to ask for an elective ceseran even though theres no reason i cant have a normal delivery?(178 Posts)
There's absolutely no medical reason that I couldn't give birth. I have a wonderful almost 4yo DD and had a pretty good delivery with her.
However, this time round I'm terrified, not of the pain but of something happening to be during labour or birth.
I keep having nightmares about dying and leave my beautiful DD without a mum. It's really starting to get to me and its just making me miserable. I keep trying to forget about it and enjoy my pregnancy and DD but it's starting to consume me.
Tried talking to Dp and he thinks I'm being silly.
I am sure a cesarean is more dangerous than a natural birth in hospital?
Personal experience, C-section every time. Mine were medical rather than psychological but it was a far more rewarding experience.
Statistically something is more likely to 'happen'
during a csection than a normal birth though. And especially as you have already had one straightforward vaginal birth, the likelihood everything will be fine this time. I would look at trying to rationalise your fears rather than look to a more risky procedure as a solution
Could you talk to your GP or midwife? I am
Not dismissing your fears, as they are clearly real to you, but I can see why your dh is worried that you are tempted to go for a far more invasive medical procedure
op, I hope you don't mind but I have suggested this thread is moved to Childbirth. If you are terrified and looking for supportive advice, I think it would be a better place.
Do let us know if you'd like us to move this thread to our childbirth section
Best of luck with it all
its a major operation.its much easier and safer to give birth naturally if you can and you havnt said anything that makes me think you cant.
Focus on getting help with the fear rather than just going for a section(which you wont be allowed anyway)
Rather than asking for a C-section you might be better to ask if you can be referred for councilling? A C-Section is major surgery and really isnt an 'easier' or 'safer' option.
I had two elective c-sections and loved it. There was no way that I was going to have my two via a vb - cs worked for me and was stress free and a lovely experience both times.
It's he idea of having it planned, going in and doctors taking over that makes me feel safer. The idea of the unknown and what might go wrong that's scaring me.
I feel more comfortable with having a date and time and a 30-45 minute operation while awake than giving birth.
Then go for it - if you feel better about having your child that way then you should do so.
Did you have a medical reason countrykitten or was it done privately if you don't mind me asking?
You should do whatever you're most comfortable with. That said, do you know where these fears have come from? Have you considered that you might have antenatal depression or anxiety?
Try talking to your midwife and see if she can help.
My dd-i-l had an elective c section [in Turkey] and it was amazing.She was awake and alert and recovered surprisingly quickly.
My dd had two normal deliveries and had good experiences both times.
My sd-i-l haemmorhaged after a vb but recovered well.My cousin's dd suffered a blood clot following a cs and was very ill indeed.
Anything could happen either way but it usually doent.Whichever you choose I hope all goes well for you.
I don't feel like I have depression but I do have anxiety problems which obviously isn't helping how I'm feeling. Im not so fond of my midwife so I'd rather not go to her. She just seems to fob me off constantly.
YANBU. I'd speak to your midwife and see if she can arrange for you to speak with someone to head down that route. I don't know how it works elsewhere but in my city your midwife can refer you to speak to someone about the anxiety and through them it is discussed with a consultant and arranged that way.
Yanbu to ask for one but yabu to think that means you will get one.
Have to talked over your fears with your dp and/ or midwife it may help
There was no medical reason but I had definite fears of vb so I suppose you could say that there were psychological reasons. It worked for me but as others have said - things can go wrong with either way. I just felt more in control and happier doing it that way.
Do you have a good relationship with your GP, could you go to them? Some areas have specialist counselling services for conception, pregnancy, birth etc. There might be one nearby.
If you're worried about something going wrong during the birth, then statistically a CS is more dangerous. An operation over a normal bodily process is always risky.
I was also terrified. A sobbing hysterical mess, in fact. Would really really recommend hypnobirthing, it made the world of difference to me. Also speak to your midwife about your concerns. Mine was lovely, and that combined with listening to the CD regularly meant that I was able to enjoy my pregnancy and when my waters went, I was excited, not frightened.
Sorry, obviously meant to put when there are no other medical issues to consider.
OP YANBU and if you do your research and know the risks etc you shouldn't be refused a c/s, the NICE guidelines are in your favour now too.
I had a c/s on the NHS due to primary tokophobia.
A cs has its risks mainly it has to be said to the mother, and you do have a prolonged recovery which in my experience meant a dull aching every night for around 3 months. But a natural birth has more risks than a cs for the baby, there's a higher risk of oxygen deprivation or problems with the placenta, not to mention haemorrhaging etc etc. As long as you're fully aware of the risks and your consultant is happy to perform a cs I can't see why anyone would consider you as unreasonable.
