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NICE recommend all women should be able to have a cs

999 replies

LoveBeingAWitch · 29/10/2011 22:59

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.

OP posts:
ToothbrushThief · 30/10/2011 22:27

No one is forcing women to have sections. This is about giving women choice.

I think some women are scared that childbirth will go out of fashion.

  1. If it does...so be it. Evolution?

  2. I doubt it will because many women choose natural birth

Forcing women to go through it is not the answer

BleedyGhoulzombiez · 30/10/2011 22:27

Sad for cerealqueen. It shouldn't be so complicated and demoralising. Am also angry for you that the NCT were so appalling - what you needed were facts, not melodramatic judgmentalism.

NotnOtter · 30/10/2011 22:27

startail - labour for some is like a living hell

the days and weeks after can be physical agony

Panzee · 30/10/2011 22:28

ToothbrushThief well said. I am gobsmacked that so many people seem to be against choice.

ToothbrushThief · 30/10/2011 22:28

I don't get why some posters want to restrict choice?

If you are scared women might choose CS...how does this affect you?

ToothbrushThief · 30/10/2011 22:29

x posted Panzee

iggly2 · 30/10/2011 22:30

But allowing women to just opt out of VB without explaining the benefits of natural birth Hmm. CS is major surgery.
Abstracts from journals indicating safety of VB over elective (I have had to resort to abstracts as not at work with access to most journal articles through the academic institute I work for):

Ann Acad Med Singapore. 2003 Sep;32(5):577-81.
Should doctors perform an elective caesarean section on request?
Devendra K, Arulkumaran S.
Source
Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, London, UK.
Abstract
The incidence of caesarean sections performed on request without medical indications is rising. The reasons for this are not only for perceived medical benefit, but are also due to social, cultural and psychological factors. Despite dramatic improvements in the safety of anaesthesia and surgery, mortality and morbidity are greater for elective caesarean sections compared to vaginal deliveries. An association exists between pelvic floor damage and childbirth, but this cannot be attributed entirely to vaginal deliveries and does occur even after a caesarean birth. The incidence of late intrauterine deaths is unlikely to be reduced by a policy of universal elective caesarean section, as these procedures carry a risk of iatrogenic fetal morbidity and mortality. The legal and ethical issues of request caesarean sections are complex. The validity of informed consent for non-indicated surgery is unclear. An individual has his/her rights and so does society. When society's rights are judged to have priority, the individual's right becomes a privilege. Based on this principle, maternal request caesarean sections must not compromise the provision of care to women requiring medically-indicated caesarean sections or should not dent the resources of public healthcare. In dealing with requests for caesarean sections, obstetricians should establish the reasons for the request and provide clear, unbiased information based on the best available evidence. Individualized modifications to the management of labour may allow some women to have vaginal deliveries. A second opinion from a colleague may help the patient to reconsider the request and make a more informed choice.

J Obstet Gynecol Neonatal Nurs. 2007 Nov-Dec;36(6):605-15.
A review of issues surrounding medically elective cesarean delivery.
Miesnik SR, Reale BJ.
Source
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, PA 19104, USA. [email protected]
Abstract
The rate of cesarean delivery has increased dramatically over the past decade. Medically elective cesareans are a major factor contributing to this rise. This article discusses the most recent evidence on the perinatal risks of cesarean delivery versus vaginal birth, the economic impact of elective cesarean delivery, and ethical principles related to cesareans performed without medical indication. Physicians' rationales and responses to the issues are reviewed and the recommendations and guidelines of professional organizations are summarized. Available evidence does not lend support to a current shift in clinical practice. Research is needed to adequately compare outcomes of planned cesarean delivery and planned vaginal birth. Until evidence supports medically elective cesarean as a birth option that optimizes outcomes for low-risk mothers and their infants, obstetric care providers should continue to support evidenced-based decision making that includes advocacy for vaginal delivery as the optimal mode of birth.

