UK to allow Caesarean births on request

Cunning Stunt

http://news.sky.com/home/uk-news/article/16115678

Just came across this on sky news and was wondering what you ladies thoughts are on this.
Personally I don't think that a caesarean should be performed unless it is a neccessity....

Women are to be allowed to have their baby by caesarean section, even if they have no medical reason for the operation.

Controversial new guidelines issued by the National Institute for Health and Clinical Excellence (Nice) say women should be allowed to have a C-section as long as they have been informed about the risks.

Previous guidelines said "maternal request" was not an acceptable reason for a caesarean.

But the increasing safety of the procedure in recent years has led some obstetricians to relax the rules.

The watchdog insists that its new advice reflects current practice and will not mean every woman is offered a caesarean.

Deputy chief executive Dr Gillian Leng said: "This guideline is not about giving free caesareans for all on the NHS.

"It is about ensuring that women give birth in the way that is most appropriate for them and their babies."

Obstetrician Malcolm Griffiths, who chaired the panel that wrote the guidelines, said most women want a natural delivery, not surgery.

"Caesarean section is a major operation - it's about as major as a hysterectomy," he said.

Women take longer to recover from a caesarean than a straightforward natural birth, and it can have implications for future pregnancies.

Currently one in four births is by caesarean. Between a third and a half are planned, usually because of medical reasons.

Nice believes the new guidelines will result in fewer women having the operation because those with a fear of childbirth will be offered mental health intervention to ease their anxiety.

But Tracey Johnston, clinical director of maternity services at the Birmingham Women's Hospital, disagreed and warned the guidelines will have a big effect.

"There is no doubt that the extra caesarean sections will put pressure on theatre time, on ward space because the women stay in hospital longer, and it's more expensive so it is a pull on resources."

A planned caesarean costs around £2,369 - around £700 more on average than a natural delivery.

The Royal College of Midwives said it was "inappropriate" for caesareans to be offered without good medical reasons.

It warned that a shortage of midwives at a time of a rise in complex births was already putting maternity services under strain.

Mother-of-one Rhonda McDougall said the new guidelines were long overdue.

She had to battle to have her baby Alyssa delivered surgically, and finally got her way with the help of information from the Elective Caesarean website.

She said: "I did not want to be treated like an idiot hormonal woman, being told: 'This is how it works and this is what you were made for, so just do it.'

"I was informed. I came across the website and knew the pros and cons and that was my choice. At the end of the day it is my body."

wmpdd3

I just cant understand how any pregnant mother could think a caesarean would be less painfull or dramatic.

I knew it was bad but it was only when i was in a ward with women and their babies who had a caesarean did I realise how serious it is. Most other people were up and about after a day even if they had extensive stitches and episotomys.

Personally I would be much more afraid of a caesarean, but that's probably because I've had a vaginal birth already.

Rubberlegs

I'm having my 3rd c section in about 8 weeks. I don't even know what it's like to go into labour. My previous 2 were for medical reasons, and the 3rd as it's safer after having 2 already. I think you'd be nuts to consider having major abdominal surgery when there's no need for it! Sure it's convenient to know the exact day you will have the baby, but I bet nothing beats being up and about after giving birth, and not in bits with a wound on your stomach that takes weeks to heal. Vaginal delivery, in normal circumstances, is the safest option for mother and baby. Can't believe it seems women will be able to have c sections on demand in England:eek:. It's not like it's the easy way out at all...

Cottontail

73Cat wrote: »

I'm having my 3rd c section in about 8 weeks. I don't even know what it's like to go into labour. My previous 2 were for medical reasons, and the 3rd as it's safer after having 2 already. I think you'd be nuts to consider having major abdominal surgery when there's no need for it! Sure it's convenient to know the exact day you will have the baby, but I bet nothing beats being up and about after giving birth, and not in bits with a wound on your stomach that takes weeks to heal. Vaginal delivery, in normal circumstances, is the safest option for mother and baby. Can't believe it seems women will be able to have c sections on demand in England:eek:. It's not like it's the easy way out at all...

