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.

I don't think it undermines you GM but I think it explains why you have such a negative view of a planned CS.

I could have written your tale of traumatic birth followed by lots of research and a controlled home birth......followed by another planned homebirth which turned into a CS.

The CS equalled the homebirth in terms of health, emotional joy and happiness. I recovered very very well.

I too think you have an idea that CS will be promoted. All the NICE guidelines will do is mean that herethereetc will be allowed to exercise choice. I hope she can.

If CS is so bad, the word would get round and VB would be the birth method of choice so I'm not sure why people are so scared of it being offered (unless you think it might possibly just possibly be better than VB?)

I think most women would opt for VB and those for whom a VB is traumatic would be allowed to give birth in a way that is good for them

I have work and must sleep. It's been good discussing it but I would like to say that there are some very traumatised women out there and a bit of sensitivty and recognition of their real real trauma would be good. We are all women and should work to a better birth experience for all.

I think this is brilliant news. More choice for women over what happens to their own bodies can never be a bad thing!

I trust women to make the best decisions for themselves and their babies.

I really don't think CS is going to be promoted or offered as a tick-box on the booking-in form. I don't understand who anyone who has read the guidelines (or even the extracts posted in this thread) could get that impression.

It very much sounds like they consider offering CS on maternal request to be a last resort. If after full exploration and discussion of the woman's reasons, correcting any misconceptions that may have led to the request, and offering counselling and support to address fears and anxieties, she still doesn't feel able to attempt VB, then they conclude that the given psychological harm that could result from forcing her to VB, the consultant would be justified in offering a CS. They are advised to refer to a colleague if they don't feel that granting the request is the right thing.

And once again, this is guidance for the health care professionals, it does not give all women a 'right' to 'CS on demand'. It may, however, add a bit of weight to the arguments of those who currently have to fight and beg for CS for psychological or personal reasons.

I don't see it adding hugely to the number of CS performed either. Currently it's a relatively small number of women who request CS in this way. Many of those already have their request granted. It's just the fraction of that small number who currently would be refused, who might have a better chance now.

"and women without 'clinical need' aren't treated with horror and contempt for choosing a c-section"

You know why I put that shag? Because quite honestly I DO feel persecuted by the attitude that I keep hearing repeatedly all over the press and from some people on this forum. I CAN NOT TALK TO FRIENDS AND FAMILY ABOUT THIS.

If you read even half the comments on other forums ALL they say is the £800 bollocks cos thats ALL thats been reported, they are cruel, callous, insensitive, rude, ignorant, judgmental... I could go on. The language such as "sliced open", "soft option". It just all appauls me. No regard for the wording or the tone of the document and no regard for the fact that its been done as mental health was a key element to it. None of the right questions being asked (some of which you HAVE asked). JUST NASTINESS.

And then to pretty much prove my point, two posts after what you put, you get someone who can't be effing arsed to read what anyone else has put and just pretty much calls everyone "lazy" who gets one with her remark about us all getting a colostomy bag. Making out that women who might make this decision are too thick to understand what major surgery is.

So yeah, I do have a chip on my shoulder about it, cos I'm so frikkin sick of hearing the same old crap and wording that constantly has c-section = bad VB = good, instead of a more balanced approach. Its funny, I stumbled across a blog of a British woman living in france who was pleased with the decision in the UK - in another of her posts she talks about the differences in attitude in the rest of europe and the US. Her comment was that it was only the British and the Americans who had such negative views on c-sections and made women feel like pariahs if they expressed a wish for a c-section.

WHY? Why is this not a problem to Germans and Swedes? Why are we constantly hounded by this "too posh to push culture" in the UK? Its utterly disguisting and positively backward. Frankly we shouldn't be having this fight. Its not of your or anyone else damn business what I think it best for me but sadly it seems to be regarded as needing a public flogging.

