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.

JustinBoobie, the sentence you chopped the bit about civilised birth from was this:

"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"

Explain why that is so "LUDICROUS". I do not consider that the use of Kielland's forceps in delivery is very civilised and I am not alone, which is why these have been banned in many countries across the wall. Misrepresent away, though

World!

World!

Not Wall.

This is not pre-1989 Berlin!

The elephant in the room of course is that, given that even on a thread like this, there is such an astounding level of judgemental and anecdotal opinion over factual evidence, how on earth is a woman to know when she is sufficiently informed to make her choice?

The answer of course is the she will never know enough, and it doesn't matter, so long as she (a) firm in her views and choice and (b) supported so that she can carry that out choice.

Anyone advocating the removal of, or limitation of, such a choice is quite plainly an arse (anecdotally, and judgementally speaking)

Microfight, I don't get your point. Education and healthcare is free, so that is what I am basing my opinion on. If that changed, then maybe my opinion would too.

I take the point that private healthcare is not widely available. But that is not something that couldn't be changed. There are many hospitals that have a private wing, where you get a standard NHS delivery and then you can pay to be in a private room withing the same hospital. The same kind of thing could be set up for people who choose to have a CS without there being a medical need.

And I also take the point that expecting people to pay for their own cs if that is the only way they will consider having a child is going to prevent some people from having children. But actually those people can choose whether or not their desire to have children outweighs their desire to not have a VB. They still have a choice.

I am all for people choosing to have a CS if that's what they want. I just don't agree that the NHS should pay for it or that NHS resources should be used when there is not a medical need for it.

When we live in a country where waiting lists for life saving operations aren't months long, where people are offered cancer drugs based on how good they are rather than what they cost, when elderly people aren't discharged from hospital before they are ready because someone else needs the bed more, when wheelchair users are given wheelchairs that actually suit their needs instead of being given the cheapest option available, when asthma patients can have their life saving medication free in the same way that diabetics can, when diabetics are offered a choice of medication rather than just being given the cheapest option, when people with MS are offered drugs that NICE currently does not reccommend because of the cost even though they would help, when people with mental health problems aren't taken out of therapy after six weeks when they need more, and when all the other shortfalls that I don't know about are corrected, then I will support women's right to choose CS for non medical reasons.

CS is, literally, a more civilised way to give birth.

It isn't always the best option, though.

I thought the whole point was that they couldn't justify refusing maternal request CS on cost-effectiveness grounds, i.e. there was no strong evidence that this would significantly increase overall costs. That's what it says in the actual text of the recommendation, anyway.

No, and I didn't say it was. I said I would prefer a natural vaginal birth but if faced with induction again in the circumstances I found myself last time (overdue, SROM, large baby, back to back), I would rather a CS. was all detailed in the long post that JustinBoobie truncated to support the idea it was about being too posh to push.

My sister in law who is doctor and specialised for a while in her early career in obstetrics says that really I should have been given a CS much earlier and that it is highly likely I wasn't because of concerns about CS rates in the hospital. Pretty uncivilised to put figures ahead of people.

"But actually those people can choose whether or not their desire to have children outweighs their desire to not have a VB. They still have a choice."

You misunderstand mental health here, slave. It is not a choice. Who would choose to be phobic, to be resistant to treatment, to see this as the best option? It is not a free choice.

Mrsheggly - if there is good quality evidence which links the use of hypnotherapy and waterbirth with improved clinical and emotional outcomes then women have just as much right to demand access to them on the NHS as they do to demand a planned c/s, which is vastly more costly than either and not linked to improved clinical outcomes for low risk mothers when compared to standard care in labour

Oh I couldn't agree more, working.

I don't misunderstand mental health at all. I have first hand experience of how crippling some phobias can be. So like I already said, people who are severely phobic and who genuinely are resistant to treatment should be given CS.

But if they can pay for their own therapy (as my DH had to for his severe phobia to food) and then go on to have a safe VB, then I don't see why they shouldn't.