My mum is the same, she had 3 sections with each of us, me and my two brothers. She has never been in labour in her life so is useless to ask for advice on such things!! She also suffered afterwards with adhesions, and had to have at least one (if not two) operations to get them removed, so no, it is definitely not an easy option.

How did you fare after your 2nd section - you obviously had a child to look after at home already? I'm wondering this because I'm due in a few weeks and have a nearly 2 year old at home. Now, I REALLY hope I don't have to have a section but I'm just wondering how you cope with looking after 2 young children after fairly major surgery?

galah

I'd also be of the opinion that you should only get a caesarean if it's medically necessary - it is major surgery after all, and there's also a cost factor involved (as long as maternity care is free, I think people should consider the cost as well). Otherwise, they could ask women to contribute to the cost of elective caesareans if they insist on them...

what would bother me most is not being able to drive for 6 weeks after - not so much fun if you're in the sticks and your partner at work.

one point that struck me though - how can you develop a fear of child birth if you haven't experienced it first? fair enough if you've gone through natural labour and vaginal birth once and know you'd be terrified of it the second time round, but the first time round you wouldn't know what to expect, so you can't really have a fear of it, right?

Cunning Stunt

galah wrote: »

one point that struck me though - how can you develop a fear of child birth if you haven't experienced it first? fair enough if you've gone through natural labour and vaginal birth once and know you'd be terrified of it the second time round, but the first time round you wouldn't know what to expect, so you can't really have a fear of it, right?

Yeah that's the thing. There will always be some who will have such a fear of vaginal birth that regardless of whether they treid it or not, they will look for this caesarean option.

Glinda

Sigh...

This is one of those things that women bash each other over the head with from time to time. Speaking from personal experience, a bad vaginal birth is much, much worse than a good section.

Of course a near perfect vaginal delivery experience beats a near perfect section every time.

My experience was that on my first baby I refused a section (having been 'empowered' by reading all the 'right' books and listening to a lot of claptrap from well-intentioned but clueless people.

I had been told that my baby was too big by my obstetrician, but I decided to let nature take its course. That was, to put it mildly, a mistake. It ended with me in hospital for nine days after the birth, several of them in a wheelchair. I am tempted to be graphic here, but I won't, except to say that I was absolutely left in shreds, and doubly incontinent. They let me out on the first day that I could demonstrate that I could get from the bed to the (ensuite) bathroom without the wheelchair, and use the toilet by myself.

My poor hubby took me home on day ten, and walking from the driveway of our small house to the kitchen left me braced by my arms on the kitchen counter crying with pain - I couldn't even get to the sittingroom to sit down. He had to call his sister (a midwife) in a panic and ask her what to do (carry me up the stairs and put me in the bath). Obviously this had a huge impact on my ability to care for the baby!

Four months later I still couldn't walk any distance, even with a pram - just to illustrate I remember getting out of the car in a hurry to drop a video (ok it was a while ago!) in the postbox at Xtravision. Because I rushed, I ended up wetting myself (as in completely soaked) and had to go home.

Second time round, big baby again, scheduled section (unavoidable as baby was transverse), few stitches, home on day four. I was actually high the day after the surgery as I simply couldn't believe the lack of pain compared to the first time.

I know people have good experiences, but I'd like to point out that even after a horror story like mine, there was still no 'medical' reason for me to have a section.

I was lucky that my obstetrician would have done one anyway, because she recognised my absolute mental terror of having the same experience again as being a valid reason. As it turned out I had no choice and would have needed one anyway, but how inhumane it would be to force someone who has been through what I had to go through the same again because someone else decides they shouldn't be able to take mental distress into account, which I think is what's being advocated here.

