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.

Do you know what.

If they made it a genuine straight choice. Then in order to keep their stats right and their costs down (assuming VB cheaper than CS all in all) - they would have to make VB attractive to women. Give them choice in where and how they do it, guarantee to treat them with dignity and respect their choices and so on and so forth. It migth drive improvement in VB facilities due to competition!

Iggly
I don't understand the relevance of the studies you are posting.

microfight they are thinking the not wanting a second child maybe linked to delivery of the first. That if the child does not survive the first year the woman's drive for a child will mean she overcomes the fear of a second pregnancy/birth to get pregnant again. If the first survives there is less chance of a second (using the time frame restraints of the study).

MrsJRT, have you had an ELCS? I have, and I BF in recovery - can send you a video, I'm totally lucid & having a chat with the midwife. No grogginess or pain. Milk came in on schedule. You're talking nonsense.

I had one horrendous birth, one home birth and one section.

Home birth and section were equal in terms of experience.

The horrendous birth affected me physically and mentally for years.

I'd be very happy to have avoided that and quite happy if my DD chose sections.

The whole natural birth is essential to the motherhood experience is very old fashioned. I can't imagine men allowing vasectomy to stay the same (to fully experience a male procedure) and not benefiting from increased medical ability and knowledge.

(Best equivalent I could think of)

Mrs JRT my breasts were leaking colostrum from about 5 months in with both mine. I assume I am not some kind of freak of nature. No problems feeding. I thought that removal of placenta triggered milk to come in as well, rather than hormones triggered by doing it properly.

The baby born by section was the one I fed most easily and for a longest time

iggly, who cares at all whether women having ELCSs go on to have more babies. Surely that's just my own business as a woman? Are you seriously suggesting that women should be forced to give birth vaginally to increase the chances of them wanting more babies? That's utterly nonsensical.

I'm not explaining myself particularly well but I genuinely believe that having obstetric nurses as opposed to midwives can only be detrimental to the childbearing population. Yes I'm biased, it's my job, my profession, my area of expertise, yes we're here to serve the population but this recommendation could well be the first step to making my job obsolete as I know it, I'm sure you'd all have similar thoughts if it was your job.

Iggly's threatening a study war with me...

Oh dear. I would but I'd bore everyone to death. I have about a billion bookmarks. I just can't find the damn one with the average ages of women who have maternal requests and how many children they plan on having...

By the way, I think theres a reference to the first in the NICE report. There is definitely one to the second.

More quotes from the NICE report:
"Trade off between clinical benefits and harms
From the evidence reviewed for maternal request the GDG noted that CS is associated with a longer hospital stay and a higher rate of women not breastfeeding at three months. However, they weighed this against the finding that women who had a CS described a significantly better birthing experience, both immediately postnatally and three months after birth.

The group noted that the findings for breastfeeding might have been influenced by the different demographic profile of the 2 groups of women. Women in the planned CS group were significantly older than those in the planned vaginal birth group, were more likely to have come from abroad, less likely to have received parenthood education and less likely to report their perceived health as good compared with women in the planned vaginal birth group."

Its a very fair and considered report...

Sardine Yeah it is the removal of the placenta that triggers milk to come in. Not how the baby is born.

It is possible that BF rates in women who had CS drop off once they get home if they don't have as much support as they need? Just a feeling, if indeed it is the case that CS mothers have lower BF rates than VB mothers.

In which case I would say more support is key, not cutting CS.

Mrs JRT

I am afraid that you are totally incorrect, the placenta removal triggers the hormone to kick start milk production and so it happens instantly whether VB or CS.
Also, it only tend to be emergency CS that are done under general so no grogginess at all.

I am going to have to go to bed now though, body clock not on this newfangled time!!!

sorry, in the recovery room I meant to say!

*correction to above

By the way, I think theres a reference to the first issue in the study you mentioned in the NICE report. There is definitely one to the second issue.

I'm all for offering individuals choice but in this case I'm only suportive providing that all pregnant women are offered proper and appropriate support to make their "informed" decisions.

