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 wouldn't have a CS through choice. Only if medically I couldn't have a VB.

But I think it should be up to the individual woman to make her choice. For me its about what would make the woman happier.

I had a c-section second time round after a traumatic VB the first time round.

I think it's fantastic that a national body of clinicians are proposing this - there are too many myths about c-sections that are propagated by idiots who think they have the moral highground because for some reason they think a vaginal birth = no risk and low cost in every case (if only!)

Trying to think of a few of the ridiculous things people said to me when I said I was having an ELCS second time round:

• ooh, but a c-section costs the NHS FIVE THOUSAND POUNDS PER BIRTH!!!
• oh, you're having a section because you don't fancy any pain then eh?
• oh, you're opting out of the important bit then?

i had a vb and cs for second and would recomment a cs all the time, what is the point of putting yourself through so much pain.

"What about the women who have instruments left inside"

That's ironic given that it was the instrument that was PUT inside me in my vaginal birth that caused me all the problems! But that's not important to you presumably hittheroad?

Peer reviewed journal article supporting cs less likely to have subsequent children:
Reduced fertility after cesarean delivery: a maternal choice.
Tollånes MC, Melve KK, Irgens LM, Skjaerven R.
Source
Department of Public Health and Primary Health Care, University of Bergen, Norway. [email protected]
Abstract
OBJECTIVE:
To explore the association between mode of delivery and subsequent fertility.
METHODS:
Deliveries registered in the Medical Birth Registry of Norway were linked to mothers through national identification numbers. The study population was 596,341 women who had their first delivery during 1967-1996, and who were followed up through 2003. We compared rates of continuation to a subsequent birth according to mode of previous delivery (cesarean compared with vaginal).
RESULTS:
If the first child survived the first year of life, cesarean delivery was associated with a significantly reduced probability of a second birth (relative risk [RR] 0.82, 95% confidence interval [CI] 0.81-0.83 during 1967-1981, and RR 0.88, 95% CI 0.88-0.89 during 1982-1996). Following a stillbirth or an infant loss, the association was less strong during 1967-1981 (RR 0.93, 95% CI 0.89-0.97) and no longer significant during 1982-1996 (RR 1.00, 95% CI 0.97-1.03). A similar pattern was observed from the second to the third birth and in subgroup analyses of women with preeclampsia or breech presentation and in an obstetric low-risk group.
CONCLUSION:
Cesarean delivery was more strongly associated with reduced fertility if the infant survived than if it was stillborn or died. This suggests that the reduced fertility was to a large degree voluntary and not related to the indication, nor to any physical consequence, of the cesarean delivery.

I think that looking at the costs and outcomes associated with induction would be very useful.

But then I would as I had a terribly traumatic induction which stopped being traumatic when they put the spinal block in for the emcs. Although DD was still distressed and so it wasn't a bed of roses.

I know that some people have perfectly fine inductions but I read so many stories about awful ones that I just wonder...

I don't want more sections because as a midwife I want to help facilitate normal birth, I don't want to be a nurse, nursing patients back to health following operations. I'm fully aware it is a part of my role but I'd really dislike it if it became the main focus, before anyone jumps on me I'm not a natural birth at any costs rabid birth supporter but I love my job and I'd hate to see it eroded even further, for vaginal birth to become acrarity rather than the norm. I absolutely support clinically indicated ceasarians including for previous section and tokophobia but I just hate the though of it becoming the norm :(

having a c.section isn't pain free, the morning after I had a c.s I felt like someone was holding a hot iron on my stomach, it was the most intense burning pain I have ever felt and I needed a shot of morphine to take the edge off.

I had pain from the c.section wound for at least a week even with taking all the analgesia I could!!!

However having said that I would request a planned c.s if I have anymore babies rather than risk what I went through last time (a hideous 4 day labour, being induced, distressed baby, emcs and sick baby at the end of it all )

I am wondering what are the statistics about safety and outcomes for babies in CS v VB?

So you want women who don't want a vaginal delivery, to not have a choice to have a CS, to keep you in your job?

I'm sure you didn't mean it to sound like that!

CS is marginally safer for babies than VB, houseofmirth, and slightly more dangerous for the mother.

So people who have CS are less likely to choose to have a second child if their child survives.
So people who have CS are more likely to only ant one child.

And?

