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.

I had natural births but I do understand why a caesearean may be needed. My sister's baby was in breech and she had one.

i would worry about resources and what if someone really needed one as oppose to be scared about giving birth by vagina and the formers life may be at risk because of lack of doctors etc. You read about overcrowded understaffed wards and not enough midwifes so wouldn't this make things worse.

Isn't a casearean more risky as it is surgery.

"whiteoleander I doubt it would be of much cost to the NHS. I don't think most women are going to start requesting them"

First time mums going to a hospital like Chelsea and Westminster - one of the largest teaching hospitals in the UK - are more likely than not to give birth by emergency c/s, or with the use of instruments than they are to have a normal vaginal delivery.

I think if women actually realised how small the likelihood was of them having a normal birth in some of our hospitals I think they'd be flocking to the surgeons for a planned c/s.

I think a point I have missed so far on this thread is one of trust and uncertainty.

I think a lot of tocophobes like myself have a real distrust of midwives and doctors. Last week there was a lady who started several threads about her fear saying she was really worried about how she thought electives would be banned in ten years and how she couldn't ever consider having kids if that option wasn't open to her.
In her words:
"I can pay for it myself if insurance doesn't cover the cesarian, but what if the doctor refuses to do it? Or what if the doctor tricks me into believing that it will be a cesarian and then doesn't give me one?"

The guidelines mean that you will now go through counselling, so there are opportunities to help some women who feel able with support to perhaps change their mind, whilst at the same time making sure they have confidence that the system isn't going to force them into anything either. They have a safety net at the end. Realising that the fear of being coerced can influence decision is playing a part in this and the uncertainty or the current system causing distress is brilliant.

I've been appalled at the standard of journalism being displayed on reporting what NICE have actually done. I refuse to believe that most have even read the report much less done background research.

general anesthetic yes.

"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"

This may well be true, but I have seven months before I have to do it again. I know the rate of change in the NHS, I work in it, and quite frankly the qualitative measures you speak of will not happen before I give birth again. Even if there was commitment to change, there would be discussions about discussions about discussions which might just be scheduled before my next due date. .

Frankly, I am terrified by some of the stories I read on here about "natural" birth. I consider myself lucky, for example, that because I had a trial of forceps in theatre I had a spinal block before I was stitched. It is a ludicrous state of affairs that a woman should be terrified of inadequate pain releif for stitching (which is not a "natural" process that our bodies were designed for!) because of the standards of care in maternity services, I agree... but while I would happily sign up to any campaign for better care, pragmatically I can see that if NICE push this, cs's will be available and more controlled than vaginal births with limited staffing/epidurals refused because of cost and staffing etc/no account taken of women whose babies are clearly in unfavourable positions and/or failing to progress in induction.

The number of women who manage syntocin/drip induction without epidurals and/or instrumental damage seems to be quite small. I think it is equally scandalous that induction is favoured over CS and women are told it is much less risky without anyone ever telling them they may end up using an instrument banned in other countries in extracting their baby. There are a lot of lies told about "natural" birth in so far as it encompasses induction.

shagmund

I total get your point about resources... HOWEVER thats not why these guidelines have been made and a lot of your points are another debate entirely, which I would probably agree with.

I do not see why this group that has been let down by a gap in the guidelines should be made to suffer over it. No one should be suffering at all!

This needs to be a double pronged attack on choice and resources in maternity.

And we also need to recognise this is a 'here and now situation' based on best approach under current system. The whole system frankly needs an institutional overhaul. The guidelines are definitely the best in the current situation, and sadly, some of the changes we really need are so deeply ingrained you are looking at least 10 years to even begin to make real headway.

Even if you do recruit a bunch of new midwives, they are still going to take several years in practice to become good solid experienced midwifes. By which by these guidelines will be up for review too.

relief, sorry.

Shagmundfreud, I agree.

Going into labour to be drip induced with a large back to back baby, 24 hours after SROM at 40+11, I had a cat's chance in hell of avoiding the "cascade of interventions" but I genuinely didn't realise this.

