27 January 2012

A Woman's Right To Choose

Posted by Happy Homemaker UK

Birth Announcements by Scriptiva Paper Studio

In October last year, 
it was announced that in the UK 
women will be able to choose whether to deliver their baby
vaginally or by Cesarean section

Through my American eyes, I just could not wrap my head around this one

Generally speaking,
American women would not opt for this surgical procedure unless recommended by an OBGYN -
with its longer recovery and inherent risks as with any surgery

In the US
it would seem irresponsible to completely leave it up to the woman to choose
to have an elective cesarean if it was not medically indicated
(excluding subsequent births after a C-section)

But talking to English women, 
100% of them in my little poll are supportive of the availability of this choice
But why?
I have been chewing on this one for a while...
Having not delivered a baby in the UK, I am no expert on the NHS system. But it appears the only 'known' on your birth plan is your hospital (which may be assigned, but at least known ahead of time). You are unlikely to have met your midwife previously. And naturally the looming unknown of each childbirth can create a fair amount of fear. So I can see having a planned C-Section could bring some comfort and would help organize your life around the birth. I get that.

...a mantra becoming popular among the affluent

A quarter of births here are delivered via Cesarean section (I'm not sure how many of those are elective), so now they are officially creating an option for what doctors have been quietly persuaded to do by patients anyway.

Is it any different from other elective surgery, including a knee replacement or cosmetic surgery? It is the woman's body after all, and she should ultimately make the decision once she knows the facts and risks.

Most births are delivered by midwives. Some mums feel the natural and holistic methods of midwives are forced upon them. (i.e. might not induce until 42 weeks)

Retro Luggage available via This Vintage Girl

As an aside, items listed below always are provided for labor and delivery patients in US hospitals. UK patients are advised to pack the following for their stay in the NHS hospital:

- 2-3 gowns/clothes to wear during labor/delivery
- towels and soap
- 24 super absorbent sanitary napkins
- 5 or 6 pairs of underwear/'pants'
- diapers/nappies
- baby blanket and hat

It is also worth noting that toilets and bathrooms are often down the hall to be shared with other patients. And don't be surprised when your recovery is in a postnatal ward room shared with 5 other moms with newborns.

Another interesting difference is if you have a doctor, he is likely to be referred to as a 'Mister [Last Name]', not 'Doctor'. 'Mr.' is used for highly specialized doctors, so it is a good sign if that is his title. If he is a 'Dr.', he is not as highly trained. Women specialists are referred to as 'Miss [Maiden Name]' even if they are married.

And lastly, the hospital can provide a gas mixture of oxygen and nitrous oxide (Entonox) through a mask or nose piece to laboring patients to make pain more bearable. This would have been a great option for me (and for my husband!) during my labor. I think this is similar to 'laughing gas' in the US. Reportedly there are no side effects to the baby, while the mother may feel lightheaded, nauseous, and/or a loss of concentration (in which case discontinue use). Anyone else vote for this during labor in US hospitals? 

I'm curious as to your thoughts on this topic :)
I find it fascinating

Post Script:

- Thank you Meg, for adding husbands can't stay overnight in the hospital with postpartum wives in the UK

- Unlike the US, babies are not granted UK citizenship just for being born in England. A baby will be given American citizenship, not UK citizenship, if born to American parents in the UK.

More medical posts:
The Dentist
More On The NHS

Sources: NHS, The Telegraph 


Liene said...

I think in the US elective Cesareans are already commonplace - under the guise of "medically advised." >33% of births are now by C-section. More convenient for the doctor, less risk of legal action. Unless women become more informed on the risks/benefits of scheduled Cesareans, as well as the hightened risk of Cesarean due to other interventions, this rate will continue to climb. It's a woman's choice, but I would like to see the freedom to VBAC just as widely supported in hospitals as the right to Cesarean...

Meg said...

