There has been a lot of discussion about the proposal that women should be allowed to opt for a C-section at any gynecology care Forest Hills even when their doctor doesn’t feel there is any medical reason for it. As with so much that is written about the NHS, I fear this may all be a fuss about nothing. I’ve had a look at the detail of the new NICE (National Institute for Health and Clinical Excellence) guidance and not much will really change.
Before I go on I feel I should state my own position on the matter. I’ve had both an emergency C-section and a ‘natural’ (for want of a better word) birth. I don’t have any kind of ideological preference for one or the other. I don’t think my natural birth was a huge achievement and my C-section was not a quick and easy option. Neither were a walk in the park but both got the job done. Neither has impacted on how I ‘bonded’ with my babies and, although I was initially disappointed to have needed a C-section, neither have affected the way I feel about myself. There were certainly pros and cons to each. If I have another baby I’ll make my choice as the situation unfolds, weighing up my own feelings and the advice of my doctor.
I don’t think anyone wants to see C-sections becoming the norm mainly because it is not the easy option women may have been led to believe by TV dramas and of course there is the issue of cost. C-sections cost significantly more than natural births and when maternity services struggle to maintain enough midwives and NICU incubators it is difficult to justify funding for a procedure that is not strictly necessary.
However if you read the NICE guidance (you can find all 275 pages of it here and the relevant bit is page 97-104) they are not proposing that you can just stroll in and demand a C-section because it seems like a good idea. It recognises that the main reasons for requesting a C-section are a lack of good information about both birth options or a traumatic previous birth experience. Just to be clear here is some of the relevant chapter that sets out what should happen:
When a woman requests a CS the first response should be to determine the reason for the request and the factors that are contributing to the request. This can then be followed by the provision of information comparing the risks and benefits of planned CS and vaginal birth.
When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner. Of course, no medication is allowed in this case. Gold Bali Kratom relieves anxiety, but it is not the medicine a pregnant woman would want to take.
For all women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.
An obstetrician has the right to decline a woman‟s request for a CS. If this happens, they should refer the woman to an NHS obstetrician in the same unit who will carry out the CS.
essentially, it proposes providing accurate information and, if appropriate, mental health support in an effort to find a solution that both the woman and doctor is happy with but if after that the woman still wants a C-section then that should be arranged. It seems to me entirely reasonable to try and solve whatever the problem is but if that isn’t possible then the final choice should be the woman’s. I sure that this is probably what already happens unofficially in many hospitals and I really can’t see it leading to a significant increase in the number of C-sections.
It is similar to current arrangements that allow some patients with an extreme phobia of dental work( Georgetown Dental Assistant School can help you out to pursue the dental course) to have their procedure carried out under general anaesthetic because even though it is not medically necessary and carries a small increased risk this is outweighed by how traumatic they would otherwise find it.
My only slight reservation is that if the evidence (both in terms of safety and the 2 day and 3 month post birth satisfaction rates) for both procedures is similar, as the NICE document shows, might it not be a good idea to focus on improving the safety and experience of vaginal birth (better facilities, one to one midwife care, improved access to pain relief etc) rather than just accepting that people will be traumatised by their experience and will therefore want a C-section?
Related articles
- All women to be given right to caesarean (telegraph.co.uk)
mishmashmum says
I was going to write about this. I was dead against it at first as I felt it was another way of telling women their bodies were not good enough to do what nature intended. However, reading around on the subject, I think if it allows women to make informed choices then this should be a good thing, no? Saying that, the though of having a c-section scares the crap out of me and it is in no way an ‘easy’ option. You get good and bad experiences for VB and CS. It is what is right for the individual woman that is important.
Yes, I think it’s not actually as bad as some of the reporting has implied. Once a woman really thinks about all the evidence she certainly wouldn’t make the decision lightly. If she still wants a section after that you’d have to assume she has good reasons.
A helpful and well-written article, Cat. I’m not 100% certain where I stand on this – I’m inclined to be pro-choice, but, I don’t think women should be allowed major surgery if there is no medical need. I agree with you, in that surely it would better to prepare women more thoroughly if they’re opting for c-sections out of fear of the birth? I wasn’t scared as such, but I was very lucky in that I had a midwife with me all the time (and it was the same one throughout) and had a water birth, and no complications. I don’t know how I would feel if the birth had happened differently – maybe now I’d be one of those women who would want a c-section the next time around!
That was how I pictured my first labour but alas it was far from it and ended up in an emergency C-section. It wasn’t really terrible but bad enough that the thought of going through it again gave me panic attacks during my second pregnancy. This meant that I had to either attempt a vaginal birth and run the risk of another emergency section or plan for a section with all the downsides that goes with it. I went for a VBAC in the end (mainly because I plan to have more kids and having 2 sections would impact on my options later on) and it all worked out but it was pretty scary along the way. I can really understand why some women can’t face it.
This is a wonderfully informative and very balanced post. Still feeling a bit odd about my own experiences to comment in a balanced way about giving birth myself, so won’t. Horrified to read the reporting of this by the Independent today, utterly unbalanced written by a woman who only gave birth one month ago and clearly hasn’t recovered yet. Best wishes to her but SHAME ON THE INDY, they should know better than to publish this stuff. Yours, I would love to see widely published and has given me a lot to think about. Thanks x
Thank you. It does drive me crazy when the NHS does something fairy sensible and then the media go crazy. I guess ‘Business as usual for C-sections’ isn’t a very catchy headline.
