Whats with the new growing trend of being too posh to push

mysterymeme123

Limited choices I suppose . I still cannot understand the hostility towards the idea of an elective section.The woman is not stupid she has no doubt researched her decision she would be aware of the pros/cons the risks involved and is making her choice. For her this is how she wants to give birth this is whats best for her. Forgetting the "system" now which is most likely overstretched and limited, why is the idea that a woman would have a choice, an informed choice to have a section so upsetting for people.

embee

mysterymeme123 wrote:

Forgetting the "system" now which is most likely overstretched and limited, why is the idea that a woman would have a choice, an informed choice to have a section so upsetting for people.

I'm not "upset" by it. Caesarean sections, whether elective or emergency, are riskier for both mother and baby than a vaginal delivery, so IMO they shouldn't be an option at all unless there are strong medical indications that a vaginal birth would be too dangerous for the baby or woman.

Breech babies can still be born vaginally - one of the reasons that almost all breech babies are now born by section is the fear of litigation. There have been cases in the courts regarding the death of breech babies during vaginal delivery.

mysterymeme123

"upset" wasn't meant directly at you embee I meant it generally.

themadchef

title; The women too scared to give birth naturally.

QUOTE:

almost half of the women woh choose to have a caeserean delivery are not "too posh to push"- they are simply too scared, researchers say.

Many mothers opt for a C-scetion for non-medical reasons because they are afraid of the unpredictability of a natural delivery, according to a study.

The latest research, the first of its kind contradicts the widely held theory that many women have elcetive Caesereans because they are "too pash to push".

the sceintists involved from the karolinska institute in Stockholm asked 496 mothers to be about teir attitude towards childbirth.


The women all first time mothers were divided into three groups:


those who had opted for a C-section for medical reasons
Those who elected to have the operation for other reasons
and thosoe who planned to have a natural delivery.

Almost half - 43% - of those having elective caesereans had a fear of child birth which was so severe that it affected their ealth
in contrast, the figures for women having a natural birth or a caeserean for medical reasons were just 13% and 6% respectively.

The study published in the British Journal of Obstetrics and Gynacology also found that women who were scared of giving birth were looking foreward to motherhood less than the other prospective parents

latest figures show that in Ireland 22% of all babies delivered in hospitals were born by C-scetion. the figure is up more than 80% on what it was in the early 1990ts END QUOTE

Thats the best bits, more to the article if anyone cares to read.

Nevyn

link please.

themadchef

Thaedydal wrote: »

link please.

I dont have a link? ..i typed it from the paper..hope that's ok.

Nevyn

Well can you have the plublication info, the date, the title of the article and the person who wrote it please.

mysterymeme123

Here's a link I found about tokophobia ( fear of childbirth) http://www.rcpsych.ac.uk/pressparliament/pressreleasearchive/pr55.aspx
The BMJ had a paper about it apparently. They were talking about it on Ray D'arcy today. A load of people text in , it seems that some doctors are aware of it and agree to a section .

themadchef

Thaedydal wrote: »

Well can you have the plublication info, the date, the title of the article and the person who wrote it please.

Source: the Daily Irish mail, date of publication Feb 6th 2008 (page 25)

By Fiona McRae

Science reporter.

FakeRedHead

embee wrote: »

Caesarean sections, whether elective or emergency, are riskier for both mother and baby than a vaginal delivery

I'd be interested to read the source of the statistics on this.

tallaght01

I think it's time to accept that a lot of women DO have c-sections because they're afraid.
As long as they make an informed choice, then I think it's fair enough.

As for the person asking for data on dangers of c-sections. I could give you references to a lot of neonatal data in the literature showing higher rates of problems such as respiratory distress syndrome in babies born by c-section if you want.

Do you have an athens password, though, to read all the papers? Coz I ain't trawling through years of papers if you have no ay to read them.

Mind you, if you do have an athens password, just search for "caesarian section respiratory distress" and you'll get what you're looking for.

It's because of this data that there's always a paediatrician at a c-section, whereas we don't routinely attend vaginal deliveries.

BostonB

Its logic that a % of sections are carried out where theres a problem. Where as a high % of normal deliveries where there no problem. So its only logical that the stats will reflect this.

