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 think this is great news. One of my twins would have been brain damaged or stillborn if I had gone into labour. (Fused placenta if you're interested. Very rare.
They put mine in the freezer to show students.)

Yes, good idea. A planned CS would be my idea of hell (I'm terrified of operations) but birth decisions are such an individual thing and women really shouldn't have to fight to get the birth that is best for them.

I wonder where they are going to find all these midwives to look after the incapacitated mums after birth? There are already huge shortages for normal deliveries. In CS there are often 2-3 midwives present in the operating theatre (or at least popping in and out all the time) and then some needs to stay with mum in recovery for a few hours while the epidural wears off. It will also mean fewer beds in the post natal ward as women stay a day or two longer than VB mums. Babies who are born after a CS are more likely to breathing problems in the first few days, also. Thus adding extra strain on SCBUs etc.

I think its right that women who really want to give this way, should be allowed to, but that it should not become the norm. CS is not without complications and just because you did not give birth vaginally, does not mean you will not have problems with things such as urinary incontinence etc. Yes you are probably much less likely to have these problems than some who had a VB of a 9lb+ baby, but it won't prevent it completely.

Women need to be fully informed, both about the risks and benefits of VB and CS and their long term effects.

When you have had a vaginal birth with a very slow recovery (nine months ish for me, Kiellands forceps/stress incontinence/ongoing sacroiliac joint pain requiring physio etc), it's hard to really feel that cs is such an awful thing.There have been many OBs who have campaigned to BAN Kielland's forceps, yet I had a birth like this without even knowing the risks to me or my baby. So I am a bit "meh" about the risks of CS as a result.

I am pregnant again but it is early days and am far from decided what birth I would like, but literally since a week after conception I have been suffering horrendous joint pain. If it does worsen during pregnancy, I don't care how frigging "capable" I am of VB, I will consider all options and weigh up what is best in the circumstances without feeling bad about it. This guidance helps women in situations like mine who would rather not face further trauma to their perineal regions etc.

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About time.

Er, what incapacitated mums, sophe29? I was up and about looking after mine independently as soon as the spinal block wore off, and up until then they were just on the boob.

Yes, there are a few midwives at delivery, but it only takes half an hours or so; I've had two, so I do know!

And breathing difficulties are only really more likely at pre-term birth; CS is only carried out before full term if there is a reason the baby needs to come out early.

I totally agree women need to be fully informed, and appreciate that you say women should have a choice, but the type of "information" you cite is simply not correct and is the type of rubbish spouted by midwives seeking to "inform"women.

I had a lovely VB at home, couldn't deliver the placenta, transfered to hospital

for a MANUAL removal, i had no idea, i thought they'd get the salad servers

out and bingo! If i'd have known some surgeon with rugby player hands was

going to fiddle about in my uterus, i'd of asked for a CC.

i agree, although i am biased as i had two great (planned) sections with both my dc.

would far rather have a planned cs than suffer some of the things friends have had go wrong with vaginal births.

I am in favour and also believe that this will not greatly increase the number of women opting for elective c-sections. If you have had an extremely traumatic then my understanding is that most pcts will allow you to have an elective anyway since, obviously, forcing a terrified mother to attempt a vaginal birth is rarely going to end well.

that should say extremely traumatic first birth

I think it hardly seems the worst thing in the world to choose a CS - lots of vaginal births are fine or even better, some are horrendous - there's nothing wrong with not wanting to risk it given the lack of midwives these days.

Ideally I'd like to see birth being handled better within the NHS because it can be done really really well with the right staff and facilities (obviously I'm not advocating a forced VB for every woman...) but as far as I can see, the political will isn't there and campaigning for more midwives isn't working. Obviously this means handing birth over to largely male obstetric staff, it's another kick in the face for the largely female midwifery workforce, and that's annoying from a feminist perspective.

But more choice isn't a bad thing in this case, I don't think. (Though IME not very many women are turned down anyway for an elective, esp if it's their second baby.)

DogsBeastFiend the 'civilised way to give birth' seriously, what does this even mean?! That a natural, VB is somehow 'uncivilised' I really take exception to that and think it is a truly insensitive and quite frankly, ridiculous thing to say. There is nothing uncivilised about a VB. it is a physiological, natural process.

If these are the NICE guidelines I'm thinking of, there's supposed to be discussion of the procedure and its risks (I'm pretty sure they have to inform you of the risks in order for you to give informed consent!), and counselling for those with psychological issues like birth phobia and previous traumatic experiences. If after all that the woman still feels that she absolutely cannot consider vaginal birth, then they recommend a section should be offered.

That sounds reasonable to me. It's not a case of the request being granted on a whim without any knowledge of what it involves.

Birth choice is a good thing.

Informed choice is even better.

But will women be really informed? and by who? NHS antenatal education is virtually non-existant. 5 minute appointments with a community midwife with massive caseloads is not enough. The internet is not reliable.