I agree with Liene. I think you are underestimating how many women in the US want C-sections. I hear about it a lot! (Though I am fairly immersed in all things birth/baby since I'm due in 6 weeks) And the elective C-section thing in the UK isn't as easy as just saying you want one. From what I understand, you have to prove that you are too traumatized by the idea of a vaginal birth (or had a past bad birth experience) in order to get one- at least on the NHS's dime.
I'll likely at least have met the midwife who delivers our baby, even if it isn't the one I've seen throughout my antenatal care. I know that varies depending on your area and I feel very lucky in the services we've received.
I recently posted about pain relief options available in the UK and find the differences fascinating! The "gas & air" as they call it is exactly the same as the laughing gas you get at the dentist in the States and I've heard mixed reviews on it. Some women love it, but I'm hoping not to need it.
As for the things to bring to the hospital with you, at first I was shocked and appalled. We were even told to bring our own food and ice! But then I started to think about how much having a baby in the US costs. I guess all the "goodies" you get in the States are absorbed by the insurance companies (funded by the patients!). The recovery ward thing scares me the most. Especially the fact that husbands aren't allowed to stay overnight! I'm hoping to give birth in our hospital's Birth Centre which means I won't stay in the recovery ward, but would go home within 8 hours of giving birth.

Happy Homemaker UK said...

@Liene - I am sure you are right. It is possible I have been jaded by the part of the country I lived in where it was not commonplace. Perhaps the C-section rate differs geographically in the US?

@Meg - This is why I was excited to write this piece - I knew I would learn a lot from the comments. It does seem the UK is totally 'no frills'; and I didn't know the husband couldn't stay overnight! I will look for your post about UK pain relief :) I'm off!

brie. said...

i also was shocked when this came about here. i have a number of pregnant friends and many are thinking of elective c-sections - mainly because they don't want the physically give birth and feel the c-section is 'safer'. (which is a nice way of saying 'too posh to push') which to me sounds crazy! (being a canadian, used to public health care.) we expect that we'll have our first child here (before moving back to canada) and so, i've done a little research, at least in london, you can get the following: birthing centre - which release you super quick, but no epidural, on-ward birth staying overnight and then of course c-section. and remember, you can also home birth on the NHS - legal and paid for, in which case you will definitely know your midwife. in all likelihood we'll probably choose either a birthing ward or a home birth (we live very close to a top hospital/med school).

in some ways i find this new trend fascinating, particularly when you consider how open to a holistic model the NHS is - it's a 180 in policy focus.

ramblinbess said...

I haven't had a baby, but I feel like a lot of women in the States feel like they got "pushed" into C-sections because of convenience, safety, and liability. I don't know how much science backs up whether one is better than the other. "Too posh to push" is just silly, as is a "push present," IMO.

Gail Dixon (Louisiana Belle) said...

Being way past my baby making years I'm not sure what to think of this. But my first inclination is that a natural birth is the best way. I always learn something here, that's for sure!!

Jocelyn Nelson said...

Hi, I'm from California but live in Yorkshire and I have had two births in York (and pregnant with my third). My first birth was an induction in hospital with pethidine and gas and air. I didn't realise that in the US you don't have access to gas and air. That's a real shame because it was fantastic for me and I absolutely cannot imagine giving birth without it. My second birth was in an ambulance- we just couldn't make it to hospital in time, with just gas and air as pain relief. For this next birth, I am hoping for a homebirth (with gas and air). Throughout my pregnancies I mostly saw the same one or two midwives at our local dr's and then during labour had completely different ones at hospital. Personally, it doesn't matter to me one bit to have someone new as long as she is nice and competent.
You do recover and spend the night at hospital in a large room with other women and their babies with a shared bathroom. They send your husband home and he can return during visting hours. This was awkward but it would be more awkward to have other women's husbands coming ang going all night long! You labour in a your own room. I found trying to sleep with other people present difficult. You can pay extra to have a private room (something like £50). With my second I was only in hospital for a few hours (after birth in an ambulance).
I think overall the NHS does a wonderful job and I am grateful for two safely delivered babies without being presented with a large bill after. And I can't even imagine trying to have a homebirth in the US and the associated costs.

Lydia @ Twelve said...

Facinating read!

I had two babies naturally with Gas & Air - too afraid to let a mahoosive needle near me. It was tough, & my pelvic floor will never be the same, but it is what we were designed to do! C sections run a significant risk of complications for mum & babe, & I would have thought be more expensive to the NHS. Suprised to read this as in my patch of Derbyshire there is a move to promote home births. Perhaps C sections are seen as the less scary option - courstesy of OK & Hello?