Its a bit like saying theres more serious injuries in serious accidents than in minor accidents.

littlebug

I would imagine there are equal numbers if not more c cections carried out because the mother had a c section for her first. I don't know the stats but most, actually anyone, I know who had a section on their first went on to have sections with their second, third and even 4th babies as elective and not because there were problems. It would be interesting to see stats on dangers of elective vs emergency c sections.

tallaght01

BostonB wrote: »

Its logic that a % of sections are carried out where theres a problem. Where as a high % of normal deliveries where there no problem. So its only logical that the stats will reflect this.

Its a bit like saying theres more serious injuries in serious accidents than in minor accidents.

littlebug wrote: »

I would imagine there are equal numbers if not more c cections carried out because the mother had a c section for her first. I don't know the stats but most, actually anyone, I know who had a section on their first went on to have sections with their second, third and even 4th babies as elective and not because there were problems. It would be interesting to see stats on dangers of elective vs emergency c sections.

Certainly from the bay's point of view, elective sections carry a higher risk than a normal vaginal delivery.

IN many hospitals, paediatricians will attend even elective sections (such as those where the only reason is a fear of vaginal delivery, or previous c-sections) because of this risk.

BostonB

littlebug wrote: »

I would imagine there are equal numbers if not more c cections carried out because the mother had a c section for her first. I don't know the stats but most, actually anyone, I know who had a section on their first went on to have sections with their second, third and even 4th babies as elective and not because there were problems. It would be interesting to see stats on dangers of elective vs emergency c sections.

In my experience the hospitials do there utmost to avoid a section even after a section on the first. Thats been the experience of the people I know. But this is all annidoctal and isn't clear in the stats as given.

tallaght01 wrote: »

Certainly from the bay's point of view, elective sections carry a higher risk than a normal vaginal delivery.

IN many hospitals, paediatricians will attend even elective sections (such as those where the only reason is a fear of vaginal delivery, or previous c-sections) because of this risk.

Why does it carry more risk from the babys POV? I thought they carried out C sections where there is a risk to the baby/mother. Which is contradictory to what you are saying. C Section is surgury which has inherent risks, even if you are getting a wisdom tooth out, they'll be a doctor there. Its abit like saying flying is dangerous which it is. But % the risks are low because of the numbers flying.

You''ll should clarify what YOU mean by elective because its a medical term, and people aren't appreciating that difference when seeing it in the stats, or used here.

tallaght01

BostonB wrote: »

In my experience the hospitials do there utmost to avoid a section even after a section on the first. Thats been the experience of the people I know. But this is all annidoctal and isn't clear in the stats as given.



Why does it carry more risk from the babys POV? I thought they carried out C sections where there is a risk to the baby/mother. Which is contradictory to what you are saying. C Section is surgury which has inherent risks, even if you are getting a wisdom tooth out, they'll be a doctor there. Its abit like saying flying is dangerous which it is. But % the risks are low because of the numbers flying.

You''ll should clarify what YOU mean by elective because its a medical term, and people aren't appreciating that difference when seeing it in the stats, or used here.

An elective c-section is one that's planned.

You can have the occasional "semi-elective" section, but by and large it's a simple distinction. It's either an emergency and you're going to theatre now, or it's not.

It's dangerous for the baby because labour itself and the complex physiological changes involved prepares the baby's heart, and lungs in particular for the outside world. The stress response inherent in a labour is good for baby.

Labour also forces the amniotic fluid out of the baby as they get squashed down the birth canal. In a c-section, this doesn't happen, so a lot of the fluid gets into the babies lungs and you got yourself a kiddy in respiratory distress. the fluid can be so grotty that you can see it on their chest x-ray.

Also, the reason behind the section often puts the baby at risk. For eg, all mothers with HIV get an elecive c-section in the western world. HIV itself puts the kiddy at risk of problems.

Some women have a section as there is growth retardation on the scan, which is sometimes a precursor to problems.

So, the section itself can cause problems itself. And the situation leading to a section being required can cause the problems.

I have resuscitated many babies who've just been sectioned for banal reasons (such as previous sections).

But it's important to point out that I have been to hundreds of them where nothing goes wrong.

The vast majority of deliveries don't lead to any dramas.

Even if you see the paediatricians being called, don't panic. Most times the paeds docs are at a delivery they're not needed. It's more a precaution than anything else.

