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> How a baby is delivered is none of anyone's business but the mother herself. I'm sorry for your loss.

Caesarian's costs the NHS around £1,700 a time compared with £750, for a normal childbirth and women also stay in hospital for twice as long on average. There is a general presumption in the UK that avoiding what is an invasive operation is preferable for both baby and mother alike, in the absence of other factors.

I would argue that clearly How a baby is delivered is other people's business since other people are involved. However the ultimate choice should be the mother's.

Vaginal delivery is associated with better outcomes for the child too. IMO that makes it not strictly the mother's choice. Indeed surgical procedures should never be entirely elective.

No, you don't get to make major body and life decisions for a mom because maybe infant outcomes are 1% better in certain circumstances. Somehow I doubt you donate 90% of your income to children in need, which would actually drastically improve outcomes for 1000s of babies.

If I donated 90% of my income then my children would starve.

However, we do have a process whereby use of my wage income is not entirely elective, it's called taxation and in part is used to improve outcomes for other people's children.

In your opinion should infants have no advocacy, should mothers (parents presumably) have complete determinency over the medical needs of their children without regard for medical outcomes.

> Vaginal delivery is associated with better outcomes for the child too. IMO that makes it not strictly the mother's choice.

Strongly disagree. The mother's freedom is not subservient to the child's wellbeing. Stable families are also associated with better outcomes for children, does that mean a man should not be allowed to divorce his spouse after they have children? What about second hand smoke or the psychological effects of parents' alcoholism on a child? I could go on (consider Vaccinations), but if a child's outcomes are the primary concern why stop at C-sections?

> Indeed surgical procedures should never be entirely elective.

Why not? What about plastic surgery, liposuction, or gastric bypass? This is a weird sort of medical puritanism.

You’re kidding right? The fact that parents are legally required to care for their children for 18 years throws a wrench into the theory that the freedom of parents is paramount. I don’t think there’s any precedent in culture or our legal system that puts freedom of parents at a higher priority over well being of children - nor should it. Children have no choice whether they are brought into the world, potential parents have full volition. Thus morally it is perfectly fair that the party with zero choice - the children - are protected.

> The fact that parents are legally required to care for their children for 18 years throws a wrench into the theory that the freedom of parents is paramount.

Except they're not. It's called adoption.

> I don’t think there’s any precedent in culture or our legal system that puts freedom of parents at a higher priority over well being of children - nor should it.

I just listed several including divorce and the freedom to choose to vaccinate (or not). I never said that the freedom of the parents is paramount, but it's also not fully subservient to the child's wellbeing. It's a balance. And my larger point is that mandating that someone go through a painful and potentially physically scarring natural birth for a dubious improvement to the child's development does not make the grade by this standard.

Nobody gives a stuff about the cost, you'll get the same pressure if you plan to deliver privately.

There's fewer than 700,000 births a year. If every one was a c-section it would cost an extra £700m a year, less than 1% of the NHS budget.

NICE guidelines state that the woman should discuss the pros and cons and then it's her choice.

> then it's her choice

Well, yes, but that doesn't mean it's a choice between two roughly equivalent options. C-Sections are invasive surgeries and come with added risks. I would argue a healthcare provider's duty is to advocate against them unless there is an appropriate medical reason.

That would be the discussion of the pros and cons.

Exactly. I don't know what your experience has been but generally the pressure from medical professionals is because C-section risks outweigh the benefits most of the time.

> I would argue that clearly How a baby is delivered is other people's business since other people are involved.

This is one major reason to oppose publicly funded health care. _Every_ decision becomes a public one.

The situation isn't terribly different for private health insurance. You're still spending out of a shared pool of dollars, and you don't have complete freedom in how you choose to do so.

And I would never choose a health care system mostly funded out of private insurance either.

Much better for every decision to be a private one made by insurance executives on your behalf.

Even if that were true, which I don't think it is, it still seems very much preferable to not getting necessary treatment because it's too expensive.

£950 for something that occurs once per lifetime seems extremely negligible.

