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.

reallytired

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

only if they are lucky enough to have a sympathetic consultant

I was scheduled for an elective c-section due to a failed preterm induction. I kept being bounced up the chart for an entire day, then I was examined and suddenly had my waters broken, with no warning, explanation or pain relief. Knowing that a preterm induction was likely to result in an instrumental birth with episiotomy (it did), I really wanted a C section. I asked, begged, pleaded and was refused outright. I had absolutely no say in what they did to my body.

It took eight months for my episiotomy to heal. Nobody really gave a toss, and I am certain that the complications afterwards were not linked back to the birth. I expect that all things considered, VBs cost more than CS.

your "medically diagnosed phobia" is subjective, it means that desperately frightened women are relying on medical professionals to support them, and that just doesn't always happen

our bodies, our choices

I complained about my care - much worse things happened than the ARM without permission - it was clear from the responses that senior management couldn't give a stuff

In some hospitals, litigation is the only way to have bad practice, or abusive behaviour from staff taken seriously.

Abso

Absolutely hospitals should be afraid of litigation. If they are unconcerned about their patients they need to be scared of something. However, my point is that by giving women a choice, and decent care, they will reduce the need for litigation and therefore probably save more than they spend.

I don't buy the argument that a lot of young, appearance and celebrity obsessed women are incapable of making an informed decision about their own birth. And that choice should be denied them in case they make the 'wrong' decision (i.e. one YOU don't agree with). That's disempowering misogynist nonsense.

WhollyGhost - your treatment was clearly wrong and I am sorry that you went through so much pain unnecessarily - unacceptable. I think we all recognize that there are serious issues with childbirth/maternity care in the NHS but personally I have my doubts that allowing ALL women the choice will better the service, if anything I really think it will only get worse.

I paid for my c-section (semi covered by medical insurance) which was considerably more expensive than a VB at my hospital. I was not a high-risk patient although did have very high BP but no other problems but other than the cost of the theatre time, I paid for 2 obstetricians (just in case something goes wrong in surgery), 1 anesthetist, 1 midwife, 1 paediatrician + general nursing staff. There were 8 c-sections the day my DS was born (no VBs) and the staff just couldn't cope. 5 of the babies ended up in ICU within the first 2 days due to breathing difficulties...this was a private hospital with so many staff and they couldn't manage and that would scare me parti. in highly populated areas in the UK...

My experience wasn't great and I was in a lot of pain for weeks and I've got some friends who have had life-threatening (both to baby and mother) experiences during/after c-sections so I would NEVER say this was the easy option. In my opinion a good/normal VB would be preferential to a good/normal c-section, however there is always such doubt that it is never clear cut (bad choice of word)...

There are also plenty of areas in the nhs, from paediatrics to dentistry, where foreign staff find work. If you want to make the bluntly utilitarian argument that by using employing overseas professionals, the nhs and its users are denying adequate healthcare to patients in the professional's country of origin, you can't restrict this to obstetrics and midwifery. Unless again it's part of the weird woman-basing thing. Would you argue that we shouldn't argue for more choice and better service in paediatric care because it might mean employing doctors from the Philippines or India, where children will suffer as a direct result?

No, I thought not.

Fruitybread - let's see in a few years...

I'm saying I think their preference would more likely go one way rather than another. I am not anti c- section and do not judge people on their choices. Most of my friends here opt for a c-section (very few are scared of VB) and that's their decision but all I'm saying is that, should ALL women be given the option then IN MY OPINION (nobody knows until it happens so maybe I'll be wrong) the rates would increase and this would bring the NHS to it's knees meaning even more widespread negligence/neglect of patients...

Montsti, as with other areas of medicine, the decision as to whether to go for elective CS or not should be evidence based. It absolutely should consider common outcomes of VB, such as faecal and urinary incontinence or loss of sexual function. These problems are particularly common where there is an instrumental birth. I don't believe those things were considered at all in my case. The outcomes of CS should obviously also be considered, and should include the likelihood of the baby having breathing difficulties afterwards.

The decision however, should rest with the mother, and if she has e.g. tacophobia, that might well determine her choice.

tocophobia

The choice argument isn't the issue (I.e. I'm in agreement that in a ideal world every woman should be given the choice as to how they give birth) in my opinion, but rather how this can in reality be implemented by the NHS in it's current form.

Celebrity obsessed young women?! How patronising?! Apart from the fact that 50% of 18 year old women now go to university (and I don't think the other 50% are stupid).... No other social pressures on young women then? I actually think that young women are perhaps a little more naive and more easily talked out of things - its the older women who have already had a baby that are more likely to be the issue imo.

