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VB or elective c


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#26 Stylus

Posted 06 January 2019 - 10:53 PM

View PostERipley, on 06 January 2019 - 10:04 PM, said:


Medical staff have told me a few interesting things since a VB wasn’t even an option for me. These include the fact that women are pushed to have VBs because it’s cheaper and easier for hospitals (unless something goes wrong) but a C-section is safer for both mums and babies and obstetricians generally opt to have c-sections themselves because they know this. I don’t know if that’s true, it’s just what was passed on to me.


How horrific. I really feel for you! My experience in a public hospital ...yes, they seemed obsessed with a vaginal delivery. I have a few friends who have delivered there that have been offered c-sections, but their babies were all in distress (a different kind of trauma that I am lucky not to have experienced - although my baby came out quite floppy, so I think he was close). I had a number of risk factors for bad tearing and am now wondering why a cesarean was never offered when the delivery started going pear-shaped. I think they try to avoid them if at all possible!

#27 Lou-bags

Posted 06 January 2019 - 11:05 PM

Ah yes, the ol’ ‘hospitals pushing women c section/VB (because you hear both versions) despite it not being the best choice for them’ chestnut. How incredibly offensive to the medical staff who care for women and their babies!

OP there are risks and benefits to both types of birth. Some risks (like maternal death) are more catastrophic than others (pelvic floor damage for example) and I really think this is a conversation for your HCP who know your full medical history and can give expert personalized advice.

Anecdata nonetheless... my friend had 3rd degree tearing with her 2nd and was advised to have a c section for any subsequent babies. Actually, the OB told her she would have to have one. She got a second and third opinion, and these two other OBs told her that with the way she had healed and the circumstances of her tear that they believed she’d be fine with a VB. Her third was born vaginally with only grazing. Her easiest recovery of all three births.

I had an episiotomy with both of my babies so my personal experience is largely irrelevant, having never torn- except to say that my second birth was infinitely better than my first. This seems to be common. But obviously there are no guarantees in childbirth.

I don’t envy you having to make this choice! Good luck with whatever you decide.

#28 Stylus

Posted 06 January 2019 - 11:17 PM

View PostLou-bags, on 06 January 2019 - 11:05 PM, said:

Ah yes, the ol’ ‘hospitals pushing women c section/VB (because you hear both versions) despite it not being the best choice for them’ chestnut. How incredibly offensive to the medical staff who care for women and their babies!


Huh? I prefaced that comment by saying it was just my own experience. I'm not out to denigrate anyone. All medical professionals agree that I should have had a c section, so, yes, the recommendation of hospital staff to proceed with a vaginal delivery now seems unfortunate.

I don't think its offensive to state my own experience or  note that the hospital's preference for vaginal deliveries (as stated to me by a doctor that worked there...) had a very poor outcome for me, a person who actually tore and whose comments come from lived experience.

#29 Lou-bags

Posted 06 January 2019 - 11:45 PM

My comment was in response to that of a PP, and even then intended as mainly directed at whomever it was who told her that hospitals push for VBs because they are cheaper. I had quoted that passage but it got lost when I rewrote hastily while putting my kids to bed. I did not mean for it to appear I was questioning your experience at all, I’m sorry it read that way.

I must admit I’m confused by your last post though, where you’ve said all medical professionals agreed you should have had a c section- but then also say that the medical professionals at the hospital supported a VB at the time? Was it that with hindsight they felt you should have been given different advice?

It’s my opinion that the vast majority of medical professionals do their best to make the right call for their patient given their individual circumstances, preferences and medical indications. Of course there will be times when they get it wrong, or where things change rapidly and the outcome is not what everyone would have hoped for. I just think it’s an awful shame that there can rarely be a discussion about birth without someone throwing out accusations that medical professionals are acting against their patients best interest, and implying this is widespread.

Anyway, it was not my intention to hijack OPs thread. Sorry.

Edited by Lou-bags, 07 January 2019 - 01:26 AM.


