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Original poster

NICE recommend all women should be able to have a cs

999 replies

LoveBeingAWitch · 29/10/2011 22:59

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.

OP posts:
Ephiny · 31/10/2011 15:26

It's a long document, but Section 5.9 (Maternal Request for CS) is the relevant part.

yotty · 31/10/2011 15:27

I haven't read article but was wondering when they were doing the cost comparisons, whether they factored into their sums the long term effect on the continence of women who have at least 2 or more babies. The cost of sorting out women's continence problems when they are 50+ must be quite a lot. Women who have multiple VBs or trauma to their perineum during delivery often have problems with continence much later in life. This needs to be included in the cost comparisons. I had 2 ELCS and I am one of the few mothers I know who can jump on the kids trampoline without leaking!

Montsti · 31/10/2011 15:28

What Ephiny's extract from the report says does not say it is more cost-effective it says it COULD make the cost-effectiveness less certain...does not provide strong evidence etc..etc..

What happens if 90% of people end up opting for c-sections? The private hospital I had my DS is had a 94% CS section rate. If it were free it would be unmanageable....

Iggly · 31/10/2011 15:29

Don't misquote me Bag. Go and read my posts. I said that is what worked for me. I don't have a problem with people going for a CS if they need it. However I do have a problem with the implication (which I read from your post) that a CS is The Best Option for baby.

microfight · 31/10/2011 15:30

Yotty Grin
Me too. I listen in when the conversation turns to incontinence not just from my friends but my mum and her friends. Having a CS has meant I have no such problems at all.

TethHearseEnd · 31/10/2011 15:31

"Women who request cs are more likely to have had fertility problems or miscarriages in the past. Clearer?"

Crystal.

Not sure why you worded it differently in the first place, that makes much more sense.

Iggly · 31/10/2011 15:32

quietly those risks to mother and baby from CS v VB - is that basically saying that they don't know that (overall) CS is safer? My brain has gone mushy.

microfight · 31/10/2011 15:32

What happens if 90% of people end up opting for c-sections? The private hospital I had my DS is had a 94% CS section rate. If it were free it would be unmanageable....

But that's because people who want c sections for all the reasons mentioned on this thread and more HAVE to go private because the NHS is a lottery regarding planned c sections for non medical reasons.

Thus the 90% would cross over

microfight · 31/10/2011 15:32

sorry wouldn't cross over into the NHS

reallytired · 31/10/2011 15:33

An additional £800 is quite a lot if thousands of women opt for a non medical c section. Ie. if 1000 unnecessary c sections are carried out then its a vast amount of money. 8 million pounds could pay for quite a lot of midwives. I think improving postnatal care is a great priority.

BagofHolly if you feel the financial difference is small then you wont have any problem paying for an upgrade. Or maybe taking out a low interest loan to pay for the extra cost.

I think that all babies are precious whether they are concieved by IVF or my little surprise at 25 years old.

juuule · 31/10/2011 15:34

microflight and yotty are you over 50?

Montsti · 31/10/2011 15:34

Believe me it wasn't just 30 mins - you need to be prepped for theatre/be in recovery/monitored regularly etc..do midwives really stay with mothers for the entire labour?

Just out of interest, is it necessary to have a paediatrician in theatre for every C-section birth in the UK? It was here and the reason I was given was that it was because of the additional risks to baby, but from reading this thread it seems as though that is incorrect...

microfight · 31/10/2011 15:36

The thing is reallytired many of us did pay for ours BUT not everyone can afford it and it shouldn't be an option only for those who can afford it, it should be a legitimate choice for those who want to make an informed decision.

microfight · 31/10/2011 15:36

Juuule
No most certainly not why?

BagofHolly · 31/10/2011 15:37

I most certainly haven't misquoted you. You endorse counselling and therapy for women requesting CS, along with looking at "facts."
And don't misquote me either. I'm not saying that ELCS is always best for baby. The burden of risk is on the mother, not the baby, and given that an uncomplicated VB (overall best outcomes for baby) couldn't be guaranteed in my case, I opted for the next option in the risk cascade, for my child. ELCS.

quietlyafraid · 31/10/2011 15:37

"What happens if 90% of people end up opting for c-sections? The private hospital I had my DS is had a 94% CS section rate."

