The blatant misogyny of “too posh to push”

Sad and stressed pregnant woman

Oxford University Hospitals, in violation of UK medical guidelines and a recent British legal case, has banned maternal request C-sections.

A major hospital trust has banned women from having caesareans unless there is a medical reason.

Oxford University Hospitals will not offer them to those who are frightened or have had previous traumatic births…

The trust’s policy breaches guidelines from health watchdog Nice, which say women should be allowed a caesarean without a medical reason once the risks and benefits have been explained.

Why? Is it to lower costs? Is it to meet C-section targets?

It’s about punishing women for having sex.

Oxford University Hospitals said its decision was ‘not related to targets but to good practice and reducing harm to women’.

The trust’s Dr Veronica Miller said: ‘A caesarean section which is not clinically indicated may have serious consequences for a woman and her baby.’

Caesareans take longer to recover from than natural births. The wound may cause severe pain and some women need to be in hospital for three or four days.

Oh, it’s paternalism! The administrators are substituting their judgment for women’s needs and desires since they “know better.”

But, but, but safety. Are they banning homebirths for those who don’t meet safety guidelines. No, they’re not. Any woman can still have a homebirth regardless of the risk, so clearly this is not about safety.

But, but, but the incision may cause severe pain. So women ought to be protected from the pain of C-section by being forced to endure hours of agony in labor?

A C-section may have serious consequences for mother and baby? No more and no less than vaginal birth. C-sections are definitely safer for babies, protecting them from birth injuries and potential oxygen deprivation, and they can be safer for mothers, protecting them from debilitating lifelong consequences like incontinence and painful sex.

So if Oxford University Hospitals’ decision is not about safety and not about protecting mothers and babies, what is it about?

The vitriolic comments to the article and on a Facebook post discussing the decision make it quite clear: it’s about punishing women for having sex.

0E4F7D41-E833-4BBA-8599-65ED99CBA895

Too posh to push!!

Another comment in case that one was too subtle:

If you don’t want a baby as nature intended, don’t get pregnant. Life isn’t about everything your own way. For gods sake you’ve had the sweet, now time for the sour.
Women of today,you want all your own way.

Nature wants women to suffer:

I think some people are missing the point on here…women have been given birth naturally for years and years and they all knew what pain was in front of them and considered it a small price to pay for the little bundle at the end…

And:

If someone chooses to have a caesarean then they should pay for it. All none medical surgery should have to be paid for.

In other words, you chose to have sex, you must take the punishment. “You’ve had the sweet, now time for the sour.”

The idea of labor pain as punishment for women who have sex is as old as the Bible. The pain of labor was so impressive to our Bronze Age forebears that the only explanation they could think of was that it was a punishment for sex meted out to Eve and all her descendants. The idea of labor pain as punishment was so powerful that it was harnessed by the founder of natural childbirth, Grantly Dick-Read, for his own ends; according to him pain was the punishment for “over-civilized” white women who strayed from the home to pursue political and economic rights.

The ugly misogyny of insisting that women must suffer the excruciating pain of labor and expose herself to the risk of life long incontinence and sexual dysfunction is captured by the phrase “too posh to push.”

Are men who take pain medication for broken bones “too posh” to endure the pain? It would be heartless to claim that.

Are men who choose less invasive treatments for prostate cancer “too posh” to deal with the lifelong incontinence and sexual dysfunction that may result from more aggressive treatment? That would be a cruel to conclusion to draw.

Aren’t people who suffer the agonizing pain of advanced lung cancer avoiding the natural result of smoking? Shouldn’t they be forced to endure the pain or pay out of pocket for pain relief? Only a vicious person would be believe that.

The phrase “too posh to push” is equally heartless, cruel and vicious. But there is such a deeply embedded cultural prejudice that women deserved to be punished for having sex that even the Oxford University Hospitals see no reason to respect a woman’s wish to avoid the agony of childbirth and the resulting lifelong injuries.

That’s not good healthcare; that’s blatant misogyny.

  • Kay

    I live in Oxford, and am 31 weeks pregnant with my first. I’ve been told that my options are one of 3 midwife-led birth centres, each a 30+ minute trip away from the hospital, home birth (!) Or the birth centre attached to the hospital.

    I asked in one of my first appointments what the better option would be and my midwife said scathingly “people think that they can go to the hospital and just pop down to the ward for an epidural if it gets too tough, but that’s not what they’re their for!’ I was told at my last scan that my placenta is low lying, and so far nobody has even discussed a c-section with me beyond saying that ‘It’ll probably move so we don’t need to think about it yet.’ I’ve been to view a stand alone birth centre and, whilst the midwives were lovely, the main benefits they talked about were how they had a nice view out of the windows and could make me toast after delivery! They also keep saying that a big bonus to birth centres is that I’ll be sent home after 4 hours as the midwives will be going home after that long!

    I asked how fast an ambulance could get me to the hospital in an emergency and the midwife there said ‘well there’s usually one around the area dealing with something or other, but it rarely happens, so it’s nothing to worry about.’ I’ve also been told that I wouldn’t enjoy an epidural because it would give me an achey back!

    I feel like they just won’t discuss any outcome except a lovely calm water birth, which is not very reassuring for someone facing a complete unknown situation. I’ve found the lack of discussion about options to be very difficult, and feel like I’m expected to make up my mind with little knowledge about any outcome other than what they clearly think is the best one – midwife led centres with birth pools but no pain relief or doctors available. Not surprised that Oxford hospitals have this stance about c-sections :/ they also have poster stuck all over the maternity section on how bottle fed babies are less intelligent, more obese, etcetera, and I feel like that’s the next battle waiting for me.

    • MaineJen

      I hate that you have to fight for pain relief. This is exactly why I didn’t want midwives or a birth center!! I think if you want pain relief, sadly, you have to start fighting for it now. I also wish you could choose to give birth in a hospital. Why do British midwives hate women so much??

  • suzanne

    Re: the smoking analogy, yes there are people who believe a smoker who develops lung cancer should be made to suffer either by being denied treatment or being forced to pay for all of it themselves.
    Those people are as vile as the commenters on the Facebook post above.

  • rox123

    I had an MRCS two months ago and I recovered beautifully! No regrets with me. I had to go private (not in UK) and it was a breeze.
    People trying to convince me into a natural delivery kept telling me I wasn’t properly informed on the risks of C section! But they didn’t inform me on the risks of vaginal birth either, only because it’s the default birth route!

  • borkborkbork

    So, there all over the world there are women who serve in combat situations, women who work as first responders, women who do solo wilderness treks in extreme conditions, women who are competitive athletes and women who play extreme sports, Women who perform heavy manual labor, women who have survived life-threatening accidents, women who have survived brutal rapes and assaults, and women who have have never had access to pain relief when having their wounds sewn up or their broken bones set.

    Many of these women also describe childbirth and the most difficult, painful, frightening experience of their lives. Many of these women want access to elective c-sections. Are they “too posh to push” ?
    Is it reasonable to believe that these women can’t handle the pain or the effort or messiness required to birth a baby?
    No. These women are making a calculated decision, after weighing the pros and cons of surgical intervention.

    • Anna

      Great point! And could it be that some women experience things differently? So that one woman feels excrutiating back labour while another finds its quite manageable with a baby in a good position. I know many women that have breezed through childbirth that would struggle to swim 2 laps of a pool or do a 3-4km walk on flat ground. And vice versa – you can be a world class athlete and super healthy and your baby may not just fall out easy peasy. Doesn’t mean you’re weak, or a sook, or too posh to push!

      • borkborkbork

        Very true. 🙂

  • Roadstergal

    I could make a sarcastic comment about how it’s not ‘real’ trauma because it’s something that happened to women, but I can’t even joke anymore.

    Like the Republican legislators who said that a mandate for a non-medically-necessary transvaginal ultrasound prior to an abortion was no big deal, because women had already had a dick up there. This is almost exactly the same argument, but for birth. It’s not even snark-able anymore.

