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Caesarean sections - choice or not?

(53 Posts)
Rosina Thu 23-Aug-18 22:19:40

I have witnessed a very heated argument today about the latest news concerning Caesareans. Evidently there is a general feeling that women should be given the choice to have one if they wish, regardless of medical need. Both my Dils had to have Caesareans due to complications and health problems, but I would have thought that natural birth must so obviously be best for baby and mother, and that to put yourself and the child through a general anaesthetic or spinal numbing, and have surgery that is not necessary, is really the worst possible choice. surely it should be undertaken only when it is medically necessary, and not be a matter of personal choice. Also, how much strain would a huge increase in caesareans put on the NHS with doctors, theatre staff etc. This seems a worrying trend to encourage pregnant women to feel that they can make a choice without medical support for that choice.

maryeliza54 Thu 23-Aug-18 22:51:49

I think it’s a bit more complicated than that. For example - what does ‘medically necesssary’ mean? Also, there are huge variations in ECS rates across the country and far too many examples of women just being ignored in some hospitals - women deserve to be listened to and their fears taken seriously - on WH this week a midwife said that when that happened, many women went on to give birth vaginally

gillybob Thu 23-Aug-18 23:10:50

My DD should have had a CS when she had her baby. They stalled so many times (the labour went on for days) until the babies oxygen levels fell so low they realised that if they waited much longer things could have got very serious indeed.
As it happens she went on to have an almost “natural” but extremely traumatic birth. Baby girl born not breathing with the chord tight around her neck (hence the low oxygen). Thankfully she is a healthy 16 week old today . Maybe through luck and good fortune , but perhaps not good judgement .

paddyann Thu 23-Aug-18 23:29:03

there are many reasons why someone would want a CS ,a previous traumatic birth for one.I think it should at least be discussed with the parents before making a decision.As someone who had a VERY long labour ending in a vaccuum extraction (ventous) which left baby scarred and ill ,she died 4 days later,I would certainly have preferred to be offerd a choice .

pinkprincess Fri 24-Aug-18 00:19:49

so sorry about your loss paddyann

Missfoodlove Fri 24-Aug-18 10:37:27

I had two long labours both resulted in emergency sections.
The first was a grim however
the second was a truly terrible experience which involved failed forceps, a ruptured uterus and our son being born blue and placed in special care.
The consultant had refused to allow me an elective section despite my medical notes advising it for subsequent pregnancies.
His pride and arrogance nearly cost a life, the hospital at the time was under pressure to reduce the amount of sections performed.
My third was an elective section at 35 weeks as it was too dangerous for me to go into spontaneous labour. It was the most calm and wonderful experience, I recovered quickly and had a son who slept through the night at 3 weeks.
This was a far cry from the older two who carried the trauma of their birth for some years.
I believe natural childbirth is always the best option and sections should only be on medical grounds, I am sure my experience was as a result of too many women demanding sections for convenience.

pollyperkins Fri 24-Aug-18 13:42:27

Im glad I read this this week and not last week. DD has just given birth vaginally having had an emergency c section previously. I would have been even more worried than I was if I had read of other experiences on this thread. However all is well, thank goodness. She was closely monitored throughout. We are very thankful and relieved. She could have had another caesarian but chose not to because a) she wanted to be able to pick up her older child afterwards and b) did not want to put unnecessary pressure and expense on the NHS. But of course would have agreed had she been advised it was medically necessary.

petunia Fri 24-Aug-18 14:17:38

I would probably say no to personal choice. Perhaps I should qualify that and say a section shouldn’t be available on demand.
A section is major abdominal surgery and comes with many potential complications. But because it is so common place and because mothers are out of hospital very quickly nowadays, it seems commonly regarded as no more serious than a trip to the dentist.
The implications of a section compared to a vaginal birth are significant. I know many people have them and all is well and they recover sure we all know of the person who had a section on Monday and by Wednesday was doing the school run, weekly shop and running her own business. She is a rare breed and there is a large dose of smoke and mirrors here, even though many women having sections are young and healthy and recover quickly. I know that many women have complex vaginal births that leave them with long term health issues. And some babies are damaged or die from lack of a section. I am not talking about that particular cohort of women. What I am concerned about is the way society has trivialised childbirth and particularly sections. Women today are expected to have their babies, come home and pick up where they left off, without any period of recuperation or adjustment to the major event in their lives. Many have their first facebook and instagram messages posted before the placenta has plonked into the receiver. Kim Kardashion or the glamorous Kate may look stunning in the aftermath of this life changing moment but that isn’t the same for the average woman.
Of course today, techniques, treatment and advice around sections is very different to twenty, thirty, forty years ago and the procedure is much safer, but...but....but........although it may happen in any birth, with a section, particularly one done in an emergency, the a woman is more likely to loose a great deal of blood during the surgery and need a transfusion. More likely to have a situation where bleeding could not be controlled and end up with a hysterectomy. More likely to get an infected section wound that is sore and oozing and smells bad. More likely to develop a urine infection during the admission for surgery that refuses to go away without a hefty dose of antibiotics and the issues that can raise. More likely to develop a DVT. More likely to have long term issues with scarring, muscle tone, and of course, potential problems with delivery of subsequent babies. For many the recovery time is slower. Getting out of bed, lifting the baby, changing the baby, bathing the baby, even having a shower is so much harder with several inches of wound with stitches or clips across the lower abdomen.
Some women will medically need a section and are advised accordingly in pregnancy, some need a section but refuse, (in both the pregnancy and sometimes labour), some need an emergency section, some, because of a multitude of medical and/or obstetric problems have planned sections. Some will ask for a section for their own particular circumstances. But I don’t think that women should be encouraged to believe it’s a simple choice with no repercussions.