If people want to argue against it, thats fine. Make rational arguments, listen to the opposite side of the story make a goddam effort to understand why they are doing this. But aside from you on this thread shag, people against it are almost all just completely hysterical, doom mongering judgmentalists.

There needs to be a wholesale change in attitude to c-sections in this country. Not just about electives but also about emergencies too. It is not right that women should feel like they have failed if they end up with one and its not right that women should be defensive if they choose one. Its not right that the NCT want to behave like creationists refusing to teach about evolution. Its not right that the risks of a VB are not talked about in the same way they are for a CS.

So sorry I'm angry and upset. Sorry, you don't seem to understand just how much attitudes are effecting women. I'm sorry you don't see the parallel or why people are so defensive. It is exactly the same type of thing as the breast feeding bollocks. Its the language and tone used as much as the comments.

its just after 3 days and seeing very very little decent coverage in the media about this (one article in huffington post, one in the torygraphy and an half assed BBC interview) I feel disillusions and despairing about how this is going to end up rolling out. I fear its going to just be completely and utterly ignored by Trusts.

ephiny, thats exactly what it does say. And even the three more positive reports on the subject have failed to state they. All it is about is the dubious £800 number.

I feel like copying it, printing it off and sticking in it big huge letters outside newspaper offices.

Its clear not one of them has read it. They have just read a press release from the Department of Health.

"it is not "the system" which turned me off having a vb? It was talking and listening to real women's experiences"

Women's experiences of birth, and their feelings about it, are shaped by the 'system' in which they give birth.

quietly - you are mistaking people's feelings about a procedure with feelings about you and your motives.

By the way - you are insistent that the £800 that is spoken of as the difference in cost between a vaginal birth and an elective c/s is 'bollocks', but you've also made the point on this thread that it's difficult for them to calculate costs in this area. You haven't properly acknowledged that a very large part of the costs associated with vaginal birth are caused by the substandard care of labouring women - particularly a lack of staffing and lack of consultant input.

You are right that the coverage of this issue is problematic. I don't think people are aware of just how much the issue of care impacts on clinical and emotional outcomes when it comes to birth. We are together on that one.

However - while we have a situation where the operative growth rate has TRIPLED in the space of a few years without corresponding falls in the stillbirth rate, then I think there are serious, serious questions to be asked about why this is happening and whether it's a good thing for the c/s to be growing in the way that it is and whether it's the best use of finite resources, given the number of mothers and babies lost in and damaged within the NHS because of current inadequate funding and staffing levels.

These are all serious questions. Access to surgerical births for healthy mums is just one small part of a much wider issue. It's not the answer to the problems the majority of women face when it comes to childbirth and mustn't be seen as such.

"All it is about is the dubious £800 number"

Yes - that figure is dubious. It could be less. It actually could be much more, if we factor in the costs over a mother's reproductive life.

And the point I've made over and over again - the costs associated with vaginal birth are not 'fixed' in the way that elc costs are. Some hospitals will spend vastly less on vaginal births than others - because they have much lower rates of emergency c/s and instrumental births than poorer performing hospitals.

This needs to be acknowledged. You can significantly reduce the costs associated with vaginal birth simply by improving practice - which doesn't always involve spending money. There are examples of hospitals doing this within the NHS - reducing rates of emergency c/s.

"Why is this not a problem to Germans and Swedes?"

Because they don't face the same hard choices about healthcare provision as they do as their systems are largely insurance based.

The main problem seems to be in how the current system is actually working, rather than how the current system is supposed to work.

In theory, the needs of tokophobic women are already catered for in the current system, as an elective CS should be medically indicated. But you don't have to read the MN birth threads for very long to come across cases of women whose tokophobia is poo-poohed by the medical professionals they actually get to see. You can only get something recognised as medically indicated if your consultant is actually prepared to diagnose the condition in question and in the case of tokophobia this requires doctors who are taught to listen.

and no, the current attitude does not surprise me at all: I have come across doctors who recognised that my child could not walk but refused to write out a letter for a wheelchair "because she might get bullied"- so that gives me an idea how easy it would be to get a diagnosis for something like tokophobia which is entirely invisible and probably slightly despised by some doctors.