    • Empress of the Iguana People

      The TVUS is definitely -not- the same as having fun with your partner. Obliging a woman to submit to one in addition to everything else is petty, cruel, and bearing, to me, an uncomfortable resemblance to assault.
      Besides, just because you see a little flutter from a 6wk old embryo doesn’t mean it registers as a person. I saw both my (very wanted) kids at that stage and they both looked like single cell pond denizens to me.

      • Petticoat Philosopher

        I wouldn’t say it resembles assault, I’d just say it is assault–it’s non-consensual penetration or, at least, coerced penetration. And, like Roastergal says, it really is often justified as “Well, she’s already had a dick up there, so maybe if she didn’t want this, she should have kept her legs closed.” Which is pretty damn rapey.

        • Empress of the Iguana People

          Anti-vaxxers throw that comparison about too freely, so I was trying to be cautious.

        • sdsures

          I prefer the terms “medical malpractice”, “coercive”, “medical assault”, “abusive” and “judgmental” in this instance, to the term “rapey”. It’s the professional level of vocabulary you expect from health care providers when discussing sexual assault.

        • sdsures

          “No man enjoys having a prostate exam, so maybe he shouldn’t use it so often.” would be the equivalent comment about a male patient.

          We don’t hear that one quite as often, do we? :'(

      • sdsures

        My TVUS was not fun, particularly because I have vaginismus. :'(

        • Petticoat Philosopher

          I’m so sorry. 🙁 The nearly complete lack of open discussion of or research on vaginismus is a whole ‘nother rant.

          • sdsures

            The good news? Whilst the procedure was extremely difficult, my husband was great support, and the technicians (doctors? nurses?) were wonderfully kind and helpful considering the rather unusual circumstances of doing a TVU on a patient with PCOS, sexual assault PTSD, vaginismus AND spastic quad cerebral palsy. My hip adductor muscles are *very* tight, so unclenching everything (hips, plus the completely separate issue of clenching in vaginismus) in order to get anything where it needs to be takes patience and practice. Even so, I can’t get my legs apart far enough like most women can in order to put feet in stirrups, so we improvised with a lot of wiggling and adjustments.

            IIRC, we had to try the procedure 2 different ways – first with drinking a bunch of water before the TVU, and then again after emptying the bladder. For some reason, a full bladder is useful for seeing anatomy?

        • Empress of the Iguana People

          That sucks.

    • Petticoat Philosopher

      Don’t even get me started on the mandatory transvaginal ultrasound, “Well she’s already had a dick up there” argument. The point is, assholes, I get to decide what goes into my vagina, and consenting to penetration from a particular dick at a particular time (if that’s even what I did, not all pregnancies were conceived consensually), doesn’t now mean that I’ve given standing consent to being penetrated by anything else anyone wants to jam up there any time. That’s what consent is.

      And yeah, some of those comments up there seem to think in a surprisingly similar way to the defenders of the unnecessary TVUS.

  • Roadstergal

    OT – I recently recommended the Parenthetical Science podcast in another post, as one put out by a group I follow on Facebook that I have generally really liked. I mentioned that their first ‘full’ podcast was slated to be about childbirth, and that I hoped it would live up to the standards that the Facebook page had demonstrated to date.

    I downloaded it, and the guest is our very own Dr T!

    I’m listening to it now – she is very much on point, speaking in a concise, clear manner that gets the broad intent across well.

    • momofone

      I’ve been listening too. I love her calm, rational manner and the way she consistently debunks woo.

    • MaineJen

      *Adds Parenthetical Science to already-too-long podcast roll*

  • Annabel

    Maybe not misogyny. Quite possibly the hospital wants to save money and unnecessary theatre time by removing more ‘non-essential’ operations. NHS resources are always stretched.

    • Charybdis

      But people seem to have a high regard for the NHS, nonetheless…

      • Annabel

        Of course, we are very proud of it. But it needs more generous funding from the government and better management. In the meantime, services can struggle. Elective caesarians are not the only female-related services to be cut by hospitals – in some areas NHS fertility treatment is either heavily restricted or totally absent. Again, contrary to NICE guidelines.

        • Sarah

          It does need more funding, most definitely, but there’s also the short sightedness of the idea that forcing already traumatised and frightened women to attempt vaginal delivery is going to automatically be cheaper.

      • maidmarian555

        The NHS is very highly regarded by most British people because, despite its faults, we almost all know someone who was saved by it. My Dad was a long-term alcoholic with multiple mental and physical health issues. The NHS (eventually) got him sober and well enough that I had five final years with him where we made peace and I got to see the man I always knew he could be if he’d just stop drinking. Without it, he’d have probably died before I was born. The current government are deliberately starving it of funding, which is part of why trusts are making apparently bizarre decisions in order to save money short-term. I am mad about some of the treatment I received during my pregnancies, but I also really appreciate not getting a bill for thousands of pounds afterwards. I am grateful that if my children get sick, we can take them to the doctor without worrying about what they might find. I think most people here have similar feelings. We’d rather have this flawed system than have people die because they can’t afford a GP appointment.

        • Sarah

          Oh certainly. And my own experience of NHS obstetrics, and that of most people I know, is that they’re much better when the shit is hitting the fan than when it isn’t. I would have a dead child were it not for the NHS.

          For those who aren’t in the UK, there’s also the climate this discussion is taking place in. One of deliberate government reduction in funding of the NHS, the aim being to take it from around 8% of GDP to 6%. Against the wishes of the majority of the population. This is to try and introduce more privatisation, and running the NHS down and eroding public confidence is a deliberate tactic. Make it seem like the whole thing is unfixable. So it’s hard to be critical because we know that when we are, there’s a risk of what we say being used to try and erode the NHS instead of improve it.

        • Lilly de Lure

          Agree absolutely – the problem as I see it is that in maternity care we have a double pronged issue at the moment. On the one hand we have the chronic lack of funding that affects just about all of the NHS right now but on the other we have an ideology affecting a specialty which is allowed to spread largely unchecked. It is not the NHS we are attacking when we go after that ideology, but merely the specific outlook of a group of practitioners within it. I want NHS maternity services to continue absolutely, I merely wish the current policies that govern that provision to change.

          Complicating this issue however is the way in which the two prongs of the problem intersect. If you are a hospital or NHS Trust manager desperate to save money it is now hugely tempting to go along with the natural birth agenda (particularly if you are prone to short term thinking, which a lot of them are) and restrict access to expensive c-sections, epidurals etc and try to funnel as much care as possible to cheaper midwives. Not only are the costs superficially much less but the professionals who normally raise all kinds of hell about cost cutting are actually applauding you and any patients that complain can be labelled as wimps, divas and too posh to push and ignored. Of course this will bite you in the arse when you have another Furness General Hospital on your hands or the compensation bill gets huge but by that time you will have had the policy in place for several years.

          • Sarah

            And you might well have moved on to your next managerial position then, of course.

          • maidmarian555

            Exactly this. For me it feels like the current midwifery leadership are merrily handing Jeremy Hunt the bullets for his gun. Whilst complaining that if he didn’t have a gun, handing the bullets over wouldn’t be a problem. And anyway, those of us complaining about those bullets are just massive wimps and being shot isn’t that big a deal anyway. It’s incredibly frustrating to watch. If they could just see that they’re part of of the problem, we might have some hope of making progress but they’re providing so much negative publicity regarding the NHS and refusing to take any responsibility for that. It feels like every day there’s a new trust caught in a dead baby scandal, with the obligatory cover-up (which is the bit that really gets everyone raging). There needs to be some really hard introspection within the profession. And probably a big change in their leadership, frankly.

          • Anna

            Bang on again.

          • Anna

            Bang on!

        • Charybdis

          That sounds like the “but all xxxxx’s (midwives, chiropractors, LC’s, doctors, etc) aren’t bad” argument we hear a lot.

          I’m truly not trying to be argumentative about it. I do see the appeal/usefulness of having a universal health care system. It just seems that there is a lot of gatekeeping and rules similar to HMO’s here in the States. The fact that you *can* get wonderful care in some areas doesn’t change the fact that it is difficult to get the care you want in the areas that you need the care in. It doesn’t matter if the cancer treatment you can get is stellar, if you need prenatal care or reconstructive surgery and those are less-than-stellar treatment areas. Or if you have to constantly fight through “step therapy” for effective medications or have to fight for things not deemed properly “cost-limiting/saving”.