There is too much of a sense of entitlement going on here. People are entitled to good quality healthcare, because we pay tax to fund it. But even then, people don't get good quality healthcare. That needs to be addressed first, because quite simply, it's more important than facilitating peoples desire to have children.

slavetofilofax. Read the whole thread and take it all in. Then comment. Then I might start having some respect for what your saying. Right now, I don't have any as its clear you haven't even taken time to read back properly. Re Cost - Ephiny summed it up. Re Maternal Choice for lifestyle reasons - written a whole pile on this being utter bollocks and how its not being properly recorded and how the press is pushing a myth.

Debate I can do on here. Ignorance, I can't be bothered with. I would like this to be better understood and respected properly but there is only so much you can do...

"how on earth is a woman to know when she is sufficiently informed to make her choice?"

Not helped by lots of Bad Science & political pressure & deliberate misrepresentation in the factual evidence too. I've got to be honest in saying that I've been very dishearted by a lot of 'scientific' evidence I've seen trying to get a real idea about this. Both sides are guilty of it too. Its hard to really know what is quality evidence and what isn't. Its hard to be impartial about it and to make an effort to question the side that you are biased towards.

Being honest about it I really should read some really hardline pro-natural stuff, but I find a lot of it so distasteful in its judgmentalness and narrow minded approach. Reading it doesn't always do a lot for your confidence if its low. On that basis, I find it hard to give it a real try. Its too evangelical for my tastes. I just end up getting angry and upset with it.

"But if they can pay for their own therapy and then go on to have a safe VB, then I don't see why they shouldn't."

Small thing called the NHS...?

Or maybe I should start saying that anyone who smokes should pay and extra tax?

Or anyone who has a breech baby should pay for their c-section?

Or perhaps we should even have supermarket weigh ins and anyone with a high BMI has to pay extra for chips and ice cream?

If you hadn't lost my respect before that, you definitely did with that gem...

I would never have CS only because I wanted to o.O to want to be cut open when there is no need? what for???

Slavetofilofax, you are actually making very little sense here. People's desire to have children is pretty basic for those who have this desire, and that is the majority. It is much like the desire for food or liquid or sex. There are a proportion of mother and baby units for mothers with severe mental health difficulties because there are genuine health needs relating to pregnancy and some of these will relate to phobias/obsessions. You are talking about it as a luxury.

I have no problem with people paying if they can, I think it would be good if there was some element of this in the NHS. However, that's not how the NHS works so it is somewhat spurious to discuss it as if it were as an argument against adequate funding of the system that we currently have. There are NO private healthcare options in obstetrics where I live, they just don't exist. That may change, yes, and I would happily pay some money towards a better birth.. but it needs not to be prohibitive. In Ireland, patients have the option of being public, private or semi-private. I can support this to an extent (though I doubt maternity care is much better there to be honest), but it is not an easy answer.

You are suggesting that because having children is a choice, a sense of entitlement drives the desire for access to safe, appropriate maternity services. That is a very strange argument to make. We do pay taxes, as you point out.. and as has been said time and time again, in terms of public health the cost difference is negligible. Really, what this is about is NICE saying that care providers need to follow the evidence NOT push for cost-cutting that is inappropriate and detrimental for some individuals. That's all. What logical argument is there against such a statement? I am baffled.

"Add message | Report | Message poster Ephiny Mon 31-Oct-11 11:51:35
I thought the whole point was that they couldn't justify refusing maternal request CS on cost-effectiveness grounds, i.e. there was no strong evidence that this would significantly increase overall costs. That's what it says in the actual text of the recommendation, anyway."

Well said, Ephiny.

working that's interesting re the CS being given too late. Targets skew things as does the narrow focus on cost.

They need to go back and look at how women have ended up in certain situations and try and anticipate them then deal with it instead of leaving it and it leaving it then ending up with a traumatic VB or CS.

There should be something done to look at the choices that women should have, the research needed to make those informed choices then the practicalities of cost etc etc come later. Starting with a narrow focus of CS v VB on cost grounds gets nowhere.

