NICE recommend all women should be able to have a cs

[LoveBeingAWitch]

Just seen tomorrow's front page of the Sunday times saying that NICE are saying cd has become such a safe op that every woman should be able to have one if that's what they want. Im quite surprised by this.

But what is wrong with an increased rate of medicalised births if that is due to women getting the birth they choose?

iggly2 just because you clearly missed it the first time.

THE £800 DIFFERENCE IS JUST A BASE COST. NICE HAVE POINTED OUT THE NEED TO ALSO TAKE INTO CONSIDERATION THE COSTS OF COMPLICATIONS ASSOCIATED WITH BOTH METHODS WHEN TALKING ABOUT COSTS. WHEN YOU DO THIS, THE COST EFFECTIVENESS IS SOMEWHAT DIFFERENT AND UNDER CERTAIN CIRCUMSTANCES COULD BE CHEAPER FOR MATERNAL REQUEST C-SECTIONS

Jeez. Wasn't that hard to understand was it?

Not sure where you are proposing these electives take place privately either, given that the only private maternity hospitals in the country are all in the south east and very few other places offer it privately. (In fact if anyone knows where they do outside the South East, I'd be very interested to know...) The 'Go Private' thing is about the same level as restricting abortion clinics in the US.

Lenin grad a difficult birth first time may well lead to the second birth (if it looks like similar circumstances) being requested on Medical grounds therefore not ELCS

ELCS means planned. Mine was elective in that I could have a CS, or probably die. Still called elective.

I had an emergency c-section with DD - it wasn't the birth I had wanted but it went well and we both recovered quickly so I was happy. I am now pregnant with DC2 and I have to see the consultant soon to decide whether I'm having a VBAC or elective c-section. I would rather go for a VBAC (no problem with another c-section but I don't see the point in having another abdominal op if it's not neccessary) BUT I am being seriously put off by all the restrictions/measures they want to put in place - restricting the length of labour, continuous monitoring which stops you being mobile, cannulae in place ready to be whipped off to surgery etc. It's totally against the way you would advice you to labour if it wasn't a VBAC and I believe that if I agreed to it all then I'd probably end up with a c-section anyway so may as well have a planned cs rather than a labour followed by the op. I'm planning to tell them I won't consent to all of those measures (mostly I want to stay upright/mobile and not have strict time limits) but if I see the consultant I saw last time I know it'll be a fight.

It's great that they are giving woman more power and say in their birth options but I strongly feel that they should also focus on supporting vb for those who want it so women like me don't feel pushed into opting for cs.

I apologise re the hormones thing, it was badly worded and insensitive, I do think that early breastfeeding can be hampered by ceasarians and I don't agree that women aren't groggy even if they have a section under spinal, so many women following section say to me "I didn't realise I'd be this exhausted, I feel wiped out" ok so the plural of anecdote isn't data but it's definitely an issue with the women I have looked after.

MrsHeffley But what is wrong with an increased rate of medicalised births if that is due to women getting the birth they choose?

The NHS just won't be able to cope. We as a department have been told rightly or wrongly we need to save 1.4 million, the increased cost of sections (ok only 800 quid but still) the lengthier stays, the increaseed staff needed to help women incapacitated from having an operatin etc all adds up.

Give me a c-section over an horrendous tear or cut down below any day.

Some of the horror stories you hear and read about vaginal births make it sound like nothing much has changed since the dark ages.

I asked for a c-section at my first consultant appointment and was told no. I ended up having an emergency one after 24 hours of labour so I got my wish eventually but it would have been much better as far as I'm concerned if I could have had my ideal birth (i.e an elective c-section) from the outset.

Oh, and I'd have willingly made a financial contribution towards the cost of it too if that's what they were worried about. It would have been worth it to me to miss out those hours where I was petrified and in absolute agony, not to mention worried to death about my baby who went into distress.

On the subject of cost, bear in mind that the NHS will not pick up the cost of every ELCS performed...there will still be women opting for a private ELCS over a public one.

If the NHS is so worried about saving money why don't they insist that everyone who's had a c-section tries for a v-bac? I was led to believe that if I had another child my wish for a c-section would be granted without question or quibble that time.

"The 'support' I was given for both of my labours was crap. The NHS fails women in this regard. It's only because I bothered to do my own research and thorough preparation that I went to labour confident that I knew how to handle it, and despite things not going to plan I was still able to manage the unexpected confidently."

Wow. Well done you. I suppose you think that when the wheels fall off during a woman's birth experience it's purely down to HER poor preparation then?

