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Women feel enormous pressure (at least here in the UK) to give birth naturally, from both their peers and health professionals. How a baby is delivered is none

by danw1979 8y ago

Women feel enormous pressure (at least here in the UK) to give birth naturally, from both their peers and health professionals. How a baby is delivered is none of anyone's business but the mother herself. My wife (an epidemiologist) deliberated for months over having our second by VBAC (vaginal birth after csection) and opted to go for it, due to the overwhelming expectation from everyone around her that she should do it naturally, and despite having read an Australian study indicating higher rates of stillbirth during VBAC [citation needed]. Sadly, our daughter didn't make it through the labor. Needless to say, the csections that safely delivered my first, and recently (yay) third children seem like a miracle of modern medicine to us both. Even before this personal tragedy, I was astounded by the sheer force of opinion surrounding the cesarean section and childbirth in general. This is creating an environment where women are not able to make their own choices and I fear that the doctors in this article, however well meaning, by warning of an "epidemic" are only adding fuel to this fire.

DanBC 8y ago
James Titcombe and others are campaigning pretty hard on this. Women need to be given correct information, but their wishes also need to be respected. These campaigners have persuaded the CQC to stop pressuring trusts over rates of C-section or normal birth, and to get the NMC to stop paying normal birth so hard.
qrbLPHiKpiux 8y ago
> How a baby is delivered is none of anyone's business but the mother herself. Try telling that to some of those here, in the US. The mantra is "do what I say, not what I do."
Angostura 8y ago
> How a baby is delivered is none of anyone's business but the mother herself. I'm sorry for your loss. Caesarian's costs the NHS around £1,700 a time compared with £750, for a normal childbirth and women also stay in hospital for twice as long on average. There is a general presumption in the UK that avoiding what is an invasive operation is preferable for both baby and mother alike, in the absence of other factors. I would argue that clearly How a baby is delivered is other people's business since other people are involved. However the ultimate choice should be the mother's.
- isostatic 8y ago
  Nobody gives a stuff about the cost, you'll get the same pressure if you plan to deliver privately. There's fewer than 700,000 births a year. If every one was a c-section it would cost an extra £700m a year, less than 1% of the NHS budget. NICE guidelines state that the woman should discuss the pros and cons and then it's her choice.
  - ng12 8y ago
    > then it's her choice Well, yes, but that doesn't mean it's a choice between two roughly equivalent options. C-Sections are invasive surgeries and come with added risks. I would argue a healthcare provider's duty is to advocate against them unless there is an appropriate medical reason.
    - isostatic 8y ago
      That would be the discussion of the pros and cons.
      - ng12 8y ago
        Exactly. I don't know what your experience has been but generally the pressure from medical professionals is because C-section risks outweigh the benefits most of the time.
- pbhjpbhj 8y ago
  Vaginal delivery is associated with better outcomes for the child too. IMO that makes it not strictly the mother's choice. Indeed surgical procedures should never be entirely elective.
  - cm2012 8y ago
    No, you don't get to make major body and life decisions for a mom because maybe infant outcomes are 1% better in certain circumstances. Somehow I doubt you donate 90% of your income to children in need, which would actually drastically improve outcomes for 1000s of babies.
gdubs 8y ago
Sorry for your loss. And I agree on the pressure around birthing choice. My wife just delivered our 3rd child, and at this point we felt confident in our choices. But the birthing class we attended before our first child was born was full of fear, pressure, and pseudoscience.
- deleted 8y ago
  [deleted]
- thrower123 8y ago
  There is an unbelievable amount of woo marketed at first-time parents. I suspect its a bit of an artifact of smaller family sizes, so that there is less practical experience in general circulation. I wish my grandmother who had nine children and a dozen or so pregnancies was still alive be a source of advice.
b_tterc_p 8y ago
I feel doctors should be allowed to refuse alternate procedures that heighten risk for the patient.
- lostlogin 8y ago
  That is an incredibly slippery slope. Apply it to other healthcare scenarios, particularly pregnancy, and it’s got a poor track record. Take this thalidomide, keep this pregnancy etc etc.
gcb0 8y ago
contributing to your social critic on everyone having an opinion; why not see the first c-section as the root of the problem?
- Herodotus38 8y ago
  They may not have had the option to avoid the first c-section, depending on the circumstances of the first pregnancy.
  - deleted 8y ago
    [deleted]
Spooky23 8y ago
I’m very sorry for your loss - my wife and I went through this and it was very difficult and awful, especially when you rationalize or question choices presented to you. In the US, there are a couple of tiers of pressures and thought process. People make these choices from reasons varying from the medically advised, to cosmetic, to schedule based, to something else. Some people make choices for trivial reasons that are disturbing to the doctors who are placing people at risk, at their direction. I think the medical concern is that there are more complications, the less informed people tend to correlate to folks who are less able to care for themselves afterwards in recovery and overall risk of anesthesia and other things.
jessaustin 8y ago
Very sorry for your loss. After her first C-section, a relative of mine was told by her physicians that all subsequent births should be the same because that was safer. It's interesting how the standard of care varies between nations.
- lostlogin 8y ago
  Standard of care may not be relevant. Stats are great for making policies to improve population health and wellbeing, but when you are the one in a million to whom a rare and catastrophic event occurs despite best practice, where does that leave one?
  - jessaustin 8y ago
    My understanding is that GP poster's wife was in the same position as my relative, being pregnant and having previously had a C-section. That they got different advice, is precisely a difference in the standard of care. Problems with birth are certainly not one in a million.
    - lostlogin 8y ago
      It quite possibly is related to different practices but good quality healthcare still has bad outcomes. Advice on treatment has a lot of variables and previous c-section is not going to be the only factor.
paulddraper 8y ago
> How a baby is delivered is none of anyone's business but the mother herself. * It's the doctor's concern because of the Hippocratic Oath * It's the baby's and therefore father's concern (but not choice), since vaginal birth is correlated with better outcomes. * If insured, it's the insurer's concern, as it's over twice the cost of vaginal delivery. (In the case of the UK, this is the government, so literally everyone.)
- deleted 8y ago
  [deleted]
throwaway1391 8y ago
I see a lot of people in this thread idly sniping talking points on the benefits of vaginal delivery, insurance/costs, etc. - illustrating the point in your last paragraph. My son and wife's lives were saved by a C-section three weeks ago. Watching that fetal heart rate monitor dip to zero and then slowly, unsteadily rise back up over and over again was the hardest thing I've ever done. The hospital staff pushed us to do a vaginal birth the whole time. I understand and appreciate what they did, but at the same time I hope there is a better way, because in hindsight I would have never put my wife and son through this again. This isn't a programming language preference. If you don't know the details of clinical practices around C-section, if you're not an expert or a patient, then you really shouldn't be pushing your opinion on others. Refrain.
kleopullin 8y ago
I'm very sorry for your and your family's loss. In the information age, there are so many irresponsible and incomplete bits supporting this, that or the other in as many superlatives as possible. What can a person do? I thought that VBAC was more dangerous for the mother than the newborn, for a healthy young woman, coupled with even a tiny amount of pressure this could easily lead people to make a decision they were not really comfortable with. The "sheer force of opinion surrounding ... childbirth in general" is astonishing; I agree with you here. The information age is badly curated and gives far too much weight to the inexpert opinion, imh (and non-expert) o. Mothers must give birth naturally, mothers must nurse their infants for x months, fathers must cut the umbilical cord. All the modern medicine in the world coupled with the power of the information age can't make these decisions for us. Maybe, in the future, machine learning methods can pull relevant information out for people to counter some of the cultural pressures.

