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.

There are a lot of NICE recommnedations that don't get implemented. For example very few people get 3 IVF cycles paid for on the nhs. I seriously doult that in the present financial climate that there will be cs on demand.

The nhs will never cover EVERY medical need. That would eat up the entire GNP of the UK.

Prehaps its cheaper to just do a c section than to give pychological support to scared pregnant women who are scared of birth. Should mental health problems be properly assessed and treated or is it just simpler to do the c section? I fear the brutal truth is that mental health problems won't get treated or women be allowed c sections.

Prehaps a better system would be allow people to pay top ups for extras. Ie. pay the financial difference between the bog standard package and the medically unnecessary c section. This could apply to other areas of the nhs.

For example I have been refused medical help for complusive self harm. I haven't even been told where I can find repruable private help.

We need a debate on what is essential medical care and what is a nice luxury . In credit crunch times we need to make harsh choices.

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

Traumatic births can cause postnatal depression. A woman is more likey to commit sucide post birth than die in labour/ c section.

slavetofilofax Mon 31-Oct-11 12:33:27

I know three babies that died because their mothers were refused CSs after a difficult birth first time. Two of the mothers had such similar experiences it's almost unbelievable. Baby number one, very large long labour, baby number two dying at birth and two days before edd, both instances the CS would have been days earlier. Noone knows if the babies would have faired differently if born before, for sure.

... and so it continues: personal experience trumps everything else .
How can anybody disagree that more informed choice is a Good Thing??

No one mentions the prolonged recovery time from major surgery (or just pass it off as not mattering, coz you have your baby).

No one mentions, the increased amounts of haemorrhage (blood loss) in subsequent CS births.

No one mentions placenta's so stuck that they cause real difficulties for the surgeon.

No one mentions added risks of blood clots following surgery. Nor the weeks of injections to prevent this. (6 weeks of self administered injections for general surgery - will be coming to a maternity unit near you soon).

No one mentions the increased amount of still births and miscarriages in subsequent pregnancies.

Add to this the fact that a lot of women are obsese going into this surgery.

The more caesarian you have the more likely you are to need a blood transfusion.

The list goes on. CS is not the easy way out of a normal physiological process.

I think NICE really do have to improve this, because women's healthcare is important and not more or less so than other areas. To be honest, if the NHS can't afford things, it needs to address this in different ways rather than pretending that the evidence says something it doesn't because of cost factors. I have seen this time and time again in my own field (am a HCP). Cost factors reduce available choice and over time practitioners begin to believe that what is offered is state-of-the-art against best available evidence.. there can even be a grudging "this is the NHS, take it or leave it" attitude that does no one any favours. If the NHS can't survive as a free-at-the-point-of-care service, that is no reason to deny or ignore evidence: there will be a need to look at different payment models and yes, involving patients in paying for some choices where this is practicable or involving a sliding scale/means-testing for some payment.

However, it is a dangerous game in public health care to place maternity services against, say, cancer care because one is more "worthy". The rate of infant death in late pregnancy and childbirth is very high in this country and despite the report I mentioned earlier (late 1990's) nothing has really changed in a long time. The forums here have been full of really shocking tales of poor treatment and substandard care, and although I feel I was fortunate in that the team dealing with me were skilled, it was definitely a "bare basics" service and at very many points a toss of fate's coin could have really caused even more serious damage to me or ds.

This is what would make me want to consider choosing a CS. Not because I really want one, but because I feel that there would be less likelihood of being left to labour alone or in situations that might risk my health or that of my baby. That's not really a lifestyle choice now, is it? Ideally I would favour decent quality maternity services that would mean a good VB was likely but I know that this is less likely to happen before I next give birth than that a CS would be adequately staffed. It is not right that people are afraid to give birth in a developed country because of fears that they will not be attended to safely in labour.

This isn't really good enough, just because childbirth is a "choice". There is more to humanity than living and dying and our biology, as mammals, is strongly geared to reproduction.. so saying "just live with your choices" is a weak argument. If I lost my partner or my child tomorrow, I would live but would be devastated... if someone told me that I had made my choice by choosing to love someone, knowing there was a risk of pain and death, I would (rightly) want to lamp them.

If your argument is that the NHS is free so like it or lump it, then that seriously undermines the feasibility of that system. It needs to be safe for all, that is a basic determinant of its fitness for purpose.

