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.

And actually I was talking about preparing for childbirth and women being afraid of it, not for women who request a CS. I'm not an idiot - people have good reasons for wanting a CS. I'm concerned about women who are scared of VB - we should look at why there scared and what the medical profession can do to help them.

Montsi
I'm not sure what you are asking me. Maybe it's me being a bit slow

for every mother who's had a straightforward CS and recovery, you'll find one who hasn't and it's exactly the same for VBs. I had a emcs and it was utterly horrendous, so much so that I lived in terror the whole of my 2nd pg that I'd end up having to have another one. As it was I had a fab vbac.

i firmly believe that mothers who have a medical (including MH) reason for a cs should have unquestionable access to them, but I do query offering first time mums a CS without any indication that they are likely to have problems delivering a VB

at a financial level, the cuts to NHS funding (yes despite what the govt have told everyone, there is less money to go around - fact) mean that hospitals are under pressure to cut patients' length of stay. increasing access to CS (assuming this actually results in more women opting for CS) would mean beds were occupied for longer, putting additonal pressure on already stretched resources.

jjkm - NICU, postpartum infection, hemorrhage were all included in the adverse outcomes section not longer term complications. They were part of the £710 difference basis methodolgy.

microflight - I've known women with some incontinence problems who had CS and women who vb without problems and vice versa. I don't think either guarantees in/continence one way or the other.

I don't know anyone who is child-free who has incontinence problems,though.

juuule everything I've read on incontinence refers to both pregnancy and VB being the cause - I've not seen anything separating the two.

Thanks quietly, that's interesting as there are some consultants stating that categorically CS is safer. But perhaps our level of care is such that the difference between the two is not significant for baby's outcome overall - but will obviously differ depending on whether there are medical indications that a baby needs to be delivered asap.

Iggly so does what you have read mean there is a risk of incontinence due to pregnancy alone or is it due to pregnancy plus vb. Could it be that even if you had a cs the fact that you had been pregnant could possibly cause incontinence?

NICE again
Xu et al. in their base case analysis assume that the probability of a woman experiencing stress urinary incontinence is 19.9% for a spontaneous vaginal birth, 21.8% for an instrumental vaginal birth, 11.5% for an unplanned caesarean section and 10.0% for a caesarean section on maternal request.

Birth method just carries reduced risks... does not prevent.

Ha ha microfight...Think it's time for me to move to another thread, I've lost it! Good luck everyone with any future pregnancies/births - hope you get the births you desire and a beautiful healthy baby at the end! X

I was always taught that the added pressure on the pelvic floor of a term pregnancy is enough to cause urinary issues. Not just VB.

No Iggly, you didn't post about what had helped YOU, how YOU got through it, you posted repeatedly your own highly prescriptive way of persuading women requesting a section without medical grounds that they are wrong.

Add message | Report | Message poster iggly2 Sun 30-Oct-11 23:38:31
NOT persuasion. Look into why they are scared, how can they be helped? I seriously think just giving CS ion demand will not be beneficial in somecases. Maybe they should look into GPs asking about tokophobia more regularly.They would be taught how to look at facts , how to access them as well.

And

Add message | Report | Message poster iggly2 Sun 30-Oct-11 23:25:18
Counselling should be offered (not a one off either but properly followed through) this may cost as much as the £800 but ELCS should be private (the one exception being that if all the counselling sessions are attended and the psychologist or psychiatrist overseeing the care agrees then ELCS should be covered.

Thanks Quietly.

We have on occasion 5 ELCS per day where I work, we struggle to accommodate those, if the numbers increase much more we will not be able to cope, at all. Post section women require so much more care tan women who have a VB, practically speaking they are unable to do anything for themselves post delivery, from having to buzz to get pads changed to buzzing to get the baby out of the cot, nappy changes etc. The existing staff infrastructure is not designed to cope with the increasing amount of operative deliveries and since we've been told as a dept to cut 1.4 million I don't see that changing anytime soon. Postnatal care is already the Cinderella service, we can't have it all ways.

