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.

These are the actual NEW recommendations gladders:

When a woman requests a CS explore, discuss and record the specific reasons for the request.

If a woman requests a CS when there is no other indication, discuss the overall risks and benefits of CS compared with vaginal birth (see box A on page 64) and record that this discussion has taken place. Include a discussion with other members of the obstetric team (including the obstetrician, midwife and anaesthetist) if necessary to explore the reasons for the request, and to ensure the woman has accurate information.

When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner.

Ensure the healthcare professional providing perinatal mental health support has access to the planned place of birth during the antenatal period in order to provide care.

For all women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.

An obstetrician has the right to decline a woman‟s request for a CS. If this happens, they should refer the woman to an NHS obstetrician in the same unit who will carry out the CS.

It goes on a bit but the basic argument the report is (quote from page 101):

^Trade-off between net health benefits and resource use

The group noted that there was likely to be an increased resource use with CS due to the increased length of hospital stay. An economic model developed for this guideline suggested that planned vaginal birth was cost-effective compared to a maternal request CS. However, this finding was limited to outcomes that were reported in the included studies for the clinical review undertaken for this guideline (see section 4.2). A sensitivity analysis suggested that the inclusion of adverse outcomes not reported, such as urinary incontinence, could make the cost-effectiveness conclusion less certain. On balance this model does not provide strong evidence to refuse a woman‟s request for CS on cost-effectiveness grounds.

The group agreed that there was likely to be an associated cost with providing psychological support to those women who experience mental health problems as a result of not receiving a CS on request. However, they noted that this was only likely to be the case for a small proportion of women. The GDG‟s experience of caring for women requesting a CS was that anxiety about giving birth vaginally was often at the root of the request, for example as a result of a previous poor birth experience.. The GDG believed that when women are given the opportunity to discuss these anxieties in a supportive environment, the anxieties can often be reduced to the point where the woman is able to choose a planned vaginal birth. The group agreed this was the preferred approach. ^

Norman- Easier for whom?

If a woman can give birth naturally and her and the baby will be healthy then why is there even an alternative?

Giving birth naturally can result in a host of difficulties for the mother.

I notice that the stipulation is that the baby should be healthy after the birth, but the mother attracts no such comment.

Interesting.

The only requirement is that the mother is physically capable of giving birth naturally, no thought for her mental or emotional state beforehand, or her mental, emotional or physical state afterwards.

Compassion is the reason for the alternative, I think. Seeing women as capable adults able to make their own decisions about their own body, that kind of thing.

Hitheroad do you actually mean to imply that so long as my baby is healthy I should subserve my own mental/physical wellbeing? I thought we had moved past the point where women were considered mere baby making machines...

SardineQueen
So to say that women who have sections are less likely to have another child full stop is not right? That applies to a certain subsection of women who have CS?

Swedish research is suggesting that women who elect to have a c-section on request plan to have smaller families from the outset. I've not seen any data (because I don't believe it exists yet) how many they actually end up having.

But it does stand to reason that if you are nuts afraid about giving birth you aren't going to put yourself through it too many times...

There definitely do seem to be patterns for who is more likely to request one though. Higher average age for first child - tend to over 35... All pretty understandable actually.

It's giving birth.

Is that not what the female is designed for? (not solely to have children, I'm talking reproductive wise).

What about women quick enough to "elect" a c section but never experiencing natural birth? How are they to know how it will "effect" them? I'm sure the hormone release of a natural birth is well documented to have a good bonding effect between mother and child.

If a woman can have a c-section and feel positive, then why not let her? I don't understand your point.

As far as I know in the UK at the mo the only people presented with a choice by the NHS as standard are women who have had a CS with their previous delivery.

The research sounds very interesting. Which way around the cause and effect is IYSWIM.

I don't understand why you wouldn't give birth naturally if all was to be fine for mother and child.

What are you scared of?

Which women are they then hittheroad?

You have decided that there are a group of women who will elect to have CS without having a natural birth first. You want to stop them doing this. Why? I would assume that they have good reason for their choice ie women are adults and capable of making decisions about their own bodies.

I can't understand why anyone would possibly choose a c section if they didn't have to. I was threatened it with DS2 who was breech and was terrified-luckily he turned just in time and saved me.

Haven't read past the first page but will go back to do so but I have to address the misguided thought that doctors and anaesthetists assist in natural birth. Do they bollocks. Med students pitch up on delivery suite, look bored at the desk for a few hours, moan that nothing is happening and then wander in to the delivery room for the 'money shot' and leave to go home before the placenta is out. They then land as SHO's having had little experience of pregnant women or childbirth other than what they've read in their medical books and do a few months before they whizz off elsewhere to become a GP. It's laughable to suggest doctors get involved in normal birth, they (in my opinion) have no interest in the low drama fuss free deliveries, it's midwives work.

I'll go read the rest of the thread now.

Hittheroad
Are you really suggesting that because a woman is physically capable of giving birth her emotional well being or informed decision should not be taken into account.

hittheroad before you give birth naturally you have no way of knowing whether all will be fine for mother and child
equally with CS you have no way of knowing

The problem with birth, whichever way you do it, is there is no crystal ball.

We are actually very bad at giving birth compared to other mammals. We have big heads.

We are good parents though. I don't know why people are so invested in natural = good. So often, it doesn't.

I'm saying that unless you need an operation, it's unnecessary and expensive.

Not "fancying" natural birth is an unnecessary reason.

Big heads and we stand upright.
Difficult births is the price we pay for our brains. And very dependent babies.

I don't understand why you wouldn't have a cs if all was to be fine for mother and child.

Hence, choice.

So who are all these women that don't "fancy" a natural birth?

Your posts show a low opinion of women in the UK IMO.

ALSO there is research building up that suggest that women with extreme fear are more likely to end up with an instrumental delivery, emergency c-section and induction. So if you have extreme fear, and more likely to end up with a risky birth, there is an argument here for a safer elective if thats what you are requesting.

A fairly decent and readable report on one of these studies (its not perfect - the report itself isn't as user friendly though).
healthland.time.com/2011/09/23/women-who-are-terrified-of-childbirth-are-more-likely-to-have-c-sections/

Not surprising, its same sort of thing that homebirther say about fear being bad in birth.

There needs to be a lot more research done. It has big implications.

I would be interested to know how many people opt for a cs first off or after a first VB, and in the former group how many have a mental health reason for doing so. I opted for VB for my first because I didn't know how my body would cope. Turns out, not well. So next time I'm not doing it. Not trying. Not going to put myself, my child or my husband through it. I will have a cs. And I know it will hurt. And I know it will take time to recover. But so did my vaginal delivery.

Last bit of my rant, this whole bloody myth about how women are perfectly designed to give birth naturally, why don't you check out the maternal mortality rate in countries with poor perinatal care? Unassisted, we do pretty badly.

I think that sort of idea was the basis behind the MLU's, wasn't it?

very informative posts quietlyafraid, thank you

Why do women have to have a 'good' reason? Good enough for who?

I'm a grown-up and therefore can make decisions about my body including whether to have a cs. A woman who is experiencing anxiety as a result of a traumatic decision has every right to choose how togive birth if it is available.

springbok someone will say that poor maternal mortality rates are due to poor nutrition and in the good old days it was all fine and you just stuck some wode up your fanny and went straight back out to butcher an ox. Or something.