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.

If there is no medical reason for surgery, why on earth would people CHOOSE to go through it????

I had one Emergency CS (an undiagnosed breech - til one foot came out!!) and then VBAC for my second - the second was MUCH easier, I would not have contemplated a second CS unless I HAD to.. I spent 6 days hospitalised for CS and came home same day for VB...

My CS daughter has allergies and gets tons of chest infections (doc says probably BECAUSE she was CS delivered)

A CS is major abdominal surgery - it takes much longer to get over, and with the pain relief available nowadays, giving birth does not have to be painful. My second wasn't apart from the first few (5) contractions before pain relief.

There are not enough obs specialists anyhow, so it all becomes hypothetical.. you may say you want one - but when the only surgeon is dealing with emergencies - I'm betting not everyone will get their choice - as now, not everyone who wants one can have a water birth, a home birth, whatever......

Filofax - gas air diamorphine pethidine - do NOT relieve my pain.... I wonder have you actually experienced childbirth?

Caesareans and vaginal births both have their pros and cons; neither is "easier" or "better" than the other in isolation - it depends on each pregnancy, each labour. In a way, it's kind of a "no shit, Sherlock" pronouncement by NICE - women should be able to have access to whichever delivery method -and what pain relief methods!- they feel is best for them, after receiving the correct information from their doctor or midwife. Not propaganda. And not "encouragement" influenced by resources, staff numbers and shift patterns!

Hpno birth and birth pools you can not be serious.You seriously think pumping money into things like this will ensure more women have safe,happy v births?

My mother and I both nearly died after my forceps delivery,her friend's dd was brain damaged during her forceps delivery.She didn't get to see me for 2 days.I have several friends under going constructive surgery for v births and have friends whose kids needed treatment after traumatic births.

I'm petrified of pain and being out of control.My babies were all breech. Yes I could have laboured for hours in the hope of them turning but you know what no thanks.All the reading,hypno birthing in the world wouldn't have made a jot of difference.I know me,my body and my capabilities and there is absolutely no way on earth I'd have coped with it breech or not.

There are thousands of women like me and we deserve what helps us. Why should you lot have your doulas,hypno birthing sessions ,birth pools etc if we can't have what we want. Surely you should just get on with it minus all these fripparies and save the NHS money like the rest of us ?

I'm actually supportive of quite a lot of what iggly says - but not all. Better midwifery techniques have their place in this, but I really don't think we can afford to also ignore factors like bigger babies, age, mixing populations and obesity too. Its a combination of things that is causing problems. Hence my argument for double pronged attack on this... fear is very complex. If what helps her worked for her, then it is going to work for others. Her experience is as valid as anyone else. Everyone is different. I really want to stress this.

I think there is room for arguments for both. I think there is room for both natural and surgical help for tocophobes. Iggly has said she supports my position - she isn't 'the enemy' for want of a better expression. As long as someone respects my opinion, I have total respect for their way - I just don't want something forced on me.

I actually have respect for Iggly and Shagmundfreud, though I clearly have differences of opinion particularly with shagmundfreud, in particular. They have both put arguments forward that are well thought out and intelligent. Its the ignorance and intolerance displayed by some on this thread that I have issues with.

I also think its hugely important the word 'failure' isn't use in association with a c-section and it is being too much. I think this is where people get defensive about it all. Social conditioning... Nothing wrong with either way.

I think this has to be good news. My moment of epiphany came during my first labour when 20 hours in I suddenly thought 'I'm a scientist (OK very old, never used degree) I wouldn't have dentistry work without pain relief!'. I actually went on to have two relatively good VBs but know some many others that have been through hell.

A couple of questions - are there some countries (ie Germany (I think)) where cs is more or less standard?

Secondly - anyone know the history of childbirth (surely there's a medical historian lurking on MN). I seem to remember reading that in Roman times a labouring women was praised and celebrated and cared for by the best possible doctors, but then with the onset of Catholicism and the general falling in the standing of women, the care and attention women received during labour also fell. Would just be interested to know if this is true.

I really think there's no way we'd be even having this discussion if it happened to everyone in the population and (as the point has already been made) if this was for appendix op or something we'd never say 'but there's not enough money for the right kind of pain relief.