Anyway, upon reflection on the way into work, Trusts should be VERY worried about the legal implications of denying a c-section now. The wording of the report is very clear in the fact they see a link between psychological damage and refusal to perform a c-section which is why they made the recommendations. This has never been formally established before, as far as I'm aware. This means that any women denies a c-section and then goes on to have a traumatic birth and subsequent mental health issues as a result of that is going to have a very good legal case - better than she had before. Just one claim against a trust could outweigh the cost of simply allowing c-section on demand.

ALSO

A lot of this is going to be totally down to how Trusts handle this. The guidelines force their hand to look at things in a way that they haven't been forced to previously.

They could look at this and be stupid & shortsighted and just go, right lets just do them and ask no questions.

OR

They could take the attitude of actually looking at the bigger picture of surrounding mental health and antenatal care aspects and take it more seriously and as more of a priority. If they are smart, and look at the research about how you can prevent secondary tocophobia and how you can talk women out of an elective with better care - such as providing one to one care and ensuring pain relief etc etc... then surely this will put money into all parts of maternity in an effort to try and keep the elective rates down in the first place - which is exactly what some of you are arguing for.

The myth of the vanity CS never dies, does it?

"The myth of the vanity CS never dies, does it?"
Indeed. And why more than anything I would like them to actually take up the recommendation of the 2003 Select Committee report on health and actually bother to standardise and record reasons for ELCS properly (including whether its a doctor/patient joint decision). 8 years on and we are still waiting...

"how this can in reality be implemented by the NHS in it's current form"

it might mean diverting resourses from elsewhere, but I agree with quietlyafraid that it may well save money in the longer term

e.g., if I'd not had such a brutal and traumatic experience with postnatal care that was worse than useless, the NHS would have saved a great deal of money on paediatric appointments, gynae appointments, GP appointments, counselling

I find it very strange that antenatally, there is so much contact with midwives, even if the pregnancy is uncomplicated. But resources are too tight to allow much access to midwives once you are admitted to a maternity hospital.

"but rather how this can in reality be implemented by the NHS in it's current form."

Have to say I'm controversial and in favour of changes to the NHS for this very reason. Unfortunately unless something changes the NHS will shoot itself in the head. The main reason that there isn't private maternity hospitals outside london is purely due to lack of demand and initial investiment needed to build one. You end up with more demand from the middle classes, and you'll get a hospital popping up in places such as Manchester. As soon as stuff like that starts happening, the NHS will be in real trouble as there will be competition and pressure for it to be an opt out service, meaning those on lower incomes are really going to be shafted. Lets face it, we are starting to get a two tier system in maternity anyway with more women who can afford it are already going private or hiring doulas... and its actively being encouraged on Mumsnet. Not good indicator for the future...

There are several big redevelopments of maternity services in the NW at the moment. I don't know the plans - they SHOULD be doing things like building loads of private rooms that can be hired out - they SHOULD be building private wings. Yes it is unpopular to say, but I'd rather we were charged for add ons such as that as an option under the NHS umbrella to put more money into the system elsewhere rather than in the healthcare itself (even in more controversial areas like this).

I do not see any way around the problems of an aging population with more expensive health care needs without a massive increase in tax or an acceptance that more of this should be done.

The bitter irony I see, is just how many of the people shouting that women should pay for ELCS are actually the same people shouting loudest about the "Destruction of the NHS".

"if I'd not had such a brutal and traumatic experience with postnatal care that was worse than useless,"
So would it be better to fund addressing that kind of experience rather than more csections?

"I find it very strange that antenatally, there is so much contact with midwives,"

I didn't think there was that much contact with m/wives antenatally. What do you mean by so much contact?

I don't get the 'appearance-obsessed' thing at all. Why on earth would anyone have a CS for 'cosmetic' reasons? Surely it would be the least appealing option if you were obsessed with your appearance, not least as it gives you a great big scar across your abdomen!

I know the scar can be made to look relatively small and neat if you have a skilled surgeon who takes care over such things, but still you'd think someone so appearance-obsessed would rather not have it at all, given the choice.

quietlyafraid

I completely agree with your post. I wish that mumsnet had a "like" button.

I think that if it was possible to pay for top ups within the NHS then it would health care in lots of areas.

For example I self harm and I have been refused help from the nhs. I would be prepared to pay privately, but it is is an utter minefield to find some repruatable in the private sector. It would be great for my doctor to be able to refer to someone in the private sector.

I think the nhs should provide a basic package, but people be able to pay for a top up without losing all nhs care. Otherwise the nhs will completely and utterly collapse.

I thought surrogacy was the in thing now with celebs...

Nicola Kidman, Beyonce (allegedly)...

juuule I had the usual, regular ante natal appointments, and was able to phone midwives to discuss any concerns. By contrast, when I was in the postnatal ward, for over a week, midwives were always far too busy to help. I've no idea what they were so busy doing, but the women there had very little contact with them. It seems strange to me that postnatal care is so poor, especially for women who've had complications or a CS.

