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.

'Minge' was her word, not mine BTW - I prefer to use fanjo.

Yes having a baby is painful. Pain relief should help and women should make informed choices on this but IMO to offer CS on demand, where not a medical need is bonkers.

Surely better to give birth as nature intended, with our without pain relief. or are we all too soft and can't bear any sort of discomfort or inconvenience now?

They should look at better care during labour rather than just promote CS. If women had better labours they may not feel so worried about giving birth naturally.

CS brings it own problems. Can't always bf easily after due to the hormones not being released in the same way after birth for instance.

"Surely better to give birth as nature intended, with our without pain relief. or are we all too soft and can't bear any sort of discomfort or inconvenience now?"

Is THAT the reason you think women REQUESTING an ELCS want them? Convenience? Avoiding "discomfort"? "Too soft"?

How ignorant.

"CS brings it own problems. Can't always bf easily after due to the hormones not being released in the same way after birth for instance."

Loads of VB women can't BF easily either, and there's very little evidence that shows that CS women BF for a shorter time than VB women. In any case the ability to BF shouldn't have a bearing on delivery methods.

Thank god for these guidelines. I had an elcs recently for my 1st dc, after a psychiatric (NHS, perinatal psyciatric team) diagnosis of severe primary tokophobia. It was recorded on my notes as 'maternal request', btw - something quietlyafraid has noted in her excellent posts.

It was a wonderful birth - painfree thanks to painkillers (apart from a few hours when a vile MW, who actually pulled a face when she read 'CS for maternal request' in my notes, withheld some of my pain medication. She said it wasn't due, when it clearly was from my notes - and when I complained of increasing pain told me 'it's a caesarian, they hurt.' She was subsequently given a bollocking for not following the pain management protocol.)

My recovery was great - very fast, and it made me quite angry at so many of the scaremongering myths about planned cs. My ds was also ebf with no problems establishing bf.

I was very grateful for my cs, and for the majority of my sympathetic nhs care. But I realise it was pure luck. Other women in my position have been dismissed, ignored, patronised, bullied and victimised because of their desire for a CS.

These guidelines are good news not just for women with tokophobia like me - but for women who want the right to choose. The vast majority of posters here support the principle of choice, even though it's not one they would make themselves. That's very encouraging to see.

No evidence at all regarding breastfeeding and sections.

I've had four.

1 emcs, following 18 hour labour,
1 emcs with GA
2 elective, 1st elective took a loooong time due to internal organs caught in scar. 2nd elective, knife to skin to baby out 57 seconds.

The worst thing for my recovery was being overweight, more than I should have been, but each baby fed in recovery for a long time including ds2 who was born to a sleeping Mummy.

"as nature intended" is a load of crap. Nature wasn't terribly clever when deciding how humans give birth. The way mature intended ie labour and birth with no pain relief or intervention happened for thousands of years. And for thousands of years women and babies were killed or severely injured in childbirth. Why shouldn't we take advantage of modern 21st century advancements and enjoy decent pain relief and/or alternate means of delivery?

Oh qand studies have shown the biggest factor in 'failure' to VB is fear of failure....

fifitot it's already been discussed upthread that it's the removal of the placenta that triggers the milk hormones, not labour.

And just because it's not what you would do, why is it then wrong? NICE is recommending choice, not compulsory C Sections.

And earlier in the thread I said I have had an ELCS but if I had the choice next time I would choose vaginal. Not because of any problems with my CS: there were none. Choice, you see.

"I haven't read the whole thread, but my personal opinion..."

"...I don't understand why a CS birth would be offered as an option if there was no real medical reason for it, nor why any woman would prefer one over a VB."

You know its comments like this that utterly frustrate me. No one gives a damn what your personal opinion is especially if you can't actually be bothered to find out why women would choose. Beyond ignorant.

Press aren't helping at all though. Sadly not surprised at seeing comments like this.