Better training in listening for medical professionals would be a start. Not to mention- as it has already been mentioned repeatedly on this thread- that better training would result in fewer tokophobic women in the first place.

If the system worked well there wouldn't be a problem: anyone who needed it, for medical or psychological reasons, would get a CS under current regulations, and nobody who did not need it would want one.

My personal experience of VB was one long drawn out process, made worse by constant monitoring and not being able to move position. However I am now pregnant again 20wks and prepared to go through labour and VB all over again.

Why? Because although it was painful and tiring, by the time my baby was a few days old I was out and about and from the start I was able to feed baby, lift baby and give baby the care he needed without assistance.

A caesarean section is MAJOR surgery, why put yourself through that unless you have to?

I don't think it should be available to everyone free or not free. The cost is not what is important here. It should be a decision based on whether or not the woman is likely to be able to have a VB safely. In some cases women may not be able to face it due to having such a traumatic time in the past and I do think this small minority should be able to choose.

IMO it is silly to choose major surgery over a natural birth.

I'm sorry if this has already been mentioned but what about the costs involved with the aftercare for damage caused by chilcare? Physio, operations & all the rest of it. Surely that makes a VB with subsequent difficulties more expensive than an ELCS?

buterflies

Just because YOU wouldn't make the decision to have an elcs, doesn't mean that other women shouldn't be able to make that choice. Some people who have had difficult births first time around might think your desire to have another one was odd, or "silly" but that doesn't mean that they have any right to tell you that you must have a c-section next time.

NICE have carried out extensive research and come to an objective conclusion that elcs is a safe option for giving birth, and doesn't even have a significant cost-impact to the taxpayer. If you read the rest of the thread, you will see that actually, we are all aware that a c-section is major surgery, and therefore has risks attached to it. However, so does vb, and this is very rarely made explicitly clear by hcps.

It comes back to the fact that I trust you to make the right decision for yourself, your baby and your family as a whole. I think you should extend that courtesy and trust to other women.

butterflies, noone knows whether or not any birth will go well, it is for women to decide for themselves.

Butterflies, making a statement that choosing CS over VB is 'silly ' is downright patronising.

Haunt, can you not recognise that it was the 'system' that gave those women you spoke of, their VB experiences.

Butterflies
So everyone has to go with what your choice is then. How very understanding of you.

Women understand it's major surgery and if they still choose to want one then they must have a very valid reason
It is so patronising that people think women aren't capable of making their own decision because other people can't understand their decision.

We are all different and have different needs and wants please respect that.

I think every woman should be allowed to have the birth she wants. But if that means an unnecessary operation that's she's choosing to have for no medical reason then I don't think it should be funded out of the public purse.

What if I said that choosing a VB over a CS was silly? Bit patronising isn't it?

For what it's worth I have been on the receiving end of many, many comments regarding my CS. Neither was "just because" but it doesn't stop the insensitive comments about being too posh to push. The simple fact is that without my ELCS and my EMCS neither I nor my babies would be here.

juneau I totally agree, any unnecessary op shouldn't be paid for by NHS.

I never said everyone should agree with my decision. The fact remains that it is a risky surgery. Unless it is necessary why do it?

I agree with juneau.

Informed choice is good but an unnecessary operation should be paid for by the woman in question.
If the CS is needed for physical (placenta praevia, etc) or psychological reasons (mother traumatised by v difficult first birth), that is different. It would apply to women (mainly primips) who just don't want to have a VB for whatever reason.

Buterflies VB isn't with out risk though is it? The facts speak for themselves on that and to pretend otherwise is misleading for mothers to be.

Why not have a look at VB v's EC for VBAC. I wish I had before I tried VBAC for DS2.