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.

springmummy yes I'd also start a new thread. But I talked a bit about my experiences on this thread and I'm an older mum (was 39 at childbirth). You can also PM me if you like

Sorry for those who had to go through this for a still-born baby though. It must be awful. Surely those circumstances should be taken into account.

I didn't know actually that there was an increased risk of infection when the baby has died. I definitely think the mother's choice is important here, though obviously she needs to be well-informed of the risks, and if in a particular situation the CS would be an extremely high risk to her health then it makes sense that the consultant would be reluctant to grant the request. That has to be balanced against the risk of psychological harm from forcing her to VB if she finds that option absolutely intolerable of course.

What an absolutely dreadful experience it must be either way though. Doesn't bear thinking about :(

MrsJRT I'm sure your heart is in the right place and I'm sorry to see how strongly you've been criticised by some posters.

But I guess many are saying that women's informed choice must be respected ( whatever the situation )

From what you say it sounds as though through engaging in this discussion your pro-choice views have been strengthened, which can only be a good thing for the women in your care.

Ephiny,
well said and I agree. Still, if it was me, I would want to be knocked out with GA and just try to forget about it. Any risk wouldn't be too big for me to want to relive the horror of the idea of my baby being dead for hours on end. No freaking risk. I'd rather die than torture myself double fold like that.

I really don't think MrsJRT meant any offense and I can see logic in the argument about making it feel like a real baby rather than just a dead baby (thats probably going to cause offense)

ANYWAY... I was going to ask you MrsJRT have you ever come across any ladies with tocophobia and have you ever had any sort of awareness about it? I get the impression its not really taken seriously by midwives and would be interested to know your experience in the context of how women with it are treated. The feeling of not being taken seriously is one that I think adds to anxiety (and as I've said before I think its really important and key part of the guidelines as it is a formal recognition that its a 'proper' health condition that should be treated in a certain way).

Ephiny, without being too graphic, if infection has been the cause of death then the chances are definitely already increased.
Juggling Thanks and I do understand what you are saying but I'm just pointing out that although ELSCS may be a relatively simple straightforward procedure when other factors such as stillbirth are included it becomes less so, vaginal birth becomes more favourable and doctors have to support that.
RalucaV I'm assuming you haven't ever gone through the trauma of a stillbirth yourself as no woman I have ever cared for in that situation wanted to 'just forget about it'. That kind of emotive language I find more distasteful than anything I have said about vaginal birth.

MrsJRT,
no, I haven't. I'm just trying to imagine what that can be like, of course. Fortunately, it doesn't happen so often nowadays, so I don't even know anyone that has experienced it (unlike clarabellabunting). Still, I likewise find totally insensitive and even cruel the fact that you might think it is right to FORCE those poor woman to have a VB, if they DON'T want to. I don't understand how anyone can even consider forcing someone in that situation to do something against their will.

MrsJRT,

and btw. this is exactly why I don't trust midwives. Because they always seem to think they know better, like they are some sort of demi-god or something. But people are quite able to take responsibility for their lives and bodies in all other aspects of life, so why do you all seem to think that when it comes to labour, only you always know what is best.
Still, I appreciate your willingness to discuss and find out more about the other side of this barricade.

quietlyafraid, I can only speak for the culture within which I work, we do have women requesting ELSCS for tokophobia, it's not something that tends to stir a bit of discussion, where I work we have quite a high section rate anyway and TBH when we get the section list in the mornings although it does state reason for section (ie prev section, breech, tokophobia etc) the reason tokophobia would probably not generate much more reaction than either "Oh, cool" (in the laidback sense of the word) or "What's that?" from the less enlightened amongst us. My thoughts on tokophobia, now bear with me on this, are: Very few of us actively look forward to giving birth, especially not for that first time, very few of us actually have a phobia of it but when we meet someone who does, we project our thoughts and feelings onto them. Say for example I met you, you say to me "I'm absolutely terrified of giving birth, phobic even, I've got tokophobia" I think to myself "God yeah I was terrified too, but it was ok, honest, just pull yourself together, it was fine, not such a big deal in the end". I clearly haven't got tokophobia whereas you have and although we may use similar words to describe our thoughts and feelings we don't actually mean the same thing. Does that make any sense? It dilutes our understanding of the word because we project our defintion of the words used to describe it. I fear I'm waffling and haven't answered your question!

Yes it makes sense that there's be a higher risk sometimes, I'd just never really thought about it before - I guess most people don't until they find themselves actually in that awful situation.

I don't really like to speculate about what I would or wouldn't do, I don't think you can really predict what you'd feel or what you'd want. Definitely though the mother's choice and wishes need to be respected, though of course I appreciate that the HCPs have the responsibility to look after her health and guide (not force!) her towards the safest option if possible.

RalucaV I'm not going to engage with you anymore. You're being entirely unnecessary.

RalucaV

If they were adament about a c-s on the grounds of anxiety before the death of the baby I would be more supportive of it as it would still be a psychological issue in the same manner.

HOWEVER if its a women who planned on a VB I'd be more torn - she, in time, will want to think of the baby as a baby and the process of giving birth may well help her deal with that rather than simply removing it like a tumour (which is a god awful way of describing it). That probably sounds really crass when there are women here who have c-s and given my own feelings on the subject. But the method of birth may help in the grieving process to make the child more real. When someone is grieving in that way, I think judgments like that are more questionable. Its an entirely different set of circumstances and as MrsJRT has said, if it carries different risks then that should quite rightly come into play.

If there is evidence to suggest women come to terms with it better by giving birth naturally then that is valid and should be the line recommended. It is the same as stating that if a woman is forced to give birth by VB she might be psychologically damaged which is the grounds for the rational for allowing c-s on demand. It is a different situation.