          And funding healthcare is a minefield any way you slice it. Short-term savings that set you up for long-term increases in cost of treatment is incredibly myopic. So they save money by denying epidurals, denying elective CS, pushing midwife-led care, home births and/or deliveries at MLU birth centers.
          The long-term cost is a lot higher due to pelvic floor damage, instrumental deliveries instead of CS, hypoxic damage, NICU stays, etc, but no one talks about that. It’s all “NOW” thinking. Instead of investing in the long-term savings that can have larger “right now” costs, they are robbing Peter to pay Paul so things look better NOW.

          Healthcare funding needs to increase and/or a good, hard look needs to be taken regarding how the limited resources are divvied up. It is a hydra of a problem and one with no simple, immediate solutions.

          • Sarah

            The other things you say are correct, but I can’t see how this is a Not All Midwives Are Like That discussion. Seems a non sequitur.

          • Charybdis

            I meant more that it seemed as if people were saying that “the NHS isn’t all bad” whilst mentioning ways in which it IS less than desirable. Just seemed kind of odd to me, that’s all.

          • Sarah

            I think a better way to look at it would be that the majority of people (though not all by any means) love it despite knowing full well there’s a lot wrong with it. The coverage of the problems in the NHS at the moment is pretty widespread, so any British person not knowing about them would have to be paying zero attention.

            I have a loved one who is receiving end of life NHS care at the moment btw. It may be that this is also impacting the way in which I am expressing these ideas at the moment.

          • maidmarian555

            The thing is that they aren’t proposing moving from universal health care to a model of private insurance and private healthcare like the USA. They are planning on contracting out existing services for *less* money to private firms. Who also will be creaming a profit off that. We’ll still have to pay tax and NI as usual, it’s just that rather the vast majority of any healthcare you need being provided by your local trust, you’ll have one firm in charge of paediatrics, one in charge of maternity, somebody else responsible for blood testing etc etc. This is already happening. Having private insurance or the ability to pay won’t make any difference and you won’t be able to shop around either. They’ve already taken this selling off services in a peacemeal approach in education, the rail network, water, fuel etc etc. I can’t think of one case in which it’s not been a fucking disaster for consumers. Schools have been handed back, for example, with a ton of debt because the contractor transferred other business debts they had to that school and then decided they didn’t want the contract any more. The children living in the catchment for those schools have no choice about going to that school, even if it’s on it’s knees and they can’t pay the teachers. Everything you’re saying has validity but when we talk about privatising healthcare here, we’re talking about the system being chopped up, less accountability than there is now and a complete lack of continuity of care with no choice for us as patients. None of the problems you’ve raised are likely to be addressed by the proposed changes, if anything what we’ll end up with is a much worse system than we have now.

          • maidmarian555

            We are also horrified when we read stories about how many people go bankrupt in America every year because they can’t pay their medical bills, of course. People here feel quite strongly that shouldn’t happen. Ever. It feels unimaginable to us. I think most of us would rather pay a bit more tax and have the government invest properly in the system we have to make it better. Which they absolutely could do.

          • MaineJen

            There are many over here who would gladly pay a few more taxes if it meant we could actually go to the doctor/emergency room when we needed to, without having to weigh if it’s “worth it.” i.e. Am I really that sick? Can I afford the time off at work? This is going to cost a bunch, maybe I can just tough it out at home…

          • maidmarian555

            Yeah I think that’s one of the biggest differences and people here really appreciate that. When we talk about our flawed system, we know it has faults but also that if an emergency happens, you’ll be patched up. In the two years since he’s been born, my son has had a chipped tooth, a pulled elbow (including an A&E visit) and bronchiolitis. Plus all his vaccines and standard baby doctor visits. It has cost us £0. When he pulled his elbow and just stopped moving his arm, we took him right in and didn’t even consider waiting to make sure he was hurt. That peace of mind is so important. It’s also cultural, we’ve all grown up with this system and we have been taught to appreciate how important universal care is. It’s a privilege to have this peace of mind if you get in a car wreck tomorrow. You know you’ll be fixed and not bankrupted just because something awful happened to you.

          • Sarah

            Although as people here don’t necessarily get sick pay (statutory is only £80 a week, which is better than nothing but not enough in many cases) there is also the time off at work issue in the UK too. We’re by no means perfect, though I do appreciate that this is still better for poor people than no sick pay and no medical care.

          • sdsures

            The simple difference is that under the NHS, you WILL be seen for your ailment in the appropriate time interval, and you won’t be bankrupted by it.

    • Roadstergal

      Is ELCS more resource-intensive in the long run, though? If you count various injuries, short- and long-term, to the downstairs, and the childbirth injuries that are generally avoided with pre-labor C/S, not to mention the ability to schedule around the staff…

    • Amy Tuteur, MD

      If they wanted to save money, they’d ban homebirth which requires two midwives/patient instead as compared to the hospital where one midwife can care for multiple patients.

      • Sarah

        Although they at least don’t appear to have a freestanding MLU- we know how underused and thus expensive they tend to be.

        • Anna

          Do you know why the MLU are under utilised? Here in Australia if you want to get in to the birth centres attached to big hospitals you need to apply before you swipe right apparently. Wouldnt every woman in the UK be flocking to MLUs? After all, “ALL” women want a low intervention birth experience according to NCB midwives right?

          • Sarah

            Well it’s not because low risk women aren’t encouraged to use them, I can tell you that!

            Basically two reasons I would say. The first is that they, quite rightly, have strict initial risking out policies. Mother and baby both low risk, singleton, BMI between 18 and 35, no VBACs etc. Hence the decent stats. So there will be some women who would want to use them but who don’t fall into that category. And it’s not like with homebirth where a woman who isn’t low risk can still just defy medical advice and stay at home- you can’t make the NHS let you into a freestanding MLU. Unless you turn up crowning I suppose. I’m not sure what percentage of the birthing population are excluded before they even go into labour, but it must be at least a significant minority.

            The second is the popularity of hospital MLUs. There are lots of UK women who do want midwife led care, low intervention etc, but the majority of them also want to hedge their bets and have it down the corridor from an operating theatre should things go tits up. It’s seen as a best of both worlds option even by some lightly NCB/woo women, as well as those who just don’t fancy an epidural.

          • Anna

            Ahh. I didn’t realise they weren’t connected to the hospital. Birth centres here are almost all connected to the hospital and they are very popular but Home Birth is a minority choice, less than 1% of the population. Shows that people would like to have the monitored water birth, with the LED candles but still have the OR up the hall. Our system is such that women can’t demand a high risk homebirth, but there are midwives desperately trying to wind back the restrictions to allow it and some will try to fudge the guidelines, claiming loopholes etc. I recently read the findings of the health care complaints commission into a dangerous high risk home birth that resulted in the death of a baby and they took a very dim view of this idea that women can define risk themselves based on their own “research”. I found this heartening.

          • Sarah

            Yeah, we have both hospital and non-hospital MLUs and shockingly enough, the hospital ones are much more popular! Important to know, in fact, because pro NCBers often talk about the popularity of midwife birth in the UK without bothering to mention that this is still mostly offered in hospitals. Very disingenuous.

          • Anna

            Yes! the loudest NCB midwives here are the same. They claim all women want/need a system similar to the UK and NZ. Some of them actually say their personal ideal would be everyone goes to a midwife, who is self employed and has no-blame accident insurance then its up to her whether she is high risk enough to see a Dr and if the woman wants she can choose to birth at home, or in the hospital, regardless of risk. Yes, some babies and some women may die, but its a risk they’re willing to take!

          • PeggySue

            Whoa.

      • ukay

        Or save on compensation…

    • Sarah

      The problem with this idea is that stopping MRCS doesn’t necessarily save money. As per NICE. You probably know that the really expensive births are instrumentals and EMCS, both of which usually require theatre time and are consequences of attempted VB.

