Over a quarter of Births were C-section in 2007

jimmyendless

http://www.irishtimes.com/newspaper/breaking/2009/1009/breaking1.htm

That sounds like the doctors are just getting the mothers in and out as fast a possible and are very quick to the knife. If home births was encouraged more it would ease the pressure on the health service and might decrease the percentage of C-sections.

Leeby

jimmyendless wrote: »

http://www.irishtimes.com/newspaper/breaking/2009/1009/breaking1.htm

That sounds like the doctors are just getting the mothers in and out as fast a possible

Are you not in hospital longer if you've had a C-Section?

lalalulu

I wonder how many were elective c section's? I know it's becoming more common. If i have another baby i will definitely be asking for a c section

jimmyendless

Leeby wrote: »

Are you not in hospital longer if you've had a C-Section?

Sorry, I meant the delivery room/operating theatre.

eviltwin

I'd say its down to a number of things. Women choosing to have them over vaginal births ( which is no ones business ), more complications due to modern lifestyles and doctors just being so afraid of legal action they would rather go for a section than risk continuing with a normal delivery if there are any issues

Home births are great but they dont suit everyone and arent cheap so while I think its great to encourage them dont expect a mass take up Jimmy

hairyfairy00

lalalulu wrote: »

I wonder how many were elective c section's? I know it's becoming more common. If i have another baby i will definitely be asking for a c section

Why anyone would have an elective c-section is beyond me, i hope i never have to have another one. Even now 5 months since having it done the area is still sensitive, especially when an active baby gives me a kick

b3t4

The data being used does not contain the reason as to why a c-section might of been necessary.

I was born via c-section and so too was my sister. Both c-sections were necessary and both of us might not be here today had our mother been forced to try natural childbirth. A friend recently had a baby which was delieverd via c-section due to the baby's heart rate plummetting. It turned out her placenta had, also, ruptured.

A healthy baby and a healthy Mam should be the only want out of childbirth. Natural should be the preferred but not the only method available.

I found the following article a good read on the subject.

Caesarean section: a life-saving option
http://www.irishtimes.com/newspaper/health/2009/1006/1224255974379.html

PARENTING: CAESAREAN sections have had a bad press of late. From the recent Economic and Social Research Institute (ESRI) report looking at why the Caesarean section rate here increased by almost 25 per cent between 1999 and 2007, to a recent article in this newspaper which spoke of how medical monitoring of labour increased the “risk” of having “the ultimate intervention in the natural birth process”, it would seem a section is among the worse things that can happen to a mother, writes KITTY HOLLAND

To read the ESRI report, Recent Trends in the Caesarean Section Rate in Ireland 1999-2006 , one could believe nothing good could come of a Caesarean birth.

It speaks of “a range of social and emotional harms of Caesarean sections to mothers”, “increased postpartum use of antibiotics and greater severe maternal morbidity and mortality” and an increased risk of a hysterectomy after a section.

C-section babies risk breathing problems, surgical cuts, non-establishment of breastfeeding and later adulthood trauma. Furthermore, babies delivered by section cost the health service more than the vaginally delivered babies.

At no point is there a reference to the fact that in most cases, a Caesarean section is a life-saving intervention for the baby, and in many cases for the mother too.

Nor to the fact that, as the World Health Organisation points out (WHO), the countries with the lowest Caesarean section rates – 0.4 per cent in Chad, 6 per cent in Cape Verde – also have the highest infant and maternal mortality rates.

The section rate in Ireland is about 25 per cent of all births.

The ESRI cites a WHO recommendation made in 1985 that a country’s section rate should not exceed 15 per cent. It does not refer to WHO’s most recent pronouncement on the issue, Monitoring Emergency Obstetric Care .

Published this year it says: “Both very low and very high rates of Caesarean section can be dangerous, but the optimum rate is unknown” and that “there is no empirical evidence for an optimum percentage”.

It comments later: “Without a Caesarean section, most women with obstructed labour will either die or be severely maimed.”

The ESRI report concludes the data it examined suggests “changes in physician behaviour over the period may well play a significant role” in the increase here.

Several obstetricians have questioned how the institute could extrapolate so generally from data which lacks details on why any of the sections were carried out.

There is no doubt that there is pressure from some quarters on expectant mothers to view Caesarean sections as “bad”.

