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.

shagmundfreud - that is a thought provoking post

I think that, even women who have previously had babies, have no idea what it is like for other women to give birth.

I can see that for many women I know, and for you, it has been a profoundly positive life changing event. For me it destroyed my confidence and left me with PTSD. That does not mean that my terror of ever having another child is based on a poorer understanding than yours. We had different experiences.

I don't believe that I had any fear when I was pregnant, I never imagined for an instant that standards of care on maternity units were so poor, or that abusive behaviour from staff members was tolerated.

As a tiny example of lack of resources and penny pinching on maternity wards when my DS was born I was advised that the "new-born" wipes I had to change his nappy might be a little harsh on his skin and that I should use cotton-wool
but they didn't have any cotton-wool for me to use. This was on the "labour ward" and he only needed changing the once (so hardly a major drain on resources ! ) before we were fortunately able to go home

Shag

I think this thread is also a little biased in representation. There are a lot of women who have had very negative experiences. There are very few women who have no children. I'm probably the only one.

There are plenty of women who I know who know the problems with childbirth and still want to go through with a VB. Educated women without children. My pregnant sister in law who is a doctor for example! There are plenty of women who have had great experiences and do say that. There are plenty of midwives who have a lot of influence who say that.

You are taking the worst examples of where planned c/s are and not considering other countries which aren't as bad and still have planned c/s. Including countries which have free health care.

reallytired - in my experience the blood taking and urine testing was usually done during an appointment which was also designed to chat about pregnancy related stuff, birth choices, results etc. My midwives were all quite capable of talking whilst taking the blood samples or dipping the test strip into the urine for instant results. I don't see how additional appointments with somebody else, who is not a midwife would free up anyone's time or resources?

Shagmundfreud - once again I agree with you. Here we (my contemporaries) do have the choice between c-section and VB too and the vast majority opt for the c-section. This is reality here maybe it won't be the case in the UK but I have my doubts.

If I were a first-time mother I would be terrified by many of the posts on here and would strongly consider a c-section...

Is there any reason to believe that a well managed c-section can't be a profoundly positive life changing event?

I accept that a straightforward natural birth would be better, but that is not what women worry about. Women who have had complicated pregnancies, or other risk factors that make a non-instrumental VB less likely, would be more likely to choose elective CS, which would in itself improve the outcomes for VB.

I didn't want a C-section when I was expecting my first - I wanted to learn all I could about birth and hope for as natural and informed a birth as possible, where I was able to make choices throughout. With the support of NCT and hospital ante-natal classes, and using the birthing pool at the hospital this is what I was able to have - notwithstanding my experience of maternity services needing to be better resourced.

I am in agreement with the idea of paying for add-ons and this is what makes things work better/more efficiently in some countries. It would, however undoubtedly lead to a lot of issues amongst those who cannot afford such extras. Would those on benefits get it for free etc..etc...a bit of a minefield but, in my opinion the only way to make this recommendation work and improve maternity services and the NHS in general.

WhollyGhost - yes it can. Many women choose to have c-sections and have wonderful experiences. Others do not choose to but still have wonderful experiences. I think, in most cases the reason for disappointment is when women have a very strong personal view on giving birth naturally and then end up having to go the surgical route.

Personally I don't feel less of a woman for not giving birth naturally, but other women may think differently.

My well managed planned CS for my 1st DC, on the NHS, was a profoundly positive and life changing experience. To see my baby for the 1st time - to hear that wail - to have a much, much wanted, deeply loved little boy was truly wonderful.

I had an easy recovery (was a good candidate for such, being healthy and fit) - and I appreciate and was grateful for the fact I had a much shorter hospital stay and a much quicker recovery time than my friends who had difficult VB's for their 1st DC. My quick recovery and relative lack of pain after the op I know made BF-ing easier for me than for my friend who had an infected episiotomy, and who couldn't bear to feed in any other position than lying on her side with one leg in the air. She and several other mums ended up reluctantly feeding formula because their recoveries were so slow, and their bodies so traumatised, BF-ing was simply a much bigger ordeal for them than me. (ironically, this wasn't something I had taken much into account when I was planning my CS - all the info I had said that BF-ing was harder to establish after a CS, which made me really do my homework and prepare for BF-ing to give myself the best chance I could. I never considered how tough BF-ing could be for women who had very tough VBs).

The important point is that if you haven't had my birth experience - THEN YOU DON'T KNOW WHAT IT'S LIKE. You can't know. And that's fine. You just need to respect my voice and believe me.

If you want to say 'MY BIRTH WAS BETTER THAN YOURS', then you are plainly talking nonsense. And really need some hobbies or outside interests or something. All you can say is 'x birth was better for me'. Which is not a reason to stop OTHER women from having the birth THEY want.

