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 would think the cost of a vaginal birth varies hugely, depending on which drugs you have and how many, what kind of monitoring you have etc.

I am relieved that this has come out. I didn't want to go down the cs route for ds. He came after three days of labour, a fair amount of tearing, a haemorrhage and a trip to theatre (without him, only minutes old) and months of pain. I won't put myself through that again. And I don't think that any other woman should have to. It doesn't make me a coward.

As a student midwife, I agree with this. Women deserve choice and to have some control over what happens to them - for me personally, forceps terrify me. If it looked like things were going south, I'd demand they go to CS.

But most women want a straightforward vaginal birth. I can't see swarms and swarms of women suddenly opting for surgery.

Yes I would like to know what the £800 is more than? A vb with epidural, anaesthetists services, continuous monitoring, perhaps more intervention-'maybe. I bet the financial differential with a natural birth attended by a midwife is much greater. We need to know ALL the facts. Also, what about totally straightforward pregnancies where the woman has the POTENTIAL to deliver naturally- I hope the risk factors are explained carefully

Personally, I could not intentionally put my baby at greater risk however slight. I know in some cases cs is the lesser risk because of medical reasons (as with one of my births) but we should not lose sight of the fact that most pregnancies are normal and have the potential for the mother to deliver naturally

Really glad there is a largely a positive reaction to this news here.

I've spent all day, getting upset at ignorant comments and poor reporting of the report.

The new recommendations are aimed squarely at a current grey area - namely women who, like me, suffer from tocophobia. It means there will now be a proper care pathway which encourages proper mental health care and proper support during pregnancy and also properly informs the woman of the risks involved. In some cases they will be able to help women decide to have a vaginal birth with appriopriate support rather than have an elective. The current system means some women have been falling through the system with terrible consequences for their mental health. I've read numerous stories of women terminating pregnancies as they fear they will not be able to get a c-section or have actually been denied one.

All the evidence out there suggests that the majority of maternal requests are for reasons relating to fear and absoluetely not about lifestyle, but the media do not report this and instead pander to the mythical stereotype. It means anyone suffering from tocophobia feels isolated and afraid of discussing it even with close family and friends due to fear that they will be judged unfairly.

To anyone who doesn't fully understand what tocophobia is, its essentially on a par with any other mental health issue - but sadly few regard it as such. I really want to get awareness out there about how badly this affects some women like myself and takes over, even if you want to have children. Its not rational or proportional. Its not the same as 'being a bit scared'. Its full on panic attacks and hysteria due to it being a phobia. Please don't think that anyone who has it is a wimp. It goes way beyond that, and often isn't just about pain or fear of dying. We need to try and get it taken as seriously as it is in Sweden where fear is actually screened for. We need more research and we need more support in breaking down the myths.

Its taboo and no one wants to talk about this properly. If this affects you, please try and talk about it. Awareness has to start somewhere.

I'm sure the cost of my VB can't be far off an elcs. I was induced, this cause complications which meant I needed cfm and 1to1 midwife care. I saw the consultant anaesthetist and was delivered in theatre following a spinal block which was adequate for a cs, by a consultant obs, accompanied by a consultant paed and the other dozen or so theatre staff you'd expect for a cs.

That's before you factor in my post-natal neglect which requires ongoing physical and mental care plus the potential cost of settling any litigation I may commence.

Whilst recovering in hospital it was mentioned that the obs who delivers by Keillands "keeps the cs rates down" so the decision in my case was as much (if not more) about manipulating meaningless statistics than it was about cost. Guidelines which mitigate the obsession with driving the cs rates down (without proper medical evidence as to why this is necessary) can only be a good thing IMO.

Those who want to VBAC and home birth are encouraged and supported. If only women who choose cs were treated in the same way.

Why don't the women that want one (not referring to emergencies) pay the £800-rather than stretch the budget for what can be considered as unnecessary treatment?

I believe the £800 is more than the average VD cost. What I don't know is whether this takes into account emergency CS or just planned.

By the way the draft can be found here:

www.nice.org.uk/guidance/index.jsp?action=folder&o=54526

Starts on page 97 with new recommendations on page 103, economics summary page 100 with more detailed break down on page 205 onwards (includes all those details you asked about callmemrs)

Hittheroad

Because it wouldn't then be a choice for everyone just those that could afford it.

HitTheRoadJack the NICE report points out that £800 takes no account of complications which NICE believe it should. The report concludes that if you use a different model to work out costs taking consideration things like urinary incontinence, then maternal request are not only cost effective but may be cheap in some circumstances.