      • Ms. Sweaterfan

        Great point! I had a very long induction, including 2 rounds of cervadil and then roughly 24 hours of pitocin + epidural and was in the hospital for about 3 days total start to finish, seeing at least 6 different doctors/residents and countless nurses. The insurance statement I got said that my hospital stay cost over $33,000 (this was in the US – I have great insurance through my employer so I paid $0). I’m genuinely skeptical that a scheduled C-section would have taken any longer or cost any more money.

        • Sarah

          One suspects not. Additionally, in a socialised system, dealing with the after effects of non-straightforward VB is all of our problem because we all pay for it.

        • Eater of Worlds

          I think in the US a vaginal birth runs about 10k and a c-section 15k (that your insurance is billed, we all know that’s not the actual real cost). So your vaginal birth was more than twice the cost of a c-section and took up space that the hospital could have used for another paying client. I would suspect they could have put another person in that same bed if you didn’t need to be induced at least once for a vaginal birth.

    • sour_sadie

      In some cases, it’s both misogyny and ableism. I don’t see it as “money-saving” at all. It’s more of a let’s punish women for daring to have sex, and let’s make it even harder for women with disabilities, anxiety disorders, tocophobia,et. al to have a choice in delivery. It’s about controlling women and punishing women who happen to be disabled, mentally ill or tocophobic.

      • ukay

        I would extend your argument that NCB ideology is about control per se. This creeps me out more than the market share battle. Being in agony makes most people incredibly vulnerable and dependent. And a woman with an epidural is not debilitated by labor pain and cannot be controlled that easily. It is all about regulating women and who gets to do that.

    • Eater of Worlds

      Forcing women to have vaginal births when they needed C-sections has already cost the NHS billions, I believe. How is it a money saving issue to deny the c-sections when being sued for not doing so is already costing them so much? If they just did the c-sections when the mothers wanted to as well as when immediately medically necessary they wouldn’t be spending billions to pay mothers whose babies have died or been permanently disabled.

  • Amy Tuteur, MD

    Imagine if men experienced lacerations, incontinence and sexual dysfunction in order to have children. https://uploads.disquscdn.com/images/0daca08a6a7dfca9d6ec04ed604196fda42f235c140475f1cbd58389da929105.jpg

    • AndreaRealMPH

      <3

    • Russell Jones

      We are candy asses. If we had to experience any of that, the human race would be a not-so-fond memory of planet Earth in short order.

    • fiftyfifty1

      Big deal. Little 3cm straight, superficial banana peal lac there. Show me a big ol’ stellate lesion with destruction of the underlying banana tissue, and then we’ll have a comparison.

      • Heidi

        Brings to mind when you put a Ballpark frank in the microwave and it semi-explodes and splits. That might be about the equivalent of 3rd or 4th degree tear.

        • MaineJen

          *whimper*

    • sour_sadie

      They’d be bending over backwards to make sure they get the care they need. They’d also allow them to have abortions.

  • MaineJen

    As I always say: You’re going to have pain, and probably stitches, *no matter how you give birth.* The stitches are going to be either in your abdomen, or on your hoo-ha. Pardon me for being skeptical of the homebirth claim “I didn’t tear at all!!!1! Gentle home birth!” More likely, your ‘midwife’ just didn’t stitch you up properly.

    • Empress of the Iguana People

      and that’s even though episitomies are not routine anymore. I didn’t have one, but I got stitches along my perineum both times.

      • EmbraceYourInnerCrone

        I tore and had an episiotomy…yay…(vacuum extraction needed is the reason for the episiotomy) What do I win? Stress incontinence! boo!!

        • Empress of the Iguana People

          Yeah! I got that prize, too! Sigh.

      • MaineJen

        Same here. I ended up tearing right about where an episiotomy would have gone…so I might as well have gotten one.

    • Heidi

      Yes, that has been my theory all along about the supposed not tearing during homebirth. I had a fairly small baby, 6 lbs. 5 oz., and he didn’t have a big head and he was positioned correctly. Labor was pretty boring and non-instrumental, he came out easily and I tore both ways. I know some of the tearing was 2nd degree. Thankfully so far I don’t suffer incontinence and after a few months (not 6 weeks!), everything was pretty much back to its pre-birth state. But I thank the OB and the stitches for that.

    • sdsures

      All homebirth stories can be (and usually are) heavily edited and sanitized so that readers don’t get to learn about nasty reality.

  • Inmara

    “and some women need to be in hospital for three or four days”
    This is the routine hospital time in my country regardless of delivery mode (women can opt to leave earlier if they want or stay longer after complicated delivery), hospitals really want to make sure that mom is healing properly and baby is gaining weight (at least that much they care for babies despite pushing for breastfeeding and sometimes ignoring signs of hunger – if baby hasn’t regained birth weight by 3rd day, you have to stay longer). Hopefully our hospitals won’t start to cut corners here.

    As for MRCS, they are available for a hefty price (unless you convince doctors to “prescribe” it) so basically poor women have no choice but to take risks of vaginal delivery. Also information about risks of vaginal delivery is short to nonexistent and our head of OB and GYN national association is firmly in the camp of “WHO recommends 15% CS, how can we reduce our 23%?”

    • AnotherOor

      Even though WHO abandoned that number years ago?

      • Inmara

        Yeah. And she touted the number and “risks of CS” after a case where baby was stillborn because nobody sent overdue (41+) mom to either induction or CS.

      • Eater of Worlds

        They say they abandoned it but it’s mentioned so fucking much (and it’s now saying 10% is the percentage of c-sections that prevent death, going higher doesn’t give you better mortality numbers) that everyone obviously believes that’s what the number should be.

    • Ольга

      In my country, you stay at the hospital for a week pp regardless of the delivery mode!
      OMG, three days in hospital instead of two, let’s ban the right of women to decide what to do with their bodies [/sarcasm]

      • Roadstergal

        Plus, that’s three days in the hospital instead of two – from the birth. If a woman is in active labor in the hospital for a day, instead of arriving for her scheduled C/S and getting it within a few hours – that’s zeroed _that_ advantage right out.

        • Ms. Sweaterfan

          Yep I just made a similar point above (great minds!) I was in labor for 33 hours, then stayed in the hospital recovering for a little more than that (maybe 36 hours?) and if I had to choose which half I’d want to do over again it would be the second half no question 🙂

          • Roadstergal

            33 hours… *crosses legs*

      • Kathleen

        That sounds amazing to me. I didn’t want to go home! Nurses to help, meals brought to you, and sleeping when I needed to (with my second especially because I knew I was going home to a toddler!)….two days wasn’t enough LOL

        • WallofSleep

          Don’t ever try and embarrass me on FA again. Pig. I’ll use your mouth for a toilet. You must be out of your mind talking to me like that.

    • Eater of Worlds

      I hate how WHO is always trying to be sneaky about that stat. They say in one place 15% for mortality reasons. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

      and they say it here http://www.who.int/reproductivehealth/topics/maternal_perinatal/cs-statement/en/

      But in their frequently asked questions, THAT is where they mention that the rate they say really isn’t 10% (which is the new number they are pushing) because that doesn’t include c-sections for reasons other than to prevent death http://www.who.int/reproductivehealth/topics/maternal_perinatal/faq-cs-section/en/

      Sneaky assholes

      • Inmara

        I’m screaming internally by reading this:
        “Some of the most omnipresent reasons behind this rise are the fear of pain during birth including the pain of uterine contractions, the convenience to schedule the birth when it is most suitable for families or health care professionals, or because it is perceived as being less traumatic for the baby. In some cultures, caesarean section allows choosing and setting the day of the birth according to certain believes of luck or better auspicious for the newborn’s future. In many countries, societal consensus has imposed a demand for the perfect outcome and doctors are sued when the results are not as expected fueling the fear of litigation. In addition, in some societies, delivery by caesarean section is perceived to preserve better the pelvic floor resulting in less urinary incontinence in the future or sooner and more satisfactory return to sexual life.”

        Perceived to be safer to baby? Perceived to be better for pelvic floor? PERCEIVED?!!!? Sneaky assholes, indeed.