Some discourse suggests women are being duped and manipulated by male obstetricians and a medicalised system, and that women “lack confidence” to insist on “natural birth”.

One woman who felt the pressure is Sandra Adams, from Dublin, whose son Liam was delivered by section in March.

“About a week before he was due the obstetrician told me there was a possibility I would have to have a Caesarean,” she says.

Her baby was lying oblique in the womb – neither transverse nor longitudinally, with his shoulder effectively positioned in her pelvis. A vaginal birth could have resulted in his death and her being maimed.

The news, she said, “really upset” her. “I went for a swim after the appointment and bawled my eyes out. I had been to antenatal classes with Cuidiú and was all geared up for a natural birth. They really give you the confidence to feel you can do it.

“About a a week later my waters broke at home and in we went to the Rotunda.”

A midwife examined her and said Liam was not in position, a diagnosis her obstetrician confirmed, and she was brought into theatre minutes later, at about 5pm. “And Liam was born at 5.50pm.”

She was glad of the preparation from Cuidiú about what to expect. “There were about eight people in the theatre – it was crowded, and it was very, very quiet.

“The staff kept talking to us, telling us at every stage what was happening, what they were going to do. All the way they were communicating.”

Baby Liam was taken to be checked over and quickly Sandra’s husband was holding him, skin to skin as he and Sandra had requested. “They went out of their way to make sure our wishes were respected.”

Asked how she was afterwards, Sandra says she had done a lot of reading and knew women could feel disappointed.

“But I realised though that I had done a tremendous job carrying Liam for nine months and the section was for the best. If we hadn’t had that option, the outcome could have been very grim, for both of us.”

When people heard she had had a section some pitied her. “And I know they didn’t mean any harm. But you have to get over this desire to have a ‘perfect birth’.

“I would be very pointed in saying I had a very good experience, if having major surgery can be described as ‘good’.”

Her recovery in the days and weeks after went well. “There were no complications and the midwives were magnificent. I was five nights in hospital and it was wonderful to have that time.”

Niamh Healy, antenatal spokeswoman for Cuidiú, says new mothers she sees generally accept having had a section, if it was necessary.

“It’s the mothers who feel their section may not have been necessary who feel very disappointed.

“I do worry sometimes that our classes, where we promote the desirability of a natural birth, sets women up to be upset when in the end they have to have a section.”

The most important thing for women who do have to, she says, is that they are fully informed of why they can’t deliver vaginally this time.

A number of obstetricians who have spoken to The Irish Times agree the C-section rate has increased beyond desirable levels, but say the ESRI report tells them nothing new.

They point to the absence in the report of the fact that sections are usually highly necessary, and necessity must be behind much of the increase.

Spokesman for the Institute of Obstetricians and Gynaecologists, Dr Michael O’Connell, says the report extrapolates interpretations from data which does not record the reasons for the C-sections.

“What we need is something like the UK’s Sentinel survey where over, say a three-month period, every C-section carried out is clearly recorded, including the reasons for it. Only then, with a clear audit, will we find out why more sections are happening.”

Dr Gerry Burke, obstetrician at St Munchin’s Maternity Hospital in Limerick where the section rate is 27 per cent, says the major changes he has seen are older and bigger mothers.

“Women are deferring fertility and that has to have consequences,” he says.

Older women, he points out, have bigger babies due to the decreasing efficiency in the way they metabolise carbohydrates as they age.

“The patients are a lot heavier than they used to be. They are older and heavier and having bigger babies, but their pelvises are the same size.”

First-time labours, which are accounting for a higher proportion of births, take longer. Longer births increase the chances of distress to and even life-lasting injuries to the babies, he says.

Indeed, a study by obstetrician Dr Rhona Mahony of the National Maternity Hospital, published in last month’s Irish Medical Journal , underlines this.

It finds the rate of cerebral palsy in babies, associated with seizures in the immediate aftermath of birth, was nine times higher among first babies than it was among second and subsequent babies.

This, says Mahony, is associated with longer labours for first-time mothers.

All of which, says Burke, may indeed be contributing to a lower threshold among obstetricians for performing sections.

“The increased medico-legal environment may be influencing obstetricians’ behaviour, but their priority, I can tell you, is to have a good outcome.”

He doesn’t sense strong pressure on mothers to have or not to have a section.

“Whichever way the baby is born is a tremendous achievement. Ninety-nine per cent of mums just want a healthy baby and nothing else matters.