Maybe treating incontinence problems should be a greater focus than at present. Incontinence is miserable and in a lot of women the treatment is cheap. I can jump on a trampoline without leaks inspite of having two children.

For some women its just a matter of an obstetric physio showing them how to do pelvic floor exercises correctly. If a mother is doing the exercises correctly and still has problems then she needs a referal. Incontinence not something someone should have to put up with.

I paid £40 to see a private physio. It turned out I was not doing the excercises properly and not strengthening the necessary muscles. The £800 extra cost for an unnecesary c section could pay for a lot of women to have help I had.

I think it's difficult to get an exact answer regarding the relative risks of different birth methods, this is partly due to the lack of reliable, good quality evidence (it is not a straightforward thing to study due to the many variables and factors, and difficulty of randomising/controlling etc) and also the fact that often we are talking about very small risks in absolute terms, working with such small values it can be difficult to establish meaningful differences.

Also it depends what outcomes you look at. Planned CS is safer in some ways (e.g. birth trauma), but may mean higher risk of some other problems. The same goes for VB of course. And a particular individual might have particular risk factors which would affect the best choice for them.

The best any of us can do really is make our decision based on the best evidence that is available, and depending on our particular situation. And be thankful that we live in a time and place where whatever happens we almost certainly will survive the birth and have a healthy baby in our arms afterwards!

In terms of costs and saving... I really do think everyone's pointing fingers and going this, this or this... nothing is independent of each other.

Proper care and support in counselling would talk some women out, if you could actually show that care in labour was good enough...

I don't actually see how everyone needs to work against each other on this.
Secondary tocophobia is preventable. So is litigation. The elective issue is one, I think that is a red herring at times, but a very key part at the same time. What we want to reduce is - instrumental deliveries and emergency c-sections. NOT necessarily electives. Various ways to do it through combination of methods which might be pro-surgical or pro-natural.

Identifying patients with very high likihood to end up with emergencies and potentially offering electives as an informed choice if they want is a possibility. (Not forgetting of course that if fear is more likely to result in emergency c-section or instrumental delivery than we REALLY should be looking at this somewhat differently). Basically we need to get better idea of risks all round.

All smacks back to research and gapping holes in it. (god I'm babbling now...)

When they factored in the urinary incontinence model the figures they came out with was:

£3,275 for vaginal
£3,359 for planned c-section
£84 difference.

Wish that home birth could also be available. Having had a c section and an assisted VB would go for natural again. Birth is natural and is becoming far too medicalised. Recovery from post c section should not be under estimated. yes they are very necessary in some cases as with my first but It would not be my first choice.

£3,275 for vaginal
£3,359 for planned c-section
£84 difference.

I suspect most people being treated for urinary incontinence are over fifty, and gave birth at a time when the c/s rate was perhaps only 10%.

How can these figures tell us anything about the cost implications for vaginal birth in the present?

Also quietly - you've read the research, can you tell us whether the cost of repeat c/s and consultant care in subsequent pregnancies was factored into the figures in any way?

Because if you look at the costs over the reproductive life of women, rather than just looking at first births, I think the comparisons would look very different: vaginal births generally become much less expensive and less risky after the first birth. Mothers who've had a first c/s become increasingly costly to care for over their reproductive life.

wish there was a like button on mumsnet sometimes so i could just like peoples comments rather than typing anymore!

MrsJRT perhaps in theory post-section women require much more care but I certainly did not have that experience. No nappy changing, help with feeding, help with lifting, changing pads, nothing. More blood pressure checks, I guess, but that's not midwives. I also left after 36 hours.

The research I would like to see is how many women ask for a CS, are turned down, and then go on to have an uncomplicated VB. Wouldn't that number represent the real cost savings of not having CS on demand?

If most women who are refused an elective CS go on to have an EMCS, then it's actually more expensive to refuse the ELCS in the first place. I have no idea what the number might be but anecdotally it seems a lot of women (including me) are saying 'I was turned down for an EL but went on to have an EMCS'