The title Dr/Mr is historical. Dr's are physicians, the oldest practioners of medicine, whereas Mr's are surgeons, stemming from thier origons as Barbers & Butchers, who carried out the first surgical interventions, ie amputations - although, thankfully they are more highly trained nowadays!
In days gone by dr were considered higher than Mr's - Heirachial rivalry at its best.....


Happy Homemaker UK said...

Ah, 'gas and air' - I couldn't remember the common name for it - thank you! Lydia, you bring up an interesting point with the tabloids making it appear more commonplace ;) I think home births are more common in the UK than in the US. And I had heard the Barber story, but so hard to believe that that is where the title came from! -I wasn't sure anyone would believe me if I wrote it - I am glad it is documented here now :)

Thank you, everyone, for your contributions here! Keep them coming :)

Sarah said...

OK, I'm going to be honest. I think this is crazy! Of course there are times when a c-section is necessary, but otherwise, our bodies were made for birth. I mean, in a c-section, they literally have to take your uterus out of the body to retrieve the body, and then put it back in (not surgically removed...just pulled out...you get the point). It is major surgery!!! I don't think people realize what c-section really involves.
Gosh, and I could not imagine not knowing who was going to deliver my baby.
I'm only telling you this because I am a nurse, so I have seen it from that perspective. Besides the convenience of knowing when you will deliver, I cannot think of any other positives.
I will also admit that I have had very good deliveries, so I do hold a small bias. Perhaps if someone had already had a traumatic vag birth, that would be different. In that case, I could totally understand someone choosing c-section.

Rhi@FlourChild said...

I'm pregnant with my third baby, and will be having him/her here in a Belgian hospital. There's no "gas and air" here either, dammit!
In Australia (where my first two were born), I used the public system, with a small team of midwives, gas, excellent care, breastfeeding support, and an as-short-as-possible hospital stay. I never saw an Ob, except when I needed a few stitches :/ We joke that our Australian babies were totally free, we literally paid nothing for any of it (though for one, we had to pay some of the Down Syndrome test we elected to have). I don't know the stats, but I think Australia has one of the highest rates of C-sections - both elective, and "medically advised". It's a big issue in the baby-world, and I personally think a lot of women are pushed in to "elective" C-sections because their Ob wants it under control, and therefore gives a medical reason (ie. one friend was told to have a c-section because her baby was very big, whereas lots of people I know have naturally birthed bigger babies with nary a tear). Anyways, I wonder who is actually guiding the "choice" making sometimes?
Here in Belgium the whole system seems fairly "old fashioned" and interventive - a lot of epidurals, birthing on your back in a bed (not active birth). a high rate of formula use, loooong hospital stays (5 days for normal birth is the standard), and almost everyone has a private Ob/Gyn. It's also quite expensive... a lot you get back on insurance, but the out of pocket expenses for each and every blood test and appointment and scan do all add up.
I will get back to you in 20 more weeks and let you know how I get on, "in the system" !!
A very interesting post, thank you! x Rhi

Robynne's Nest said...

I can't possibly imagine electing to have a cesarean over a natural birth. Although a vaginal birth is painful...all is forgotten pretty quickly, whilst following major abdominal surgery a new Mum is in for quite a recovery. Ultimately, I think it should always be a woman's choice, as long as the babe is not put at risk. Having delivered 3 babies naturally, I look back on those births as the best days labour I've ever done! Robx
p.s. I did meet a lady in my village who chose to have her second at home as she would get 2 midwives instead of 1 at the hospital. She did point out that it helped that the nearest hospital was only 10 minutes away in case of an emergency situation. I was lucky enough in Australia to have all of mine privately which is not uncommon...and couldn't imagine not having my obstetrician present! Rx

Lydia @ Twelve said...

Tis all true - the Dr Name thingy - I learnt something as a student Nurse!

~♥~ Sara @ Doodle Dandy ~♥~ said...