I think each mother should be treated with dignity, and as an adult who is entitled to some basic control over her body. That control should never be taken away unless she is mentally incompetent. Strong advice and information is one thing, forcing someone to undergo something so traumatic against their will is something entirely else.

galah

see, to me, having a baby that will be too big for a normal, complication-free vaginal delivery would be a medical reason for a section, especially when the ob/gyn doc mentions it. women don't need to be martyrs, but undergoing surgery just for the sake of it is also not the way to deal with what's 'normally' a natural process.

then again, if everyone had a section, they could schedule births properly, avoid overcrowding, bottlenecks, late night rushes to the hospital, and deal with any issues during business hours. could alleviate some of the problems of an overburdened health system as well :rolleyes:

Maybe they just need to redefine 'medical reason' - to me, non-medical reasons are some perceived fear of childbirth on a first child, the whole 'don't want tears, piles, etc' bit, or 'just' knowing the exact birth date without having to wait to go into labour and hang around in pain for a good few hours...

Rubberlegs

Cottontail wrote: »

My mum is the same, she had 3 sections with each of us, me and my two brothers. She has never been in labour in her life so is useless to ask for advice on such things!! She also suffered afterwards with adhesions, and had to have at least one (if not two) operations to get them removed, so no, it is definitely not an easy option.

How did you fare after your 2nd section - you obviously had a child to look after at home already? I'm wondering this because I'm due in a few weeks and have a nearly 2 year old at home. Now, I REALLY hope I don't have to have a section but I'm just wondering how you cope with looking after 2 young children after fairly major surgery?

When I had my 2nd section, my eldest daughter was almost 7. Our baby was born with spina bifida, so she was in hospital miles away for a month. The travel to and from the hospital was the most stressful part of it all. My 7yr old was very independent though anyway. By the time we got our little one home, I was well recovered from the surgery.
The girls are 18 and 11 now, so I expect (well, hope!) they will be of great help, on no. 3's arrival.
I know what you mean though,I imagine it would be daunting to have other little one's so dependant on you, after a normal birth, nevermind a caesarean. My brother in laws wife recently had her 3rd section, and had 2 small kids at home. She took help wherever she could get it from, while recovering. I'd imagine this is the only way to do it, if you are lucky enough to have people around you to help out.

Glinda

galah wrote: »

see, to me, having a baby that will be too big for a normal, complication-free vaginal delivery would be a medical reason for a section, especially when the ob/gyn doc mentions it

Your position seems very reasonable, but I think you've put your finger on it there - who decides what a valid 'medical reason' is? - my experience certainly felt pretty medical to me, but seemingly the baby was never in distress, so there was no 'danger' second time round. I also had one doc tell me that since everything had 'opened up' now (you're telling me:() that I should at least 'give it a try'. To me a completely unacceptable risk - I still have permanent damage from first time round.

Seems to me the new guidelines just allow the doc to take the likes of my situation into account, where previously that wasn't possible (although there were humane doctors who would allow it, others would take a much narrower view).

LordSutch

Cunning Stunt wrote: »

UK to allow Caesarean births on request

Maybe just England & Wales? I guess we would have heard many more screams from politicians on this island if Stormont had allowed this to go through up North? and I can't see Holyrood allowing it either! so I guess its just England and Wales, right?

although I might be wrong . . .

Hannibal Smith

I don't know...I think I miss the point when it comes to c-sections. I don't know why they keep you in for so long afterwards. The last time I was in hospital there women around me with 3rd degree tears and episiotomies who were struggling to walk. There were women who couldn't go to the toilet who had catheters and were walking around carrying their bag with them and another woman who had a 3rd degree tear and who wasn't allowed home until she had a bowel movement. I've had friends who have had to go back into hospital months after a forceps delivery because they were stitched together wrong and had to have their nether regions basically reconstructed.

Then there's me, I've had 2 sections and fair enough the day of the procedure I was in a terrible state, the last time I was vomitting and everything for the whole day. But on the second day I was flying around, well that maybe a bit of an exaggeration but I was walking around much more freely than some of the others in the ward. I had a catheter in for the night only, and it was removed the next day, after which I was going to the toilet with no problems. This time I developed an infection in my wound, apparently it was a bug I picked up in the hospital, and all I needed was an antibiotic and a talc and everytime the doctor had to look at it I just had to show him my tummy!