My experiences match those of other women I know.

I kind of agree with you there reallytired about top-ups.

It just seems such a shame that women are getting inadequate care during birth by an under resourced maternity service obsessed with the cost of everything when parents are buying all sorts of paraphenalia for their babies and nurseries etc. as they want to give their baby the best possible start in life. But there is no way for people to put their money where it would really count for the mother and baby by helping to resource good maternity care.
Obviously there could be problems with more of a two tier health and maternity care service developing. But the present system is already failing many women and the whole maternity service urgently needs a thorough re-appraisal.

"It absolutely should consider common outcomes of VB, such as faecal and urinary incontinence or loss of sexual function. These problems are particularly common where there is an instrumental birth. I don't believe those things were considered at all in my case. The outcomes of CS should obviously also be considered, and should include the likelihood of the baby having breathing difficulties afterwards"

I've had an instrumental birth, and pelvic floor and perineal damage which have led to minor urinary and faecal incontinence. I didn't consider this issue prior to my first child because there wasn't a choice to be made: an elective c/s wasn't a possibility on the NHS at that time. If I had been told about these issues I probably would have been strongly influenced by them.

What I wouldn't have known about was 1) that the experience of labour can be a profoundly positive life-changing event, even when the mother experiences injuries which continue to cause her problems after the birth. I also wouldn't have known that the majority of women who experience symptoms relating to pelvic floor damage in childbirth usually don't find it particularly distressing or life-limiting.

Women can look at facts and figures as much as they like - but what they can't know is how they're going to feel about their births or their bodies afterwards.

We live in a culture where even the normal pain of childbirth is presented as being pathological, even in the absence of tokophobia or PTSD. That's what I pick up from many of the posts on this thread: that labour is actually a horrible, dangerous event that it's quite reasonable to want to side-step. I think this view of labour as being intrinsically a negative experience because it involves pain is becoming more and more prevalent in our culture.

And I think women who're coming to childbirth for the first time pick up on this fear and disgust - and it WILL influence them in their choices, far and above what they read about the clinical outcomes of birth. They can't know what it's like to give birth, because, to be honest, you have to do it to know. Those women who've never been through labour haven't got a clue how they'd react to it, or how they'd feel about it afterwards. And nobody will say to them - 'you can have a very difficult labour, with lots of interventions and perineal damage, and STILL feel brilliant about it and have a happy, fulfilling sex life' - even though this is a very basic and real truth. First time mum's choices will be driven primarily by FEAR of something they don't really understand.

I think that's very sad.

And for those of you who are working on the assumption that the offer of planned c/s will only be taken up by a small number of people - I think you're wrong. In countries where c/s is affordable and available to low risk mothers the c/s rate is very, very high. In parts of Brazil, planned c/s accounts for over 80% of births. In the UK, where it'll be available for free I image there will be a very big take up, particularly among first time mums who have been scared rigid by what they know about standards of care for labouring women in many hospitals.

I feel that my ante natal appointments were managed very inefficently. For example does it really require a qualified midwife to inject me with ante D as a seperate special appointment with a qualified midwife? Is it really a good use of four years of training to test piss pots or take blood?

I would like a plubotonist to come to the surgery to take bloods and test the urine and possibly administer ante D where necessary. It would free up the midwife to do things like discuss pregnancy issues, results or even birth choices.

I apologize that my point was interpreted as patronizing. This is absolutely not how I meant it to come across. However I do think a huge number (not all) of women in their teens/early twenties (as well as many older too) are influenced by others/celebrities/peer pressure and are certainly more naive in general than more mature women. I, for one was and I was and am certainly not stupid. I also don't think it's stupid to opt for an ECS - this is a woman's choice (well it should be).

Maybe I have a skewed view on this as I currently live in a country where a large part of my contemporaries do have these anti-VB attitudes. I sat yesterday with 10 other mothers and other than one (who is not from the country where I live and wants to train to be a midwife as she is appalled by the amount of c-sections that take place in private hospitals here) they all expressed disgust for VBs and how they didn't want to tear and they would be incontinent for life and that c-sections were far and away safer for mother and child etc..etc...these women are not stupid in any way but it's interesting how they view this.

And yes I think the NHS needs to change their practices. Building private rooms etc.. In maternity wards ad charging for them might help, who knows?

On the c- section scar, mine is below my panty line and unless you have a Hollywood wax and attend nudist camps is not visible to others. Maybe I was lucky are maybe it's because my CS was planned and not an emergency...
Not sure but I've never noticed any of my friends either when they're in bikinis...