#30 avocado toast

Posted 07 January 2019 - 05:35 AM

I had a 3rd degree tear for my first with a long recovery and my public hospital gave me option of vb or c for second and I chose the c section. Best decision ever!

#31 HolierThanCow

Posted 07 January 2019 - 07:10 AM

I think the PP who mentioned the public system pushing vaginal deliveries was just quoting what someone else had said to her (to be taken with a grain of salt). In her defence.

I agree that the vast, vast majority of medical professionals have patient best interest at heart and will do/recommend what is best, but a situation like the OP's doesn't have a clear path one way or the other with the information we have been given, IMO, and would have a good argument for both avenues being in the patient's best interest.

#32 Veritas Vinum Arte

Posted 07 January 2019 - 07:18 AM

I do know my elective (scheduled or would have been scheduled but baby decided on earlier birthdate so get to hospital for quick eviction) cs were easy recovery. I was always driving by 3wks but really my OB told me I was fine by 10d as I was walking around the neighbourhood pushing pram with NB and toddler. My cs recovery was much easier and quicker than GF with tears. I had 3 x cs for various medical reasons.



#33 ERipley

Posted 07 January 2019 - 11:45 AM

View PostLou-bags, on 06 January 2019 - 11:05 PM, said:

Ah yes, the ol’ ‘hospitals pushing women c section/VB (because you hear both versions) despite it not being the best choice for them’ chestnut. How incredibly offensive to the medical staff who care for women and their babies.

I didn’t mean to offend, and I had never heard of staff pushing for c-sections before. Why would they? It was medical staff who looked after me and my children who told me this, not just random people off the street. Maybe that was just their experience. I think the basic idea is as little intervention as possible unless there’s a solid reason to have a caesarean.

#34 ERipley

Posted 07 January 2019 - 11:58 AM

View PostStylus, on 06 January 2019 - 10:53 PM, said:



How horrific. I really feel for you! My experience in a public hospital ...yes, they seemed obsessed with a vaginal delivery. I have a few friends who have delivered there that have been offered c-sections, but their babies were all in distress (a different kind of trauma that I am lucky not to have experienced - although my baby came out quite floppy, so I think he was close). I had a number of risk factors for bad tearing and am now wondering why a cesarean was never offered when the delivery started going pear-shaped. I think they try to avoid them if at all possible!

Yes, they wouldn’t let me have one part way through either, even though he was facing the wrong way, contractions were all on top of one another from the start (18 hours with hardly a break at all) and no drugs. It was incredibly painful and I just felt like a number/piece of meat. They sent me home once and I stayed there unti it was even more painful, which was only about 3 hours but I could have done without the extra drive there and back in labour. They wandered in and out on occasion, mostly ignoring me, and even though the obstetrician was in the hospital all day she didn’t even come in to see how I was until I was ready to push. Then the rest of the drama.

I just remember the cesarean being so lovely and calm and happy. Everyone was so nice and caring.

#35 Lou-bags

Posted 07 January 2019 - 01:29 PM

View PostERipley, on 07 January 2019 - 11:45 AM, said:



I didn’t mean to offend, and I had never heard of staff pushing for c-sections before. Why would they? It was medical staff who looked after me and my children who told me this, not just random people off the street. Maybe that was just their experience. I think the basic idea is as little intervention as possible unless there’s a solid reason to have a caesarean.

Really? It’s a pretty widely share belief by many that private OBs push for Caesarean sections as they are more controlled, can be scheduled to suit OBs, earn them more money, will avoid weekend and late night deliveries and so on. The hospital I birthed at has a 57% caesarean rate- people are scathing in their comments about the doctors there.

Wouldn’t you agree, though, that less interventions is better unless medically indicated? (Or a patient has a strong preference?). I guess I don’t see that as ‘pushing a VB’ so much as providing evidence based best practice advice for patients, and is to be encouraged?

I do think that a frank discussion about the risks and benefits of both types of birth should be presented to all pregnant women. And their informed choices supported. I don’t see any issue with making the case for the lowest risk option is a problem though. Surely that is what we’d expect from all medical professionals regardless of the specialty?