BostonB

Thanks for explaining.

tallaght01 wrote: »

....It's either an emergency and you're going to theatre now, or it's not.....

Also, the reason behind the section often puts the baby at risk....

..the situation leading to a section being required can cause the problems.

My point really is none of the above is quantified in the stats. Without that distinction the stats are flawed for the purpose of arguing "too posh to push".

tallaght01

BostonB wrote: »

Thanks for explaining.



My point really is none of the above is quantified in the stats. Without that distinction the stats are flawed for the purpose of arguing "too posh to push".

I've read papers where they've looked at elective Vs emergency sections in terms of their outcomes for the kiddy.

Don't have the references to hand. But if you've been getting your stats from an athens search, just refine it down to search for both "elective " and "non-elective" sections and you'll find the papers.

I think there was a big one in the archives of diseases in childhood.

tallaght01

I was doing some journalising, and had a quick look for data on maternal problems i the different types of sections.

Dr. Hannah in the canadian medical journal (CMAJ • March 2, 2004; 170 (5). ) states: The underlining and bold emphasis are my own:

What are the risks of cesarean delivery? The maternal mortality is higher than that associated with vaginal birth (5.9 for elective cesarean delivery v. 18.2 for emergency cesarean v. 2.1 for vaginal birth, per 100 000 completed pregnancies in the United Kingdom during 1994–1996).3Cesarean section also requires a longer recovery time, and operative complications such as lacerations and bleeding may occur, at rates varying from 6% for elective cesarean to 15% for emergency cesarean.1,4 Having a cesarean delivery increases the risk of major bleeding in a subsequent pregnancy because of placenta previa (5.2 per 1000 live births) and placental abruption (11.5 per 1000 live births).5 Among term babies, the risk of neonatal respiratory distress necessitating oxygen therapy is higher if delivery is by cesarean (35.5 with a prelabour cesarean v. 12.2 with a cesarean during labour v. 5.3 with vaginal delivery, per 1000 live births).6 Also, a recent study has reported that the risk of unexplained stillbirth in a second pregnancy is somewhat increased if the first birth was by cesarean rather than by vaginal delivery (1.2 per 1000 v. 0.5 per 1000).

I've also read another study somewhere that stated elective section at term is as safe as vaginal delivery though *confusion*. Found it...it's an older study, in the British medical journal 1998. They allow public access to this article, so it can be viewd at :

http://www.pubmedcentral.nih.gov/articlerender.fcgi?&artid=1113715

Note the following 2 paragraphs into it (again emphasis is my own):

Evidence of risks
The strongest argument against caesarean section relates to maternal complications. However, evidence supporting this for elective operations under regional blockade with antibiotic cover and thromboprophylaxis is poor. Data on mortality from caesarean section relate to procedures performed for medical or obstetric reasons, often emergencies and often under general anaesthesia.1-5,1-6 These are not comparable to the elective procedure, which most practising obstetricians consider safe. Recent evidence of maternal morbidity after caesarean section and normal and instrumental vaginal delivery challenges some deep rooted obstetric and midwifery teachings: normal vaginal deliveries can cause damage to the pelvic floor,1-7 and instrumental vaginal deliveries are associated with slower recovery1-8 and greater pelvic floor damage and incontinence1-9 than normal delivery and caesarean section. Previous caesarean section does compromise future obstetric performance,1-10,1-11 but evidence is limited and, with reduced family size, this has probably become less important in decision making.

No wonder the public are confused


Here's the data for the kiddies: Acta Obstet Gynecol Scand. 2007;86(4):389-94.