If I had realised the odds and/or the potential consequences in terms of recovery from my "natural" birth (which was about as natural as aspartame), I would have favoured CS.

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.

I did try and engage with this Shagmund
My point is that we've known about the problems with staffing and instrumental births etc etc etc for years and years

Not a lot has changed and it will get worse in current financial climate

If you can leave a woman shut in a room labouring unsuccessfully vs cost you will do the first at that point in time

If there is a clear protocol protecting women's right to choose you'll be treading a sticky line refusing her if something goes wrong.

Make VB better and this problem (CS) will go away

I've seen quietlyafraid on other threads and can see that women in her position have a clear case for a CS.

However I worry about the blanket rush to CS for the reasons outlined by shag above. I want a VB. I want decent support before, during and after birth (last time around I paid £3k for it but why should I?)

Why isn't more being done to look at why people are afraid of childbirth, why people want more control (I certainly do but don't see a CS as giving me that), why people end up being cut and having their babies pulled out with instruments?

Some serious research is needed.

Can I suggest that this argument has got needlessly polarised into

1. This NICE guieline means all women will have CS
2. The anti NICE guideliners want to force women to have traumatic birth

I stand by my stance that choice is good. I'd choose a good natural birth but since this is not always provided I'd opt for a section if odds were against VB.

The bias to VB at all costs, is what bugs me. A drop in instrumental delivery and a drop in traumatised women is something to be desires and if the consequence is increased CS that's ok with me

A few of my thoughts.
We are told that he NHS maternity services pot is stretched to its limits already.
There is no more money available to recruit additional midwives even though there is a need for more midwives.

As others have commented a request for an epidural is often met with the response that there is no anaesthetist available. Would having a dedicated anaesthetist for the maternity units be an answer to that? Obviously, would cost and there is no money available so not possible.
If the money is short as we are told then I have to ask how would offering CS to all women as a choice be possible? Or would it cut costs somehow and free up resources? If, as an extreme, every woman had a CS would it be better for the hospitals in that it could be planned ? scheduled surgery date, finite nursing, home for recovery ? done and dusted. As opposed to the uncertainty of natural labours/deliveries. If enough were requested wouldn?t CS lend itself very easily to a conveyor belt system.

Another concern I have is that by increasing CS rates, midwives have less experience with non-straightforward births leading in some cases to de-skilling. So anything other than a straightforward birth would be referred for CS as I have heard happens now with breech deliveries which at one time were not a problem to an experienced m/w.
I don?t have strong feelings either way tbh. I do think that a CS should be easier to obtain after reading some of the posts on this thread. But then after reading those same posts I think that maternity services and attitudes to women and childbirth should be massively overhauled. If it?s possible that a lot of the problems women have had could have been averted by considerate care and more one to one attention and less harassed midwives then maybe that?s a main area that any funding should go to first.

It makes me so angry when people say fear of childbirth is irrational, or ask over and over why are women afraid?

FFS, it's incredibly painful, lasts ages, there's a good chance of lasting damage to your nether region, and if there are complications you and/or your baby could die.

Combined with the endless studies and tabloid headlines about grossly inadequate and negligent maternity care in the UK not to mention often inadequate antenatal care that women experience I think it's perfectly rational to be afraid. Especially if you had a previous traumatic birth.

Drives me bonkers to see women's perfectly rational concerns being put down.

Indeed Iggly. I couldn't agree more on the research angle.

I was very pleased to hear that last week Norway has just completed the biggest study so far having looked at 4000 women over the last two years. Still not enough, and there doesn't seem to be much coming out of the UK.

Hospitals know there has been a rise in the number of women asking about elective through fear of childbirth. Liverpool Women's Hospital have said in one news article fairly recently the rise has been more than 40% in women who have already had one birth. 20% of claims are in maternity. 60% of payouts. £85 million in total. And theres been a huge jump in the last 5 years. I do appreciate some of the points made here very strongly about care across the board.

Interestingly, I can actually find any figures about rates of injuries in birth to women or children. So there is no way of telling if these are actually rising... I can't help but feel that might be a good reason for this. In being completely obsessed with rates for c-sections that we are loosing sight of all the other issues that are equally relevant.