        • AnnaPDE

          Perceived in some societies to preserve pelvic floor health? Yep, in the societies where access to medical information is available. Perception can be accurate.
          And I love how they frown upon taking into account what’s convenient for a family, or women’s wish for continence and a sex life. For the WHO, clearly nothing can even approach the importance of having the baby pass through their mother’s vagina, whatever the cost.

          • Charybdis

            Except maybe breastfeeding a baby to death. That one ranks pretty high on WHO’s list too….

        • ukay

          Let alone this craaaaazy obsession with perfect outcome (healthy mom and baby) as opposed to letting zealots take a gamble on the health and life of both.

          • kilda

            “societal consensus has imposed a demand for the perfect outcome” –> sounds so “demanding” and unreasonable, til you translate it and realize it means “people are unwilling to accept death of a baby.”

          • ukay

            „..when we all know that process is more important than outcome. How DARE parents sue for malpractice.“

            Reminds me of the midwives here who whine about the high insurance costs that make it more and more difficult to offer homebirth, when it was their dangerous stunts that made insurance explode in the first place.

  • Emilie Bishop

    Honestly, I regret not getting more information on elective c-section when I was pregnant. Of course, my hospital couldn’t even tell me my baby was starving because my breasts didn’t make enough milk and never would, so that information would have been hard to come by, but I wish I’d had articles like this and some of the other recent ones at my disposal three years ago. Maybe I wouldn’t have chosen it, but I do remember saying if my son was breech we were just scheduling the section, not messing with the version my doctor said we would do. I’d had abdominal surgery prior to birth–I knew it wasn’t a walk in the park, but something scheduled and planned sounded great after all the ups and downs of trying to become a parent for so many years. My own take on things, I know, but it shouldn’t have been dismissed before I could even fully admit to all of it. Women so desperately need FACTS about childbirth, infant feeding, and motherhood in general. Ideology just gets in the way.

    • sdsures

      “Of course, my hospital couldn’t even tell me my baby was starving because my breasts didn’t make enough milk and never would, so that information would have been hard to come by”

      How is this legal?! It’s blatant failure in their duty of care to both you and baby.

  • fiftyfifty1

    They are just jealous.

    • AnotherOor

      I think that’s a huge part of it – “I had to suffer, you should too!”

  • Abby

    I hoped you’d see this one Dr Amy…. Yet again another article about the horror show of having a baby in the NHS. I don’t know how they have the nerve to tell women they can’t have an elective section when they are paying out millions in compensation for brain damaged and dead babies after botched natural deliveries with inadequate monitoring.
    Is there any way to contact this woman Veronica miller and ask her if women will be guaranteed an epidural on demand and compensation for any perineal trauma that results from the forced natural delivery they didn’t want?? Way to go sister, supporting women in oxford to have less choice!
    And if she realises she’s playing into the hands of misogynistic men who believe women should be punished for sex (yet seemingly men get away with it scot free???)

  • momofone

    “Women of today, you want all your own way.”

    Yup.

    • fiftyfifty1

      Yeah, imagine that.

  • StephanieA

    ‘Women of today, you want it all your own way.’ Wtf? Yes, we would like to enjoy sex and pain free deliveries. Pretty much how men have been living their lives for forever. But we’re women so we shouldn’t be able enjoy sex without consequence, should we?

    On a personal note, I’ve had two vaginal deliveries. The first was super easy with zero pain or problems after. The second was really tough. Weeks of not being able to have a BM without suppositories and a damaged pelvic floor. Kegels saved my sex life, but I know I’m lucky and many women have much worse damage. I’m worried that this time around I could have a bigger baby (first was 7.9 and second was 8.5) and even more damage that maybe can’t be as easily recovered from. I’m sure everyone at my conservative hospital would bad mouth me for having a voluntary C section to preserve my vagina and pelvic floor.

    • Eater of Worlds

      who cares what they say? If you want one, talk to your doctor about the damage you had last time and say you feel another vaginal birth will possibly destroy things beyond fixable and you found things traumatic after your birth. If your doctor is fine with your reasons for wanting a c-section, who gives a damn what others would say?

  • StephanieJR

    So what if they are (they aren’t, but for the sake of argument) ‘too posh to push’? So fucking what? How does one woman’s choice what to do with her body and her baby affect yours? It’s not like there’s a magical curse that means the pain gets transferred to you, or something. It’s none of your business. You aren’t allowed to police other women’s bodies.

    • The Bofa on the Sofa

      Thank you.

      I asked this other day, and still want to know the answer: What’s wrong with taking “the easy way out”?

      • Who?

        A woman’s place is in the wrong.

        When looked at through that particular lens, the answer to your question is obvious. Get a cs, you’re either ‘taking the easy way out’ or ‘setting yourself up for a long and miserable recovery’ depending on who is talking, and what their core message is.

        Either way, you have done the wrong thing, by definition.

    • Casual Verbosity

      I find it obscene the way society seems to equate pain and suffering with moral virtue, especially since it’s very selectively done. When we use suffering as metric for morality the natural consequence is that refusing to suffer makes one morally deficient.

      • StephanieJR

        It’s a particularly irritating game of misery poker, really.

      • Eater of Worlds

        Mother Teresa did it! No pain relief for those she took care of, but you bet she went to the best poshest hospitals in the US that she could go to when she was dying. To add to that she’d secretly baptise people as they were dying. So being in pain brings you closer to her god, especially if you’re croaking she can bring you even closer. Liked lying on a thick cushy US mattress in a room to herself rather than on a dirty cot in one of the 500 warehouses for the dying that she created and bragged about. It certainly wasnt her lack of suffering during her illness prior to her death that made her morally deficient. No one knows where millions of her money went, she took it from people like the Duvaliers of Haiti and praised them publicly.

    • AnnaPDE

      Though I’m not sure how “too posh to push” is even a workable insult. I know I am.
      I’m also too posh to just knock my teeth out if they hurt (as opposed to having them fixed by a dentist who starts by providing pain relief), too posh to have my broken bones mend in whatever position they happen to be in, and too posh to suffer through weeks of pain plus possible complications with UTIs instead of going to the doctor and taking antibiotics.
      Also too posh to live in a cave and hunt and scavenge.
      Women today… we’re so soft and spoiled.

      • Daleth

        You prefer anesthesia and doctors? Me too–man, we are some high-maintenance chicks!

      • MaineJen

        I recently had a horrible kidney stone. I was too posh to pass it without pain meds and anti-nausea meds. (I was also too posh to walk into the emergency room, doubled over hyperventilating in the fetal position as I was. Had to send my husband in to grab a wheelchair.) I mean. It only took 36 hours for the thing to work its way out. What a wimp I am!!

        • Eater of Worlds

          I have a chronic pain condition that is rated as more painful than kidney stones. I have had this pain every day of my life, all day long with no rest for 20 years and counting. I sometimes kind of want to experience a kidney stone to see how it compares.

          • MaineJen

            OMG I am so sorry. I hope your pain is being adequately controlled! 🙁

          • sdsures

            I have had chronic pain for about 15 years now. I bet we would have much in common to discuss. <3

    • AnotherOor

      Well, that’s where the fear mongering and lies about c sections causing obesity, diabetes, being “dangerous” comes in…

    • AndreaRealMPH

      Yep. I just went to a Physician Assistant graduation from a very elite school a few months ago, almost all of the grads were in their late 20s. I’m sure some of them were bottle fed, elective repeat c-section, or both. I sure couldn’t tell.

  • Kathleen

    The comment “I think people are missing the point here…women have been giving birth naturally for years and years and they all knew the pain in front of them and thought it worth it for the little bundle at the end”….I mean, SERIOUSLY?! Let’s just bear in mind here that for centuries there was no reliable birth control. NONE. And that marriage was specifically designed so that men would have heirs – so they kind of HAD to have a baby. It wasn’t like they were making the informed choice like women today have (theoretically). They weren’t saying “honey, I think we’re ready to have a baby now that we have six cows and a bigger thatched cottage…” “Are you sure? You know the pain of labor….”
    “Oh, no darling. It’s worth it for that little bundle at the end…I mean, sure I COULD die and leave you to raise a newborn but there’s a new wet nurse down the way and I’ve heard wonderful things about the new midwife in the village, so I doubt that will happen.” (Remember, no f-ing choice to NOT have pain in childbirth too).

