual.

The Portland hospital in london has a 43% c/s rate.

Now imagine offering women the opportunity for c/s in the context of the NHS as it is right now?

It would be completely understandible if HUGE numbers of women opted for a controlled surgical birth with pretty much guaranteed medical care throughout, in preference for being left to labour alone, strapped to a monitor on a depressing and chaotic labour ward.

tittybangbang · 31/03/2010 19:48

"And tbh, I want a midwife who supports my birth choices, and who supports me whatever happens, rather than one who is only interested in a particular kind of birth that they personally find rewarding or acceptable."

You can want what you like, but most midwives want to work as midwives, not obstetric nurses. It's what their whole training is geared towards. Yes - they understand the need for nursing skills in certain situations - but to spend large amounts of their time doing this type of work? Most would find it depressing and demoralising.

flameproofsuit · 31/03/2010 19:48

Oh ffs, get the fuck over yourself titty.

tittybangbang · 31/03/2010 20:11

flameproof - there's no call for that sort of nastiness. I've not said anything personally offensive to you have I?

Why the need to be such a bitch then?

foxytocin · 31/03/2010 20:13

and the point of that remark, flameproofsuit, was...?

tittybangbang · 31/03/2010 20:22

"When I moaned to them about by m/w trying to push me into a home birth this time round they were very supportive of the fact that there is no hierachy and a drug-free natural birth is no more of a 'correct' birth experience than any other type."

Hope you found your spiteful outburst cathartic Flameproofsuit (I imagine you did, given what you say above).

barkfox · 31/03/2010 20:26

titty....

Well, yes, I do 'want what I like' as far as birth goes - I'm intelligent, responsible, and capable of making my own decisions about my life. Maybe your post came across harsher than you intended - but whether or not MW's find my birth choices/experience 'depressing and demoralising' really doesn't figure that high on my list of priorities! I'm not having a baby to please them.

And if I understand your post correctly (and genuinely, I'm not sure I do) -

Then you want to refuse women the option of maternal choice CS... because you think a lot of them would go for it over VB... on the grounds that they would find current VB on the NHS an awful experience - "being left to labour alone, strapped to a monitor on a depressing and chaotic labour ward."

Gosh. I think that's putting the cart well and truly before the horse in terms of maternal welfare.

I do see, as other posters have suggested, the merit in providing better overall care in the expectation that fewer women MIGHT end up with a CS that they don't want. But that's a supportive approach, not a fundamentally coercive one. Which is what you're describing here, sorry.

gailforce1 · 31/03/2010 20:26

Please can this thread stop being so personal (if that is the right expression). Such comments takem away from the serious nature of the subject of the thread and if women cannot get on and support each other whilst having different opinions then there is very little hope.
By the way, if anyone is in any doubt about the need for CS to stop maternal injuries then have a look at Hulla'a thread about Keillands forceps.

tittybangbang · 31/03/2010 20:36

"Well, yes, I do 'want what I like' as far as birth goes - I'm intelligent, responsible, and capable of making my own decisions about my life. Maybe your post came across harsher than you intended - but whether or not MW's find my birth choices/experience 'depressing and demoralising' really doesn't figure that high on my list of priorities! I'm not having a baby to please them."

No - but if we want to get midwives back into service we're not going to tempt them in by offering them loads of work in operating theatres! That was the point I was trying to make. Won't make any difference to what you want for your birth, but it is an issue which needs to be acknowledged and worked with.

"Then you want to refuse women the option of maternal choice CS... because you think a lot of them would go for it over VB... on the grounds that they would find current VB on the NHS an awful experience - "being left to labour alone, strapped to a monitor on a depressing and chaotic labour ward."

Gosh. I think that's putting the cart well and truly before the horse in terms of maternal welfare.

If tomorrow all women were offered the option of an elective c/s, and the following year the c/s rate increased to 45% (quite feasible) maternity services would be put under severe strain and we would see an increase in preventable deaths of mothers. So no, I wouldn't support a change in current protocol. Would you? Currently we only offer c/s on the NHS for health reasons (including tokophobia). Would you argue that we should change that before institutional improvements in staffing were made so that care could remain as safe as it is at present?

tittybangbang · 31/03/2010 20:39

"By the way, if anyone is in any doubt about the need for CS to stop maternal injuries then have a look at Hulla'a thread about Keillands forceps"

I'm sure nobody here is in any doubt whatsoever that CS can sometimes prevent other, more serious birth injuries.

But a CS is a birth injury in itself, and in order for it to be justifiable (at least in health terms), it has to hopefully prevent more damage than it causes. That's what this thread is about - the comparative risks and benefits.

But nobody here is arguing that CS is unnecessary.

flameproofsuit · 31/03/2010 20:40

Thanks for that titty, saves me having to repeat it.

And I repeat, get over yourself.

Swipe left for the next trending thread