Actually, with regard to cost, many women (a very unrepresentative straw poll of those met in antenatal clinic, queueing up for scans, antenatal and postnatal groups!) would be happy to start paying a contribution for certain resources like a ward with more staff (ie fewer beds per ward), private wing rooms (properly staffed by midwives) for post natal and antenatal care, a contribution to a nonmedically indicated CS or epidural on request, etc, etc, as long as those are safe for mother and baby as per doctor/midwife advice. Nobody is saying that they wish for luxury care on the back of the taxpayer. But then, an inappropriate or overheroic attempt to have a vaginal birth for a baby in an unsafe situation that then leads to an emergency C section and prolonged SCBU stay - or even ITU stay for the mother, or God forbid (but it happens) death or birth injury, ultimately leads to even more expense for the taxpayer, particularly if on top of that a medical negligence settlement is deemed justified and is paid out.

It's only because many private obstetric hospitals don't have ITU or SCBU facilities that more women don't go private - it's likely more would if these facilities were possible. Or perhaps these private medical services can be offered more widely in NHS hospitals so that more money can go into obstetric resources. Why are there so few private postnatal beds? Why are there so few private obstetric staff employed when there is clearly a market for it?

reallytired and quietlyafraid, if the mental health issues antenatally are that severe that someone is likely to take their own life, then a CS would be medically indicated. And therefore, not what I am talking about.

Also, traumatic births resulting in PND can happen in people who very much wanted a VB, so offering non medically indicated CS's would make no difference to that.

Posies, the incidents you refer to are undoubtedly very sad, but again, I'm not sure that offering non medically indicated CS's would have made a huge difference if those births were managed properly.

The second baby may have been saved if he/she was delivered by CS, but equally, that baby may have dies because of something completely unrealted or unprevenatable, or something that could not have been detected before birth. The fist baby could well have survived if teh brith was managed better and a EMCS was done. There are other factors to consider in those cases, you can't just say without doubt that those babies would have lived had they been delivered by a non medically indicated CS.

And maybe the trauma the Mothers suffered in their first births should have consituted a medical reason for having a CS. I don't know. That was up to the doctors, and maybe the doctors made a mistake.

Wait a minute, we all know that ELCS is the safest way for the baby, this is purely because it negates the need for an EMCS.

I've had four sections, as have two of my friends, none of us have had any of the issues, except me. My emcs with GA left my organs stitched to my scar.

None of us had weeks of injections, that I can recall, for weeks.

The only people I know who have had mcs and still births have never had a cs, in fact there is no evidence for this claim. Certainly none that rules out complications in first pregnancy that lead to CS in the first place.

Withwoman, of course people mention those things.

Does anyone really not know that a section is surgery and thus there is a recovery period? (prolonged, not necessarily, only days for some)

Maybe people don't mention weeks of injections because that's not a given either, I had 6 days.

etc.

None of the things you mention are a given for CS, they are complications and risks.

I think what people really don't mention are the complications and risks for VB. I think those are equally as horrific as those for CS.

That's why I think each woman should be evaluated individually as to what's best for her, rather than making blanket decisions that VB is always better.

"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."

Repeated again. It's NOT about cost. Which is why NICE say it's ok - it represents a cost effective option.

Working, I wholehartedly agree with most of what you have said.

If your argument is that the NHS is free so like it or lump it, then that seriously undermines the feasibility of that system. It needs to be safe for all, that is a basic determinant of its fitness for purpose.

My arguement is not that the NHS is free so like it or lump it. My arguement is that there is a limited amount of money, and we simply can't afford to accomodate everyones wishes. It would be great if we could, but we can't. And it makes me angry that women think they have as much right to resources so that they can have a child as sick people who have no element of choice at all.

If I had to choose between giving a woman with no medical need a CS because she has read up and decided that she would prefer the risks of CS to the risk of VB, and a woman free medication when she is severely asthmatic, on a low wage and unqualified for free prescriptions, I would choose the person who has a medical need rather than the one who has a preference in the way she chooses to have her child.

Lenin - you say you physically couldn't cope with the pain. How would you feel if the same level of pain was as a result of an injury or illness that required surgery, but you had to wait six months because there just wasn't enough money to do it sooner. Imagine how awful and how debilitating that would be. Would you really think that you should have to wait for longer to have your pain relieving surgery because the operating theatre was too busy dealing with CS's that people don't really need?

"we all know that elcs is the safest way for the baby..." um no - safer almost definitely than an emergency c-section yes but it's called an "emergency" for a reason...however c-section babies are much more likely to be born with fluid on the lungs and subsequently have respiratory problems as not expelled by the pressure of contractions during labour. Research has also shown that infant mortality is almost 3 times as high within the first month of life for c-section babies. The stats are still low and obviously there are bad outcomes in both CS and VBs but the statement that elcs is the safest way for the baby is NOT correct.

It is. It is small, but it is true. The respiratory problems are almost eradicated once baby reaches 39 weeks.