“I am constantly impressed at women and what they will put themselves through. They will go through anything to achieve that goal.”

Sandra Adams agrees. While some mothers, particularly those who may have been in labour for hours before finally having a section, may feel very disappointed, she feels there should be more balance. A section is not a failure to “have the baby yourself”.

“There is no ‘perfect birth’. Birth is messy, it’s visceral. The most difficult things are getting pregnant and the pregnancy.

“The birth should just be about getting a healthy baby and mother, and it doesn’t really matter how that’s achieved.”

eviltwin

I dont think any doctor is going to recommend a section unless its really needed.

You have to remember though that the nature of pregnancy is changing. Mums are having bigger babies - that in itself can be a problem. Many mothers have issues like diabiates (sp ) or pre eclampsia which make a natural birth more dangerous.

I'm due in 5 weeks and my baby is breech so its looking like a section for me. I dont mind, I had a vaginal birth with my daughter and I dont really see the advantage of one over the other.

I know in a lot of countries that a breech baby can be delievered vaginally with little or no problems but the hospital wont even consider it because the doctors just dont have the experience and would rather be safe than sorry.

Thats just fine by me...as b3t4 says all that matters at the end of the day is a healthy baby and mother.

lalalulu

hairyfairy00 wrote: »

Why anyone would have an elective c-section is beyond me, i hope i never have to have another one. Even now 5 months since having it done the area is still sensitive, especially when an active baby gives me a kick

HairyFairy, i had a what the hospital called a "natural" birth. It was in no way natural for me. My first few hour's with dd were awful. I was in so much pain and all i was offered was panadol!! DD is 1 this month and i am still attending my gynae as i am still in constant pain. I would take sensitivity over agony anyday!
My friend had an elective c section a few month's before i had my daughter. She picked the day she went in and was so relaxed and actually enjoyed her birth experience. That was all i wanted. I think if a c section is an emergency it can be a very different experience for the woman.

ebmma

Home birth is free with Holles St. community midwives. You do need to be very low risk though.

I think I'd like to try it on my 2nd if all goes well :-)

hairyfairy00

lalalulu wrote: »

HairyFairy, i had a what the hospital called a "natural" birth. It was in no way natural for me. My first few hour's with dd were awful. I was in so much pain and all i was offered was panadol!! DD is 1 this month and i am still attending my gynae as i am still in constant pain. I would take sensitivity over agony anyday!
My friend had an elective c section a few month's before i had my daughter. She picked the day she went in and was so relaxed and actually enjoyed her birth experience. That was all i wanted. I think if a c section is an emergency it can be a very different experience for the woman.

I wouldn't blame you for wanting one then, both of us have had a bad experience so just as much as i wouldn't have another c-section i understand why you wouldn't go through another vaginal delivery.

BostonB

Both types of delivery can be difficult or easy.

Khannie

eviltwin wrote: »

I dont think any doctor is going to recommend a section unless its really needed.

Needed is probably subjective though. To be fair, there are 6 billion live births walking around the planet, the vast majority of which were not done by section - I'm guessing that in poorer countries (which have larger populations) the percentage of births by section is much lower. 25% seems way OTT to me.

hacked

OTT or not...like people have said, you don't have the facts and figures.

How many problems are running through your head when you think of what might require a section?
My mother had a section with my youngest sister due to back and pelvis problems.

I'm only just half way through my pregnancy and I'm already able to tell my limits. Genetically my baby could be huge...in which case I know my body wouldn't be able to handle a natural birth.

There are such a huge range of problems that could require a c-section. And, if women are now allowed to choose to have a section....it wouldn't surprise me that the numbers have gone up.

I know in america doctors are encouraging women to have sections so tha they can schedule births.

I'm not making sense...all I'm trying to say is....the birthing process is a personal choice between a mother/couple etc and their doctor. What works for one person won't work for another. So I don't see how those figures are debatable....especially without the details.

BostonB

Khannie wrote: »

Needed is probably subjective though. To be fair, there are 6 billion live births walking around the planet, the vast majority of which were not done by section - I'm guessing that in poorer countries (which have larger populations) the percentage of births by section is much lower. 25% seems way OTT to me.