But plenty of people with MH issues have no choice but to suffer or pay for their own therapy already!

It would be great if it was available to all who need it on the NHS but it isn't. And even those who do get it often have to wait for months.

Smokers do pay extra tax.

Breech babies are already medically indicated for CS.

And people with a high BMI have to accept the healthcare that is already offered, the same as pregnant women should.

No, I haven't read the whole thread. It's long.

I am prepared to accept that if offering ELCS to women who have no medical need for one is more cost effective than the system we have at the moment, then it's a good thing. If it is going to take even a pound away from other more important services, then I stand by my opinion that offering CS without medical need is morally worng.

"No, I haven't read the whole thread. It's long. "

So don't expect responses to your silly posts until you do.

I am British but currently live abroad and have had one CS. Am pregnant with no. 2 and was told even before TTC that if I wanted to stay with my gynae (with whom I am happy and comfortable) I would have to have another CS. Most gynaes here refuse to do vbac full stop. It is absolutely the norm here (private healthcare but it is a third world country and I can't imagine the conditions in the state hospitals) to have CS and there always seems to be a reason why you should have one which I think is more for the convenience of the medical staff and the fact that is more expensive. Most of my contemporaries are convinced that they will die/be ripped to shreds if they have a VB and have been totally brainwashed to think like this.

Although I am very much pro-choice and certainly not anti-c-section I personally don't believe the NHS should be paying for this extra cost especially at a time when it is so stretched both staff and money wise. I know people say that they wouldn't go down the CS route etc.. but most of you are intelligent/well-informed people which is not unfortunately the case for much of the population (I know loads of people who would categorically choose a CS for convenience/cosmetic reasons alone...). I know some people have had absolutely horrendous VBs but equally I personally know a lot of people here who have had serious problems after an elective c-section and that's in addition to the standard issues that follow a big op.

I think, unless there is a valid reason (each patient should be assessed before proceeding as there will of course be patients who mentally wouldn't manage a VB as there will be those who physically shouldn't be put through it) for a c-section then the patient should pay the additional cost or go private. Sorry but pregnancy is not an illness and I, for one would much rather be paying NI/taxes to help cancer sufferers/accident victims etc.. than women who feel it's their human right to be able to choose a CS over VB.

People with high BMI take much more out of the NHS than just about anyone else... so based on your great logic...

I am now officially voting for supermarket weigh ins to force people to loose weight because I am sick of paying for their extra health care needs. None of them might have mental health issues or even physical issues that might be leading to their problem. They are all just lazy and weakminded individuals. And they absoluetely shouldn't be allowed to breed as it costs the NHS more as they are far more likely to have complications and end up with a c-section.

(Please note tough firmly in check and no offense intended to anyone else. Just think ridiculous comments are being made here).

You are suggesting that because having children is a choice, a sense of entitlement drives the desire for access to safe, appropriate maternity services.

No, I'm not. Safe and appropriate maternity services should of course be available to all. I just don't think that non medically indicated CS's fall into that catergory.

People's desire to have children is pretty basic for those who have this desire, and that is the majority. It is much like the desire for food or liquid or sex.

The desire to have children is not like a desire for food or liquid. Without those things, people die. No one died because they couldn't have a non medically indicated CS. No one died because they couldn't have sex.

I'm not trivialising people's desire to have children, I'm really not. I knwo how powerful that desire can be, and I realise that MH issues can arise from an inability to have children. But a childbirth phobia does not physically prevent someone from having children.

I agree with lots of your post working. And I'm not trying to say that I want to see women suffer just for the sake of it. I'm just saying that imo, there are far far more important things that the NHS, and especially NICE, should be thinking about improving. As I said in my post above, when all the other, more important, shortfalls in the NHS are addressed, I will support women's right to choose their own method of childbirth.

No one died because they couldn't have a non medically indicated CS.

...and lets ignore all the terminations they have caused.

Right I'm off for a bit, cos I'm started to loose patience again.