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.

Being in a post-natal ward post CS is like hell on earth. I am absolutely dreading doing it a third time and have no idea why people would choose it.
In the case of first time Mum's I totally disagree with them being given the choice of ELCS.

Don't twist my words, I'm not after a medal for doing my job, a little but of recognition at the job we do would be lovely but I understand not everyone has the same view as I do. It's all very well saying you don't want to hear whinging about how overworked midwives are but for many it's the reality. As for refusing to work under such conditions, I'd love to, but where would that leave all the women who had given birth? We always put in report forms when the ward is understaffed but nothing is ever done.

"Add message | Report | Message poster Wormshuffler Mon 31-Oct-11 18:38:58
Being in a post-natal ward post CS is like hell on earth. I am absolutely dreading doing it a third time and have no idea why people would choose it.
In the case of first time Mum's I totally disagree with them being given the choice of ELCS."

Have you read this thread? Or even half of it?

I know someone else has already said it, but -

It is the most narrow minded response in the world to say 'I don't like x, I don't understand why anyone would want it - therefore NO ONE SHOULD BE ALLOWED IT'.

I don't want a homebirth, ever. But I would never, ever argue for them to be banned because I don't want one. I support a woman who wants one, even if I don't think her reasons for wanting one are sensible (according to MY worldview). I support her right to her views, her body, her life and her family.

I was a first time mum who had an ELCS. I have come across women who have had difficult VBs who feel angry about that - and who seem to feel that they suffered and I somehow 'got away' with it. I think that (quite understandably), women who have been through a tough VB adopt an attitude of 'no point crying over split milk - I had to go through it, so I did, and that's that.' But their trauma isn't really resolved - and it comes out as anger at women who have had Csections, and who seem to have had a less traumatic time. A couple of times, women who have been vehemently anti-CS during group conversation have got in contact afterwards privately to ask me how I 'got' mine. I've also had angry reactions from women who have had traumatic CS's (EMCS's), when I've given a happy account of my CS. As if because they've had a hard time, that's the only experience permissible. I try to be sensitive - it's not as if I'm ignoring their unhappiness, and singing the praises of my ELCS - but I'm not going to lie about it. I accept there's a range of experience in CS and VBs.

I think the NICE guidelines are a welcome evidence based contribution in what is a very emotional and often poorly informed state of debate about CS.

After a 16 hour labour, (was really hoping for a vaginal birth) with my baby in fetal distress, only to get to 4cm dilation, followed by weeks in NICU hoping and praying he would live, I would really like a C-section next time.

I feel very hurt and angry about some of the comments on here from people who think they can comment on something they know nothing about. My mental health has suffered greatly, and I have both PND and PTSD.

I would just like to say to those who don't support choice for other women, I'm really happy you had your amazing birth vaginally. Well Done.

Now let those of us who nearly lost our babies, and our confidence in trying for a VBAC get on with it. I wouldn't question your choice, don't question mine.

All those supporting the choice, thank you. I am already dreading the conversation with a midwife and having to justify myself.

Sorry, meant to say got to 4cm and then rushed to theatre for an emergency section to save his life.

Yes Bag of Holly I have read the thread, it hasn't changed my opinion.

MrsJRT, I didn't twist your words, I used them verbatim. I'm not really sure why you are talking about recognition for your work, to be honest. Sure, everyone loves a bit of recognition. Never had a box of chocolates for your efforts? Cake on the ward? No? Many trusts have "award ceremonies" where you can nominate yourself for all the hard work you do. They cost a fortune but they are supposedly good for staff morale.

And actually, I didn't ask you to refuse to work, I asked you to raise your concerns. Every time you have them, which is every time you see any hint of someone being poorly cared for. This is certainly mandatory in any Trust I've worked in and it is a legal, moral and ethical responsibility for anyone working in Healthcare so good for you that you do it, but again, it is just part of your job to report.

I made a generic point that it is not okay to deny evidence because of resourcing, and every time a HCP starts to believe that the resource levels are more important (in an objective sense) than the evidence it is a blow for the NHS. Any of us working in the NHS face staffing concerns, yes it is a reality. It is not right to deny best clinical evidence because of your concerns. Don't take it so personally, it is my opinion about standards in the NHS.

It's about time. I had both mine by elcs. Went home the day after. Breastfed successfully. I am a qualified midwife as well. No longer practising! Choice with this is every woman's right

MrsJRT if you are still around... (or any other midwife or someone who knows about this)

As a matter of interest and purely to gauge an idea based on what another poster said about induction on the last page...