The two things are totally connected - particularly with regard to secondary tocophobia. Secondary tocophobia is a lot more preventable than primary tocophobia. There are different issues for both groups, and whilst there are a lot of similarities and overlap in concerns there are also big differences too.

Haven't had time to read the whole thread but as someone who was terrified of childbirth, would massively have preferred a CS and demanded an epidural immediately......... I am actually quite glad now that I didn't have the choice.

The reason being I am now pregnant with DC5, something I never originally planned. I am not sure if this point has already been made, but you don't always know how life will pan out, and if you choose CS from the off you are limiting the number of pregnancies you can have. Just a thought.

Having said that, I was lucky in that my body COULD manage to give birth, despite all my fears, and I didn't end up with anything gruesome. If I had I would be the first in line for a CS next time. And probably not pregnant with DC5!

I think it's perfectly valid to ask why women are afraid screaming.
Because there are people who aren't afraid as well. Research is needed. quietly makes a very good point about secondary tocophobia as well.

This debate has got polarised because IMO experiences are polarised. Mainly because of poor maternity care or high levels of intervention. I can see it becoming a choice of you can try a VB but end up with forceps (for example) or have an ELCS

There is absolutely no need whatsoever for NICE to have done this.

If a woman has a real genuine fear of natiral birth, she can already get a CS on the NHS.

I'm all for supporting women's right to choose, I just think that if it is choosing because of personal preference rather than medical need then they should pay for that choice.

At a time when live saving drugs are restricted on the NHS, it is morally wrong for a woman to choose an expensive option just because they prefer the sound of it.

When we can afford to adequately provide high standard care for people who are actually ill, then we can think about providing choice for free. Until then, people who make a lifestyle choice should not be a spending priority over people who are actually sick.

I'm a bit confused by the "about 800 quid" figure being quoted, the thread is very long now so I'm sorry if I didn't see a link to the current proposal figures. Meanwhile, this link says the cost difference is over 900 pounds, from 749 to 1701 on average.

And that therefore CS costs more than double than VB. That is quite an increase.
Perhaps the CS costs go down sharply for planned CS? I hope so, anyway!

I am quite keen to see costings for planned NHS homebirths, btw, I would tend to think these are a bit dearer than hospital VB; then again, maybe not.

planned HB is the cheapest way for a woman to give birth, ragged

iggly but we're not asking why women aren't afraid, are we?

No, because the default expectation is that women will happily go for VB, because it's natural and what we're designed for (and oh yes, because we've got to keep the midwife industry going, as some on here have suggested).

The risks of VB are never explained, it is simply assumed you will have one unless there are very serious problems.

Thus, being afraid or worried about VB is seen as outside the norm, as irrational, as ignorant. If women try to talk about it they're dismissed: 'oh it will be fine', 'nature's way is best', 'read some Ina Mae'.

There is already plenty of evidence about why women are afraid. What we need are better ways of addressing it. One of them is indeed better antenatal and maternity care, more midwives, more education. Another is better access to epidurals and CS.

"Costings for planned home births include the cost of transfers to hospital, and of hospital treatment thereafter.

The National Birthday Trust report on home birth in the UK found that the average cost of planned home birth to the NHS was less than the average cost of planned hospital births. In that study, Henderson and Mugford reported that:

? Costs for antenatal visits and tests, staff presence in labour and delivery, procedures and pain relief in labour, perineal damage, and most importantly, days in hospital, all confirmed the greater cost of hospital delivery.? [1]"

screamingbohemian - that's exactly why I was afraid of childbirth. Our society doesn't help one bit with all the negative images and horror stories we delight in sharing.

coffeeaddict, I ended up much like you (except that I didn't have quite so many babies! ). I think it's because I'd been so scared for so long that I felt I had to do something about it, for my own peace of mind.