Rugby, there's a homebirthing website which I recall has lots of info about VBAC. Also you could join the Uk 'radical' midwives yahoo group and post questions to them. They are brilliant.

Lenin, my post was not knocking CS, but saying that it needs to be used within a better-informed context.

Perri - just because you've had one c-section it doesn't mean you'd definitely get another one.

It totally depended on the reason you had your first c-section and vbac definitely encouraged.

Yeh, first reactions - I think that's a good thing really - to treat women with the respect to choose their preference.
Not that I'd opt for a CS all other things being equal as I was happy with my two VB's.
I would opt for a water birth again though - as I had with DD (DC1)

Being a bit gloomy it's a bit like voluntary euthanasia - I wouldn't necessarily go for it myself but I'd quite like the choice/ option

My life ! My body !

i saw this a few months ago and downloaded the article hoping to get the CS i have longed for

I went to see my consultant and ws given a blanket 'NO NICE say NO'

I bit my tongue and thought - next time I will take the report

Benandholly, do read my post properly, you'll find it immensely helpful. The wheels did fall off during both my labours, but having prepared well I was able to handle it better.

Well said jugglingwithpumpkins. All these people who "don't understand" why women would choose VB/CS (depending on their point of view), well it's not up to you to understand. Let us all have a choice.

Well, MrsCampbellBlack everyone without exception that I know who has had a c-section and has wanted an elective one next time around has had one. No questions asked.

The only people I know who have delivered vaginally after a c-section are people who expressed a wish to.

Maybe it's a postcode lottery like with some drugs but it certainly happens around here.

CS are major surgery; not something to be taken lightly (of course, neither is VB!) In the US where CS is much more common than over here, many unnecessary deaths postpartum have been caused by certain methods of stitching ( I think stiching the wound in a single 'layer' to save time/cash rather than treating the three layers separately but i'm no expert - i think Ina May Gaskin has something about it on her website if anyone's interested).

I have read it properly

The wheels fell off your labour, but because you were well prepared ityou handled it well.

Bravo to you.

Obviously if someone doesn't handle things going wrong well it's all their own fault for not being prepared, yes? Stupid bloody women, if only they could be as well prepared as you are.

Perriwinkle If the NHS is so worried about saving money why don't they insist that everyone who's had a c-section tries for a v-bac? I was led to believe that if I had another child my wish for a c-section would be granted without question or quibble that time.

Because a lot of the time the reasons behind the first section will still be there in second and subsequent pregnancies, it's still cheaper to perform a planned section than an emergency.

quietlyafraid I have suggested intense counselling. This is addressing the phobia.

THE £800 DIFFERENCE IS JUST A BASE COST. NICE HAVE POINTED OUT THE NEED TO ALSO TAKE INTO CONSIDERATION THE COSTS OF COMPLICATIONS ASSOCIATED WITH BOTH METHODS WHEN TALKING ABOUT COSTS. WHEN YOU DO THIS, THE COST EFFECTIVENESS IS SOMEWHAT DIFFERENT AND UNDER CERTAIN CIRCUMSTANCES COULD BE CHEAPER FOR MATERNAL REQUEST C-SECTIONS

This mentions both methods so I can only assume there may well be extra costs for both methods that have not been mentioned. I have not read the report (I have enough scientific journals to read for work). Certain cases may well be cheaper or more expensive than the average.

NICE have given the RCM's 'Campaign for Normal Birth' a good punch in the nose with this recommendation. Which pleases me immensely as I resent the implication by the RCM that my ELCS was 'abnormal'.

I'm not trying to say that if women are fully informed then they won't end up needing a cs for reasons that they can't control, nor am I saying that all women will be able to overcome a true phobia with counselling (and where did I say that this can't start before a woman becaomes pregnant?).

Quietlyafraid says "I did point earlier that the guidelines are above providing a clear pathway of mental health care to try and support women consider a VB and have proper support JUST AS MUCH as they are about giving women choice here. Its a key point that is being missed."

I've not missed that point at all - it's just noth something that I think is happening as it should at the moment and is something that I think should be put right before more women undergo cs.

"Frankly I regard your post as rather patronising and insensitive. You aren't even trying to understand." In that case QA, you've totally misunderstood me.

Well Perri - I can tell you that is not the case in Bath or Bristol unfortunately.

It is discussed at appointments but with me was not 'agreed' until my 36 week appointment.

There has been a definite push to encourage vbac where I live. And I know many on mn have had to really push to get an elective c-section after having an emergency one previously.