And obviously, that choice isn't a crystal ball. All you can do is look at 'facts and figures' (why so dismissive? An evidence-based approach? Quelle horreur!) - AND take into account your emotional responses and needs. Mental and emotional health isn't something to taken lightly, if you take any kind of holistic approach to maternal and infant welfare.

Once you start down the route of 'I know better than you how you will feel', you are in very dangerous and paternalistic territory.

"There are plenty of women who I know who know the problems with childbirth and still want to go through with a VB....and not considering other countries which aren't as bad"

The countries where elcs is available on demand but still have low c/s rate also (assuming France and Germany) also have generally excellent maternity services, so that women opting for a vaginal birth have less to fear than we do here in the UK. In the context of a healthcare system which is struggling to deliver high quality care to women in labour, I believe that the option of planned c/s for women with no clinical need will have a very big take up.

Want to add - whatever the risks are of vaginal birth - the basic facts are this: the majority of healthy women opting for a c/s, particularly second time mums, will come home with a more significant injury to their bodies than had they gone for a vaginal birth. This is a basic truth. Most women who opt for a vaginal birth come home with no serious birth injuries. All women who opt for c/s will come home with an 10 cm full-thickness wound, and damage to their uterus which will pose an increased risk in subsequent pregnancies. I appreciate that many people will see their c/s as a sort of 'insurance policy' against a problematic vaginal birth but if we're talking in sheer numbers - more c/s at a population level = more women overall with damage to their bodies post birth.

"For me it destroyed my confidence and left me with PTSD. That does not mean that my terror of ever having another child is based on a poorer understanding than yours. We had different experiences. "

And do you think that the increasing access to surgical birth in the absence of a properly funded drive to improve standards of care across the board will result in more, or fewer experiences like yours?

"If you want to say 'MY BIRTH WAS BETTER THAN YOURS', then you are plainly talking nonsense. "

Who has said this?

"And really need some hobbies or outside interests or something."

No need for this sort of contempt and nastiness fruitybread, you're not being attacked her.

"All you can do is look at 'facts and figures' (why so dismissive? An evidence-based approach? Quelle horreur!)"

I'm not dismissive, so no need to be sarky.

"AND take into account your emotional responses and needs. Mental and emotional health isn't something to taken lightly, if you take any kind of holistic approach to maternal and infant welfare"

I absolutely agree.

shagmund, I am certain that increased access to c/s would result in fewer experiences like mine. Not having a choice in how they take your baby out is disempowering. It not being my decision, meant that there was no need to discuss options with me, or warn me prior to bringing out the giant crochet hook and rupturing my membranes.

You seem to be arguing as though women would be making personal choices based on statistics at population level. Pregnant women who have additional risk factors are well aware of them. We know if we are unlikely to have a straightforward birth. I was in no way as badly affected by tearing as you, but I'd still much sooner have a 10cm full thickness wound than loss of sexual function, post-episiotomy.

Fruitybread - am pleased your birth experience was a positive one. Mine was difficult but still in some ways positive, but some of the reasons for my negativity could've been avoided and I will do my utmost this time round to eradicate those and then hope nature is good to me. I will have the same obstetricians/anaethetist/hospital etc.. etc.. but who knows if it will be a better/more positive experience. At least I feel more prepared and know what to expect.

My point about freeing up community midwive time is that not all women need a chat every time their piss pots are tested.

When you have had more than one child you are more confident and provided that your bloods, urine and blood pressure are OK as a mother you might want to be out of the door as soon as possible. It is not fun attending an ante natal appointment with a bored tot.

I found it frustrating with my second that when I did run into problems I could not get an extra midwives appointment, yet a midwife's appointment was wasted just simply to inject me with ante d.

Who else is going to do that stuff though reallytired? You might not have needed a midwife at every appointment but you are not representative of the women on any given community midwives caseload. You still need someone qualified to interpret blood and urine and blood pressure so although the actual physical act of doing could be done by say a health care assistant, you still need the midwife to sign off on any follow up required. Some women do need to speak to a midwife at every appointment, some are particularly anxious, some have complex pregnancies that require lots of input, some just want to feel looked after by someone who knows what they're doing (all I'd wager).

Hmm...

My sister-in-law made an informed decision to have kids younger because she knew about the risks after 30 for first child. She wanted a natural birth and so is going to put her career on hold rather than wait which many women in her position might do. Working in maternity whilst she trained made a difference to how she viewed things.

I think women tend to be more influenced by the experiences of friends than a magazine. There are plenty of women who have had bad c-sections - some of them have commented here. They may have been EMCS but I think there is a lot of confusion over the two and the risks involved. A lot of women completely hate the idea of being 'sliced open'.