BytheWay1, most people who have not got a major phobia of childbirth (of a level which requires mental health services) and/or who have not experienced painful, traumatic birth with a slow recovery time will not opt for a CS, let's face it. Some of us who have had "natural" vaginal births have had extremely long recovery times.. and ELCS is very different to EMCS by all accounts.

Kipperandtiger, you hit the nail on the head. Choice based on individual circumstance and what is best for that person, not resource-led.

Slavetoafilofax, have you any other points to make here? Are you seriously suggesting that it is reasonable to suggest that women should choose not to have children because they have serious phobias rather than expect adequate care pathways? How odd! I suppose really people with phobias should just pull themselves together, and those with depression need a good kick up the arse, too? Where do you draw a line under that high horse of yours?

Otter, I have two children, one was delivered in hospital after an induction, one was delivered in an ambulance.

With DC1, I tore quite badly. Both times I had gas and air, but with ds1 I did end up asking for an epidural because the pain got unbearable, but by then it was nearly over.

In response to the thing about why women are scared, I think many women are scared because they know that maternity services could be much much better than they are. Many will have their own reasons too, but knowing that the service that is about to take the most precious thing in the world out of your body, is severly stretched, it stands to reason that you would find that quite scary.

Personally, I was more nervous than scared, because I trusted my body and I trusted my hospital.

screaming - agreed. I NEEDED an epidural. Needed. My friend had 2 VBs, each lasting less than 3 hours. She herself has said she had it easy, that she did not experience what I did, and is so thankful for that.

slave - do you REALLY think people will be queuing up for C-sections just cos theyre available?! Loads of people dont have epidurals even tho they're widely available. The CHOICE is there now. That's all. The cost differences are NOT huge. ELCSs are dearer than a STRAIGHTFORWARD natural birth. They are not significantly different from natural births involving epidurals, ventouse/forceps, episiotomy. And they are similar costs when a natural birth turns into an EMCS.

"It's like me saying 'thanks for providing my child with an education, but actually, I have a few resons to think that private education will provide him a better outcome, so can the rest of you pay for that please? It's ok if that means that other people miss out on things they need, I don't mind'"
It's not even remotely the same thing. One involves pain/potential trauma/problems that you might never recover from. And we now have the choice to avoid some of that. C-sections are no walk in the park - but I dont believe anyone is saying that they are easy, so I'm unsure who you're arguing against, tbh.

"Are you being forced to concieve? Are you being forced to carry a child? Are people taking away your ability to earn money and pay for your own cs?"

You are being very ignorant and don't understand why the changes have been made slavetofilofax

You are potentially taking away my chance for a family if you make me have to go private. As has been said before on this thread, the majority of requests are made for fear not lifestyle choices. Private maternity is located only in the SE of England. This means that women outside that area have significantly fewer options even if they do want to go down the private route and face significantly higher costs. The fact that I need the support of my partner and that I do not have family in London means that if the NHS does not support this right, I may loose my chance to have a family that I might desparately want. Just because I am afraid, does not take away my desire. In fact I am desparately struggling with this at the moment still. How do you begin to terms with not having a family because of your fears? You aren't infertile and you still want a family. NO ONE understands and there is no support for it.

Do not take away that from someone because they might not be able to financially afford it or because they have mental health issues that are not being taken as seriously as they should be.

Working I have never said that people with severe phobias should not have NHS cs's.

There is a huge difference between NICE stating that women with diagnosed phobias should be offered cs and all women should be offered cs.

I suspect that there are women who are scared of VB who claim to have phobia, when the reality is that they are actually shit scared. That's not the same as a phobia.

And phobias can be treated and managed and in some cases, they can be overcome completely. When a woman presents with a genuine phobia of childbirth, the default option should not automatically be major surgery.

Slave
So if free education and health care stopped in this country would you be campaigning to get it re started or just pay for your children?
Would you still have the attitude "well these things are not provided so you'll just have to pay yourself or not have your children taken care of if they get ill"

Quietlyafraid, you make a good point about the lack of availability of private maternity care. That is not an option where I live (up North). I actually looked into it on ds as I would have liked a private/semi private option.