    • WonderWoman

      Yeah, and the fragment about childbirth pain being “worth it”? WTF? If I can have the same “little bundle” without the pain, why endure it? People are crazy. Unless, of course, the woman has a different reason than to become a martyr (like fear of needles or relatively little pain)

      • Kathleen

        I mean…if there’s no other choice, or it comes too fast or something, sure I guess it’s “worth it”…..but quite frankly, so were both my epidurals! Same bundle of joy, way less pain.

    • The Kids Aren’t AltRight

      Not to mention that just because pain is “worth it” doesn’t mean it is necessary. I think the pain of a broken leg would be “worth it”, but nobody would gain anything from that, so I am not going to go out and break my leg to achieve “worth it” points.

      • Ms. Sweaterfan

        Yes! I’ve always hated when people would ask how pregnancy/childbirth/early weeks of parenting was going and I would answer honestly about the things that were difficult, and then they would invariably say “but it’s worth it.”
        First of all, nobody but me gets to decide what my suffering is worth. Second of all, even if that suffering is the result of something really wanted and loved (i.e. my baby) that doesn’t mean I don’t want to minimize the bad things in some way. I mean, if it truly were a binary choice – have a baby and feel every bit of labor pain vs. never have any children but never feel that pain – I would have of course chosen the baby, which technically means it’s worth it, BUT it’s not a binary choice!

    • carovee

      Wasn’t Queen Victoria the first woman (or famous woman) to have anesthesia during birth? And didn’t english women (who could) flock to it after?

      • Kathleen

        I believe so, yes. I mean, why wouldn’t you avoid the pain and still have a “little bundle” afterwards?

      • Queen Victoria liked being a mother, but didn’t care for babies. She used ether so she could avoid the pain and wake up to a baby at the end (that someone else would take care of.)

        I imagine she would have been one of the first to sign up for reliable birth control, too. The history of Russia, for one, might be very different if she had stopped at an heir and a spare.

        • MaineJen

          I read a little bit of a biography of her a while ago…from her journals it sounded like she was *super pissed* that she got pregnant so quickly and easily after marrying Albert. She knew what was in store, as far as childbirth, and she didn’t look forward to it.

        • Eater of Worlds

          I’d like to think that she’d like to use pot for cramps too. She really didn’t but everyone thinks she did. https://mistakinghistories.wordpress.com/2017/08/29/queen-victorias-cannabis-habit-again/

        • sour_sadie

          If I have to give birth vaginally, it’s ether time for me!

  • The Kids Aren’t AltRight

    As someone who is fairly early in pregnancy and thus new to the bizarre world of birth culture, one of the most incredible things to observe is how C-section are both the most terrible thing that can happen to a woman and women who want C-sections are also lazy and spoiled. Doesn’t it have to be one or the other?

    • WonderWoman

      Exactly, natural childbirth advocates say that c-sections are done for convenience and to avoid pain, but at the same time they say that recovery is sooo much longer and the scar hurts sooo bad etc. It has always amused me. The same with breast- vs bottlefeeding. If you ff you’re lazy but bottle feeding is sooo time-consuming. Washing bottles, getting up in the middle of the night to prepare formula etc. 🙂

      • Roadstergal

        And AP. Moms who really love their babies go to the extra effort of AP, which is so much easier because you’re wearing the baby in a sling…

        • Cat

          And co-sleeping*. Moms who aren’t too selfish and lazy to put their newborns’ emotional needs first co-sleep, which is so much easier because you can breastfeed in your sleep…

          * I’d never judge anyone for co-sleeping with a baby out of desperation, because newborns are the most sophisticated torture device ever invented, but the ‘”how can you put your poor vulnerable baby in a cot alone?” brigade make me want to puke.

          • Charybdis

            So you answer them like this: “How could I put my poor vulnerable baby in a cot alone? Easy. Feed, burp, change, swaddle, walk over, put baby in the cot/crib. How is this difficult? You just walk over and put the baby down. It’s not rocket science.”

            Then maybe feign concern: “Oh, sweetie, did you not know how to do that? Tsk, tsk, tsk. Let me show you how easy it is.” Or: “Did you not know this was a viable option for you? It’s CRIMINAL how new parents are not given adequate information on these things.”

            Then enjoy them gaping at you in disbelief.

      • borkborkbork

        Honestly – this is exactly the reason I breastfeed exclusively. Other moms think I’m some super-committed crunchy-granola type. The truth is I’m just too lazy to mix formula and sterilize bottles. I’d rather just lay in bed, reading a book, while the baby does all the work. 🙂

        • swbarnes2

          Eh…bottles don’t need to be sterilized, except for before first use. Just washed. The trick is to get your baby to take formula room temp or straight outta the fridge.

          • Kathleen

            Oh yeah. I breastfed (we weren’t against formula if it didn’t work out but it did) and my brother and his wife (who had four kids, all formula fed) warned me about the temp….

          • Kristi Berry Pedler

            I would make up a pitcher nightly & then pour it into bottles which were then refrigerated. Never warmed them up. #shitmom. Who has time to make up every bottle individually?

          • Empress of the Iguana People

            We prepped several bottles of water, left them on the counter, then added formula as needed, and daughter was good to go. It’s easier for my Demodocus to measure and pour powders than liquids and he had the night time feeds. Plus, big brother had a -minor- tendency to pour stuff on the floor. grr.

        • sour_sadie

          I believe that fed is best.

        • Ozlsn

          I planned to breastfeed partly because I knew there was no way I could leave home without my breasts. Given I managed to forget nearly every part of the expressing equipment at least once, had spares of every part of the tube feeding equipment in the nappy bag (and used all of them at least once along the way too) and then – when my son finally tube weaned and was eating – forgot to take food or water to a hospital appointment it would have definitely been a help if I could have just breastfed!

        • Heidi

          Heh, I didn’t sterilize bottles and I used a Baby Brezza. So posh I am. I let anyone who wanted feed him. It’s fun and exciting to feed a baby that isn’t your own! He was and is still absolutely fine.

          • Ms. Sweaterfan

            I’m glad to see someone else who didn’t sterilize bottles XD Whenever I see comments about the toils of bottle feeding my heart beats a little faster and I start to feel guilty about not having some elaborate bottle sterilizing set up, but I’m glad to hear others went the route of merely scrubbing with dish soap and everyone survived!

          • Heidi

            I’d hope no one would sterilize their breast nipples. I don’t know why with actual boobs, just being clean is adequate but with bottles, you are expected to have some elaborate sterilizing routine.

          • kilda

            because boobs have mom’s own flora which is all natural and beneficial, and plus they have the magical breastmilk to ward off all things bad.

            If you’re going to feed your kid formula, the least you can do is perform a sterilization ritual to drive out the evil spirits.

          • The Bofa on the Sofa

            We just put them in the dishwasher. They were glass, so didn’t have to worry about melting or anything.

            Jeez, if our kitchen/dishes aren’t clean enough for our kids to eat off of without having to sterile things, the bottles are the least of our worries.

          • Charybdis

            Us too. Just toss them in the dishwasher, end of story. I roll my eyes when that “sterilizing the bottles and nipples” crap is trotted out.

          • Heidi

            I threw mine in the dishwasher all the time when he got out of the eating every couple of hours phase (handwashed simply because he’d go through bottles faster than the rest of our dishes would accumulate). But then I was told I did that all wrong too because the nipples would get damaged in the dishwasher and be a hazard. Um no, that never happened. I didn’t lose one nipple to the dishwasher. They are made of silicone these days, not delicate natural rubber.

          • The Bofa on the Sofa

            Handy tip: stores have little baskets (with lids) that you can put in your dishwasher, and they hold things like nipples and other little pieces. A very handy piece of equipment (I just gave one to a friend for a baby shower gift).

            It doesn’t just hold nipples and bottle caps – we used ours for 9 years for everything little (medicine cups and sippy cup lids and whatever), until we got a dishwasher that has a third shelf for those types of things.

            When the kids were babies, we had two of those baskets in the dishwasher.