So as far as c-sections being worse recovery wise, I'm not too convinced that's all together true, but maybe I was lucky and I'm certainly open to correction on it . Plenty of women go home in a lot of pain after a vaginal delivery.

krankykitty

I for one am delighted to see that the British health service are treating childbearing women as adults and allowing them to make informed choices about their bodies. I don't believe for one minute that it is an easier option (and indeed some women are horrified at the thoughts of getting a section) but it should really be a choice.

Hopefully it will make its way here soon also.

Cat Melodeon

I'm also finding it very hard to form an opinion on this one. Who chooses what is 'medically necessary'? Very few C-sections in Ireland are considered to be anything other than emergencies. If you are offered a trial of labour and end up being sectioned, that is an emergency section. If you previously had a section due to complications, a subsequent delivery by section may be considered safer, even if there is no indication of potential problems with this particular pregnancy. Whether this is due to maternal anxiety, caution on the part of the doctor or fear of litigation, who knows, but I think it is almost impossible to distinguish between 'medically necessary' sections and those which err on the side of caution.

I do think that in general first timers should expect to deliver normally unless there is a clear indication that it would be dangerous to give birth vaginally (maternal or foetal complications such as eclampsia, breech baby, true macrosomia etc). Fear of labour when you have never experienced it before should not be a reason for c-section - it should be a cause for education and possibly antenatal counselling.

For the record, I had both my babies vaginally. Both times I had a 2nd degree tear. On the first, it took me fully 4 weeks to recover, not much less than someone who had been sectioned. On the second, I was feeling fantastic 3 days later. My sister had two sections. On the first, it took her 2 months to recover. On the second, she was back to herself after 2 weeks.

Experiences are so wildly different between individual pregnancies, never mind say individual women, that creating a one-size fits all policy to any aspect of antenatal care is wrong. Some women should be allowed to have elective sections, others should not. It depends on their personal medical history and their previous experiences of birth. Someone like Glinda clearly should be allowed to make the decision regarding subsequent births for herself, although it should also be recognised that fewer than 1% of births result in such awful, awful injuries. I can't imagine that anything would persuade me to attempt a subsequent vaginal birth after such an experience and risk reopening old wounds, physical or emotional.

However, allowing c-sections for purely social reasons is a step too far - when c-section babies are at greater risk of later complications, it is doctors who should be making the decision, not parents lacking in medical training. Should parent-led sections with no medical reason become a reality, they shold certainly be made to pay for it themselves (as Minister Poots in NI has demanded), and not leave the bill for their more 'convenient' birth to the taxpayer.

D rog

I also think it's great to see such a progressive attitude and hope that similar attitudes arrive in Ireland soon as there has been a tendancy to use the NICE guidelines as a bar to aim for.
If you believe that women should have the right to labour naturally, not to the confines of our time system, or at home, then you have to see that a woman also has a right to birth how she sees fit- including by section. I also consider not wanting to tear, fear of incontinence and other related birth injuries as valid reasons to choose section.

Unless you believe there is a 'right' way to birth and a 'wrong' way, and if you believe that well that's the end of the coversation right there :rolleyes:

krankykitty

D rog wrote: »

I also think it's great to see such a progressive attitude and hope that similar attitudes arrive in Ireland soon as there has been a tendancy to use the NICE guidelines as a bar to aim for.
If you believe that women should have the right to labour naturally, not to the confines of our time system, or at home, then you have to see that a woman also has a right to birth how she sees fit- including by section. I also consider not wanting to tear, fear of incontinence and other related birth injuries as valid reasons to choose section.

Unless you believe there is a 'right' way to birth and a 'wrong' way, and if you believe that well that's the end of the coversation right there :rolleyes:

You just put into words my thoughts. It seems for some people there IS a right way to give birth. Otherwise why bother even caring how others give birth? After all, a woman who wants the choice of a section isn't going to force you to have one if you don't want to. If its paid for by the mother I totally don't see why its anyone else's business.