It's so interesting to find out the differences between the system in the US and here in Britain. I have had two c-sections, my first was an emergency and my second was because I was told I couldn't go over 42 weeks and have a natural birth as my scar tissue may rupture. I have to say the second time around I was more aware of what was happening, possibly because the first time I had gone through a long labour and consumed quite a large amount of 'gas and air' that resulted in me vomiting water, and I was completely 'away with the fairies'. If I had been given a choice, I would have opted for a natural birth, that's what I had intended to do! People need to understand that a c-section is a major operation, they cut open your body, through muscle and it takes time to recover! You have to share a ward with 5 to 6 other women who snore throughout the night and keep you awake for at least 2 nights, and every time you need to use the bathroom you have to take an antibacterial wipe to clean the toilet before you use it (paranoid, what me?) MRSA people!!! So I guess what I would like to say about the decision to give people choice is, okay its your choice but its much quicker recovering from a natural birth!

Jane The Booklady said...

What an interesting post. I have had two babies here in England, one in hospital and one ( by accident) at home. Both were natural births. Many women do get to meet their midwives but because you never know when exactly you are going to give birth, you can't be sure who will be on call at that time. There simply isn't the room for husbands to stay in hospitals and of course there are wards, rather than private rooms, for the same reason... it's free, so the money isn't there to pay for luxury accomodation! The National Childbirth Trust is very active in parts of the U.K and is a great help to women who wish to have a more holistic birth/follow their own plans.I feel sorry for women who choose to have a c. section because of fear, there should be people there to give them healthy advice.

Ariana said...

I am not sure quite what to think about this! As someone who was unable to pay for midwifery care in the US and had to have a hospital birth, this is kind of surprising to me. I love that most care here is provided by midwives, and that natural seems to be the way to go. In my case, I believe it was all of the unwanted medical interventions (I was high-risk, and certain things were just protocol) that lead to my having a C-section. I know it would be hard to even find a doctor in the US that would be willing to do a V-Bac with me. I guess it's always nice to have a longer list of options, and I can understand that some might prefer a scheduled C-section. And the laughing gas sounds like a great a little assist to those that are needing a little relief while otherwise birthing "naturally!"

little macaroon. said...

An elderly and highly educated mother of three, who worked in the field of medical research, once put an interesting point to me re the mother's right to choose a c-sections. She felt that despite all the wisdom (received and otherwise) about a "straightforward natural" birth being what we as humans are designed to do, there is no other procedure (for want of a better word) in the medical realm where people are encouraged to buck up and get on with it in agony. Indeed, in any other specialty, to make a person experience unnecessary pain is immoral. Her point was that if women want to have a natural birth, that's fantastic. But if they want a spinal, epidural, section and morphine, then they should not have to justify their choice or show some sort of psychological trauma in order to have what is, in this day and age, pretty standard care.

Since we're here on the topic (and I guess I should dicslose that I've delivered "naturally" with little or no drama) I don't understand the curious double standard in the UK that women who have had a section first baby get to choose whether they'd like to opt for a second section or vbac (despite there being very few proven contraindications to vbac), but women who've had a "natural" birth first time round aren't given the choice for their second...

I'm not pro one thing or the other, but I am pro a person's right to choose (and not to feel like they've not done it "properly" if they choose a section, for whatever reason)

Pom Pom said...

I can't quite get my mind around the "too posh to push" thinking. Wow!
Thank you for an interesting post!

Eli said...

So glad you posted this, Laura. It is a fascinating conversation. I will say that giving birth naturally (just some IV meds) gave me a sense of "I am woman, hear me roar." Whenever I feel like something is challenging or scary, I say to myself, "Hey, I gave birth. I can do this!" Not sure it would have been the same with a C-Section so I'm glad that I did not medically need it.

Just something to think about. Miss you.

Iota said...

I think the fear issue is a big driver here.

Gas and air is fabulous stuff. I don't know why it isn't available in the US for childbirth, or why it isn't used for other medical procedures in the UK. (I think perhaps it is in dentistry?) It doesn't have any effect on the baby, works pretty much instantaneously, wears off in minutes... It's lovely lovely stuff. I'm a bit puzzled as to why we don't have it on the market as an alternative to alcohol. In my limited experience, a few breaths of it is like receiving the effect of downing a few gin and tonics, but instantly. It would get parties going much quicker, you're much more in control of the effects, you could drive home, you'd have no hangover. I don't know if it's addictive, but even if it is, it strikes me that it's much less potentially damaging than alcohol or drugs.