Ive had 4 vb's but then for DC5 had to have emcs. I had a massive PPH after delivery, had to have a blood transfusion, a drain in for 4 days afterwards and a hospital stay of a week. Not to mention the recovery time at home. After 4 previous uncomplicated, speedy vb-id never had an overnight stay after any of my babies were born-i can honestly say id have a vaginal birth every time over a c-section. Although i appreciate that most people don't have the same experience as mine! One strange thing i do like about my section tho is my scar! Im very proud of it!
It's up to you, but recovery is quicker with a natural birth IMO. You can still have a medically assisted birth if you opt for an induction I suppose.
I had an elective cs with ds after a difficult first vaginal birth.
It turned out I had undiagnosed placenta previa so I would have needed a cs anyway but they didn't know that till the op!
Personally I would opt for a cs over a vaginal birth anyday. I appreciate I'm comparing my difficult and painful recovery to a "normal" birth but for me the recovery from the cs was easier and less painful.
I wouldn't hesitate to have another cs.
Had both mine by ELCS by choice on NHS. Guess it was more the fear of the consequences of a 'bad' VB which I used to convince the consultant I was serious and not fear of labour if you understand what i mean (not that there is any way on earth a VB appeals to me). Didn't have to have any counselling for it either.
Vaginal births can be good, CS can be good. Both can also be bad. Please speak to your dr/MW about your concerns and don't assume that a CS is a totally safe alternative.
DSis had an awful induction with her dd resulting in failed ventouse, followed by forceps delivery, then hr and half in theatre being sew back together. Having been left with only some muscle weakness rectally, Dsis thought she'd been "lucky" and didn't want to risk a second vaginal delivery so went for an elective CS.
The moment the surgeon made an incision Dsis began to haemorrhage. She recalls hearing her partner being told to stand by the wall and not move, blood bank being called and the crash team. She was awake throughout. Dsis had enlarged blood vessels. Lost 2.5 litres of blood.
She and her baby ds were & are ok. Dsis has been advised by several medical professionals not to have more children as same could happen.
This is not meant to terrify you, just to make it clear that CS has its risks too. Dsis doesn't regret her decision to have ECS as she cannot of course predict what would have happened if she'd attempted a second vaginal delivery.
You need to talk to someone about your fears and make the best decision for you and your baby. All the best op.
In my book having a baby-sized baby inside your belly which needs to come out is enough reason to ask for a Caesarean. Nothing unreasonable about that.
If your main worry is of something happening to you during your birth then please remember that a spontaneous labour and birth of a second baby is statistically the safest birth you can have.
I was shit scared waiting to go into labour with my second. Ignorance was bliss the first time around- I didn't know what I had to worry about. I felt similar to you in that this time I had more fear. I'd also had such a good experience the first time aound, I was worried I wouldn't get that again.
When it came to it, it was so quick and relatively 'easy', it was almost an 'anti-climax' because I'd built it up so much IYSWIM (I had a home birth)
It was great and things happened so quickly I didn't have time to worry, I was excited.
Talk to people. Ask for an appointment with a consultant to discuss your fears and discuss options. Research cesareans. Consider a homebirth (statistically the safest 'mode' of birth for low risk multips) Good luck.
Just want to make a few things clear:
- you cannot compare an emergency CS to a planned/elective one - a planned one can be a fabulous, relaxing experience;
- a vb is great so long as nothing goes wrong - but it is definitely not risk free!
- if you have any tearing/cutting during your vb, then recovery is going to take longer and the effects longer lasting than CS;
- under the NHS you can insist on having a CS - it's just a matter of educating yourself a bit and not letting yourself be bullied into doing something you don't want to.
had a horrible c/s, hate when folk think its the easy option
Go for it C/ss are sooooo safe,they really are if you're healthy.Even for those that aren't the risks are slightly higher so it's a very small risk.
Also the injuries you can get with a vb are often swept under the carpet and not that great to live with.
Both of mine were fab and I am a complete chicken was also up and about very quickly(quicker than the vb on one ward I was on).
And yes, of course a CS has risks. But I think it's time women allowed to weigh up those risks and make their own decision.
Had an emcs - found it very clinical, unnatural and quite unnerving being so out of control. Hated not being able to feel my legs. Hated the catheter. Hate the belly overhang. Hated comments from peopp who said 'ah well at least you had an easy time instead if a proper birth'
BUT i was desperate for a vaginal birth - had done my research, trusted my body etc so i am biased!