Ephiny,

guide is the word, yes. Anyway, I still think your body is your own personal responsibility, so I would happily sign any no-litigation papers in that situation.

MrsJRT,
very good point. BTW. I don't think tokophobia is really irrational phobia. I find it highly rational, although women in all cultures of the world are conditioned to think of birth as something desirable and wonderful. Right, because if they knew the awful truth, humankind would have died out long ago:)

i dont get why so many people are still debating why THEY think this is right or wrong for others - you only need concern yourself which method is right for YOU, and stop criticising other people's choices

MrsJRT,
please yourself :) My opinion of your profession has been only made firmer by all your comments on this thread, btw. But don't worry, I'm probably just one of a few heretics in your crowds of faithful.

MrsJRT, I think that's actually a pretty well articulated response (speaking as some who had a CS for primary tokophobia) -

You are sensitively recognising that you can project your own responses onto someone, which is understandable! but by doing so, fail to grasp what they are going through. I think just recognising that is a huge leap, frankly. People who have never been depressed tend to mistake depression for 'being a bit down', whereas it ain't the same thing. People don't top themselves because they feel a bit miserable...

I think failure to understand phobias in general is fairly standard - I don't mind spiders, so don't 'get' why some people become hysterical around them - but that doesn't matter, as long as I understand that they just DO. And that waving one in their face and saying, 'see, doesn't bite, it's only tiny!' won't help them in the slightest.

I do think attitudes towards tokophobia and CS are different though. The 'if I have to go through it, you do too' response is more common than I would have imagined beforehand - and because people have all sorts of moral and emotional responses to birth, and women, often not really acknowledged openly, I don't think - then their attitudes are complex to say the least.

I THINK get what you mean I think MrsJRT. Its very difficult to express what you feel. I know when I talk about it, I can use language that would seem very 'alien' and not right to most people. (Partly the reason I don't want to go into to many of the ins and outs of it on a forum on a personal level unless someone else expresses some of the same feelings). I know it has affected my feelings for a long time - a complete denial of wanting children, to avoiding other peoples babies, to refering to them as IT rather than he or she (that one drives my husband nuts), to removing friends with kids from FB etc to downright hysteria about it. Its not 'normal' so I get that is very difficult for other people to understand and actually be able to use words in response that are sympathic or actually reassuring to someone like myself. The attitude of "pull yourself together" I guess would actually help some women in the same situation, but to me would be most insensitive and almost cruel and make me even more hysterical. If that makes any sense too... I get the idea of projecting your experience of fear though. Difficult to explain. Fear is a weird thing. I can be rational and intelligent on a forum about it, but in person reduced to a mumbling, idiot incapable of even remembering my own name.

fruitybread and quietly,

I will repeat myself, but I really admire your patience on all these different discussion boards. I tend to lurk only, but then explode, when I read something so shocking for me. Thank you for that. I guess I'll get back to lurking.

BTW. what you both think about this?
"I don't think tokophobia is really irrational phobia. I find it highly rational, although women in all cultures of the world are conditioned to think of birth as something desirable and wonderful. Right, because if they knew the awful truth, humankind would have died out long ago."

It's not my original idea, but it somehow seems like a better explanation of this supposed 'phobia'.

I don't know ralucaV - I find it hard to understand other women's attitudes towards birth, I really do. But I guess I would, wouldn't I. I do see a lot of contradictions in the way that birth is discussed, and I also see that a lot of women struggle to articulate how they feel about birth. I think there is a huge difference between women who see birth as a means to an end - they want a baby, and a family, and that's just how you get one - and those women who have a big agenda, and for whom birth is something mystical/a rite of womanhood/the ultimate destiny and proof of a woman etc.

I think the best I can do is just accept that women have different attitudes towards birth,and that I don't have to understand them to do that. That's why I support women who want HBs, even when it goes against conventional medical advice. I would never want to go through it - but I know how it feels to to think you are going to be forced through a birth you emphatically do not want.

fruitybread,
exactly. Women simply have different attitudes and agendas, as you put it, and that is why I don't understand why there is always so much bashing when it comes to a choice of ELCS. I tend to bristle when I read these anti-choice comments because I feel a lot of "I had it bad so you have to suffer too" behind it in the same breath with "CS is a major surgery" just like you said it so eloquently in one of your posts.
Just like you, I don't have anything against HB and I can even understand a lot of the reasons why women decide for them. I just don't get why when it comes to choosing CS, lot of people suddenly become so interested in other people's birth choices.

cost.............

Many useful posts on this thread about cost you might want to read, iggly2 - but in brief, the NICE guidelines have changed partly because they feel the cost effectiveness difference between a VB and planned CS is not significant enough to be a reason for a blanket refusal for CS's, if you take a long term holistic view (i.e not just an 'on the day' cost for the hospital, which of course overlooks all post birth AND post op complications).

Check it out for yourself - page 218 of the NICE guidelines, I believe -

"Including urinary incontinence greatly reduces the incremental costs of a maternal request caesarean section, because the ?downstream? costs of a planned vaginal birth increase more due to the higher risk of stress urinary incontinence with vaginal birth. Similarly, the greater reduction in health related quality of life arising in women having a planned vaginal birth from stress urinary incontinence now leads to caesarean section on maternal request having a higher QALY. An incremental cost-effectiveness ratio of £373 per QALY would suggest that a maternal request caesarean section could be considered a cost-effective alternative to planned vaginal birth."

PFI looked great on paper... NHS at its best.

But there are also other costs from CS not accounted for on both sides.

The costing is not fully detailed either way but as it stands their rudimentary figures imply it costs more for ELCS.