DanBC 8y ago

James Titcombe and others are campaigning pretty hard on this. Women need to be given correct information, but their wishes also need to be respected. These campaigners have persuaded the CQC to stop pressuring trusts over rates of C-section or normal birth, and to get the NMC to stop paying normal birth so hard.

qrbLPHiKpiux 8y ago

> How a baby is delivered is none of anyone's business but the mother herself. Try telling that to some of those here, in the US. The mantra is "do what I say, not what I do."

Angostura 8y ago

> How a baby is delivered is none of anyone's business but the mother herself. I'm sorry for your loss. Caesarian's costs the NHS around £1,700 a time compared with £750, for a normal childbirth and women also stay in hospital for twice as long on average. There is a general presumption in the UK that avoiding what is an invasive operation is preferable for both baby and mother alike, in the absence of other factors. I would argue that clearly How a baby is delivered is other people's business since other people are involved. However the ultimate choice should be the mother's.

isostatic 8y ago
Nobody gives a stuff about the cost, you'll get the same pressure if you plan to deliver privately. There's fewer than 700,000 births a year. If every one was a c-section it would cost an extra £700m a year, less than 1% of the NHS budget. NICE guidelines state that the woman should discuss the pros and cons and then it's her choice.
- ng12 8y ago
  > then it's her choice Well, yes, but that doesn't mean it's a choice between two roughly equivalent options. C-Sections are invasive surgeries and come with added risks. I would argue a healthcare provider's duty is to advocate against them unless there is an appropriate medical reason.
  - isostatic 8y ago
    That would be the discussion of the pros and cons.
    - ng12 8y ago
      Exactly. I don't know what your experience has been but generally the pressure from medical professionals is because C-section risks outweigh the benefits most of the time.
pbhjpbhj 8y ago
Vaginal delivery is associated with better outcomes for the child too. IMO that makes it not strictly the mother's choice. Indeed surgical procedures should never be entirely elective.
- cm2012 8y ago
  No, you don't get to make major body and life decisions for a mom because maybe infant outcomes are 1% better in certain circumstances. Somehow I doubt you donate 90% of your income to children in need, which would actually drastically improve outcomes for 1000s of babies.