If I am honest about this and how I feel about VB v ELCS my feelings are much more greatly connected to my panic attacks and how this will affect me and what other risk factors I think I have. I've said on other threads in the past that in an ideal world where I didn't have the problem I did that actually I maybe I would like a VB with the right support - precisely because of the empowering nature of it. But then I'm somewhat unusual and perhaps you don't beleive this because of the point of view I have. This is about what I think is probably the best option for me... I personally think that given my mental place, that to have a child at all, by any means would be something of an achievement for me and deeply empowering... but then I'm a naive woman who has never had a kid so my opinon on this doesn't count.

I think its dishonest not to educate women properly - ideas of empowerment really ARE persuasive and attractive and are completely valid and should be discussed, but not at the expense of hiding other possibilities. Many women on this thread have spoken of the sense of betrayal because they thought it would be like that and then got a different experience... but equally, when you are told the risks of something, young people without experience are more likely to take the attitude of 'thats something that happens to other people'.

Women like the idea of being able to do this great act and push out a baby, and given so many women feel failures because they can't... well that also speaks volumes for the culture in this country too.

As for assessing risks. There's reams on this and theres currently a massive study going on about the way in which doctors should explain risk to patients as the way it is discussed can be extremely important and influencial. But a lot comes down to whether your personality is as a gambler or someone who likes known quantities - guarenteed injury to your abdomen or potential risk to your pelvic floor.

IME, it is only the risks to the baby which are discussed. As a mother-to-be, your personal welfare is less relevant than that of the foetus. Maybe rightly so.

I expect that if a healthcare professional wants to persuade a woman not to opt for a c-section, they will simply emphasise the risks of the baby having difficulty breathing. Much easier to do that than organise acceptable peri natal care.

i think cs is alot safer for the baby

CarrieInAnotherBabi
If you go on what the NICE report says, then no CS is not safer for the baby - the opposite is true according the statistics they used. That said there is no conclusive evidence of greater neonatal mortality.

According to NICE

Risks for babies:
VB better for:
NICU admission
13.9% planned cs 6.3% vaginal (inc unplanned cs)

No difference:
Hypoxic-Ischemic Encephalopathy (CNS depression, seizures, pH < 7)
Intracranial haemorrhage Neonatal respiratory morbidity (intermittent positive pressure ventilation, transient tachypnoea, endotracheal tube insertion, pneumonia)

Conflicting findings from studies:
Neonatal mortality
Apgar score at 5 mins < 7

Did they match the mothers in the c/s group to the ones in the vb group?

Because as things stand, women in this country are generally given "elective" c/s for very good reasons, and their babies would be at higher risk whatever the decision.

WhollyGhost

I don't know, and tbh, in some respects I'm not sure its relevant in the sense that this is what NICE are saying doctors should tell patients. This is the 'official' line - which I'm sure will be very important in influencing decisions. I'm sure it will put a lot of women off.

I'd have to look at the study to get a proper idea - my suspicion is it will be across all electives (which as you say will be influenced by the inital health of the mother), though they could have looked at just breech babies as a balance for higher risk women. There aren't any studies on this type of thing purely on maternal request atm - the first one is underway in Australia at the moment I believe. And we honestly can't give fair data in the UK on this simply because of proper record keeping on the subject (maternal request is often listed in cases where a doctor has given the woman a choice but made a recommendation one way or the other based on their clinical circumstances).

thank you, that is very interesting

BTW, thought this might be of interest. I'm pleased to see that its not just me who has concerns over the media reporting of this being misleading.

This is the offical response to the draft guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG).

"The RCOG does not comment on draft consultation documents since the content and recommendations are subject to change.

However,in light of the misleading headlines on the availability of c-sections on the NHS, the RCOG would like to state that:

?C-sections are a safe medical procedure but as with any intervention, there are risks involved. All doctors must ensure that women are informed about the risks and/or benefits of procedures undertaken and the alternative options. Women must have access to good quality information so that they can make informed decisions

?Tokophobia, or the morbid fear of childbirth, may lead to maternal request for c-section. Tokophobia is a complex rare condition and women need to be supported by a range of healthcare professionals, including midwives, obstetricians and occasionally perinatal mental health specialists, so that the most appropriate choice of delivery can be made.

The headlines ?Now all women have the right to NHS caesareans in hugely expensive move? and ?All women get right to caesarean birth on the NHS... even if they don't need it? are inaccurate. There is no proposal in the current NICE guidelines which state that women should have the automatic right to a caesarean section. Indeed, the current Hospital Episode Statistics show that the c-section rate over 2009-10 was 24.8%. This shows that the majority of women currently deliver normally or by assisted vaginal delivery depending on their circumstances.

There are well defined indications for caesarean section for both elective and emergency and these should form the basis of clinical practice.

Healthcare providers have the responsibility to ensure the safest, most cost-effective method of delivery for women and babies accepting that very occasionally women will request an elective c-section in the absence of conventional obstetric indications."