Clearly some cases, like the OPs, are not straightforward and perhaps the case could be made for either option. Which is where is gets tricky. Because it’s a bit of a damned if you do, damned if you don’t for the OB.

Unfortunately for OP, she has a difficult decision to make and ultimately she’ll be the one who deals with the outcome. Which is why I said, and will repeat, that this is a decision she should make together with her OB or hospital staff- not EB- as they have all the facts and nuances of her own personal medical history and circumstances.

#36 Hollycoddle

Posted 07 January 2019 - 01:38 PM

View PostStylus, on 06 January 2019 - 10:53 PM, said:

How horrific. I really feel for you! My experience in a public hospital ...yes, they seemed obsessed with a vaginal delivery.

If there are no contra-indications for a vaginal birth then of course they aren't going to encourage a c-section (mine were both caesars, the first an emergency and the second an elective due to overdue and the hospital not wanting to risk induction).  I found our hospital to be quite risk averse when it comes to vaginal births and VBACS in particular, a few people I know who had babies around the same time as me had to have c-sections for various reasons. I have heard it whispered that at that hospital they do their c-sections on a Monday and Tuesday and that if looks like you might be at high risk of having to have one for any reason they will just go ahead and book it on one of those days anyway.  No idea if that's true or not, it sounds a bit flippant, like the old one about the patient booking in a c-section to fit with the rest of her plans.

Edited by Mollycoddle, 07 January 2019 - 01:48 PM.


#37 HolierThanCow

Posted 07 January 2019 - 01:54 PM

View PostLou-bags, on 07 January 2019 - 01:29 PM, said:

Wouldn’t you agree, though, that less interventions is better unless medically indicated? (Or a patient has a strong preference?). I guess I don’t see that as ‘pushing a VB’ so much as providing evidence based best practice advice for patients, and is to be encouraged?

I know this was't asked directly of me (reply was to ERipley), but the evidence as I understand it doesn't point clearly to intervention-free vaginal deliveries (i.e. the least intervention possible) being best for babies and mothers. It depends which risks each individual woman would rather take. Several risks associated with attempted vaginal deliveries have been mentioned on this thread (debilitating tears, poor pain management, episiotomy, prolapse, emergency caesarean section). It is perfectly reasonable to choose interventions that would reduce these risks (and many do). I know you weren't saying that they shouldn't/shouldn't be allowed to, but I fundamentally disagree with the premise that lack of intervention is inherently better.

#38 Lou-bags

Posted 07 January 2019 - 02:01 PM

View PostHolierThanCow, on 07 January 2019 - 01:54 PM, said:



It is perfectly reasonable to choose interventions that would reduce these risks (and many do). I know you weren't saying that they shouldn't/shouldn't be allowed to, but I fundamentally disagree with the premise that lack of intervention is inherently better.

Of course it is, which is why I mentioned patient preference in my post. This topic is more nuanced and complicated than simply VB vs C section of course and I was speaking more toward c section when I was speaking about intervention.

I had a number of interventions based on my own risk threshold, medical/pregnancy history and straight up preference (hello epidural).

There are risks to all interventions and obviously pregnancy and birth are risky in and of themselves.

I’m certainly not saying one kind of birth is ‘better’ than another. But I do believe that it’s entirely ok for HCP to recommend to women they avoid unnecessary intervention. The tricky part is deciding what is necessary!

I would argue my epidurals were necessary even though my first one put my DS1 into distress and landed him in the SCU for his first night. As an example.

#39 Hollycoddle

Posted 07 January 2019 - 02:14 PM

View PostHolierThanCow, on 07 January 2019 - 01:54 PM, said:

but I fundamentally disagree with the premise that lack of intervention is inherently better.

To be fair, she DID say that no intervention is better unless medically indicated.  All those risks you described sound like medical indications against VB so obviously it makes sense that a VB may not be the best option in these cases.