Happy Homemaker UK said...

Iota, I know - such a mystery why it isn't more widely used. I thnk in the US it is only used in dentistry. Why?

Sharon Parker said...

Fascinating conversation here — and I've actually read all the comments and found them all interesting. My two U.S. births, more than 20 years ago, were a mixed experience, with the second one ending in a c-section after an unsuccessful induced labor. I do have relatives here in Minnesota who've had elective c-sections, I don't think women have any trouble getting them if they want, and I share the mixed feelings that others have expressed. I do think women should have some control over their birthing options, but I feel like where we need more control is in those choices that lead us down the path to what becomes an emergency c-section. I certainly would have waited longer for natural labor to start with my son, who was over 42 weeks but doing fine, but it was like it made the doctor too uneasy and she just couldn't stand it anymore. Once they have you hooked up to their devices, it becomes a slippery slope to more intervention.

NotesFromAbroad said...

In the Northeast US where I lived , elective c-sections are commonplace.
I was all ready to go the natural route with my second child but his size and my size turned out to be a bit of a problem .. I would have much rather have had a c-section than the vaginal birth and subsequent ten thousand stitches after .. ( maybe I am exaggerating)

ann said...

Most interesting. My daughter is due in June. She will deliver in June with a mid-wife in a hospital. Oh. And my mom had that same suitcase. My little granddaughter has it now.

Barbara said...

I learned so much, although I think in the US it is also becoming more common place from what my friends tell me. I just had my second child in a French hospital and they definitely try to avoid c-sections at any cost. It is more about the health of the baby and the mother.

Beth said...

Very interesting topic Laura. In the UK I think the experiences of childbirth will vary dramatically depending on the location. For example the hospital where I had my daughter was quiet and even though I had organized for a private room I ended up not using it as I was the only person in a small section of the ward. I knew the registrar that delivered my baby as I had met him as part of the medical team prior to the birth.
In contrast, I know of others who lived in different locations opting for home births due to the terrible conditions in their local hospitals.
Things could have changed in ten years but c section births were discouraged in my pre natal conversations.
Fascinating reading through comments from different parts of the world.

Kris said...

I gave birth in the UK, and oh I absolutely hated the gas and air when I was in labor... I wanted to throw the thing in my midwives face - the way she kept trying to get me to use it! My vaginal birth experience was quite horrendous for me, and even a year and 4 months later it's still fresh on my brain... for that reason I might jump at a chance to have a c-section, but don't think I could justify having one unless there was a real medical reason.

Another very good post Laura. I love reading what everybody has to say about this topic.

Looking forward to Post of the Month!!

lizzybradbury said...

I do think it is rather strange that women choose to plan in their births by having an arranged c-section, I've even heard people planning it in so they can still go on holiday that year!!!

Very interesting post, I believe I need to have my first baby before seriously commenting on this topic!

Lizzy x

Great Scott said...

My husband and I are ready to get pregnant with number two, so I've read every word of this post as well as every comment - since I'll soon experience prenatal/birthing care through NHS firsthand! My daughter (almost 3 years old) was delivered naturally by a midwife in a hospital in America. As I understand it, the UK is very pro-natural birth (which is NOT the case in the USA), so that aspect appeals to me. The sharing the bathroom part, however, does NOT! I worked in a hospital (as an Occupational Therapist) before my daughter was born and am very well aware of how dirty they are and the idea of sharing a bathroom with 5 women that have just given birth...well, it kind of freaks me out! I feel stupid saying that but it's true. If I hadn't had complications after my daughter's delivery, I'd gladly hop on the UK "home birth" bandwagon just to avoid all the needles, knives, separation from husband (seriously...seriously??!!) and the germs! As far as packing my own supplies, I'd be happy to do it as it cuts down costs for NHS and makes the "healthcare for all" system possible - but it strikes me as odd that NHS doesn't provide gowns or sanitary pads but willingly increased the number of expensive elective surgeries and the days in hospital required to recover from it. Hmmmm....that doesn't make much sense.

Emily said...