I've only read a few pages so sorry if this is covered anywhere else.

I've had two vaginal births and two major abdominal operations. The physical recovery from the latter was much slower than the former so I'd never go for a CS unless in emergency.

I do support women's choice in birth as in everything and I suppose if the risks are manageable and the extra burden on the nhs and on the baby's immediate future are negligible then there's no reason why this shouldn't include elective CS.

I think there's a parallel with the increase in plastic surgery in a way. People are far less averse to surgery generally. If more and more people are prepared to accept the associated risks just to change the size of their breasts/nose/bum then why would they be worried about being cut open to have a baby?

WT actual F.

"a more civilised way to give birth"

I cannot believe my eyes.

I'm all for choice, in the right circumstances, but that comment is LUDICROUS!

Have you read any of this thread, slave? Seriously? It is not going to be the "default" option, it is going to be made more available to women who request it and the press releases suggest that this will be post-counselling etc for women with fears. I would be HIGHLY surprised if there are any women who will choose CS who do not have genuine fears that they have tried to address in other ways.

CS is a major operation, you are guaranteed that you can't drive for six weeks after it when you could be bounding about energetically after an uncomplicated VB, you could have a haemmorhage or an infection, your baby could have breathing difficulties. Who is going to choose that unless they have seriously weighed up the alternatives? You are talking about this as though it were straightforward.

I really don't want a CS, I have to say. I would personally rather the pain I know than that I don't... but I would like the option for CS ahead of induction. Have you any reasonable arguments as to why that is immoral and/or I should have to shell out just to avoid a repeat of my disastrous last labour? Is there any evidence a second induced labour is more cost-effective or safe than a planned CS? I doubt it.

do you REALLY think people will be queuing up for C-sections just cos theyre available?!

No, I don't. But I think that there will be women who would have been fine having VB that will choose to have CS just because they can, and from that, there will be complications to both mothers and babies that wouldn't have happened had they never been offered a cs.

As has been widely recognised, CS is not 'the easy option', it is not guaranteed to be complication free, so it stands to reason that there will be cases that an ELCS has caused problems that could have been avoided with VB.

Why not Slave,if that's what women want.

Also sorry "major surgery".I've had surgery,years of IVF,invasive procedures,lap & dye tests,toncillectomy the lot.My elective c/ss were a walk in the park compared with pretty much everything else I experienced previously.You're awake and stitched up in 15 minutes,It's so safe now and pretty routine if elected.

Sorry you're trying to make it into something it isn't just because you don't agree with it.

Yy quietly i don't think I was clear - we shouldn't ignore other factors. I think better midwifery (and better medical care generally) will help but the other factors have to be considered too. I think there is a lot to be done to understand and help people in your position - I find it awful that tocophobia is not taken seriously.

I think there is far more likelihood of complications both during birth and in the future from a v birth than a c/s to be frank.

The cost difference was clearly stated as not including costs of urinary incontinence etc following VB. So the cost difference is heading towards insignificant.

A GP friend once told me that as the average age at which we have DC has increased so will our pubic joints have fused more. Too much information but age does play a part in need for interventions.

I don't think it's going to be exactly 'offered to all women', I think there's some misunderstanding about how this would work. The woman would have to request it, and the recommendation is that if after discussion and counselling if appropriate (e.g. for phobias) she still feels unable to consider vaginal birth, then CS should be offered as an option. They also note that if fear and aversion to trying vaginal birth can be overcome with discussion and support, that is considered a better outcome. So no one is saying the 'default option' should be surgery!

No, I don't. But I think that there will be women who would have been fine having VB that will choose to have CS just because they can, and from that, there will be complications to both mothers and babies that wouldn't have happened had they never been offered a cs.

There are women who end up with complications after having to go through a VB who feel they were never fully told the risks involved. How is that any different?

Words for me are 'informed decision'.

howling which is exactly why we need more research. Given that we're in 2011 our collective understanding of pregnancy and childbirth is woefully inadequate.

Slave
You really need to read up before you post. There are likely complications for VB just as there is from CS. Different risks but both have risks and more so if a mother is pushed into a VB against her will!