This isn't being reported. It should be. Its VERY important.

CS is major surgery. It is very painful to recover from. People who have had one are less likely to have subsequent children. It costs more to the NHS. If you plan to have a CS (not for medical reasons) you should go private.

hittheroad - i thought that too

i would have happily paid that for mine.

Cs Not necessarily a painful recovery,and it's alarmist to suggest cs will affect future fertility.it can,yes.as can a difficult vb. Labour and pregnancy is the most potentially medically difficult event women face.but that is not to say all childbirth will be challenging

Anyone had a CS without any pain?

People who opt for c-sections have less children iggly2. They tend to delay pregnancy and tend to have underlying mental health issues. NICE and a government report dated 2003 both state that most requests are done for fear and not lifestyle. Too posh to push is a total myth that is damaging women.

This isn't just about the elective at the end - its the mental health support and care on that route. Forcing people down the private route doesn't ensure they get that. In fact it means they don't. Also this is a problem that affects rich AND poor. Swedish studies suggest its actually more of an issue for women who aren't as educated and lack the support of a partner.

the £800 being talked about is the difference recieved by Trusts for a "Normal" (vaginal) delivery and a C/Section.
It is identified that the income for Trusts for each delivery does not cover the costs associated with the delivery, so the additional income will not cover the extra theatre, nursing or hospital stay costs associated with the c/section.

Whilst agreeing with quietlyafraid that there could be long term savings, the initial hit to PCTs will mean less money for other things - 5 extra c/sections per year would equal 1 less Hip Replacement or 2 less hernia operations.
I am NOT trying to say that their shouldn't be choice for mothers, but I doubt that any additional money will be made available to the system overall and that the iimpact will be less of something else for other patient groups

People who have had one are less likely to have subsequent children

Where on earth does this gem come from? Please quote your source Iggly.

I think the key thing here is maternal choice. If women genuinely want to give birth via CS, knowng all the facts, then I am with NICE, it is their right to choose. The Times article outlines that NICE have made this decision based on recent data that a planned CS is no riskier for mother and child than the average VB.

The Time article also considers the cost - and suggests that women who opt for CS without medical need could perhaps contribute towards this. Could work - with some sort of means testing?

Personally I had a CS for breech baby and then got scared second time round at 41 weeks. Was then confronted by a very aggressive registrar who informed me that I had lost the right to opt for a CS. The most stressful part of my whole pregnancy.

Katharineclifton, yes - I have had 2 sections with no related pain.

quietlyafraid - people aho have c sections tend to have underlying mental health issues????

You are slicing open the womb.

It shouldn't be elective. It should be for women and babies in distress or other complications.

I can't see any other reason of having one.

I think that women who want to deliver vaginally should be allowed that choice. I find it strange that some of these women would prefer to restrict choice for other women who (for whatever reason) wish to deliver by CS.

If the Times suggested that the journalists needs shooting and read the report. The cost analysis was very thorough. This is SOOOO frustrating that journos can't do their effing job properly. It makes a massive difference to the story.

NICE SAID THAT THE COST DIFFERENCE WAS NOT AS SIMPLE AS THE £800 BASE. IT NEEDS TO INCLUDE COMPLICATIONS ASSOCIATED WITH EACH METHOD OF BIRTH.

How frikkin' hard is this to understand? How difficult is it to actually report a sodding report.

NO ONE SHOULD BE PAYING EXTRA. THIS IS THE GODDAM NHS AND THIS IS ABOUT MENTAL HEALTH ISSUES WHICH AGAIN IS CLEAR AS DAY IN THE EFFING REPORT

Sorry I'm Soooooooo angry. Please report the facts and full story.

well said Sardinequeen. also find it odd that these people are rejecting the considered findings of a medical think tank.

The vast majority of women are capable of a VB

Probably, but that doesn't mean that one's unborn child is going to comply!

My DD was back to back and looking where she was going instead of head tucked in. It would have been physically impossible for me to have given birth naturally!

I realise that's not what we're talking about here, but it's obvious from the differing views on the subject that allowing an elective CS for those who want one in not necessarily going to cause an influx of 'too posh to push' exponents being a drain on the NHS. (not a view I hold personally btw!)

There are some corkers coming out on here BTW

For the record, CS are slightly safer for the baby and slightly less safe for the mother IIRC. However in the UK both processes are pretty darn safe (assuming we are talking mortality).

I think it is a shame that longer term things like mental health and physical problems associated with different types of birth do not seem to be tracked for cost to women or monetary cost.