YANBU I had 2 elective cs because of anxiety over birth. NHS - no questions asked. Oh - and recovery was easy for me and I'm old (over 40) and very unfit.
I've had two natural VBs and then a c-section. LOVED the c-section. Calm, stress free, wonderful, amazing, quick recovery and TOTALLY PAIN FREE!
Seriously, I would choose a c-section over a VB anyday.
My GP has has two elective c-sections because of all the natural births she has seen go wrong - no word of a lie!
If it's what you want, then don't be fobbed off. I had to jump through hoops, but I stuck to my guns, and I'm so glad I did.
Please don't let others make you feel guilty either, your body, your choice.
Yes, exactly as Polka says...
Midwives don't tend to mention bowel incontinence or painful scarring, do they...
Personally I did find it v v easy.
CS and VB have risks. Of course women should be allowed to weigh up the risks either way and make an informed choice, but please be aware that either method of giving birth has risks that cannot necessarily be foreseen. The choice should be informed, recognising risks and advantages of both. There is no magic answer. What's best for one woman and her dc might not be best for another.
it's ultimately your decision but I would discuss your worries with your MW - hospitals have specialist services for anxious/scared mothers
I had an emergency section with DD1, VBAC (with assisted traumatic delivery) with DD2, VBAC that turned into a section with DD3
In hindsight I should have had 3 nice calm elective sections
I had a so called wonderful medically first VB. I wasn't in established labour for long either and had one small tear - pethadine, Dh massaging me, wonderful MW's, moving round - there was nothing really that could have gone better.
Mentally and emotionally it was horrible and I didn't want to do it again. I was battered by the time the baby came, three nights no sleep, cyring every time went to the loo etc etc etc....
I would much rather if something was going to go wrong, it went wrong in a theatre with staff all round me, than totally vulnerable with a baby stuck inside me. I also much rathered have stiches where I could see them, than down where the sun don't shine.
I had my ELC, and I was scared, I fainted, I worried about infection, about everything, the recovery was straight forward but not pleasant, however I made sure I made it as easy as possible for myself in terms of support and equipment.
The run up was calm, when the baby came I was calm, mentally and emotionally fine to just adore her and look after her.
NOW, several months on, physically I feel 100 times better than after my so called wonderful delivery.
I most definalty feel better down below - my back feels fine, whereas ached and hurt for ages after VB.
Out of my NCt group of 6 ladies, myself and another lady came through unscathed - all second labours, two were horrific - two were episiotmoy. Out of my friends I had one straight forward delivery including myself and I would have lost 5 friends if it were not for modern medicine.
With DD I was given the option of a CS because of my back. I ended up being induced after I got preclampsia. After 24hrs of labour they did a CS.
I remember speaking to my Dad and telling him that I didn't feel right. I assumed it was normal pregnancy discomfort. It wasn't, DD stopped growing at 37wks and part of the placenta had stopped functioning. We are darn lucky that she is fine.
IMO this isn't about being unreasonable. Sometimes you just know and if you have that gut instinct I would suggest you speak to someone about what your gut is telling you. When i spoke up my obn listened to me and started running all the tests. Thats when they found the problem and started the induction. I developed preclampsia 12hrs after they started the induction.
I am terrified of giving birth but also terrified of surgery (I'm not having anymore kids partly due to this). I felt exactly as you do during my second pregnancy, I was so scared. I completely freaked out during early labour but then managed to calm down and focus on a safe birth. Labour was very straight forward, I was fine, DS2 was fine and DS1 stayed overnight at my friends house and was also fine. I remember feeling intense relief after giving birth and knowing that it was all over and done with.
I think sometimes hormones can make us feel anxious and also in my case a very close family member had severe complications and almost died during childbirth (very rare complications and also a very complicated pregnancy) so it made me more aware that it happens.
It's likely that all will be fine though OP and I think a vaginal birth is actually safer than a c section.
I had an emcs. I never had any issues with it despite having been gung ho about natural birth beforehand. Afterwards, one of my mummy friends was the wife of a gynae and a medical professional herself. She nodded sagely when I told her I would be looking for a CS next time around and told me that you would be hard pushed to find a gynae who's wife had a natural birth. I will be looking for a CS for sure.
Don't do it! I had a horrendous vaginal birth including episiotomy that got infected, and I also had an emergency c section. Even though the v birth was bad and took some recovering from, recovery from the csec was so much worse. I could barely move, couldn't pick up baby for ages, couldn't twist or bend or drive. Everything was so much harder for a long time.