Going back to comments about how this will affect c-section rates. Couple of points:
Maternal requests are already available in other parts of Europe. Again Sweden is a notable example given that a lot of the NICE guidelines is following the evidence coming out there. They have a slightly lower c-section rate than the UK. With the way they are counselling, as part of the system, there doesn't seem as if its driving the rate up considerably. The rate, I believe, though I'd have to double check this, is actually staying fairly steady, maybe increasing slightly.

There is a very big and active natural birth movement in this country. You can not get away from the influence that the NCT has, especially at the moment, when they have an increasing slice of the ante-natal system. Midwives also have a significant amount of clout with the way maternity is institutionally set up in the UK. VBs have huge political and public support. I honestly can not say I see women choosing a c-section over normal birth en-masse. Its still a huge decision to go that route, and one even I wouldn't take lightly. I'll be honest in saying I've looked for 'evidence' that c-sections are 'better' - I can't find it (though equally I can't find anything that says VB are better either). And I do think that the UK on the whole supports a culture of variety throughout our society.

Then there is the very important issue of private v public. Our system is very different from places like Hong Kong, Brazil, Iran where there rates of 80% upwards on c-section in some private clinics. There are contributing cultural influences there too, but the profiteering off c-sections is a big driver of the very high rates. We don't have that issue for obvious reasons (and despite what others think, I don't think its something we are likely to see either).

Haven't read the whole thread, but to those who say that CS invilves a lot of pain and a long recuperation time, I can honestly say that wasn't the case for mr with DD2 elective CS. I really felt NO PAIN at all, and was up and walking around about 4 hours after the op. The most pain I had was later when ghe stitches were taken out, that did hurt a lot.

With DD1 I had an emergwncy CS under general anaesthetic as she was in distress and they had to get her out ASAP, I had't had an epidural. The recovery for that was a lot harder, I felt more pain afterwards bit I think tnat's because I'd already gone through hours of painful induced contractions attempting the beautiful natural birth experience.

In both cases after a few days I was fine and here in Switzerland there is no prohibition on driving after CS so everything was normal.

What is so wrong with thinking that though? I genuinely don't understand why some women would choose to have CS - so enlighten me.

mrsfruicake, safety of delivery for both parties and fear of pain are the two main reasons I think

To avoid needing a repair of their fanjo. We're not talking about flappy fanjos...we're talking incontinent, prolapsed rectums

I was a HCPin maternity. The docs knew women would be brutalised by birth because of a) their size b) size of baby c) position of baby but their scetion taes were monitored so all women had to endure VB as the party line.

NICE are redressing this

section rates

shagmund argues that women should be forced into VB rather than risk CS affecting care of VBirthers and it will force maternity services to improve. My DD is 20 and maternity services still make same cock ups with birth as they did then.

I was refused epidural (middle of the night)
I laboured for 29 hours
She was known POP face presenting
Midwife ignored me most of the night

Not a lot has changed if you read current tales

A bit of healthy competition (e.g. choice to opt against VB) may make midwives campaign for a better VB birth experience

Would that not be a medical reason to have a CS Toothbrush?

My ob/ gyn advised me that if there is the slightest hint that there could be complications with birth, CS is safest option

Or Mrs Fruitcake... you could read the thread. Many people have shared their experience.

I haven't made a decision, I have quite a bit of research to do but my first "natural" birth following induction at 40+10 took nearly a year to recover from and since I have become pregnant again, a lot of the old issues are reoccurring. I have intense sacroiliac joint pain from the birth because my son was in such a ridiculously poor position, not helped by the very unnatural process of labouring on a bed while attached to a syntocin drip and continuous fetal monitoring as there were "suspicious" signs. Since becoming pregnant again, I literally can't get out of bed in the morning without squealing. Facing this again is pretty tiresome. It took nine months after the birth for this pain to subside. I was practically crippled in the early days and literally couldn't sit up straight or climb or descend the stairs for three weeks.

This was following a birth by Kielland's forceps, which have been banned in the US as they can be very dangerous indeed.