This is such a fascinating conversation! I'm from the Southeast US, and I would say "elective" c-sections are almost unheard of (I've never heard of one, but I'm sure it happens in theory). Most everyone one I know uses the Bradley method or epiderul (sp?). I tried all of the above: Bradley didn't work after pitosin (sp?) kicked in, epiderul didn't take, and then after pushing I was rushed for an emergency c-section (which my husband is most grateful for, otherwise he would have lost me and baby). Many of my friends were able to do a v-back, but that wasn't an option for me. I cannot imagine choosing a c-section as a way to give birth! The recovery is difficult. Meanwhile, my Bradley-method sister-in-law got up to take a stroll and shower after delivering her baby. I, on the other hand, was in the recovery room (waiting for my blood pressure come back up) for 3 hours before holding / nursing my first. Then I had a few days before I could drive, a few weeks before I could enjoy laughing again, much less lift anything. Tell me, which would you prefer? Although, I have to say, at the end of the day, a mother is just overwhelmed with joy when her baby is safely in her arms!

Privet and Holly said...

This truly is fascinating, Laura.
I know a decade or so ago, my
friend in NZ said that it was "the
thing" to have home births. It
was so popular that birth
announcements in the newspapers
would always say something like,
"Baby Girl Jones, 8 lbs, 2 oz, born
at home on January 31." My
friend said that she was looked
down at a bit because she didn't
choose this option. I can't imagine
having to traipse down the hall
to use the loo after giving birth!
I kind of wonder if this is where
our US system is headed, though......

xx Suzanne

EnglandTripTips said...

Nice discussion. Our body is equipped with everything it needs to deliver a baby using natural methods, it also naturally copes up with whatever is required to be a great mum (breastfeeding) and so healing comes quickly (heaps of positive thoughts & expectations, good nourishment, exercise!)englandtriptips.com

Anonymous said...

It saddens me immensely when women themselves go up in arms against another woman's right to choose. It may not be an option you would choose, but why support a school of thought which bans other women from making choices they prefer?

To answer the question WHY would anyone choose a c section? Because, a vaginal birth comes with a long list of risks as well which many women prefer not to take. These risks are often underestimated and ignored but the fact us that they're very real. Not all women who opt for a c section are Madonnas looking to avoid stretch marks (which is rubbish anyway)

Here are the risks associated with vaginal birth for the baby-
1. Brachial plexus nerve palsy
2. Cerebral palsy
3. Brain heamorrheage
4. Spinal cord injuries
5. Intracranial heamorrheage
6. Shoulder dystocia which can cause the shoulder blades to fracture
7. Asphyxia and hypoxia which may cause brain damage and strokes
8. Epilepsy

Here are the risks to mothers with a vaginal birth-
1. Severe perineal tearing, which requires a long recovery period
2. Incontinence (anal and urinary)
3. Uterine prolapse
4. Rectocele and cystocele
5. Recto-vaginal or colorectal fistulas
6. Pelvic floor dysfunction
7. In extremely rare cases, the need for a temporary or permanent colostomy
8. Vaginal laxity
9. Sexual dysfunction (including the little known clitoral tears and lacerations)
10. Infection at the site of the episiotomy or perineal tear.
11. PPH is just as likely

A lot of the above conditions can deeply impact a woman's career, marriage, health and self confidence. They may also require major surgery to correct.

Yes, birth is a natural process, and women may have been giving birth without c sections for millennia, but not without complications and a fair share of morbidity.In the 1700s the maternal mortality rate was almost 35%. Until the 1980s, there was a procedure called a symphisiotomy which was used when a baby got stuck in the birth canal- it involved breaking the mother's pelvic bones to facilitate delivery and it left many women unable to walk with pain.

I am in no way implying that all women must have c sections. I am merely pointing out that the expectant mother alone has the right to decide how she wants to give birth- be it a home birth, a water birth, a hospital birth, a medicated birth or an elective c section.

I don't believe that surgery=evil. Yes, it has risks, but an informed woman planning on a small family is justified in making that choice.

The ACOG has stated in 2004 that physicians are ethically justified in performing non medical c sections on fully informed women.

Anonymous said...