I can't believe that hearing the example of those horrific injuries a previous poster spoke about wouldn't actually be a valid reason to choose a section.

cynder

I glad they have finally made the step, only a few months ago i wan on a different thread and said c sections should be more available. Looks like NICE agreed with me...

I gave birth to the 3 of mine naturally but i would have liked a choice. I still would have went for natural unless the baby howed signs of distress, or i was too weak. I know a few people who had traumatic births and ended up having c-sections at the last minute at least with the guidlines one can say i have had enough give me a section.

A step forward in my books.

wdmfapq4zs83hv

I attended the Coombe last year for my pregnancy, now I was having twins so not straight forward but I was given the impression that the decision was mine & if I really wanted a section then that was my choice. The thing is it didnt seem like it was because I was having twins, it seemed like they would have said the same if I was having one. Maybe Im wrong. In the end the section was medically neccessary but had I not needed a section but wanted one, I could have had one

Cunning Stunt

I started this thread last year when I was happily pregnant and of the opinion that first-timers opting for a c-section (other than when it is deemed necessary) was a bit of a cop-out.

I just want to say that my opinion has now changed after having endured the loss of my baby. I am all for elective c-sections now. Every woman should be able to insist on a c-section if she wants to do so, regardless of whether the hospital deems it necessary or not.

Coriolanus

I don't see why not.
It'll be right for some women, wrong for others. Some will get it for the wrong reasons, some will refuse it for the wrong reasons, same as pretty much every other action open to us.

Hannibal Smith

Cunning Stunt wrote: »

I started this thread last year when I was happily pregnant and of the opinion that first-timers opting for a c-section (other than when it is deemed necessary) was a bit of a cop-out.

I just want to say that my opinion has now changed after having endured the loss of my baby. I am all for elective c-sections now. Every woman should be able to insist on a c-section if she wants to do so, regardless of whether the hospital deems it necessary or not.

Cunning Stunt, I'm so very sorry to read this. I remember you from the pregnancy thread and really am so sorry to read about your ickle one.

I can't imagine what you're going through, but hope you're feeling stronger every day xx

GoerGirl

I advocate for a woman's right to full autonomy and informed decision making - this includes a woman's right to request a Caesarean Section.

There are benefits and risks within every choice; policy and recommendations are there to provide guidance to care providers and women - but ultimately, the final choice should be of the woman and this should be repsected.

My problem with the Irish maternity system is that informed decision making and autonomy are often blocked by routine local policy and lack of clear options for women. Routine local policy is based on consultant led recommendations; so the choices are often biased toward medicalized care.

The head obstetrician in Ireland (National lead) is Michael Turner from the Coombe. He has written a paper for the BMJ supporting the "Yes" side of maternal requested Caesarean Sections. He, and many others, are very open in supporting a woman's right to informed choice within the medical model of care.

Unfortunately, there is no such support for women who wish to excercise their same rights outside the medical care model; homebirth, mlu, domino, waterbirth, etc

With regards to Tokophobia (the fear of birth) within women whom have never been pregnant or given birth before - there are many arguments to be made into how this developes in such circumstances. As a society there is a general conditioning and acceptance of "birth" which is portrayed in various media outlets and shared between women which reinforce that birth is traumatic, dramatic, scary, life or death, painful, etc. The Western societal "norm" depics birth as something which must be endured, as horrific, as barbaric, an emergency. Traumatic stories are shared readily. Caesarean section, intervention is considered "normal".

Never under estimate the power of suggestion!

We have to re-condition society into seeing birth as a normal physiological event. How, is the question...

GoerGirl

Cunning Stunt wrote: »

I started this thread last year when I was happily pregnant and of the opinion that first-timers opting for a c-section (other than when it is deemed necessary) was a bit of a cop-out.

I just want to say that my opinion has now changed after having endured the loss of my baby. I am all for elective c-sections now. Every woman should be able to insist on a c-section if she wants to do so, regardless of whether the hospital deems it necessary or not.