J Perinat Neonatal Nurs. 2001 Dec;15(3):23-38; quiz 89.
The case against elective cesarean section.
Goer H.
Abstract
Prominent American and British obstetricians have been advocating for performing more Cesareans. They argue that Cesarean section is as safe or nearly as safe as vaginal birth, eliminates pelvic floor damage and the consequent symptoms caused by vaginal birth, is safer for the infant, and is desired by many women; however, abundant evidence in the medical literature refutes the validity of those claims.

LeninGrad · 30/10/2011 22:30

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goodasgold · 30/10/2011 22:30

With my dd1 I had such a nice birth, that the mw asked me whether I had considered a hb.
With my my dd2, she was back to back, it hurt, but she was a hb, the main thing was that we had dd, And she was so sweet.

With ds he has just been so lovely, I am so in love with him

NotnOtter · 30/10/2011 22:31

cerealqueen - I agree

My dp has watched me have six labours and is himself in a medical field. he agrees with what you say - the pain relief /caesarean lottery is barbaric.

I wish to choose how i suffer my pain

CharlieN79 · 30/10/2011 22:32

I am having a planned cs for my 2nd dc in 11 days. The birth of my dd ended with failed ventouse and inner canal forceps with 27 people in theatre at delivery. I also lost a lot of blood. The recovery was long and painful. I have had complete support from midwives on my cs request and although I am aware the recovery will not be pain free I am not fearful of the delivery.

iggly2 · 30/10/2011 22:32

Particularly like the last one as generally I do not think highly of the medical profession.

LeninGrad · 30/10/2011 22:33

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Message withdrawn at poster's request.

iggly2 · 30/10/2011 22:35

Yep. explain it all.

BagofHolly · 30/10/2011 22:36

Iggly:"But allowing women to just opt out of VB without explaining the benefits of natural birth"

What makes you (wrongly) assume that women who opt out of VB don't know of the benefits of natural childbirth? Shock Women are perfectly able to make an informed decision, even if that decision isn't the same as yours.

(And your references are awfully old and obscure. How about reading the ones which NICE used? Wink

Panzee · 30/10/2011 22:36

iggly2 so you agree with informed consent then.

Kayzr · 30/10/2011 22:39

I think it's good that NICE have said this.

A friend of mine had an awful VB. She got to 10cm in about an hour and had really bad tearing. She was desperate for a CS with her DD2. The MW really didn't want her to and in the end she did get her CS but only because the baby was breech.

It should all be down to the woman making her own choice. Like I said earlier I would never choose to have one. I'm not great with needles so an epidural terrifies me. But each to their own I think.

iggly2 · 30/10/2011 22:39

Oh I did not have a lot of explained as again the emergency CS was under GA. But...... knew all about it anyway. I am not stopping choice if they are willing to pay the difference NHS is broke and will get worse.

LeninGrad · 30/10/2011 22:39

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Message withdrawn at poster's request.

quietlyafraid · 30/10/2011 22:40

Iggly, I'm starting to loose patience here. I've now pointed out at LEAST twice that the new guidelines detail a care pathway that is supposed to lay out all the pros and cons as part of the process. Its about helping women face a vaginal birth with support if it is appropriate to them as much as it is about allowing a choice of an elective.

You have conveniently chosen to ignore this as you are so utterly blinkered in your opinion that c-sections are completely evil as you had a bad experience.

No one is being forced to do anything here. I really don't understand what your problem is with choice apart from the fact you aren't interested in anyone else's voice but your own.

And I can also pull a bunch of studies out of the air that say very different things to those studies...

quietlyafraid · 30/10/2011 22:41

iggly, for a third time seeing as it is yet to go in...

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

LeninGrad · 30/10/2011 22:42

This reply has been deleted

Message withdrawn at poster's request.

iggly2 · 30/10/2011 22:42

References are relevant as developed countries. I discounted a hugh one which came to same conclusions about elective CS bing dangerous as it focused on Africa and Asia and discounted developed countries.

PS that study was by WHO.

carriedababi · 30/10/2011 22:43

women should have the choice, well done nice.

i had 4th degree tear with dd, and still suffer 4 years later

vaginal births have huge risks that we are not informed of, i wish i had known of the risks of vaginal births

LeninGrad · 30/10/2011 22:43

This reply has been deleted

Message withdrawn at poster's request.