Interesting reading on Pg 213
In this one-way sensitivity analysis shown in Figure 13.11 below, we see how the actual vaginal birth rate determines the incremental costs of maternal request caesarean section. Figure 13.14 shows that if the actual rate of vaginal birth for planned vaginal birth fell to 44% or below, then maternal request caesarean section would become the cheapest birth option when only the immediate birth costs are considered. However, the current caesarean section rate in England is 24.6% (Department of Health, 2009) and therefore, given that a large proportion of these will have a medical or obstetric indication, the lower bound of planned vaginal births which result in actual vaginal birth must be at least 75.4%.

Ephiny · 31/10/2011 15:38

They also say this:

"However, in situations where women persist in their request for a CS, following provision of the opportunity to discuss and explore their reasons for the request, the GDG believed that the potential for psychological harm caused by denying this request was sufficient to warrant this unacceptable in terms of the woman‟s health and has the potential to be costly in terms of long-term need for psychological support. It was concluded, therefore, that if a vaginal birth is not an acceptable option to the woman after discussion and the offer of support, she should be supported in her choice of a planned CS."

It's NOT about asking every pregnant woman whether she fancies a CS instead of VB, it's about treating women humanely when they feel unable to contemplate VB even with counselling and support. I have a hard time envisaging this leading to 90% of women choosing CS. In any case, these are guidelines for best practice, contrary to what some of the the papers are saying it's not about an absolute right to free CS for everyone.

The cost-effectiveness issue is not clear-cut, it's obviously a very difficult thing to calculate as there are so many possible unpredictable outcomes both during and after childbirth, and often the quality of evidence available is not very good (it's not easy to do randomised controlled trials in obstetrics!). But it is definitely not so simple as saying 'CS costs more'.

juuule · 31/10/2011 15:39

Microflight because if you are not over 50 how do you know that you won't have continence problems due to carrying a pregnancy (or just age) once you do pass 50. Over 50 being the age mentioned in previous posts as being when vb incontinence shows up.

Montsti · 31/10/2011 15:40

Sorry microfight I don't get what you're saying - maybe I'm just being thick... I'm not in the UK btw. If I were and I fancied a c-section then I certainly wouldn't go private but would have it on the NHS (assuming things actually do change on the NHS) and that would be my worry that a lot of people wuld have that mentality.

BagofHolly · 31/10/2011 15:41

Reallytired:"BagofHolly if you feel the financial difference is small then you wont have any problem paying for an upgrade. Or maybe taking out a low interest loan to pay for the extra cost."

NICE don't feel that such a small cost difference justifies refusing ELCS on medical grounds. Not me. I don't work for NICE.

And personally, seeing as you are being personal, I had the whole thing privately. It was lovely.

jjkm · 31/10/2011 15:41

This reply has been deleted

Message withdrawn at poster's request.

microfight · 31/10/2011 15:41

I am saying that I have friends who had VB and who are my age and younger who have incontinence problems due to child birth. None of my child free friends or ELCS friends have such problems.

Iggly · 31/10/2011 15:42

Bag you said: This is what gets me about the likes of Iggly et al, who assume that I, or you, could have been "shown the facts" which would have swayed us towards a natural birth.

I said that is what worked for me. that's not the same as saying it would work for everyone.

So I deliberately misunderstood your post to show you just how annoying it is.

reallytired · 31/10/2011 15:43

" it should be a legitimate choice for those who want to make an informed decision."

That is already a case. In practice people get their c section on the nhs if they can put forward a reasonabe case. (Including medically diagnosed phobia)

Where do you draw the line? Surely the nhs should focus on basic care.

quietlyafraid · 31/10/2011 15:44

"quietly those risks to mother and baby from CS v VB - is that basically saying that they don't know that (overall) CS is safer? My brain has gone mushy."

YEP. But then we did only have 35 maternal deaths and just over 224 babies 'dying before, during or after birth' according to the new mortality figures out last week for last year.

I guess with such a small number studies done from one year to the next you could end up with big differences even if there was only a couple of difference in the number of dead.

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