Quietlyafriad has posted a number of issues above that women may have when it comes to having a VB:

"Fears include (but are not restricted to):
Fear of death - major surgery isn't without risk either
Fear of losing the baby - even cs can't guarantee this 100%
Fear of pain - umm, you're having major surgery, post-op pain is a possibility just as post VB pain is, both can be managed with analgesia
Fear of injury (either to baby or to mother)
Fear of incontinence
Fear of a woman?s body 'not being the same' afterwards - a cs scar will be permanent, and the woman would still have been through a pregnancy
Fear of it affecting sex - the woman will still have carried the baby which will have affected her pelvic floor
Fear of no longer being attractive to a partner - is this due to him having witnessed the lady during labour? Perhaps he would prefer to see your innards then?
Fear of embarrassment and loss of dignity - being on a theatre table being cut open when you're likely to be wide awake, with a catheter post-op when it may nt be necessary isn't even a bit undignified?
Fear of not being listened to by medical staff - will they definitely listen to you during a cs then?
Fear of not being in control - who's in control during a cs? Certainly not the woman
Fear of flashbacks to a previous experience
Fear of being treated poorly by medical staff - still a risk surely? Especiallyt post-op when you're still under the influence of an epidural
Fear of vaginal birth - good counselling and provision of information , along with experienced and supportive midwives may help with this issue
Fear of c-section - see above
Fear of not bonding with their child - can also happen if the child was delivered by cs
Fear of doctors - you're less likely to see a Dr with a VB

I do know that women can have real fear of giving birth, and that this can be for first time Mums and those having subsequent children. I think that all women should be able to access specialist counselling services and that if this isn't successful in helping the woman overcome these fears then cs should certainly be offered as an alternative.

What I don't support is any woman having a cs without proper counselling (even without those fears). Major surgery isn't the easy option that some may see it as, and should only be given to those in medical need after appropriate support has been given.

I do think that if women received more antenatal eduaction then we wouldnt see so many cs atm. If all women knew exactly what choices they had during labour, they may be more confident in their decision making. IME, obstetrics has become so fearful of litigation that they recommend cs at a very early stage in some cases.

If the cs rate rises further, I wonder whether we should start to see more general nurses on the wards to nurse the post-op ladies with things such as their wound management, catheter care etc to avoid tying up the midwives time.

Lots to ponder on this issue.

I think the NHS is broke and it will get worse. Counselling should be offered (not a one off either but properly followed through) this may cost as much as the £800 but ELCS should be private (the one exception being that if all the counselling sessions are attended and the psychologist or psychiatrist overseeing the care agrees then ELCS should be offered).

The studies quoted used large numbers in a western society with well respected medical care. Medical studies use large numbers to attempt to identify trends there will always be exceptions eg Toothbrushthief.

I wish NICE had first recommended that women be given lots of help and support in having VB. CS has an important role to play when needed but there is a startling lack of knowledge and experience among medics and mothers about how to do natural birth well. Lacking this essential knowledge, decisions about offering a major op to all cannot be made in the best interests of the woman: the decision-makers only have one part of the picture.

The 'support' I was given for both of my labours was crap. The NHS fails women in this regard. It's only because I bothered to do my own research and thorough preparation that I went to labour confident that I knew how to handle it, and despite things not going to plan I was still able to manage the unexpected confidently.

I'm always amazed whenever I meet a pregnant woman who is not planning to prepare in any way for the impending birth. It's like running a marathon without doing any training: madness, and potentially dangerous.

"MrsJRT Sun 30-Oct-11 20:50:20
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."

I can give you an anecdote, since you are only relying on supposition here -

My vaginally born DD1 lost 20% of her birthweight in five days (milk didn't come in until late on day three) and was admitted to hospital because of her worrying weight loss.

My ELCS born DD2 lost 7% of her birthweight in five days (milk came in after 24 hours) and she had a tongue tie which wasn't diagnosed for quite some time afterwards.

Exactly Ghoul. If only a fraction of the cost of the potential increase in numbers of cs was spent on proper antenatal counselling, I'm sure that some mothers would really have thier eyes opened into what they might be able to do to help themselves and their baby for the impending birth.

Of course there are always going to be complications but a lack of knowledge and awareness on the part of the women and their birth partners surely only increases the rate of medicalised births?

IwishIwasmoreorganised

I did point earlier that the guidelines are above providing a clear pathway of mental health care to try and support women consider a VB and have proper support JUST AS MUCH as they are about giving women choice here.

Its a key point that is being missed.

You are also talking about a PHOBIA. Its not normal or rational or even proportional. As I pointed out. Its not as simple as just giving counselling or giving those responses... And then you have the added issue of addressing these issues in a short time frame of pregnancy. Might work for some women. Might not for others.

Frankly I regard your post as rather patronising and insensitive. You aren't even trying to understand.