          • BeatriceC

            I still use those little baskets all the time and my kids are teens and young adults. They’re fabulous for all manner of small items that otherwise couldn’t go in the dishwasher.

    • yentavegan

      I can tell you about my own experience. I have had 5 births, two were c/sec. My doctor did not wait for the shit-hit -the fan to convince me that the c/sec was the best possible way to deliver our baby. If I can give you one piece of advice, get the iv lock in place for just in case and don’t grouse about intermittent fetal heart monitoring.

  • Stephanie

    And what about the whole ‘mother’s intuition’ thing that many ‘natchural’ pushers like to pander? They like to push the whole women’s bodies know best… My anecdote: I had 2 successful vaginal births, and with my third, requested a Maternal Request Csection. My first 2 were 6 and 7 1/2 lbs respectively.
    They tried to convince me otherwise, but I gave them a 5 page list of why I refused another vaginal delivery, and they agreed. There was a big push with the statement that I’ve done it twice already, it can’t be that bad. Any damage would have been done already.
    When they took my 3rd baby out, he was 9 1/2 lbs at 38 weeks. His head was already trapped in my pelvis from the north side, and took a while to get out. There was the statement, Oh Shit, that kid’s got a big head and shoulders. He’s going to be a linebacker. And then to me, thank goodness you had a section, he would have never made it out the other way.

    Sometimes women know what’s best for them. For the record, If I’d known a maternal request csection was a possibility, I wouldn’t have ever had a vaginal delivery. My mother had shoulder dystocia that nearly killed both her and my brother, and now has a vaginal prolapse. Plus I am very unimpressed with the stress incontinence and rectocele that started after the first birth.

  • Jen

    I am solidly pro-Cesarean. Can you imagine if those in my camp had a “Cesarean Only” policy unless there was medical indication otherwise? It makes just as much sense. Maybe more because overall outcomes for babies would be more favorable.

    • Sarah

      More, in fact, since it would be cheaper if everyone had an ELCS- as per NICE.

  • Roadstergal

    We went to dinner at a friend’s this past Saturday, and after a few drinks, she started talking about her incontinence. She’s a super-classy, well-put-together woman, so I think it startled my husband and his friend that she had this going on… but she’s never talked to an OB or PT about it, and she had NO idea that pregnancy and vaginal birth were both risk factors for it (it started after her first kid and got worse after her second). How can women make informed decisions if they’re not given the information??

    And now they’re saying that you’re not allowed to even make that decision. They’re going to ‘reduce harm’ by making women ‘who are frightened or have had previous traumatic births’ go through a frightening, traumatic experience with potential long-term, irreversible consequences.

    • Steph858

      Of course I would never wish incontinence on anyone, but, should any poor women who were refused a C-Section suffer complications related to giving birth vaginally, I hope that Oxford University Hospital is sued into oblivion. Nothing quite like the prospect of losing a lot of money to make an organisation suddenly hyper-aware of the risks it’s taking/imposing on others.

      • Daleth

        I hope that Oxford University Hospital is sued into oblivion

        I join you in that hope!

  • AndreaRealMPH

    I’m thinking of having kids soon, and this weighs on me. I’ll probably want an epidural; but hoping I’ll have the guts to resist so I won’t be labeled a tough client or offend a Bible thumper in the room.

    • No, no; please do what you think is best for your care, and don’t worry about offending people!

    • momofone

      Their offense is their problem. Your only job is making sure you have what you need.

    • mabelcruet

      The only people who need to be involved in making a decision are you and your health care provider. Everyone else, including other mums, friends and family, can safely be told it’s absolutely nothing to do with them. I would start practicing your resting bitch face for when they try to intrude and practice saying ‘I am not prepared to get into a discussion about this’. Trouble is, once your bump becomes visible, I get the impression most of the rest of the world seems to think they have a right to ask about it.

    • AndreaRealMPH

      On the snarky side, maybe my insurance company will choose for me. Paying out of pocket for an anesthesiologist is scarier than labor pain. Or maybe the opiate tsunami is bad enough in my demographic that the hospitals have chosen for us, too.

      • Heidi

        I would hope the opiate epidemic wouldn’t have any impact on epidurals. While I do recall fentanyl being one of the meds in my epidural, there was zero high or anything.

        • Charybdis

          I wouldn’t be surprised if it was phased out, or that you have to provide an ID, be checked against “The List”, have to sign a special form to get it and will be dose restricted to a pitiable amount. And you have to be seen by the anesthesiologist AGAIN if you need a top-up dose, get your ID re-scanned and sign another special form so you can get another drop in your epidural.

          Sorry about the snark level. I’m PISSED OFF and terribly vexed about the whole opiate clusterfuck situation and how it is making it SO FREAKING INCONVENIENT to get my migraine meds.

          • Mishimoo

            Want to hear something more enraging? When my daughter broke her arm a few years ago, the nurse was gently persuading me away from the gas + fentanyl pain relief route as she thought (and I agreed) the break was too severe for that pain relief option. We decided on ketamine, which was my first preference, and while we were waiting for all of the safety stuff to be organised: the fentanyl showed up. A little vial, needle, etc. Another nurse walked in, said something like “Here’s the fentanyl.” dropped it off on a side bench, and walked out while I was saying “But that wasn’t meant to be ordered?” It was ridiculously unsafe, and the nurse who was looking after my daughter didn’t even seem to be bothered by the lack of supervision around a fairly potent drug.

          • AndreaRealMPH

            Ugh.

          • Heidi

            I wouldn’t be too surprised if some crazy CPMs and NCBers didn’t somehow blame the opiate epidemic because addicts’ mothers received an epidural and lobbied against epidurals. I mean, it’s not like the science has to be there to pass legislation anymore.

          • Roadstergal

            Whenever the opioid problem comes up, people yell BIG PHARMA and say we need to cut back on prescriptions. While it’s not nothing, I think the fact that you can buy designer opioids from China, delivered straight to your door by the USPS, is a _bit_ of a bigger issue…

            (And all of the societal issues that cause people to become addicts in the first place, and the lack of support for recovery. I’m reading a lovely little history of quackery, and it has many chapters on patent medicines and tonics. Man, widespread drug addiction is NOT new.)

          • Mishimoo

            Oooh, which book is it? Speaking of patent medicines, I recently acquired an (empty) old bottle of Mrs Winslow’s Soothing Syrup for my collection.

            Yeah, addiction and controlled drugs really are a huge mess. Thankfully, there is a growing understanding of the issues around the problem (at least in my social circles). I was lectured by my eldest recently on the topic of societal influences on addiction, because she’s been watching a lot of Sci-Show and associated channels. Which was adorable, and I’m glad that she feels comfortable talking to me about these things.

          • Charybdis

            I generally trot out my story of lifelong migraines, severe ones (with auras!) where the head pain lasts between 3-4 days and that doesn’t include all the other crap that goes with migraines (light/sound sensitivity, smelling phantom odors, nausea, brain fog, etc). I’ve tried ALL the triptans (bad side effects), ergotamines (made me want to scratch my skin off), topamax (couldn’t eat while taking it), toradol injections, steroids, etc. Over my many years, I have discovered what works for me. I take a preventative regimen of medications as well as medications to take when I DO get a migraine. What works best for me is to take my anti-nausea med and a Midren as soon as I see an aura/feel a migraine coming on, get home ASAP, get into bed in a cool, dark room and take the heavy opioid med. If I do this and can get some sleep (couple of hours), when I wake up, the head pain is tolerable; I can do my normal things, albeit a bit slower and I’m less mentally “sharp”.

            These days, I have to see my doctor for every new opioid prescription I get, because they can’t call them in to the pharmacy anymore or give refills on a prescription. I get my ID scanned at the pharmacy both when I drop off and pick up the prescription. My name is on “the list” and is checked each time I request a refill that I have to pick up in person from my doctor. Every year, he pulls my records from the list and goes through them with me, to make sure I’m not ‘doctor shopping’. The time I had bronchitis so bad that I was passing out when I coughed, I had to damn near justify the fact that I went to Urgent Care and they prescribed codeine cough syrup (4 oz, no refills) so that I could sleep without coughing constantly.