gdubs 8y ago

Sorry for your loss. And I agree on the pressure around birthing choice. My wife just delivered our 3rd child, and at this point we felt confident in our choices. But the birthing class we attended before our first child was born was full of fear, pressure, and pseudoscience.

deleted 8y ago
[deleted]
thrower123 8y ago
There is an unbelievable amount of woo marketed at first-time parents. I suspect its a bit of an artifact of smaller family sizes, so that there is less practical experience in general circulation. I wish my grandmother who had nine children and a dozen or so pregnancies was still alive be a source of advice.

b_tterc_p 8y ago

I feel doctors should be allowed to refuse alternate procedures that heighten risk for the patient.

lostlogin 8y ago
That is an incredibly slippery slope. Apply it to other healthcare scenarios, particularly pregnancy, and it’s got a poor track record. Take this thalidomide, keep this pregnancy etc etc.

gcb0 8y ago

contributing to your social critic on everyone having an opinion; why not see the first c-section as the root of the problem?

Herodotus38 8y ago
They may not have had the option to avoid the first c-section, depending on the circumstances of the first pregnancy.
- deleted 8y ago
  [deleted]

Spooky23 8y ago

I’m very sorry for your loss - my wife and I went through this and it was very difficult and awful, especially when you rationalize or question choices presented to you. In the US, there are a couple of tiers of pressures and thought process. People make these choices from reasons varying from the medically advised, to cosmetic, to schedule based, to something else. Some people make choices for trivial reasons that are disturbing to the doctors who are placing people at risk, at their direction. I think the medical concern is that there are more complications, the less informed people tend to correlate to folks who are less able to care for themselves afterwards in recovery and overall risk of anesthesia and other things.

jessaustin 8y ago

Very sorry for your loss. After her first C-section, a relative of mine was told by her physicians that all subsequent births should be the same because that was safer. It's interesting how the standard of care varies between nations.

lostlogin 8y ago
Standard of care may not be relevant. Stats are great for making policies to improve population health and wellbeing, but when you are the one in a million to whom a rare and catastrophic event occurs despite best practice, where does that leave one?
- jessaustin 8y ago
  My understanding is that GP poster's wife was in the same position as my relative, being pregnant and having previously had a C-section. That they got different advice, is precisely a difference in the standard of care. Problems with birth are certainly not one in a million.
  - lostlogin 8y ago
    It quite possibly is related to different practices but good quality healthcare still has bad outcomes. Advice on treatment has a lot of variables and previous c-section is not going to be the only factor.

paulddraper 8y ago

> How a baby is delivered is none of anyone's business but the mother herself. * It's the doctor's concern because of the Hippocratic Oath * It's the baby's and therefore father's concern (but not choice), since vaginal birth is correlated with better outcomes. * If insured, it's the insurer's concern, as it's over twice the cost of vaginal delivery. (In the case of the UK, this is the government, so literally everyone.)

deleted 8y ago
[deleted]

throwaway1391 8y ago

I see a lot of people in this thread idly sniping talking points on the benefits of vaginal delivery, insurance/costs, etc. - illustrating the point in your last paragraph. My son and wife's lives were saved by a C-section three weeks ago. Watching that fetal heart rate monitor dip to zero and then slowly, unsteadily rise back up over and over again was the hardest thing I've ever done. The hospital staff pushed us to do a vaginal birth the whole time. I understand and appreciate what they did, but at the same time I hope there is a better way, because in hindsight I would have never put my wife and son through this again. This isn't a programming language preference. If you don't know the details of clinical practices around C-section, if you're not an expert or a patient, then you really shouldn't be pushing your opinion on others. Refrain.

kleopullin 8y ago

I'm very sorry for your and your family's loss. In the information age, there are so many irresponsible and incomplete bits supporting this, that or the other in as many superlatives as possible. What can a person do? I thought that VBAC was more dangerous for the mother than the newborn, for a healthy young woman, coupled with even a tiny amount of pressure this could easily lead people to make a decision they were not really comfortable with. The "sheer force of opinion surrounding ... childbirth in general" is astonishing; I agree with you here. The information age is badly curated and gives far too much weight to the inexpert opinion, imh (and non-expert) o. Mothers must give birth naturally, mothers must nurse their infants for x months, fathers must cut the umbilical cord. All the modern medicine in the world coupled with the power of the information age can't make these decisions for us. Maybe, in the future, machine learning methods can pull relevant information out for people to counter some of the cultural pressures.