Secondly, not all mums are wanting c sections just to plan around a date or for 'convenience'.

In my experience, women who opt for c sections are victims of sexual abuse, tokophobics, women who have had prior traumatic deliveries, or woman wanting only one child and preferring the risks associated with a c section.

Research has shown that forcing tokophobic women or victims of rape to give birth vaginally can affect their bonding with their baby.

Irrespective of what I'd choose myself, I'd never ever interfere in another woman's choice about something so personal.

Anonymous said...

Also think about it logically- how would someone plan a c section to go on holiday or a party? Any kind of birth comes with a recovery window, you can't just walk out of a hospital and into an airport (especially with a newborn!!). These kind of silly reasons are myths perpetuated by the media.

Most women who ask for c sections have valid reasons- they don't do it to plan a party or holiday.

Happy Homemaker UK said...

@ Anonymous: I think you are commenting on the comments? My curiosity is that it is a choice given to women in the UK but not in the US. I think it is wonderful that a cesarean is a safe option for women.

Anonymous said...

I think you are mistaken. USA has been allowing CDMR for fully informed women planning on a small family for several years now.

If you read the guidelines by the American College of Obstetricians and Gynecologists or the March of Dimes, you'll see that it clearly states that women are allowed to ask for cesareans and OBs can agree as long as the woman in question demonstrates that she is aware of the risks (informed consent as it would be for any procedure). The only stipulation is that the woman should not be planning on a large family, and that the cesarean should not be done prior to 39 weeks of pregnancy. If a doctor is not convinced that he should perform the CS, he is obliged to refer the patient to someone who will.

Remember also, that USA has private healthcare unlike UK. People have the liberty to choose their healthcare provider so it becomes easier to find someone who us on board with your birth plan.

I know several women with one or two children who had non medical cesareans in the USA, whereas my friend who is a rape victim was refused in the UK. These new guidelines will help people like her to have a peaceful birth experience.

Anonymous said...

For those who expressed concern about MRSA, they now offer antibiotics prior to the surgery which reduce your chances of infection and fever to almost nil. They meds are breastfeeding friendly and are quite well accepted by most women.
Let's also not forget that episiotomy stitches (or tears) can also get infected, so infection isn't a risk with just c sections.

I also noticed how someone admitted that even though her pelvic floor will never be the same again, she feels this is what we were "made to do". I will alter that slightly- the female body is certainly designed to give birth, but not always to bounce back to what it used to be.

For some women, the risks of surgery (such as infection, longer recovery etc) are preferable to living with pelvic organ prolapse, incontinence, obstetric fistulas, cystoceles, rectoceles or weakened vaginal muscles.

I completely understand those who prefer to go natural and avoid surgery, but I also understand why someone would prefer to do it differently. Not everyone is opposed to the risks of surgery, and not everyone views vaginal birth as a mandatory rite of passage.

Like sunshine in the home said...

I found it very surprising that any woman would elect for surgery, the thought of being sliced open by choice...shudder. But I realise that for some women it may be more distressing (or even dangerous to mother/baby health) to give birth vaginally.

Interestingly though, the benefits of a vaginal birth to both mother and baby are, in normal circumstances, higher than that of a caesarian. Mortality rates are better for vaginal births for both mother and baby. I do think that mother should be encouraged to give birth vaginally.

As an aside, a doctor is not more qualified when he has the title 'Mr' unless he/she is training to be a surgeon. In the training process a surgeon will start Mr/Miss, then become a Dr, then go back to being Mr/Miss/Mrs. However, if they are training in medicine then they will start Mr/Miss/Mrs and then become and stay Dr. The level of qualification depends on their job title, House Officer (foundation stage), Speciality Registrar (StR) and then Consultant. You also get some doctors who are staff or associate specialist doctors, they are non-consultant grade. You can be a consultant physician (Dr) or a consultant surgeon (Mr/Miss/Mrs). (I used to work for a university Postgraduate Medical Dean as her PA)

If you were having a surgical operation, and you want the highest qualified surgeon, you want a 'Mr/Miss' if you were being treated for a medical condition you want a 'Dr' - check his or her consultant status. NEVER suggest to a consultant that they aren't as qualified for their field because they aren't a 'Mr' (Miss/Mrs)! Only consultant surgeons are Mr/Miss/Mrs, physicians stay Dr. For your caesarian you would most certainly want a Mr/Miss! :)

Sorry if that's a bit long a convoluted.