Iam64 Fri 24-Aug-18 14:28:52

The experience of our daughters and their friendship group is certainly not that C sections are available "on demand", or that mothers don't have the risks of C Sections spelled out in graphic detail.

What has until recently been given less publicity are the risks associated with vaginal deliveries. We know too many young women who have had dreadful times, needed reconstructive surgery, been left with permanent damage and needing continued physiotherapy.

The expectations on young mothers seem too high to me. Back home within a couple of hours with a first baby, unless it was born by C Section, in which case 24 or maximum 48 hours is the norm. Visitors popping in whether they feel like it and just look at the number of grandparents we have posting on this site, complaining about their 'rights' to see the new baby.

OldMeg Fri 24-Aug-18 15:13:11

My mother was a midwife. She died 40 years ago and this arguement was around then.

Delivering vaginally is best for mum and baby in most instantances. It’s when complications arise due to the size of the baby, the positioning of baby, the progress of the labour, etc. that a judgment call has to be made.

Elective C-sections are between the mother and her gynaecologist.

Morgana Fri 24-Aug-18 19:09:32

I watched part of that Victoria Derbyshire about C sections and was frankly horrified. It seemed to encourage pregnant mums to choose a C section. It said that anyone who is very anxious about giving birth should be offered a C section - weren't we all terrified?
I can't help thinking that part of the problem with vaginal births is that some hospitals seem hell-bent on the baby arriving when the hospital think it is time. My daughter had a difficult time with baby No. 1 as they were determined to induce labour. She later asked to be debriefed about the problems she had encountered during childbirth - so this is an option for any mums anxious about what happened during a traumatic childbirth.

Melanieeastanglia Fri 24-Aug-18 22:10:17

I have experienced a C-section and a normal delivery.

Had I not had the C-section, I think my child and I would have possibly both died so I am glad I was born in an age where such operations are possible.

However, I certainly wouldn't have opted for a C-section without a medical reason as the recovery period is often much longer - perhaps not for everyone.

My friend had two normal deliveries and ended up with incontinence problems (they have been fixed now) and one good thing about C-sections is that you are less likely to become incontinent after them. That is my understanding anyway - I am happy to be corrected if in the wrong.

humptydumpty Fri 24-Aug-18 22:46:07

When I was in hospital after giving birth, a woman in my ward had a C-section - she was booked in for one but her waters broke early so she had an emergency one. I remember she was unable to lift up her baby for days after and seemed in a lot of discomfort, I don't know if something had gone wrong but it put me right off the idea...

Bathsheba Fri 24-Aug-18 22:50:28

My DD had an ECS because she was nervous on being told at 38 weeks that the head was nowhere near engaged and there was a strong chance of a protracted labour.
She was told afterwards by the surgeon (I was there when he told her) that she was extremely lucky to have chosen that path. Her baby's head had never engaged, and she was so high up that they had to use forceps to deliver her by CS; a vaginal delivery would have been very risky for both herself and the baby due to the length of time the surgeon felt it would have taken for the baby to travel through the birth canal. And he was sure that this would ultimately have led to an emergency CS, which is always much riskier than a planned one.
I would never advocate CS on demand, and I have always spoken against this idea, but by golly I'm glad my DD had the option and took it.

pen50 Sat 25-Aug-18 09:59:53

If I'd been given an elective caesarian I'd be absolutely delighted! Natural childbirth is all well and good when you're giving birth at the first time at a natural age - late teens, early twenties. However, like many new mothers now, I was in my thirties before I had children. And frankly, I don't think anyone bounces back from their first labour as easily when they're older. Mine were big babies too; both over eight and a half pounds. So I'd say choose a caesarian if you're over thirty!