How much work is involved in an induction? Are EMCS a lot more likely when a patient is induced? Is there more work involved in helping a woman after an emergency c-section compared to an elective?

Its just if there is a change its going to impact on EMCS as well as VBs. If there is an increase in electives, I'm trying to think about other possible impacts on your workload and whether it might be completely negative.

Are there any aspects or scenarios in which this might have a positive influence on your workload at all? Or is it just all negative?

"The evidence says it is warranted, the evidence says that it should be allowed."

The evidence also says that a lot of vaginal births are mismanaged and lead to poor outcomes.

And that if substandard care for labouring women was reduced, elcs would no longer look comparatively safe compared to planned vaginal birth.

That's what the evidence says: that compared to women who are often having substandard care and emergency surgery, planned c/s is no more harmful.

What it doesn't say is that planned c/s is as safe as v/b when women trying for v/b are getting optimal care.

Or perhaps - you get more for your money in health outcomes from v/b (because I'm sure if every woman opting for a v/b was given care in labour which cost as much as a routine elective c/s, the outcomes would be vastly better.

Because the £3500 an elective c/s costs would fund the cost of an first rate midwife, a team of doulas, and the services of a consultant, should he or she be needed.

That's a good point quietly -- more ELCS would probably mean fewer EMCS and inductions, which are incredibly time consuming for midwives.

I would guess maybe? postnatal on ELCS is also easier as women will be better rested and prepared. They can be scheduled in the mornings so the partner is there all day to help out.

fruity thank you for that.

Personally I think home births for first time moms are a terrible terrible idea. But, like you, I think that every woman should have the right to choose that if that is what they want. The idea that someone would restrict my choice because they wouldn't choose that option is appalling.

Are all or most inductions very time consuming for midwives? I only ask because some statements that are being posted don't match with my personal experiences.

juuule, I admit I could be totally wrong about this. But I would imagine inductions would be more time consuming than a naturally progressing labour because a) you're on the ward, not at home, b) they can take ages, c) they can worsen the pain and make epidurals more likely.

I would never say all inductions are more time consuming, but just generally I would think longer labours with more interventions will be more work than a planned ELCS.

I was in hospital for the same amount of time before and after my failed induction/EMCS, if it could have been planned that would have cut out a big chunk of work for the midwives.

Microflight- I'm not over 50, but very close, was quite an old 1st time mum, so thought of keeping my perineum intact was quite appealing. The older you get it seems to take longer for your body to recover and less likely to repair well.

my fear of birth is just that - a fear - not really a phobia...

I am petrified of the pain - the crippling all consuming pain that does have me begging to die... the only way i can ensure not having this pain in childbirth and being totally out of control and unable to even vocalise my torture - is CS

If I ever chose a c-section, my reasons would be that it is fairly impossible to have a good VB for someone like me within the current VB model. And that the issues I have coukd be resolved through opting for a c-section.

Should the NHS award me £3k to plan, arrange and take responsibility for my own care I woul, without exception, chose a VB.

I admit my 1st induction (1st baby) would have been time consuming for m/ws (10hours and quite grim). But a subsequent induction progressed similar to my spontaneous labours. 2 lots of gel, monitoring for 20mins each time and then left alone. Called the m/w about 40mins before delivery. I did take up a room for a day, though. As I was anxious about the induction (due to experience with previous one) the m/w did say that inductions for subsequent births usually follow the pattern of normal labours and that was the case for me.

"normal labours" I should probably have qualified that as what was a usual pattern of labour for me.

juule have you had any epidurals?

Blimey!

I'm really surpised at the number of people that would want a cs by choice. Honestly!

When I was pregnant with DS1 I broke out into a panic and sweat at the thought of one.

I had vaginal births and nearly kissed everyone with relief!!

(I'm just a scaredy cat!!!)

No epidurals - I'm frightened of them. I wanted to avoid needles into my spine - just in case

Upahill - I also dreaded the thought of cs.

"Personally I think home births for first time moms are a terrible terrible idea"

Is that because you've seen any good quality evidence that they're linked with poorer outcomes for mums and babies, or is that just prejudice on your part?

Starlight - maybe that's what they should do: offer all mums £3600 (or whatever a planned c/s costs) to spend on whatever pattern of care they chose, including independent midwifery care - something associated with hugely improved perineal outcomes, lower rates of c/s and assisted birth and massively higher rates of continued breastfeeding.

It would be the first step towards dismantling the NHS so probably strongly supported by the Tories.