Yes but their fatalities are higher too....

horselala

Jimmyendless on home births only a very small percentage of woman are suited to a home birth and these are mostly second pregnancy after a normal no pain relief first birth, and alot of home births end up in hospital not for medical reasons but for pain relief.

Khannie sections are probably lower in poorer countries but so is mortality in childbirth!

The term elective is often misunderstood, its planned...... for many reasons. My two sis and I all had sections- five kids between us all...no we're not too posh to push. One had pre-eclampsia twice, one ended up having an emergency section and was not allowed be induced on her second due to a reaction to the drug and my baby was breech. I was offered an ECV to try to turn my baby but I wasn't taking any chances, and the same with having a section I wasn't going to attempt a VB. Before I was advised on section I was having a natural birth, no epidural for me ( I was petrified of the needle in spine). So to find out I was having a section and needing a spinal block I was very, very upset came out of consultants crying. So elective sections aren't glam!

I actually found the section grand but all experiences are different for all people. I think if someone elects for a section for none medical reasons and would be too afraid to have a child if they have to have a VB, then leave them to it, but don't let how their baby is born condemn them as a parent or person.

BostonB

I wonder how many in those statistics have had a natural births AND c sections. Lots of people have both for a variety of reasons.

Khannie

hacked wrote: »

I'm not making sense...all I'm trying to say is....the birthing process is a personal choice between a mother/couple etc and their doctor. What works for one person won't work for another. So I don't see how those figures are debatable....especially without the details.

I'm not debating the figures. Just saying that they seem OTT to me. I don't think that there's a requirement for that number of sections (i.e. I think that if there were no such thing as a section, the vast majority of those babies would have been delivered just fine). Don't get me wrong: I firmly believe that sections save lives.

Khannie

BostonB wrote: »

Yes but their fatalities are higher too....

Yes, but not to the level of 25%. I wouldn't question that sections save lives. The midwife that we spoke to said that fatalities in the mother in Ireland during birth are almost unheard of. I'm sure that's partially (if not mostly!) down to sections.

hacked

Khannie wrote: »

I'm not debating the figures. Just saying that they seem OTT to me. I don't think that there's a requirement for that number of sections (i.e. I think that if there were no such thing as a section, the vast majority of those babies would have been delivered just fine). Don't get me wrong: I firmly believe that sections save lives.

My point being the babies may have been fine...what about the mummies? I know your a man, and therefore haven't been pregnant yourself...but as a pregnant woman having a bit of a rough pregnancy, I can see many possible reasons for why women would need a section. Maybe it's just cause I'm on my own, but if there was a risk to me having this child, I'd definately go for the section. I can't risk hurting myself and dealing with a baby on my own. I don't see why the number of sections is even a problem.
I mean, even minor things like back problems/pelvis problems after forcing yourself to give birth naturally...thye don't sound major...but can be major consequences to live with.

Khannie

You lost me a bit with your logic (not being smart). Sections have a much longer recovery time than a normal delivery. That's the main reason I'd think people would want to avoid one. You can't drive for 6 weeks, etc. etc.

Otherwise they've got a lot going for them.

BostonB

The other point is that a c section is used where's there's risk. It's a safer option in a modern hospital. It might not be an option in other parts of the world and in poorly equipped hosptial it might not be safer.

So it's logical it would be used more in developed countries.

hacked

Khannie wrote: »

You lost me a bit with your logic (not being smart). Sections have a much longer recovery time than a normal delivery. That's the main reason I'd think people would want to avoid one. You can't drive for 6 weeks, etc. etc.

Otherwise they've got a lot going for them.

With all due respect, this is why I mentioned the fact that you are a man.

I know a lot of people who have had sections for seemingly minor reasons.

Let's put it this way...I would rather a 6 week recovery than years of back problems, or a year or two of having to walk with a cane and do exvercises. (All the while looking after a baby)

Sections are not necessarily just for the high risk and emergency which some people seem to be forgetting.

Khannie

hacked wrote: »

With all due respect, this is why I mentioned the fact that you are a man.