And who will look after these women post CS? one woman to one midwife doesn't happen as it is. Who will be doing the postop care? Staffing cutbacks mean that on a postnatal ward each midwife has to look after more than 10 women (plus babies) at a time. Who will be monoring the health of those women and babies? Who will be checking a womans blood pressure isn't dangerously high? Or that she is bleeding? Who will be checking jaundice levels? Monitoring infection? changing dressings? Planning, Implimenting and documenting care? Recognising a problem? Calling help when needed? Who will be educating women in babycare and parenting? Encouraging and supporting? Who will be helping with breastfeeding? Who will be providing a shoulder or hug at 3 am when it is needed?

I suspect that more and more care will be handed over to maternity support workers (who are wonderful but not autonomous, accountable professionals). Volunteers are valuable but not on hand 24 hours a day.

There will be fewer midwives around, because lets face it they won't be needed. As caesareans become more 'normal' those who choose labour and vaginal birth will have to fight harder to get it.

All NHS trusts are facing budget shortfalls. Why would they pay for a midwife (with degree level education and skills to provide evidence based care and the ability to develop professionally) when an MSW or even better unpaid volunteer can do the very basisc? Because that is all that will be done.

Midwifery is an endangered profession. Just as soon as childbirth can be completely medicalised it won't be needed. And then there will be even less choice in birth than there is now.

and it is just tragic that birth is no longer normal, but a problem to be fixed.

I had three VBs (nothing horrendous, but certainly not pain free either, and a nasty episiotomy after DC1). I then had a CS due to foetal distress with DC4. It was certainly less painful initially than VB, and I was kept topped up with morphine in hospital...BUT post natal recovery was awful. I couldn't roll over, get out of bed, pick up my baby (don't forget, they'd just sliced through my stomach muscles - or whatever was left of them after 4 DCs!) I felt like crap for weeks (this was surgery after all) and couldn't drive. Also, the strong painkillers had their own side effects. In contrast, I popped to Tescos when DC3 was just 24 hrs old! Given the choice, I would always opt for a VB over a CS.

I am surprised to, but I'll respect that NICE is there to judge whether it's a cost-effective and reasonably safe way to proceed.

Not sure how to take the news that I have "uncivilised" preferences. My impression is that most people who prefer CS for non-medical reasons, just want to feel more "in control" of the birth, what the birth does to their body, and particularly in control of their emotions during the birth. I can't help but suspect that lots can fail to go to plan with CS (and in the recovery period), so it could be placing too much faith in CS to achieve the aim of superior control.

I recall all sorts of slightly depressing study results about CS, like having even just one CS reduces future fertility, reduces breastfeeding success, future pregnancy problems more likely, increases some risks for infants... how many of those increased risks apply only to em. CS and not to elective CS, too?

Oh, and whilst I'm soapboxing, could we call it a "planned" CS rather than "elective"? Sometimes there's almost no choice in it.

it is just tragic that birth is no longer normal, but a problem to be fixed

Get a grip. No-one is forcing women to have a c-section. They're suggesting that women who don't want to aren't forced to have a 'natural' labour.

Women asking for most effective pain relief - epidural - are routinely refused it or are made to wait for hours. Women who have had previous birth trauma are told that they can't have a c-section and spend their pregnancy terrified of what's to come, or in some cases, decide they won't have a second child as they can't face a vaginal delivery. Women who have had problems delivering their first child - with the baby getting stuck- are told to wait and see and end up with crash sections.

Those figures usually include crash sections Ragged, where something has gone wrong and it's a case of get the baby out ASAP. And then it becomes more chicken and egg.

I think the assumption that women who choose a cs are not making an informed choice is a very dangerous one, and is thankfully at odds with these new guidelines.

ragged. No, you may recall but you're wrong. I'm an old hand when it comes to CS and the ONLY thing you can say is that a planned section is the safest delivery for a baby.

I would be interested to see more research to allow a full comparison of risks/advantages of planned CS, emergency CS and VB. I am naturally sceptical and suspect that some of the specific complications of emergencey CS and VB get swept under the carpet.

I had an EMCS at the end of a very long labour and know that the recovery time was far longer than after the planned CS I had for DCs 2 & 3. It makes sense to me. No one would prepare for an operation on their leg by doing a marathon the day before.

How many of the long term problems suffered by women after difficult VBs are actually mapped back to the VB? Problems with continence, sexual intercourse and mental health all seem to occur quite often post VB yet seem to be trivialised sometimes both here on MN and in real life.

I dont have numbers for this and would be interested to see research.

True GnomeDePlume. Many emergency sections involve an exhausted mother and baby after hours and hours of labour.

I know someone who had a traumatic planned CS after 3 emergency CSs that seemed fine. There's just no telling.

Some of the risks from CS would seem to definitely arise from having any CS, like increased risk of placental abrupture or ectopic in subsequent pregnancies. Some, like reduced breastfeeding success, might be more due to mindset/trauma from the birth.

Deleterious impacts on baby's immune system might be very complicated to untangle, although a medical solution might be found to lower that possible risk, anyway. Agree more studies need to be done!