Cunning Stunt, just only reading page 2 of this thread and seeing your update. I am so very sorry for your loss.

Cunning Stunt

Thanks. I just feel that if I had been one of the so-called 'too posh to push' brigade and gone in there insisting on a c-section, maybe she would have survived the birth - maybe not, who knows. But anyway hindsight is 20/20 as they say.
I just wouldn't judge any first time mammy for wanting a c-section now.

krankykitty

I'm so sorry for the loss you've endured Cunning Stunt.

dublinlady

Your right cunning - the safety of the child is paramount. Whatever the mother feels most appropriate should be allowed. I had a section because I was told I had to as my baby was breech - after the last 2 & 1/2 weeks I can confidently say its not the easy option! But for me it was the safest and so the only option.

I can't imagine how your feeling cunning - sorry seems more than inadequate my thoughts are with you, x

Moonbeam

Cunning Stunt wrote: »

I started this thread last year when I was happily pregnant and of the opinion that first-timers opting for a c-section (other than when it is deemed necessary) was a bit of a cop-out.

I just want to say that my opinion has now changed after having endured the loss of my baby. I am all for elective c-sections now. Every woman should be able to insist on a c-section if she wants to do so, regardless of whether the hospital deems it necessary or not.

So sorry to hear about your loss:(

Hannibal Smith

Cunning Stunt wrote: »

Thanks. I just feel that if I had been one of the so-called 'too posh to push' brigade and gone in there insisting on a c-section, maybe she would have survived the birth - maybe not, who knows. But anyway hindsight is 20/20 as they say.
I just wouldn't judge any first time mammy for wanting a c-section now.

Aww Cunning....:( I don't know your birth story but I think if they were aware she was in trouble you would have been whisked off for a section whether you wanted it or not. It maybe is just one of those cruel awful unfair things

Cunning Stunt

Long story short - I had a 21 hour labour which went by the book - things only fell apart in the last half hour or so, when they discovered she was stressing. She was a vaccum assisted delivery instead of a caesarean - I don't know why - maybe because she was already in the birth canal. They gave 2 attempts with the vaccum cup and got her out on the second go. She was still alive and I thought it was over but she went very poorly within a minute of landing on my chest. They worked on her for nearly a half hour but no joy. Doctors were baffled and 3 months later we are still awaiting autopsy results. I have a sneaky suspicion that it will be meconium in her lungs, as she and I were covered in the stuff.

My point is that if I had decided from the start that I wanted a caesarean then the outcome may have been very different. So I wouldn't judge anyone for wanting a caesarean instead of a 'natural' labour.

Hannibal Smith

Cunning Stunt wrote: »

Long story short - I had a 21 hour labour which went by the book - things only fell apart in the last half hour or so, when they discovered she was stressing. She was a vaccum assisted delivery instead of a caesarean - I don't know why - maybe because she was already in the birth canal. They gave 2 attempts with the vaccum cup and got her out on the second go. She was still alive and I thought it was over but she went very poorly within a minute of landing on my chest. They worked on her for nearly a half hour but no joy. Doctors were baffled and 3 months later we are still awaiting autopsy results. I have a sneaky suspicion that it will be meconium in her lungs, as she and I were covered in the stuff.

My point is that if I had decided from the start that I wanted a caesarean then the outcome may have been very different. So I wouldn't judge anyone for wanting a caesarean instead of a 'natural' labour.

Will you get a consultation with anyone once the results come in? I hope you get some answers.

And no, I don't see the big deal in opting for a caesarean.

LegacyUser

Cunning I just cant imagine what you have been through I have no words, just wanted tlo say (and you probably already know this), but you are entitled to your medical records from the hospital. I had major complications during my twins birth but they were all realting to me & thank God my babies were fine. But I have found myself unable to get over the ordeal so far & I know the only way I can move on is to see my medical records & find out exactly what happened. Obvioulsy you already have a good idea what happened but maybe there may be some conclusions in there that you arent awarre of... I wish you the best