I was up the same day after my twins c/s(combined weight of 14lbs).
It's your decision but the recovery time is longer & despite what some on this thread think, vb aren't that bad.
I wonder how many of the "CS recovery was awful" camp was elective or emergency? You can't compare the two.
I am 99% certain I'll be asking for an elective CS if I get pg. the thought about pushing something so huge out, fucking up my pelvic floor, tearing, the pain, the exhaustion, the uncertainty. Fuck. That. I'll have a date booked in, be awake and pain free and hopefully have a good recovery.
I think unreasonable as for someone with no medical issues and history of a normal vb another vb is safer (ie less chance of dying) than a cs.
vb aren't that bad
For you maybe. Not for my SIL who has haemorrhaged twice and had forceps on the third. Not for my mums god daughter who had a v bad year all the way to anus.
I don't think the recovery time is always longer. I think there are good recoveries with both vb and c/s. And there are bad with both too! Every woman and every birth is so different.
FWIW I had a very good recovery from my c/s. I wasn't in loads of pain, I breastfed successfully, the midwives commented on how well I was moving and things like that the day after I had the c/s. It was a bit hard getting out of bed for a couple of weeks, as was going up stairs if I was a bit tired. All in all I wouldn't hesitate to have another caesarean.
Or for two of my friends who have had years of reconstructive surgery(which still hasn't worked).
These are the friends not too embarrassed to talk about it.
Please seriously consider going to see your GP about this anxiety. I had pregnancy-induced anxiety and spent weeks and weeks crying in secret because I thought that me, my baby and DH were going to die. Every time DH left for work I was convinced that I would never see him again. It was horrible and I suffered from terrible PND after DS was born. I'm sure that if I'd spoken to my MW or GP about how I felt during pregnancy then that year needn't have been so utterly awful.
The recovery time isn't necessarily longer, at all. It all depends on what kind of birth you are comparing with what kind of birth.
My easy, uncomplicated, well handled planned c section was a doddle to recover from, compared to a few friends' very long labours, severe tears/forceps damage. In an ante-natal group of 6 1st time mums, one mum (who had a very straightforward and quite fast vb) was out of hospital after an overnight stay - I was out after 2 nights after my elcs but could have gone after 1 really - the rest were all vbs and in for between 2 nights and a week and a half, for the grimmest instrumental delivery. And she came home with a catheter still in.
But then you can find women who had awful emcs's and long recoveries and women who have homebirth vbs where it all goes swimmingly. So much depends on individual circumstances.
All I would say is don't think an ELCS is an easy way out, or in fact easy at all. I absolutely hated mine (DD was a footling breech) it was so uncomfortable, you cant get out of bed for the first night and it's a major operation so takes time to recover from (frustrating when you have another LO to look after). Having done induced labour with my DS, I have to say I preferred that! Good luck.
Yabvu. I had to have an emergency section with ds1 and I don't have the choice of having this next baby naturally due to the risk factors. I'm incredibly jealous of women that can birth naturally AND go without weeks of recovering (it is literally agony). I'd much rather have hours of painful labour than weeks of painful recovery.
it is longer,even for an easy section.
i had a water birth at home with 2 and 2 drug free vb at hospital,all 4 times i got up off the bed,had a shower,got dressed,dressed my baby and walked to bed,within 5-10 minutes after giving birth,you cant do that after a c section no matter how straightforward.
The other thing to think about is if you'd like more children op. you might feel differently next time, then you'd have to fight the system for a vbac.
Have you thought about a doula? Get some personal support for yourself and dh and perhaps some fear release?
I know this is controversial and women have choices now BUT i really think that cs should only really be done for medical reasons on the nhs. Feel free to flame but my reasons include:
- the cost. Non medical birth is room with a midwife. Cs is theatre with lots of staff
-emergency cases may have to wait (in potentially life and death situations) whilst someone has an unnecessary elective
-cost in recovery. In hospital for usually 2 nights v quicker release time with normal births
Hmm - probably more reasons and i know lots will disagree strongly but that's fair enough
I had very easy recoveries from both my ELCSs and was up out of bed same day doing nappies etc both times. No discomfort or pain and i had a 15 montb old to deal with too second time. Started running again five weeks after each so they couldn 't have been that bad - but everyones different.
No, amber. if you have a bad vb it can take a lot longer to recover than if you have a an easy elcs.
Depends what kind of recovery "time."
Immedialty after op - pretty disabled, and limited for about three weeks - but in no pain.
I had a so called great text book VB but I still feel 100 times better four months on - after a section than I did after a VB with no intervention or complications.