I can only publish the abstract for copyright reasons. The underlining is my own:

The Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Aarhus, Denmark. akh@svf.au.dk

AIM: The aim of this review was to assess the relationship between delivery by elective caesarean section and respiratory morbidity in the term and near-term neonate. METHODS: Searches were made in the MEDLINE database, EMBASE, Cochrane database and Web of Science to identify peer-reviewed studies in English on elective caesarean section and respiratory morbidity in the newborn. We included studies that compared elective caesarean section to vaginal or intended vaginal delivery, with clear definition of outcome measures and information about gestational age. RESULTS: Nine eligible studies were identified. All studies found that delivery by elective caesarean section increased the risk of various respiratory morbidities in the newborn near term compared with vaginal delivery, although the findings were not statistically significant in all studies. It was inappropriate to carry out a meta-analysis with a pooled risk estimate because of a variety of methodological differences between the studies. The overall risk for respiratory morbidity, however, seemed to increase about 2 to 3 times, though some studies presented much higher risk estimates. A decreasing risk with increasing gestational age was shown in 2 studies. CONCLUSION: Delivery by elective caesarean section was shown to increase the risk of respiratory morbidity in all studies eligible for inclusion. The magnitude of this relative risk seemed to depend on gestational age even in deliveries after 37 completed weeks of gestation.

The above study only relates to breathing problems, but they're the big issue in c-sections.

I don't know if I've added to the debate, or confused everybody with the baove lol

FakeRedHead

It's interesting if there's research to show that c-sectons are riskier than vaginal deliveries that there's been an increase in c-sections in the US due to consultants 'fear of litigation' and wanting to take the 'safer' c-section option.

Or maybe that's just a myth and sections haven't increased in the US?

Kernel32

FakeRedHead wrote: »

It's interesting if there's research to show that c-sectons are riskier than vaginal deliveries that there's been an increase in c-sections in the US due to consultants 'fear of litigation' and wanting to take the 'safer' c-section option.

Or maybe that's just a myth and sections haven't increased in the US?

As far as I know sections have increased dramatically in the US and for the reason you describe 'fear of litigation'. It has nothing to do with doctors wanting to take the safer option, it's because for them it's the cleaner option legally and medically. They are able to take a natural process and turn it into a medical procedure. Anyone in the US giving birth in a hospital will have signed all sorts of documents and some of them would be related to the legal liabilities involved in a c-section. Because a c-section is a medical procedure it's much easier to document what happened etc. So if a baby is born by c-section in respiratory distress, so what, the pregnant mother had signed off on the possible complications due to the c-section. If there are complications during a vaginal delivery things can fall into a gray area.

FakeRedHead

Interesting, Kernel32.

So it's common in the US not because it's 'safer' but because there are fewer variables involved for a consultant.

But even that has a comfort for some of us.
I suppose that's why I chose it as an option.....a definite plan from a to z of how it was supposed to go was what I was looking for.

tallaght01

Kernel32 wrote: »

As far as I know sections have increased dramatically in the US and for the reason you describe 'fear of litigation'. It has nothing to do with doctors wanting to take the safer option, it's because for them it's the cleaner option legally and medically. They are able to take a natural process and turn it into a medical procedure.

There's a fear of litigation all right.

Obstetricians have some crazy cases brought against them.

Most fail, but the doc has this court case hanging over them for 3 or 4 years.

But claiming that docs think c-section is a celaner oprion medically is simply not true. The stats are widely known.

Look at the underlines bit in the first piece of research I've quoted above.

BostonB

Interesting studies indeed. I think it illustrates you have to be very careful to look at what are the specifics of the survey and how the data is collected. I don't think this is a simple issue and sweeping generalisations aren't useful.

suzi-suz

i had 2 c sections...my first was because i was to small to have him or so the doctor told ( size 3 foot ) and my second i asked for because there was a rick of my scar rupturing so ppl that say its all about fanity or wanting to deliver on their choosen date is not true at all.. and if i had another baby i would have a section again no probs

kelle

suzi-suz wrote: »

i had 2 c sections...my first was because i was to small to have him or so the doctor told ( size 3 foot ) and my second i asked for because there was a rick of my scar rupturing so ppl that say its all about fanity or wanting to deliver on their choosen date is not true at all.. and if i had another baby i would have a section again no probs

Once you've had 2 C-Sections, subsequent births will be c-sections. I'd had 2 sections, then on my first appointment for my third baby the doctor just pencilled in his diary the day I would go for my elective section.

ckd

Hi Suzi-Suz & Kelle,

I also had 2 c-sections and on my third I really wanted a vba2c so I contacted all the maternity hospitals that would be convenient for me to see which hospitals would agree to this, I found a few that would but in the end chose holles street where I had a successful vba2c so if thats what you want it most certainly is possible.

You cannot be forced into a section if both mother & baby are perfectly healthy.:)