Great post. I had an emergency section and the recovery was awful. What I read in my notes afterwards has so far had me wanting another section if / when I have another. It does take ages to recover from though so I really hope women don’t just opt for it because they are nervous.
It’s such a hard choice as it’s not going to be easy either way and there is so much to weigh up.
Firstly, what a great first post for your NaBloPoMo – very informative and a ‘proper’ post!!
Secondly, this is a great read and really helpful to anyone in this kind of dilemma. I think that if your first birth was very traumatic and scary and has scarred you emotionally then there are grounds for an elected c-section (I know women who are in this situation). But i don’t agree for just cosmetic purposes you know the old too posh to push argument or if its your first its because you are afraid of the pain of a ‘normal vaginal birth’ – i mean, lets face it labour hurts and thats the way it is!!
anyway, each to their own? i guess xx
Thank you. I don’t tend to go in for the ‘issue’ posts but I’ve been so frustrated by the way this has been reported. I don’t like the idea of choosing a c-section because it’s easier but once you tell people how horrid a c-section actually is I can’t imagine many people will choose them with out a good reason.
Very well written post on the subject, I don’t really know entirely how I feel either. I think if there are grounds for opting for a c-section, i.e a traumatic labour first time round then it should be considered but I don’t think women who want to do it as an easy option should be allowed. I was adament that I didn’t want a c-section just because the idea of it scared me, and I didn’t like the idea of such a long recovery time. Although having said that, I had an assisted delivery which has led to me having an ongoing problem and was awful. I don’t think any option is better, but as long as whatever method gets your baby out sefely then that’s all that matters 🙂 x
It’s all just a means to an end really, isn’t it? We’ve all had such different experiences that it’s hard to put ourselves in each other’s shoes. Thanks for commenting. x
So annoyed at the media coverage of this.
The Daily Fail reported this:
“Cathy Warwick, a professor at the Royal College of Midwives said c-sections for non-medical reasons were ‘inappropriate’.”
What she actually said is here – she states that the RCM were pro-informed choice. There is one line about lifestyle choices to fit in with schedules not being appropriate:
http://www.huffingtonpost.co.uk/cathy-warwick/caesareans-nhs-women-choices_b_1067710.html
I’ll quote the final line so you get the idea
“The NICE guidelines and the debate they are generating is not about denying women choice. Ultimately they are doing something very important, they are promoting informed choice.”
The Royal College of Obstetricians and Gynaecologists also said although it didn’t comment on draft guideline that it felt it necessary to comment that the headlines aren’t true in the newspapers observing that:
“The headlines ‘Now all women have the right to NHS caesareans in hugely expensive move’ and ‘All women get right to caesarean birth on the NHS… even if they don’t need it’ are inaccurate. There is no proposal in the current NICE guidelines which state that women should have the automatic right to a caesarean section.”
I find it deeply frustrating that guidelines aimed to help women with a mental health issue have been hijacked by the press in a moral panic about “too posh to push”. Its simply not true and it means there are a lot of very scared women out there unable to talk about this to friends or family due to the judgmental culture this is creating. Its all very depressing….
Well said! I do wonder who all these ‘lazy’ mums are that would rather have a section. I’ve never met one and I have a feeling they might be a myth.
For me the interesting bit around the reporting is that this is a guideline and not a right – the guidelines say you can opt to not be induced at 42 weeks but how often is that adhered to?
Better education, better support during labour, more midwives are going to be key to better outcomes, not 300 pages of framework
Yes, they are a guideline for what doctors/NHS Trusts should do rather than a rule but in my experience there would need to be a very good clinical reason for them to deviate from NICE guidance once it has been adopted. Patients on the other hand can ignore guidance completely and often do 😉
I had both of my children by emergency C-section. I opted for a VBAC with Tigger and luckily my consultant was happy for me to try this, in the end it ended up as another c-section. Opting to be induced, try for a VBAC or requesting a c-section should be a joint decision between the patient and her medical team. Only when both sides have all the facts can they both feel the right decision can be made.
I had a “natural” delivery first time round. Tore so badly I needed 25 stitches internally, 10 externally, 2.5 hours of surgery, a blood transfusion to replace the blood I lost because my daughter was so badly positioned when she was delivered she shredded me and ripped vessels open, and took 2 years to be heal, with a lot of medical input plus the pshycological help I needed for the PPD that was mostly a result of all of this. When I was pregnant with my son, at my first ante natal appointment, my midwife brushed off my fears about what had happened, that I “didn’t need” a planned maternal request c section (what I wanted) and that it “wouldn’t be allowed”. Thankfully, I stood up for myself, read the then guidelines, insisted on seeing an OB who read my notes, examined the scar tissue that to this day is still painful and told me in no uncertain terms that “if you want and feel you need a c section, then that is what you shall have, I’m not going to put you through a natural birth if you don’t want to. We could see if we can prevent further damage, but I can’t promise it, so we will do what you want to do”.
I did have a natural second birth, but was booked for a ECS all the way through. His birth ended up being ok, but if we get pregnant again, I likely will be requesting a c section as I still have issues from the first birth that another large baby (he was 4.2kg) will worsen further.
If a woman wants a c section and has all the relevent information and advice, it’s her choice. I think very few women would actively choose major surgery lightly, there is usually a good reason behind it, but unfortunately the “natural childbirth movement” and the militant advocates make these reasons seem trite.