Unfortunalty there isnt really a climate where people can truthfully say how thier birth went.
Whois yes you're right, for me both my vb were quick with no complications but with an episiostomy both times & very fucking painful (gas & air) but I would not for a minute consider asking for an ecs. Giving examples of worse case scenarios just isn't helpful, very few vb are like that as I'm sure very few ecs are horror stories
Seems that this thread is simply all about how fabulous an ecs is, just though it would be good to give another slant to it.
OP I'd speak to your mw to see about talking through your fears before deciding for definate on an ecs.
No Rain, It can also take longer to recover if you have a so called text book birth to recover from than an easy elc.
I would say about four years on did I feel OK again after VB, nothing major - but a lot of nagging things.
Actually.... I WAS up the same day as my elcs - in fact, I was out of bed the same night. dp reminded me. I had ds late afternoon - I can't even remember why I got out of bed now, as I didn't shower until the next morning (and after weeks of getting up every hour to pee at night, I was quite happy to have a catheter in overnight!). But dp is right, I was up. Maybe I was just keen to mobilise. Not that I think recovery should be competitive, it all takes as long as it takes, however you give birth....
Can I say again - an emergency CS is completely different to an elective one...
Also, I am sorry to say but you only get a belly overhang from a CS if have belly already.
Sorry clementine - x post - well, yes, I have heard friends who had what could be described as ok deliveries talking about various problems, and I do wonder how widespread that is. I'm not a big one for birth stories though, and I do tend to keep quiet irl about my elcs. I don't want to go on about it being a good birth around women who had bad vbs, and (on a different tack) women can have VERY strange attitudes towards elcs, and I don't like to make their problems my problems!
everyone is different
saying 'BV aint that bad' is flippant and a bit goady - YOURS where not
My sections here fine - other peoples aren't
gory detail wont help the OP with her fear though!
notcontent that isn't true at all. My belly skin folds at the c sec scar creating a hangy skin flap. Never had a belly before and certainly never one that hung!
Re cost- the surgery and other medical treatments often needed after a vb I'm sure would make either option comparable.
I think there is a problem with information and freedom of speach though.
I think that women are afraid to say they had a bad birth because someone somewhere will say " yes but it was worth it you got the baby" whilst they are nursing a damaged for life bladder and a catheta or something, or they are afraid to say like op - they want an elc for fear of being told they are selfish and will cost our poor NHS money needlessly.
I think culture is changing - hopefully by the time my DD's have DC the whole thing will be open and balanced and ELC will be recognised as a fine and viable option for the ladies that want it and need it - and that VB is also a viable option but with more truthful disclosure of the things that can go wrong.
Again, people who have had bad VB experiences are told they are being competitive or scaremongering if they speak about it.
It is totally irrelevant what kind of deliveries we've all had; lots of examples of good/bad VBs or good/bad CSs will not help the OP.
ditsydoll, YANBU to favour one method of delivery over another (your body, your choice IMO), but you sound as if you are feeling the way you do due to your anxiety. That is what needs to be addressed, not the way you'll deliver. Of course the predictability of a date and 'doctors taking over' might seem reassuring, but it really is an avoidance behaviour which will make anxiety worse. The danger is that you might latch on to something else to get anxious about once this worry is out of the way. Your way of thinking is not entirely rational and that IMO is a bigger danger to you than the mode of delivery.
Please speak to somebody: your GP? Or consultant if you don't feel comfortable with your MW? Don't carry this on your own. Do you/did you in the past have any help with anxiety/avoidance?
I agree Clementine.I was shocked to hear of the birth injuries you can get that are still rife in the countries without the option of c/ss.The way it is swept under the carpet and not talked about is just dreadful.
Doublecakeplease would just like to say with regards to your post, NICE guidelines have stated that cost should not be a reason to refuse a request for c/s. You could argue about cost for so many things the NHS do. The cost of the medical care some women need potentially years after a vb can be more than the cost of a c/s. And as for hospital stay, other posters on this thread have mentioned longer hospital stays for vb in some instances.
Also, hospitals have systems in place to ensure no emergency case would have to wait- they run two theatres where I had my c/s. Set days for having planned c/s. And careful monitoring of women in labour, so if an emcs is needed that will be pre-empted. A planned c/s would be delayed for an emcs.
And what do you judge as medically necessary, physical reasons only? Psychological reasons are still a medical reason.
polkadot on childbirth thread there are always these debates - and people throwing stats around left right and center.