I have been trying to find text of that NBT report, Edless, can you link? It's 1994 data, from what I read, would like to see the % difference, which you would expect to hold up over time (even though it hasn't held up for CS ).
2007 Telegraph (pants source, admittedly) says cost diff between CS & VB on NHS was nearly 1000 quid then, why has it gone down since when everything else has gone up?

I do think it is imperative, that for the new guidelines to be most successful that the flip side of the coin is also pursued at the same time. Its about giving a range of options to women and letting them decide which is going to be the best way to manage any fears that they might have.

It shouldn't be a process of simply "here have a c-section" (which there IS a danger of). It should be talking about what the fear is based on & what alternative solutions there might be AS WELL as risks. There is a very real danger of this NOT happening even with the NICE guidelines. This is a critical point to making it work effectively. And as much as I support the guidelines I'm not too shortsighted to see that much.

I have no doubt that some women who are making requests, would actually like to go down the VB route instead but they are utterly traumatised by system they don't feel they have other options available. Its clear that the rising popularity of homebirths is in part down to growing fears too...

But thats not a problem with the guidelines, thats an issue with how they will actually be implemented. I don't think anyone has actually pointed out the fact that Trusts are free to completely ignore NICE anyway, so the guidelines hold no guarantees. I'm guessing public mood due to poor reporting, will mean a lot will ignore it. Chances are it will still be a postcode lottery. But they are empowerment.

The most important thing about the guidelines is a recognition of the importance of fear and mental health as valid concerns that should be being addressed. Not the electives. People have really missed the point because of poor reporting.

slavetofilofax "If a woman has a real genuine fear of natiral birth, she can already get a CS on the NHS." Not true unfortunately. Current guidelines aren't clear. Lots of women have been refused on these grounds. The changes are exactly for this reason.

ragged Figures you point out are dated 2002. They are also for ALL c-sections instead of just PLANNED c-sections. They are not weighted for outcomes.

The new NICE figures are £1,954 for a VB & £2,664 for a planned c-section after adverse costs such as a planned VB than ended up being a c-section are factored in. (Not entirely sure how £710 becomes £800 but it is the figure difference being quoted throughout the press - note the exaggeration - tells you something about bias here). HOWEVER - These figures don't include long term costs resulting for complications such as urinary incontinence though, which NICE quite rightly should also be considered. It looked at the sensitivity this had to the £800 figure and realised this had a potentially massive impact on the real lifetime cost to the NHS between the two methods.

"At a time when live saving drugs are restricted on the NHS, it is morally wrong for a woman to choose an expensive option just because they prefer the sound of it."

Is there even one example on this thread of a woman wanting to choose an expensive option 'just because they prefer the sound of it?'

Even one?

CS doesn't "sound" great. It sounds bloody barbaric. It's just that for a lot of people it sounds marginally less barbaric than the other options in the current system. CS is not an easy option, it has its own risks and the recovery time is well documented. However, for those of us who have had traumatic first births due to the pushing of "natural" birth (e.g. strap you to a bed and load you with a dripful of drugs and see what happens, terribly natural ), it seems a more civilised option than something which carries a very strong likelihood of instrumental birth. I will happily try a vaginal birth if nature allows it. I don't want a malpositioned baby to be forced out of me through the use of unnatural drugs and labour positions while I am attached to wires and machines.

Why is this a moral issue? I personally think it's immoral that a situation was allowed to develop where I had to have my baby extracted using instrumentation outlawed in the US and that has massive risks attached to its use, when I wasn't even informed of this. I think it's immoral that women whose labours aren't progressing well because of CPD/malpositioning have to endure watchful waiting that puts them and their babies at risk because hospitals want to drive down CS rates. I think the stillbirth and neonatal death rate in this country is shockingly immoral. There is wholly inadequate labour care in many parts of this country, and it is hardly surprising that women want to control an experience that is potentially life-threatening to them or to their babies. A planned CS is safer than an EMCS and if you have been through this or close to it it seems sensible that you shouldn't have to fight like a demon and cry your eyes out at every available option not to be put through that again. This is all that is under discussion. It is clear from the documentation that this will not be something that is offered without counselling and appraisal of the evidence and is really aimed at women with primary or secondary tokophobia.