Withwoman - applause for your post.

I haven't been able to find a breakdown of the cost analysis of planned c/s. I strongly suspect though that it doesn't factor in increased costs associated with placental implantation problems and other complications in subsequent pregnancies and births after c/s.

"Withwoman, of course people mention those things".

With respect - I have seen literally hundreds and hundreds of posts reflecting on the pelvic floor and perineal damage associated with vaginal birth on the childbirth board here on mumsnet, and none discussing placenta praevia, placenta percreta, or placenta acreta within the context of previous c/s.

You are completely wrong about women not being aware of the possible complications of vaginal birth. They are. They discuss it obsessively here on mumsnet and have done for years.

Would also like to add to this that on the subject of emotional and psychological outcomes of vb compared to elcs - I think the satisfaction women report with c/s as a mode of birth arises from their belief that in opting for surgery, they have avoided what they see as little more than a painful and unpleasant ordeal. You see this satisfaction in posts here on mumsnet - people talk of their births being minimally intrusive - in the sense that they are over quickly and they aren't an unpleasant experience.

Compare this to the response of women who've had what they describe as a 'good' vaginal birth (and I don't necessarily mean a straightforward or easy birth here) - which may have involved a great deal of pain and feelings of loss of control. It is remarkable that many will have intensely positive feelings about the experience - some (far more than you'd think given how bloody hard labour is), describing it as 'life-changing', and an experience that has left them with increased confidence in themselves as mothers and as women.

I appreciate it's very unfashionable to discuss the issue of childbirth as an emotionally transforming experience on mumsnet, given the number of women who are terrified of or disgusted by the whole issue, but it's certainly something that midwives think, talk and write about professionally.......

1. fear. unfortunately the facts - even the hard statistical facts, never mind the anecdote - relating to childbirth - do justify fear. Fear may be unhelpful, but that doesn't make it go away. Making those statistics better would remove the justification though.

2. it is not an either/or between instrumental/c/s birth on a population level - the tactics that reduce c/s rates will usually reduce instrumental deliveries too (e.g. not using CFM) buckets of research already - largely ignored in practice.

3. the current high rates of intervention are due to poor/ improper care, and are not simply a inevitable consequence of an older fatter population. compare the intervention rates/ trauma rates experienced by women who hire doulas vs general population (bearing in mind one reason you might hire your own care is a previous bad experience/ high risk birth) - and the benefits of good quality support in childbirth become apparent. equally, comparing different hospitals in the same area, or even different practitioners in the same hospital - different rates of intervention. the current Status Quo is not inevitable - we don't have to accept it as such.

4. choice - to provide real choice, the NHS would offer 1:1 skilled midwife care to all attempting VB as well as ELCS for those who desired it. the existing situation is not choice - or at least not for mothers.

Montsti with regard to infant mortality in the first month of life for c-section babies being 3 times as high, surely that is down to "at risk" babies being delivered by c-section as VB would be deemed too risky for them?

Who on earth would have a CS for cosmetic reasons?

Cesarean shelf anyone...?

I for one will never wear a bikini again after my CS, I don't think anyone would choose to have one for cosmetic reasons unless you were planning to get a tummy tuck straight after! (Which I think is the stuff of legends!)

Seriously though, I do think it is important that women are given choice. I think cases of women choosing a c section just because they fancy it would be very rare. Risks of both CS and VB should be made very clear. I knew most of the risks of having a CS, especially highlighted through the NCT classes but none really of the VB. It was glossed over as being something that if you thought positive would be positive.

Well I was extremely excited when I went into labour (weird I know but towards the end I was starting to look forward to it as blessed relief from being pregnant!) and I handled contractions with gas and air, felt ok, so really it should have been a breeze for me. But it ended in a CS. If I was afraid, I imagine it would have been much worse, so why make women suffer just because it's 'natural' when there is something there that'll help with that fear? What is the point of the advancement of medical science if it not used to help people?

Edless, do you have a link for that info on doulas vs general population? I would like to investigate this option further. Thanks!

I was told at the hospital that CS was marginally safer for the baby and marginally more dangerous for the mother.

So.... conflicting information on here. odd.

Monsti that isn't what I got told.

My highly respected consultant told me a c/s was safer for baby.When you consider all they have to go through during a v birth as opposed to a c/s it's not rocket science to see why.

All 3 of mine came out at 39 weeks with top apgar screaming the place down and 2 were twins.

Also

I think that many women are not aware of the possible complications with VB. I for one was unaware of things like severe tears, real proper incontenence, loss of sexual feeling and so on. Women don't generally talk about these things IRL. And they most definitely weren't mentioned at any of my antenatal classes (NCT and NHS).