I think the general conseus is that problems incurred after a bad VB are not included in the comparable figs to an elc, so you cant really compare costs like for like and say outright - an elc costs the nhs more.
YANBU C-section is safer for baby than vaginal.
Do it for the right reasons though. You should have the right to choose your style of birth. Good luck.
But polka - most ladies won't need follow up treatment. Cs must be much more expensive than a straightforward delivery. My local hospital had 2 theatres running cs operations when i was in. Unusual but they had (quote from anaesthatist) back to back emergencies in all day. I'd hate to think an emergency turned critical because a non medical elective was taking up a theatre.
ditzydoll if you're terrified of having a vb then that is good enough reason to have a cs.
However, as your anxieties seem out of proportion (considering your previous birth), I would second the advice to speak to your GP. If your current midwife is unsympathetic, hopefully you can arrange to see different one, might be at another surgery tho.
Another suggestion is to contact the maternity unit where you had DD and ask if they have a Birth Trauma counsellor. Although you didn't have a traumatic birth, I imagine they have a lot of experience in helping women with fears of childbirth.
Op I was very anxious.My mother had a dreadful time(won't go into details) and after 7 years of trying I was petrified of losing my twins so was over the moon when I found out they were breech and I'd be having c/s then another for dd.
Seriously the consultants both time were amazing as we're the teams in allaying any fears,making you relax and enjoy the whole procedure. Consultants who carry out thousands of c/s yearly know their stuff and can answer any questions, put things into perspective and allay fears.
Ariel i know what the guidelines say but the nhs is on its arse! Surely if we can avoid the massive cost of medically unnecessary operations then we should try to?
I'm with doublecake* I'm afraid. If you want an elective C/s then you should probably pay for it, not expect it on the NHS. The pressure from genuine emergnacies id too high, and if you ahve psychological reasons for not wanting a vb money would be better spent on getting you to deal with that. a normal VB is the safest kind of birth. I write as someone who had a very dodgy and dangerous vb.
Apologies for typos. I don't think they affect meaning!
YANBU, go for a CS if that's what you want. NICE guidelines have changed so you can now get ELCS on request. I don't understand why some people think anyone else should have a VB if they don't want it.
Again doublecake, what do you class as medically necessary? I had what consultant described as the worst case of tokophobia he had seen in 20 years. I can't go into all the details as it is far too upsetting for me but the impact on my mental health could have been disastrous without me getting the care I needed and ultimately, a c/s. The midwife and consultant I saw certainly viewed it as being necessary. Psychological reasons are health reasons. It's so sad the way mental health problems are viewed in our society.
We can all want things though Flora. I really don't like this culture of 'i want, i have a right'.
The cost is a bit academic too when somebody posts in distress
ukatlast, you statement about 'CS is better for babies' is a bit sweeping; it is not quite as clear cut:
"This finds that babies born by vaginal delivery are quite substantially less likely to be admitted to neonatal intensive care at 6.3% compared with 13.9%. But this does not take into account that most caesareans are carried out for medical reasons, and therefore the likelihood of needing neonatal intensive care is high. The evidence on neonatal mortality is conflicting with one study suggesting that there are one fewer deaths of babies born by caesarian per thousand live births and a second suggesting that there are one fewer deaths of babies born by vaginal deliver per thousand live births. The evidence is also conflicting on whether birth method affects the Apgar score, which is used to assess a newborn's health."
Like I said, of course you should be able to have the delivery you want, but make your choice with all the information available and quite clear on the pros and cons.
'We can all want things though Flora. I really don't like this culture of 'i want, i have a right'.'
FFS we or our partners pay loads in taxes over the years, the least the NHS can do is let us have a C Section if we want one. Most people wouldn't choose it without good reason because it is major surgery.
defo not true about the saggy belly, i had a six pack at one point but still that saggy bit at the bottom where my scar is.
I don't want to get into nasty arguments and really genuine fears must be horrendous and i don't want to demean your feelings in any way. I don't honestly know how it could be decided who gets elective but i genuinely don't think that our nhs could cope with giving everyone who just wants one a cs.
Well - whatever you feel you may find you have extreme difficulty persuading anyone to grant a elcs, regardless of what the NICE guidelines have to say. The way funding is organised within maternity care is changing which will put a huge squeeze on the NHS. It's going to affect all pregnant women.
Thankfully - what you think or want has no bearing on what should happen, Nice guidelines have changed and are there for a reason, for basic humane reasons. Sadly they are only guidelines but they still put pressure on cost driven consultants making the descions.
