Elective c-section - a justifiable delivery choice?

http://www.guardian.co.uk/society/20...11/nhs.health1
I just read this and wondered what others thought. The NICE guidelines tell us that we should only do a c section for medical reasons, but what if a woman wants this for non-medical reasons, should we allow it or refuse it?

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Laugh in the face of the devil Eat Chocolate

Very good article - I actually found it quite balanced. I think they hit the nail on the head for many of the reasons that obstetricians go for ELLSCS; these procedures are normal for them, and occur daily, and their only interaction with normal birth tends to be when something goes wrong. So, I can understand how it would be a logical step for them to just bite the bullet and elect, rather than leave it to the fickle finger of fate.

Personally I think that not enough emphasis is put on LSCS as a 'major abdominal operation' - there is a complacency about these operations being an acceptable part of childbirth.

Having said that, I still believe that informed choice is vital, and a woman should have that right to choose if she wants. And as to an obstetrician refusing to do a caesarean? Hate to stereotype, but...

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Whats the difference between a top because of maternal wish and a el lscs? As in 'medical grounds' can be covered whenever it suits - to me it's all about informed choice

I want a ducking imocon!

As far as I am concerned, on the NHS, people can only decline treatments but NOT insist on a certain type of treatment.

I think if women want elective sections for no other reason but maternal request, then they ought to pay for it, I'm sure the NHS should ok with people paying in installments.

The implications of this is just enormous - theatres being held up by elective sections due to maternal request when they could be desperately needed by compromised women and babies.

Interresting article but although it's fairly balanced I do worry about what women will think reading that many obsetricians would opt for a section? I am all for informed choice but I still think the section rate is too high...as the article mentions, it is major abdominal surgery. Out of about 6 of my friends that delivered around the same time as me - only 1 other (plus me) had a NVD, all the others had sections - 2 elective and the other 2 were em LSCS for undiagnosed breech babies.
xxx

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Karen
Currently doing access course part-time Yay! I'm on my way now

I've only skim read the article but I had an elective for Jack and it was fantastic. They offered me this after I ended up with an emergency c section for Chloe. Plus I had a massive amount of fluid around him and he was looking to be a large baby. Being only 5ft2 with a 6ft husband, having a big baby in there and knowing my mum had a horrible labour with me ending in an emergency c section I would have loved to have chosen a c section for Chloe and it would have saved a lot of grief! I think deep down I know it would end in a section.

I think very few women would chose a c section unless they really felt that they could not cope or could not physically deliver the baby.....But maybe not? A friend of mine was so scared of natural labour she begged and sobbed for a section and they would not discuss it until she was nearly hysterical, I don't see why she had to be so distressed, and think people should be able to make an informed choice. But of course if I had good natural birth experiences I would probably not be saying this!!
x x x

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Decided to postpone my application to 2010 for Beds and ARU x x x

I wonder whether more women would opt for a section if given the choice too? For example, a friend of mine had an EM LSCS for her daughter who is the same age as my son, she went through labour and it was only when she was fully dilated that they discovered baby was breech, cue much panic and a section under GA. She's an ideal candidate for VBAC but when she last saw cons (she's 32wks preg with her 2nd baby now) he mentioned that baby was back to back and as she'd heard this can be a longer/more painful labour she's decided now not to try VBAC and to go for an EL LSCS I'm not saying her decision is the wrong one as it's her choice, the same way as we differ on our feeding preferences, I opted for B/F all the way whereas she didn't want to and A/F from the word go - I did what suited me and she will do what suits her.

But does anyone know why they automatically offer a section after a prev section? Obviously I know there are some reasons where it's medically advisable not to have a vaginal delivery but in the case of a previous breech, if subsequent babies are cephalic- are vaginal deliveries not discussed as a matter of course?!
xxx

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Karen
Currently doing access course part-time Yay! I'm on my way now

I personally think that women should be able to make an informed choice about their delivery. If they feel unable to cope with a natural delivery then they should be allowed to opt for a c/s. Perhaps this can only be changed when women have more confidence in maternity services.

There really does need to be more positive experiences for women in labour and also more education for women. I was offered a c/s for my second child as I had an emergency with my first child. I opted for a vbac for several reasons and now wish I had had the c/s as the consequences of my delivery have been devastating!! If I had chosen the c/s I would have been okay and if I'd had a better midwife I might have been okay too.

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Coffeebean xx


Student Midwife

We support VBAC fully, and are auditing constantly in order to reduce our rates, they say c/section again due to risks of placental implantation, main reason is the uterus is thin due to being cut so it isn't as strong, nor thought to be as efficient therefore the woman is at greater risk of abruption (statistically) and the women can get a lot of scar tenderness when in labour.

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great post nappy sack!

I think they try to push for VBAC these days a bit more, but in my experience it scares the pants off the midwives and the minute anything starts to look dodgy they whip them in for another section. The risk of uterine rupture, although small, is nevertheless higher in those that have had casareans, and i think thats why many opt for an elective after previous. It might even be what the cons/obs recommend, who knows?

I thought the article was balanced too, and the point about the docs only ever seeing the negative side of childbirth is key- they are probably only ever present at about 5 or 6 births as a med student and even then they don't really get the normal ones (too busy taken with student midwives lol!) stuff like them being bleeped especially to do a VE when one needed doing is bound to give them the creeps about natural childbirth. And about them listing the complications- yes childbirth can go wrong, you can be damaged, phsically and emotionally, but it can also be fantastic, quick, empowering and ultimately life changing, and you are able to adequately care for your baby immediately after birth.

They don't really put much emphasis on the negative outcomes for baby either- the stuff that i see all the time on postnatal- baby hasn't had that rush of adrenaline it would get in labour- it's not alert- it won't feed, breastfeeding is diffcult to establish and we all know the LT implications of that. and the 'gruntyness' that babies' get- they haven't been 'squeezed' lol so their lungs/stomach often have a lot of fluid- que them 'singing', grunting and bringing up copious amounts of mucous, some of which often they can't bring up and end up choking/going blue on it.

I do agree with informed choice- but it has to be just that, they need to know the pros and cons of both sides. saying that, I helped to look after a woman in community last year- 17, primip, living in quite alot of poverty. she absolutely would not tolerate the thought of a normal birth, but wouldn't talk about why not, and we think there may have been a history of sexual abuse somewhere. she had an elective and gave birth to a healthy baby girl, but beacause she didn't feel comfortable enough to talk about her experiences she probably never, and ever will be, given the chance to talk about her fear of childbirth.

that was a bit of a long one- interesting topic!! x

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