Edited by Mollycoddle, 07 January 2019 - 02:15 PM.


#40 HolierThanCow

Posted 07 January 2019 - 02:16 PM

View PostLou-bags, on 07 January 2019 - 02:01 PM, said:

I’m certainly not saying one kind of birth is ‘better’ than another. But I do believe that it’s entirely ok for HCP to recommend to women they avoid unnecessary intervention. The tricky part is deciding what is necessary!

Yes I agree, that's the problem. I would have three elective caesareans at 39 weeks if I had my time again (instead of just my third child). A crystal ball would be a wonderful thing to have when making these decisions.

#41 HolierThanCow

Posted 07 January 2019 - 02:27 PM

View PostMollycoddle, on 07 January 2019 - 02:14 PM, said:

To be fair, she DID say that no intervention is better unless medically indicated.  All those risks you described sound like medical indications against VB so obviously it makes sense that a VB may not be the best option in these cases.

No, I was saying they were things that could happen during a planned vaginal birth without prior medical indications (i.e. not indicated until they happened). I was saying women might choose the risks of an elective caesarean over those and other risks of a planned vaginal birth.

I wasn't trying to attack Lou-Bags. It's almost impossible to discuss this kind of topic without sounding combative, but it wasn't my intention.

#42 Lou-bags

Posted 07 January 2019 - 02:33 PM

View PostHolierThanCow, on 07 January 2019 - 02:27 PM, said:


I wasn't trying to attack Lou-Bags. It's almost impossible to discuss this kind of topic without sounding combative, but it wasn't my intention.

You’re all good. I know I’ve prob come across harder than I’ve intended so I do try to remind myself to give posters the benefit of the doubt and not read too much into the way things have been phrased.

A crystal ball would be super! I’d change nothing much about how DS2’s birth was handled, but my first birth? If only I’d known so many things! Such is life.

#43 ERipley

Posted 07 January 2019 - 03:35 PM

View PostHolierThanCow, on 07 January 2019 - 02:27 PM, said:



No, I was saying they were things that could happen during a planned vaginal birth without prior medical indications (i.e. not indicated until they happened). I was saying women might choose the risks of an elective caesarean over those and other risks of a planned vaginal birth.

I agree with this. At no point during my first pregnancy did anyone say, “here’s a list of all the possible negative outcomes of a VB and the statistics for each, here’s the same for caesarean, and after you’ve weighed it up let us know which you prefer”. There’s so much talk about how great and natural and wonderful a VB is, but with babies getting bigger and healthier the risk is increasing. Personally I would like to have been armed with all the information possible to make my decision but my obstetrician basically acted like it’s total nonsense worrying about these possibilities. She certainly changed her tune.

#44 tinselfoil hat

Posted 07 January 2019 - 04:29 PM

View PostERipley, on 07 January 2019 - 03:35 PM, said:



I agree with this. At no point during my first pregnancy did anyone say, “here’s a list of all the possible negative outcomes of a VB and the statistics for each, here’s the same for caesarean, and after you’ve weighed it up let us know which you prefer”. There’s so much talk about how great and natural and wonderful a VB is, but with babies getting bigger and healthier the risk is increasing. Personally I would like to have been armed with all the information possible to make my decision but my obstetrician basically acted like it’s total nonsense worrying about these possibilities. She certainly changed her tune.

Shoutout to RBWH birth centre - I was given a booklet which had stats on various choices related to birth and their outcomes. It really helped decision making and helped me know that although my DD’s birth went pear shaped, statistically it was the best possible chance I had at a boring birth. I think every woman should get this basic information.

#45 Soontobegran

Posted 07 January 2019 - 05:01 PM

View PostERipley, on 07 January 2019 - 11:45 AM, said:

I didn’t mean to offend, and I had never heard of staff pushing for c-sections before. Why would they? It was medical staff who looked after me and my children who told me this, not just random people off the street. Maybe that was just their experience. I think the basic idea is as little intervention as possible unless there’s a solid reason to have a caesarean.