I would like to try a vaginal birth again if I go into labour spontaneously but I do not want to face the rigmarole of induction again. Given that none of the females in my family went into spontaneous labour within 72 hours of waters going (my grandmother lost a baby because of this), it is likely that I may be in a situation where I do not go into labour naturally. CS for me then, thanks. All the way.

MrsFruitcake, the new guidelines are very directly being aimed at a particular gray area in the current system that is giving cause for concern. The wording and emphasis is almost exclusively about women with extreme fear and differences of care throughout the system. The mental health concerns are a primary factor in their decision to change their recommendations. I've already talked at length about this earlier in the thread...

Fear in childbirth is being recognised as a real and significant issue in care elsewhere in Europe. We are behind other countries in recognising this as we are so obsessed with the myth of "too posh to push". The vast majority of requests are made for this reason. And a disproportionate number of those women have a history of anxiety/depression issues, sexual abuse or rape or have had an previously traumatic birth.

Its worth stressing the guidelines are not just about allowing c-sections - they are about providing guidelines for an appropiate care pathway for potentially vulnerable women in order to ensure they get mental health support and are given the risks properly. The lack of guidelines at the moment is creating wide differences in care and is meaning that mental health issues aren't being addressed where they should be.

Its about a particular medical issue that is largely being labelled as a 'lifestyle' choice and not taken as seriously as it should be being. It is a fallacy that there is no medical need in the majority of maternal requests - there is no apparent psychical need. Massive difference.

What is the medical reason Fruitcake?

I wasn't allowed one/offered one etc

They also stitched me without adequate anaesthesia resulting in huge complications. Holding me down whilst I screamed as they stitched...not good. they even asked by husband to help restrain me as I moved away from the Dr stitching me crying in pain.

The pursuit of the holy grail of VB is what allows this

Oh and baby number two I wanted a section but was refused, both my baby and I nearly died. I had a GA.

What is a GA Posies, is it general anaesthetic?

Toothbrush, I am appalled. That is just so misogynistic.

working - it was a female Dr and a female midwife

I do understand why the natural birth is a choice for midwives and some mums

But you need willing participants. At the moment you have women with no other choice

This is about choice and as such midwives and maternity services will have to up their service, to encourage women to be posting/talking about their 'great' experience.

You can have a 'bad birth' but still want another VB if cared for properly. If you don't want a VB WTF should you be forced into VB which is brutal and is hard work and can result in major medical complications

"but for women who want the right to choose. The vast majority of posters here support the principle of choice"

But there is a finite pot of money available to fund these choices at present, so decisions need to be made about how it's spent.

At present there is strong evidence for the view that the high emergency c/s and intervention rate for women attempting a vaginal birth would come down if staff shortages were addressed.

I believe that if there's money to be spent it should be spent on improving clinical health outcomes for women and babies. At a population level, reducing the emergency c/s and instrumental rates IMO would be a better way to spend the NHS pound. It's wrong to expand access to operative birth on demand without the current failings which are resulting in difficult and damaging births for so many mothers.

Have to say - I'm very disappointed that those women on this thread are refusing to engage in the argument about the current care standards for women across the board.

Maybe it's because those people who are arguing for c/s on demand don't want to consider how money could be spent improving the experience and outcomes for planned vaginal birth, as it weakens their argument on the subject of economic and clinical parity between v/b and c/s.

"NICE is recommending choice"

But at present women opting for one to one care in labour - one of a small range of things proven to improve clinical and emotional outcomes, is not an option for large numbers of women in the UK.

Many women are giving birth in consultant hospitals without 24 hour consultant cover.

Extending choice to planned c/s on demand without addressing the basic faults in the system which are responsible for so many poor outcomes is simply unethical.

And for those of you arguing that if you take into account the cost of treatment for urinary incontinence, c/s is no more expensive than v/b - A significant number of women having treatment for urinary incontinence have had c/s.

It's true that instrumental births are responsible for much pelvic floor damage to women in the UK, but the answer to this is to reduce the number of instrumental births - something which is possible with better and more skilled care in labour.