And probably can be divided by 2 or 3 (twins, triplets) more frequently than non-caesarean births can.

and that’s why we don’t want socialized healthcare in the US. because it shouldn’t be other people’s business

In the US, we still make it other people's business. It's just that here, those other people work for insurance companies whose goal is to turn a profit (even if they claim otherwise by getting themselves classified as non-profit organizations), in part by paying out as little as possible to healthcare providers. Yes, it's theoretically possible to pay out of pocket, so one has a "choice", but doing that for e.g. a C-section would bankrupt most of our population.

I've lived in a country with socialized medicine. It's not perfect, but at least they don't have a huge chunk of the population walking around with easily-treatable conditions that slowly destroy them because normal people don't get decent health coverage.

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

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

I see a lot of people in this thread idly sniping talking points on the benefits of vaginal delivery, insurance/costs, etc. - illustrating the point in your last paragraph.

My son and wife's lives were saved by a C-section three weeks ago. Watching that fetal heart rate monitor dip to zero and then slowly, unsteadily rise back up over and over again was the hardest thing I've ever done. The hospital staff pushed us to do a vaginal birth the whole time. I understand and appreciate what they did, but at the same time I hope there is a better way, because in hindsight I would have never put my wife and son through this again.

This isn't a programming language preference. If you don't know the details of clinical practices around C-section, if you're not an expert or a patient, then you really shouldn't be pushing your opinion on others. Refrain.

James Titcombe and others are campaigning pretty hard on this. Women need to be given correct information, but their wishes also need to be respected.

These campaigners have persuaded the CQC to stop pressuring trusts over rates of C-section or normal birth, and to get the NMC to stop paying normal birth so hard.

I'm very sorry for your and your family's loss.

In the information age, there are so many irresponsible and incomplete bits supporting this, that or the other in as many superlatives as possible. What can a person do? I thought that VBAC was more dangerous for the mother than the newborn, for a healthy young woman, coupled with even a tiny amount of pressure this could easily lead people to make a decision they were not really comfortable with. The "sheer force of opinion surrounding ... childbirth in general" is astonishing; I agree with you here. The information age is badly curated and gives far too much weight to the inexpert opinion, imh (and non-expert) o. Mothers must give birth naturally, mothers must nurse their infants for x months, fathers must cut the umbilical cord.

All the modern medicine in the world coupled with the power of the information age can't make these decisions for us. Maybe, in the future, machine learning methods can pull relevant information out for people to counter some of the cultural pressures.

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

They may not have had the option to avoid the first c-section, depending on the circumstances of the first pregnancy.

I’m very sorry for your loss - my wife and I went through this and it was very difficult and awful, especially when you rationalize or question choices presented to you.

In the US, there are a couple of tiers of pressures and thought process. People make these choices from reasons varying from the medically advised, to cosmetic, to schedule based, to something else. Some people make choices for trivial reasons that are disturbing to the doctors who are placing people at risk, at their direction.

I think the medical concern is that there are more complications, the less informed people tend to correlate to folks who are less able to care for themselves afterwards in recovery and overall risk of anesthesia and other things.

> How a baby is delivered is none of anyone's business but the mother herself.

* It's the doctor's concern because of the Hippocratic Oath

* It's the baby's and therefore father's concern (but not choice), since vaginal birth is correlated with better outcomes.

* If insured, it's the insurer's concern, as it's over twice the cost of vaginal delivery. (In the case of the UK, this is the government, so literally everyone.)

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

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

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

Standard of care may not be relevant. Stats are great for making policies to improve population health and wellbeing, but when you are the one in a million to whom a rare and catastrophic event occurs despite best practice, where does that leave one?

My understanding is that GP poster's wife was in the same position as my relative, being pregnant and having previously had a C-section. That they got different advice, is precisely a difference in the standard of care. Problems with birth are certainly not one in a million.

It quite possibly is related to different practices but good quality healthcare still has bad outcomes. Advice on treatment has a lot of variables and previous c-section is not going to be the only factor.

> How a baby is delivered is none of anyone's business but the mother herself.

Try telling that to some of those here, in the US. The mantra is "do what I say, not what I do."