From my experience pushing anything is not really a 'thing'. Suggestions and recommendations are not always what we want to hear however the risk from any type of delivery these days for mum and baby is at an all time low and medical staff like it that way.
If someone 'pushes' you for a C/S it will be because they think it is best practice....not because they want a few more dollars. If someone 'pushes' you to have a vaginal birth it is generally because they believe you will be able to do so safely. Very occasionally they are wrong.

People often underestimate the damage that can be done to a perineum. I have seen surgery that is far more complicated on a perineum than on a straightforward C/S. You hear C/S being called major surgery.....so then is a vaginal repair......
Yes a C/S is more costly for a public hospital but then ongoing care for obliterated perineums is too.

C/S are a necessary evil, some people have them when they 'should' have delivered vaginally, some people deliver vaginally when they should have had a C/S.

#46 Contrebasse

Posted 07 January 2019 - 05:48 PM

I had a third degree tear with a long recovery, and my pelvic floor will never be the same again.

Second time around I had an elective C - calm, peaceful, pain very well managed. A much better recovery really. Only lasting effect was occasional slight itching at my scar for the next year. Oh, and not being able to lift the toddler for 6 weeks was a non-issue, I was already not supposed to lift her due to pelvis issues and damage from the first birth.

#47 cabbage88

Posted 07 January 2019 - 06:56 PM

View Postalfoil hat, on 07 January 2019 - 04:29 PM, said:



Shoutout to RBWH birth centre - I was given a booklet which had stats on various choices related to birth and their outcomes. It really helped decision making and helped me know that although my DD’s birth went pear shaped, statistically it was the best possible chance I had at a boring birth. I think every woman should get this basic information.

That is so brilliant. Those sorts of stats are hard to find but so helpful because when it does go pear shaped it puts it in perspective -"such and such happened but I took that chance and I unfortunately was the one in 20".
I have genes for allergies and intolerances (as does hubby), and one of the few things that increases the risk of these  genes actually being active is Csect (and antibiotic use at birth I would imagine too). So my VB dd1 was fine, but c sect DD2 and DS both had several allergies and intolerances. I just can't help but wonder if I was able to VB could I have avoided all the drama? I'll never know but I'm adamant on VBAC for my current cooking bub. We'll see if my hunch is right!

#48 Stylus

Posted 07 January 2019 - 07:36 PM

View PostLou-bags, on 06 January 2019 - 11:45 PM, said:


I must admit I’m confused by your last post though, where you’ve said all medical professionals agreed you should have had a c section- but then also say that the medical professionals at the hospital supported a VB at the time? Was it that with hindsight they felt you should have been given different advice?


Correct.

I agree that the medical profession has our best interests at heart - but sometimes, despite those good intentions, there are still poor clinical outcomes. To share an experience of how a hospital's stated preference for vaginal births led to one of those adverse outcomes does not invalidate the other amazing work that profession does.

#49 Stylus

Posted 07 January 2019 - 07:38 PM

View PostMollycoddle, on 07 January 2019 - 01:38 PM, said:


If there are no contra-indications for a vaginal birth then of course they aren't going to encourage a c-section (mine were both caesars, the first an emergency and the second an elective due to overdue and the hospital not wanting to risk induction).

Sure. But as the rest of my post explained, they didn't encourage sections even where vaginal birth was contraindicated.

#50 MwahMum

Posted 07 January 2019 - 10:19 PM

Gosh, just catching up on all the posts.

Thanks all for your generous stories and views.

A PP has captured it well: I do have options, my treating team will advise, we'll make a plan and then adapt it if need be.

I'm leaning towards the VB for now, but will see if the advice changes, or I feel differently  as we get closer.

I'd really like my decision to be a positive intentioned one, rather than one driven by fear.

I have two very useful pieces of advice above that I will use:
1. Seek clarity on the hospital's position re: VB or c sec
2. Have scar reviewed by pelvic physio (or Ob?) to help inform decision making.

Without the comments above, I wouldn't have thought of these two things. Thanks again all xxx




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