SunnySusie Sat 25-Aug-18 10:26:38

My DD and her friends were discussing this when I met them for a drink yesterday, they are all in their early 30s with partners, but only two of the group of seven have children. Four of the five childless ones said they might consider giving birth if they knew they could choose caesarian. They have watched umpteen films and dramas where women in labour are screaming at the top of their lungs, or in excruciating pain, and have decided they wouldnt be able to cope. I argued in vain that for a relatively few hours of pain you have a lifetime with your family. I must say I was a bit shocked that young women who would like a family are too afraid, maybe we need a few media depictions of labour and birth as normal and joyful.

harrigran Sat 25-Aug-18 10:36:08

Both of my babies were posterior presentation and the labours were very long. First born in hospital and they faffed until the baby was distressed and had to be delivered by forceps, took a long time to recover from the large incision and stitches.
Second baby born at home 9 pounds and after 27+ hours, there was an ambulance at the door and theatre on alert but the old school midwife told me to ' give it some wellie ' and save the bother of transfer. In both births I would have welcomed a CS and I was only in my early 20s.

peaches50 Sat 25-Aug-18 10:36:34

I'd say more than half the world's female population don't have a choice and would view the idea of a C very odd and unnatural. Maybe that's why they can be working in the fields hours later, baby tied to breast. after relatively short labours. I'm afraid I'm with the 'only if medical necessity' brigade on this one. With the huge financial competing demands on the NHS and operations such as knee and hip surgery denied to those in true agony,if a woman chooses to postpone having a child after the medical optimum which is late teens and early 20s as pen50 says ( and it is a lifestyle/career choice it shouldnt be an option. Unless of course the extra years on work and additional salary means she can pay for it privately? Sorry if this offends some.

Blue45Sapphire Sat 25-Aug-18 10:37:06

I ended up having an emergency C-section with my first after a long labour, I was tired, he was tired and he was a big baby (8lb). I was so relieved when at 37 weeks with my second the consultant recommended an elective section as she was also a big baby. At least the second time I could have an epidural and DH could be with me; it was lovely! She was 9lb 3oz - and I'm 5ft nothing! And I was 33 with my first, 37 with the second. I'm all in favour of choice.

4allweknow Sat 25-Aug-18 10:45:09

If people are terrified if birth why do they become pregnant. There are many things in life people are scared of and because of this do not do them. Being able to decide you want an EC when there is no medical reason to do so is not what the NHS is for. E.g. I am losing my hair and would love a hair transplant. Not medically necessary so not approved by NHS but I could have one if I paid to have it done. I am aware my comments may be shot down in flames given the emotion attached to this subject.

Jane43 Sat 25-Aug-18 10:46:29

My two births, 52 and 50 years ago, were both very difficult deliveries, the first one 36 hours at home resulting in a 9lb 4oz boy delivered after an episiotomy and the second a shorter labour but difficult at the end resulting in a hospital admission, forceps delivery and my 10lb 4oz son being cot nursed for the first 48 hours. All the doctors and midwives involved said I was very brave but both births were traumatic for me and for my DH and I only said to him the other day if I could have requested a C section I would have liked at least one more child and he agreed with me. I don’t think they should be available on request though for those mothers ‘too posh to push’.

maryeliza54 Sat 25-Aug-18 11:12:22

Define medically necessary - medical includes metal as well as physical health. If someone is frightened by birth, the answer shouldn't be for them not to become pregnant - the ear might be because of a previous traumatic birthing experience for example. As for the complete rubbish about working in the fields , giving birth and all is well - I suggest you inform yourself on maternal and infant mortality and morbidity figures in this rural idyll you postulate peaches

maryeliza54 Sat 25-Aug-18 11:13:17

ear= reason confused

Witzend Sat 25-Aug-18 12:11:21

I don't think it's necessarily the worst possible choice at all. My dd had a very difficult first labour, which left her with damage, and personally I blame the midwife unit in a supposedly excellent hospital, who absolutely must have realised things were going on with no progress for far too long, because the baby's head was round the wrong way.

IMO they just didn't want to 'give in' and send her down to the obstetric unit - only just downstairs - where she ended up eventually for an epidural and forceps. Since it was her first, she had naturally assumed that the midwives knew best, but said afterwards that another time she'd ask to be transferred much sooner, to save damage, not to mention hours of unnecessary pain.

For no. 2, I wouldn't have blamed her in the least if she'd opted for a C section, but she decided to try anyway, and thank goodness it was all over very easily in just a couple,of hours.

I wouldn't blame anyone who's had a very difficult first labour for opting for a C 2nd time. However just 'too posh to,push' is another matter.

Might add that niece had a C first time, not her choice, and a natural delivery 2nd, and when talking to dd about it, said, 'Well, I've done it both ways and they're both crap!'

grandtanteJE65 Sat 25-Aug-18 12:18:55

I honestly think that what the western world needs is more discussion of what normal pregnancy and childbirth are. For far to long both have been regarded more or less as medical conditions requiring treatment.

I am all for CS when there is any indication of a risk to the child or mother during childbirth, but part of the problem being discussed here is surely caused by expectant mothers being frightened and confused by hair-raising tales of labour etc.

For some reason a proportion of old wives have always delighted in scaring young mothers; now things have apparently got to a point where some (probably only a very few) healthy women with normal pregnancies would like to be able to chose a CS. Or is it rather hospitals wanting to be able to schedule births that only take a specific length of time?

Induced labour, from only being used if labour didn't start naturally, seems now to be used if a birth is delayed by a very short length of time after the time the midwife or obstetrician worked out. In our day, midwives and expectant mothers were just accused of getting the dates wrong!

If one "unnecessary" CS saves a life then that is fine by me.