I'd hate to think an emergency turned critical because a non medical elective was taking up a theatre
and I'd hate to think of a woman literally petrified of childbirth having to go through a vb. I hate it even more if she and her baby turned out to be the statistic that did have significant problems.
It's all unknowable outcomes; we are all trying to make decisions for outcomes we cannot know.
OP please get some help for your anxiety; it's not good enough to be fobbed off by a mw. Don't worry about having to put a brave face on it on front of her.
I am with doublecake. Ariel if you had tokophobia then that is a medical reason. A few posters have said they didn't fancy a VB. I would guess there are many others who easily fake tokophobia as it is hardly easy to check, is it.
CS is a major operation. I come from a place where all my friends have elcs. They do it blindly and without reason and some are shocked by the infections, complications etc. I had a long Vb, ventouse delivery with episiotomy. I had no pain the next day apart from a bit of discomfort from stitches. I would never have a CS unless there was no alternative. Our bodies are designed for childbirth and in the event of a problem MW can suggest EMCS. We are lucky to live in the first world.
I have the exact opposite experience Numerical.
I know people who had an ELC/Emc who were made to feel they should try for the VB next time, and have ended up shocked and with major bladder complications/ many other problems and have spent months in and out of hospital with on going problems, wishing they just had another section.
Personally I would just go with whatever makes you feel better and relax. You will hear horror stories from Both methods of delivery and absolutely delightful stories as well.
It's personal. You choose what makes you feel more in control. Both come when pros and cons and I feel this country puts too much pressure on women to do it the natural way and to breastfeed. Whilst I agree that healing is easier after a normal birth I can tell you terrible post natural birth tales too.
Fortunately you have done this before and probably have some good reason for being 'unreasonable' so if you don't think therapy/counselling will help. Then go for a csec only if it makes you feel less panicky! Your body, your baby, your decision - the pros and cons exist about everything!
FWIW doublecake I didn't think you were demeaning my fears, I think its impossible to understand if you've not been in my position. think one of the reasons the NICE guidelines were changed (from what I remember at the time a doctor interviewed by the BBC said this, sorry I can't remember more accurately though) was that they genuinely didn't believe that there would suddenly be a huge increase in the number of women requesting a c/s, Ttherefore they believed the NHS could cope with the cost. The guidelines were changed to help women in my position. I think if was a move to recognise psychological reasons for requesting a c/s.
I think the most important thing is for the OP to know that her fears should be taken seriously by her midwife and consultant and the guidelines are there to back her up.
I had an emergency c-section and it was the worst experience of my life, i was in pain, i couldnt sleep in my own bed for 4 weeks, had to sleep on the sofa, it was bloody awful.
To consider a c-section, you need to think about aftercare, its not as simple way of delivery as people think.
I don't like culture of entitlement either doublecakeplease, but I think that putting birth choices under that heading is misguided. Doing that assumes that one choice is somehow better than the other for the mother and baby involved and/or society at large, and I don't agree that is the case.
Everyone's view will be highly coloured by their own experience. My own was that DS1 had to be delivered several weeks early because his placenta was failing. The medics wanted to induce me which I absolutely refused, having read up on early induction and how much less successful it is than when overdue. Cue ELCS. I was up and about 17 hours post op and spent 1 night in hospital, no complications. It later turned out that DS1 has heart defects which could have seriously endangered him if I'd had a long or difficult VB. A win for us and I think probably a win for the NHS.
2nd time round, I get the choice (and at a very cash-strapped hospital). I want to spend as little time in hospital (we are frequent fliers with DS1) and to be as relaxed as possible. I have spoken to midwives and consultants about VBAC but for me, another ELCS is the right choice. DS2 is apparently a big bugger and I don't have 95th centile hips. I don't fancy 4 years of discomfort and repairs like my DM had after I was born.
Neither of my CSs was strictly medically necessary, but I don't feel I've ripped off the taxpayer. Exercising choice makes what can be a scary time generally much more bearable and I think all women should be supported in that, whether they want VB, HB or CS. I'm glad NICE guidelines have moved in that direction.
Oh and if an emergency pops up when I am booked in I go to the back of the queue, and quite right too.
op,have you read any of Ina Mays books?I found them really empowering.
I really like the idea that birth is not unpredictable(apart from extreme cases),and that you have control over the sort of birth you have,it might all be a load of tosh but i am so glad i found them as i went into my labour experiences totally believing i was in control and that everything would be ok,and that it was just a safe natural process that my body was made for,and i have had 4 very positive birth experiences.
Like i say it could all be rubbish,but it helped me!
YANBU. As long as you are going to pay for it yourself.