            It is to the point now that I seriously debate whether or not I hurt badly enough to actually take the medicine that I KNOW will help me, because it is getting harder and harder to get. If I take one for this migraine, what if the next one is worse? Do I NEED to take the med, or can I tough it out? Forget even trying the ER if I have a scary bad migraine (haven’t in awhile, knock on wood) because I have to go through the IV phenergan, imitrex shot, toradol shot, IV tylenol, steroids, rigamarole because, according to the ER folks, “If it is a migraine, this will stop it in it’s tracks.” Because, you see, if I tell them what works for my migraines (that I’ve had all my life), then I suddenly become a DRUG SEEKER and they won’t help me.

            It makes me wish that those old laudanum-based patent medicines were still around.

          • Heidi

            I had a tooth abscess a few weeks ago that was the worst pain I’ve ever experienced in my life. I literally felt like someone was drilling up my tooth into my skull and brain. I had even been to the dentist a couple of weeks before that for the pain, had x-rays and then an exam and cleaning and nothing showed up. The dentist thought the pain was from a too high crown and buffed it down. Anyway, I had the misfortune of the tooth going from ow to “I think I’m dying and if I’m not, I’m about to kill myself” pain after-hours. He couldn’t do anything for me. I had some hydrocodone leftover from lovely childbirth tears and honestly they didn’t work for me and I’ve never had any luck with opioids relieving pain (and I don’t get the slightest bit high or euphoric from them either. I just get severely depressed.) but if they did work for me, it’s ridiculous he wasn’t allowed to call in a prescription until he could see me the next day! I mean especially considering I had seen him for the tooth not too much before that anyway.

          • sdsures

            I’ve had severe chronic migraines since 2003. After trying one medication after another (about 14 total in as many years), Botox injections are helping. I still get migraines, but they are father between and of shorter duration.

        • sour_sadie

          It’s probably a very small amount if it wasn’t the only med in the epidural.

    • yentavegan

      Ha ha. With baby number 3 I cursed with a mouth so foul it startled my husband. A nurse( nun?) in the Catholic Hospital i delivered in eventually told me to hush up.

      • AndreaRealMPH

        That’s what I am afraid will happen with me. Then they’ll chart that I’m difficult and foul, then probably provide substandard care next time I go in for anything.

        • AndreaRealMPH

          So of course, it feels like “damned if I do, damned if I don’t.” Get and epidural? I’m spoiled. Forgo it, then everyone and their doctor’s brother knows I have a toilet mouth.

    • MaineJen

      It’s not about “guts.” It’s about being in pain and wanting relief, and it’s no one’s business but your own.

    • Kathleen

      If you want one do it….or, you can always do a middle ground. Talk with your partner or birth coach or whoever is there to help you and let them know that you’re not against an epidural, but want to wait and see. That’s what I did with my first and second. Sometimes it doesn’t work out, but I liked moving and all that for awhile because I’d never done it before (in the case of my first)….after the pain started getting really bad and I was clearly not even close, my DH was like “your call, but it’s okay if you get the epidural in here.” Knowing I had someone there to back me up if needed or to re-focus me was helpful. With my second, I knew what to expect and still did the same thing. Only in that case, it got bad and I was like “I want the epidural now.” When my anesthiologist (sp?) came in (he was my OB’s husband) and he was joking “I figured you’d be calling soon.” Because he’d been monitoring my progression as well. That epidural worked so well, and I was even able to nap and relax…

  • How misleading it is not to list the risks of vaginal birth. Yes, yes, of course tell women the risks of an elective section–but ALSO THE RISKS OF NOT HAVING A CESAREAN. We are not talking about “nothing significant” vs. “major abdominal surgery”; we are talking about “risks of vaginal birth” vs. “risks of major abdominal surgery.” I.e., removing a baby from a pregnant woman has risks, whether said removal occurs via the vagina or a section; it’s violating patient autonomy not to list said risks and then deliver according to the patient’s wishes.

    (PS For parachuters, I’ve had three vaginal births and am very happy with the outcomes of these births. I am not “pro-cesarean” any more than I am “anti-cesarean”; I think women ought to have the choice of delivery, however.)

    • crazy mama, PhD

      THIS. I’ve given birth both ways, and there are pros and cons for each.

    • mabelcruet

      But the behaviour of the parachuters (like Anna Perch and that Hocking one) is that you don’t reveal the risks-you don’t tell people the facts, you tell them only what you (i.e. Perch/Hocking) want them to know in order to make the decision that you (Perch/Hocking) want. That type behave so incredibly unethically and do not give balanced information about pros and cons, or risks and benefits. They routinely massively exaggerate the risks of the choice they don’t want you to make, and massively underplay the risks of the ‘correct’ choice. It’s misogynist, patronizing, unethical and paternalistic-its so far from good medical practice its scary.

      • Dr Kitty

        I really don’t understand how the Trust plans to do this, since it is at odds not just with RCOG and NICE guidance, but also Montgomery Vs Lanarkshire- which specifically states that the patient gets to weigh the risks of CS vs VB and chose what they believe is best, even if their obstetric team feel a VB attempt is in their best interest…

        • Sarah

          Same. I’d be very interested to see a copy of the actual policy, all I’ve been able to find so far is news reports from not especially reliable sources (Daily Mail and LBC). That’s not to say the reports are inaccurate, but I’d like to know how this is envisaged to look in practice. It’s one thing not to apply NICE guidance (and I’m pretty pro NICE) quite another to not apply the law of the land.

          That trust have historically had a bad reputation for not allowing sections anyway, so I wonder if this is basically someone reporting the status quo rather than much of a change?

          • Lilly de Lure

            I think they’re hoping that most patients won’t be aware of the case and will take the dr/midwife saying “you can’t have a c-section if WE decide you have no medical need for one” as the final word on that option. For the occasional PITA who knows their rights on this and has the time/determination/money to actually start (or threaten to start) legal proceedings they will probably decide that yes, they’ll do the operation after all but they’re gambling that the overwhelming majority of their patients will not do this.

          • ukay

            They heard of the Streisand effect?

          • Lilly de Lure

            Here’s hoping they’re about to!

          • Sarah

            Yes I suspect so. The reality is that if you kick up enough of a fuss in the NHS, you’ll probably get what you want, especially if the NICE guidelines back you. I have no doubt, for example, that if I were to be having another child and giving birth in Oxfordshire, I’d be able to get an ELCS agreed, simply because I’m a lawyer and I know what to say and I’ve a pal who works at the GMC and I would be infinitely, infinitely more trouble than it was worth to keep saying no to me. They’re just banking on enough people being put off by the stated policy to get the section stats down.

    • Merrie

      Also one of the risks of *attempting* vaginal birth is having it not work out and having to get a c-section anyway, and getting a lot of the drawbacks of both methods… hence why moms who’ve had one c/s and are considered likely to need another one for the same reason are not encouraged to try for VBACs, because there are downsides to even *trying* to have a vaginal birth.

      In a choice between a quick and easy vaginal delivery vs. a c-section, a quick and easy vaginal delivery looks pretty good, but you don’t know if you will have a quick and easy one. A planned c-section is more of a known quantity.

      • Casual Verbosity

        Yes I always find it interesting when people talk about the risks of a c-section vs a best case scenario vaginal birth, as if “choosing” a vaginal birth guarantees you the super fast, super painless, super quick recovery version. When you choose not to have a c-section, you aren’t so much choosing a vaginal birth as choosing to ATTEMPT a vaginal birth.

      • Cat

        I was told when I had my planned c-section that the target was to discharge me after 24 hours. The staff on the ward made it quite clear that they thought I failed at being a post-op patient because I ended up staying a couple of extra nights, mostly because I didn’t have the support at home. The midwife checked my stitches on day five on a home visit, and then that was it as far as follow-up care went. There was a 6-week check but that was just for the baby. So yes, there’s a ridiculous disconnect between the popular perception of c-section recovery (one of my best friends thought I was still at risk of tearing open when I carried a light pushchair ten months later) and the reality for the average woman where the section was scheduled.