I dunno, to be honest I don't think there's any need to mention the fact that I'm a man, repeatedly. I'm well able to have a discussion about recovery times while all the while being male.

hacked wrote: »

Let's put it this way...I would rather a 6 week recovery than years of back problems, or a year or two of having to walk with a cane and do exvercises. (All the while looking after a baby)

So maybe my experience is limited (to my wife and friends) but I haven't met anyone yet who has had to walk with a cane or had years of back problems from a natural birth (if you're talking about back trouble from an epidural....well....that's a *whole* other story. My wife has made it clear that she'd much prefer a section than an epidural birth. We were absolutely SHOCKED by the number of people who have back trouble after epidurals.). My wife was out of the hospital within 24 hours after both deliveries. She wants to avoid a 6 week recovery period so unless we're really pushed by medical staff, 3rd time's gonna be a natural delivery too. Recovery time has been unquestionably shorter for us.

Honestly, you seem to be getting pissed off with me, and I'm not quite sure why. My perspective is that 25% of births being by section seems OTT to me. I am a firm believer that sections save lives. I believe they're necessary in a lot of instances, but not in all. I /believe/ (though I don't have the figures to back this up) that there's a trend by medical staff towards using sections when they're not necessarily a necessity and I believe that this is in instances where a mother would prefer a natural birth.

hacked

Sorry, I don't mean to come accross as irritated. I used to be somewhat articulate, and these days it seems like I can't string a sentence together so other people can understand! My irritation is more with myself. My apologies.

That's all I was trying to do...bring in another element that you may not have experienced through your wife/friends.

To be honest with you, I've never heard of doctors in Ireland pushing sections. In my own experience, it's been the opposite. However, if they were pushing them for maybe more minor medical reasons, I can honestly understand them wanting to cover their asses.

The other thing thats been running through my mind is this whole article might be more clearly defined by the section trends of 06 and 08.

eviltwin

Less than 1% of women who have epidurals experience long term problems.

The ones that do are usually ones with a history of back problems anyway.

Epidurals are used in mainstream surgery, not just childbirth, and have a very good success rate.

BostonB

First I've heard about problems with epidurals. You can have a natural delivery that results in a longer recovery than an section. I think if you've had a relatively easy delivery there's a tendency to think they all happen like that. They certainly don't.

Khannie

hacked wrote: »

Sorry, I don't mean to come accross as irritated. I used to be somewhat articulate, and these days it seems like I can't string a sentence together so other people can understand! My irritation is more with myself.

Oh hey...no problem at all. I probably misread you too. I find it very difficult to get tone across in written stuff.


In other news: Those (very low) figures for epidurals shock me. We went to a pre-natal class in the rotunda on our last baby for 2nd time mums (there was an 8 year gap, so a refresher was on the cards for us for sure ) and the woman there asked how many had had an epidural...most of the hands went up. Then she asked how many had had some back pain afterwards and a good chunk of the hands stayed up. Now I'm working off memory, and it was a small sample size and all the rest. We just both got a fright to be honest so it stuck with me.

eviltwin

BostonB wrote: »

First I've heard about problems with epidurals. You can have a natural delivery that results in a longer recovery than an section. I think if you've had a relatively easy delivery there's a tendency to think they all happen like that. They certainly don't.

They do slow down the birth process mand they can take away from the feeling of needing to push which some women don't like.

To me that was a small price to apy form having a pain free labour. There are no medals for being a hero when it comis to giving birth.

There are always good and bad stories with anything in medicine. All you can do is get as much info as you and make as informed a decision as possible.

eviltwin

Khannie wrote: »

Oh hey...no problem at all. I probably misread you too. I find it very difficult to get tone across in written stuff.


In other news: Those (very low) figures for epidurals shock me. We went to a pre-natal class in the rotunda on our last baby for 2nd time mums (there was an 8 year gap, so a refresher was on the cards for us for sure ) and the woman there asked how many had had an epidural...most of the hands went up. Then she asked how many had had some back pain afterwards and a good chunk of the hands stayed up. Now I'm working off memory, and it was a small sample size and all the rest. We just both got a fright to be honest so it stuck with me.

pregnancy in itself is hard on your back. its hard to know what level of backache after is down to the changes in the body or the epi. Lots of women who never took one report backache of some degree.

You should take a lot at the stats of people who use them for non pregnancy related ops like hip replacements as that might give a more accurate picture

BostonB

eviltwin wrote: »

They do slow down the birth process mand they can take away from the feeling of needing to push which some women don't like.

To me that was a small price to apy form having a pain free labour. There are no medals for being a hero when it comis to giving birth.

There are always good and bad stories with anything in medicine. All you can do is get as much info as you and make as informed a decision as possible.

I know about those problems I mean the back problems.