Happy Homemaker UK said...

Glad this post still gets lots of reads & comments. I still have so much to learn about your system. Thanks for your thoughts

Lara said...

The maternal and infant mortality is NOT always better for vaginal births. The thing is, in most studies emergency and planned cesareans are put in the same category leading to a false comparison. Obviously emergency cesareans will have a higher mortality rate than normal births because they are done in complicated situations where lives may already be at risk.

A recent study by the WHO concluded that the maternal and infant mortality rates for a non medical planned cesarean were almost zero. The findings by the NICE were similar and the new Guidelines which allow cesareans on request are based on them.

I'm sure some people can't understand why I'd volunteer to have my abdomen sliced open, but I can't understand why anyone would be OK with third or fourth degree tearing, loss of vaginal muscle tone and pelvic organ prolapse. Fear is relative isn't it?

I disagree completely that vaginal birth is safer for babies. As a PP pointed out, vaginal births include risks like cerebral palsy, brachial plexus nerve damage, intracranial heamorrheage, brain injuries and worse. I'd take the risk if mild respiratory disorders any day over that.

BTW, I live in New York and I've had a fully elective c section. I don't know why the Happy Homemaker has assumed maternal choice c sections aren't allowed in USA? We were one of the first to declare them ethical.

Happy Homemaker UK said...

Perhaps it is regional in the US? I've never known a mom who was given the option unless indicated by a doctor/midwife in my part of the US.

Lara said...

No, it isn't regional. Read these links:



ACOG, NIH and March of Dimes have declared patient choice c sections ethical since years. The thing is, doctors will not offer it to you themselves. But if you ask for it and can demonstrate that you are fully informed they cannot refuse to respect your choice. If they do, they are obliged to refer you to a doctor who will carry out the procedure.

What part of the US are you in anyway? Maybe you haven't heard of women asking for c sections but the phenomenon has been going on for years- PARTICULARLY in USA.

There is a difference between the doctor giving every woman a choice and certain women requesting the procedure individually. You may not have been aware of it but America was one of the first countries to accept the practice and declare it ethical for informed women planning on small families.

Tess said...

C sections on request are definitely allowed in USA and it isn't regional at all.
I'm live in Boston. I was given a c section in 2009 because I requested it. I only wanted one child and I was very apprehensive about the risks associated with a vaginal birth for me and for the baby. It was a fully informed decision that had nothing to do with absurd reasons like scheduling the birth or avoiding stretch marks.

I couldn't be happier with my choice. I recovered really well! I was up and about the day following the surgery and I was shopping a week later. Don't believe all the horror stories you hear about c section recoveries. My daughter is happy and healthy as well and was brought into the world with minimum trauma. I wouldn't change my experience for the world.

Happy Homemaker UK said...

I think everyone is getting off topic. I am pro-Cesarean, first of all. I think it is wonderful that Cesareans are an option for women. I do not judge what option a woman chooses; that is NOT what this post is about. You do not need convince me that it is safe, a positive birth experience, etc when I already agree. Of course it is :)

And YES, women have been requesting c-sections to their doctors for ages in the US. Absolutely. But what has not happened in the US is doctors asking ALL patients at their very first consultation if they would like to birth naturally or c-section.

Lara said...

What you are saying isn't happening in the UK either. All midwives and consultants are not required to ask women which mode of delivery they prefer. Vaginal birth remains the default mode of delivery. The only thing the guidelines suggest is that if women request c sections themselves, their requests must be considered and taken seriously.

These are the actual guidelines-

"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. [new 2011]
For 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. [new 2011]
An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS. [new 2011]"

Nowhere does it say obstetricians or midwives will ask women at their first consultation how they wish to deliver. That's all media hype.

Even these guidelines are just guidelines. Hospitals and consultants are free to neglect them (as they often do) and refuse to perform the CS. Offering c sections to women who have valid psychological reasons to ask for them is a far cry from giving every person the option irrespective of whether she has asked for it.