I really don't think that c-sections would become the norm though. I'm sure most women would rather have a natural birth but if they have a traumatic first birth - well they should be allowed to have a c-section and know that it will be agreed rather than have to wait until 34 weeks for approval as many have to at the moment.

My mum had fourth degree tears with me due to my shoulder getting stuck. Bless my mum to bits, she's had surgery after surgery on her bum, a colostomy for quite a while when I was young and she continues to suffer rectal incontinence to this day. She has never made me feel bad about any of this, takes each day in her stride and is an inspiration to me. This has, however, left me with a very strong and real fear of childbirth. I have now been ttc for 11 months to no avail and do, in more surreal days, wonder if this fear is getting in the way. Maybe counselling about this might be helpful to me. But, of I could pay £800 tp have a a c section I'd jump at it. I've seen lots of my friends have vbs and be fine and watched my friend who had a emcs struggle to hold her baby. But, I think of my poor mum and this matters not a jot to me. But, I need to be pregnant to actually have to work through this!

CS also linked with drop in BF:
Elective cesarean delivery: does it have a negative effect on breastfeeding?
Zanardo V, Svegliado G, Cavallin F, Giustardi A, Cosmi E, Litta P, Trevisanuto D.
Source
Department of Pediatrics, Padua University School of Medicine, Via Giustiniani, 3 35128 Padua, Italy.
Abstract
BACKGROUND:
Cesarean delivery has negative effects on breastfeeding. The objective of this study was to evaluate breastfeeding rates, defined in accordance with World Health Organization guidelines, from delivery to 6 months postpartum in infants born by elective and emergency cesarean section and in infants born vaginally.
METHODS:
Delivery modalities were assessed in relation to breastfeeding patterns in 2,137 term infants delivered at a tertiary center, the Padua University School of Medicine in northeastern Italy, from January to December 2007. The study population included 677 (31.1%) newborns delivered by cesarean section, 398 (18.3%) by elective cesarean, 279 (12.8%) by emergency cesarean section, and 1,496 (68.8%) delivered vaginally.
RESULTS:
Breastfeeding prevalence in the delivery room was significantly higher after vaginal delivery compared with that after cesarean delivery (71.5% vs 3.5%, p < 0.001), and a longer interval occurred between birth and first breastfeeding in the newborns delivered by cesarean section (mean ± SD, hours, 3.1 ± 5 vs 10.4 ± 9, p < 0.05). No difference was found in breastfeeding rates between the elective and emergency cesarean groups. Compared with elective cesarean delivery, vaginal delivery was associated with a higher breastfeeding rate at discharge and at the subsequent Emergency and elective follow-up steps (7 days, 3 mo, and 6 mo of life). Conclusions: cesarean deliveries are similarly associated with a decreased rate of exclusive breastfeeding compared with vaginal delivery. The inability of women who have undergone a cesarean section to breastfeed comfortably in the delivery room and in the immediate postpartum period seems to be the most likely explanation for this association.

if men had babies they would have c sections we all really know this!

spending hours in pain and stretching yourself in ridiculous ways isn't heroic

iggly sum that up in a sentence or two would you

microfight that study was on women who gave birth between 1967 and 1996 in norway. So there are a host of factors that we don't know the answer to (as we're not norweigan!!!)

Unless maybe some of us are... I have no idea about anything to do with mat service in norway between 1967 and 1996 and who had CS how and when as so on.

"The inability of women who have undergone a cesarean section to breastfeed comfortably in the delivery room and in the immediate postpartum period seems to be the most likely explanation for this association." In Italy.

I BF both of mine in the recovery room after having them. It was fine.

Cherry picking studies from all around the world with different rules, medical systems and cultures doesn't prove much TBH.

Sardine Queen I guess I just hope that not many women would prefer a section over a VB or I can see the future of midwifery looking very bleak.

MrsJRT hmmm not sure that came out the way you wanted it to...

Good point SQ, I breastfed mine in the delivery room too.

Yes but surely as a midwife you would want what is best for individual women?

I don't think people would be queueing up to have CS even if it was a free choice anyway.

MrsJRT - the midwifery industry exists to serve pregnant women. Not the other way round.

I'd think that the fact the body hasn't gone through the hormonal changes facilitated by giving birth means there is a delay in milk production, not to mention the grogginess and discomfort associated with operations and anaesthetic.