Hospitals have systems in place to ensure no emergency case would have to wait- they run two theatres where I had my c/s. Set days for having planned c/s. And careful monitoring of women in labour, so if an emcs is needed that will be pre-empted. A planned c/s would be delayed for an emcs.
This is wishful thinking. Obstetrics is just about the most unpredictable area of medicine.
Of course hospitals have systems in place, but they are not bullet-proof, it's just not possible sadly.
Do you really think having elective sections on 'set days' makes a difference? Emergencies unfold any time and often concurrently. An elective C section means a theatre and a team not available for an emergency. I've been at meetings in the hospital I'm working at where 'near misses' have been discussed and one of the factors behind things going horribly wrong is having expert staff tied up in theatre with an elective section. If in the meantime another emergency section takes place and another woman's baby on the labour ward suddenly decompensates, the stat c section that woman needs is delayed for crucial minutes. Baby is born flat and goes to NICU. Or, less dramatically, that 'careful monitoring of women in labour' isn't as careful as it should be because there aren't enough staff out on the ward because they are in theatres. It happens, sorry.
There are plenty of clinical indications for elective C section but 'maternal choice' isn't one of them. We all know that maternity units are overstretched and it is beyond doubt that the increasing number of elective C sections for 'maternal choice' will at times end up compromising care of other mothers and babies - however good the systems are.
We've all paid our taxes but there is still a limited amount of resources to go round, even in the best units in the biggest hospitals. C sections for maternal choice that aren't indicated clinically are not the best use of those resources.
Tired - exactly what i mean! Unfortunately the guidelines people are referring to didn't come with an endless pot of free money or extra theatres or extra staff.
The lady who said she'd go to the back of the queue if an emergency came in - what if you were 5 minutes into your elective?
An emergency c/s is a whole world away than a planned section.Both types of section are done often on riskier more complicated patients hence the slight bigger risk in the figures which are still fab in this country. A planed section is going to be hugely safer but the figures will still be counted as the same.
Again re cost the follow up care and reconstructive surgery needed for a lot of vb patients must cost billions and be a false economy to be frank if people are going to bleat about cost.
One of my sections was done by one of the best c/s consultants who has written a lot on the subject.All I cared about was my babies living,said consultant was of the opinion a c/ was safest for babies hands down.
Soo glad to hear about the NICE rules.Choice is available across the NHS and it annoys the hell out of me that women are treated like naughty little school girls when they want a choice over something as momentous as birth.The lack of true info re vb and the implications is appalling imvho -it's 2013 not 1813.
Op I hope you get what you want,try to get an appointment so you can start planning and enjoying the rest of your pregnancy.If you go for a C/s it is over in 20 mins,literally the minute you hear your baby cry they're stitching you up. I was amazed and loved both of mine.You can have skin to skin and it's a very calm atmosphere.Good luck!
II would look at dealing with the anxiety before deciding
If you are in the uk and want an elective c-section but the nhs won't pay for it how much would it cost to go private? Not that I do, those days are long gone Just curious.
I had an elective section with my only DC, it was a lovely civilised experience. I was up and about from the next day onwards. Can highly recommend it in my experience
I've had two, one emergency and one planned.
Recovery was fine, I was home the next day from planned one. It was a fabulous experience. Music on, chatting and joking with staff, baby relaxed and feed for forty minutes in recovery.
Entirely your decision.
It seems to me though that if your fears are based around safety then natural delivery has fewer serious risks, as in life altering risks. You have to remember that whilst there is nothing 'wrong' in c sec in that it isn't inferior (have had 3 myself) it is still major abdominal surgery with all the risks that entails - blood loss, potential infection etc.
You need to think hard about the situation in a pragmatic way rather than having your emotions rule you on this. Perhaps counselling could help you with that thought process?
YANBU but maybe being a wee bit naive in your assumption that a planned CS will mean less complications and be safer.
I've been terrified of childbirth for as long as I can remember ( I put it down to seeing a documentary on c4 when I was a kid showing a woman giving birth, I had nightmares after it) I didn't ask for a CS with DS but spoke to the midwife and they tried to reassure me as much as possible. As it turned out, I ended up needing an emergency CS with DS1 which I found pretty traumatic. Although I was up and walking around easily enough afterwards (most of the midwifes didn't believe I'd had a CS until they saw the scar) I had a lot of complications afterwards with infections in my wound. With DD I was still scared of labour given my experience first time and was offered a section when it was confirmed she was lying the same way as DS. Whilst the delivery itself was far calmer I had lots of problems again with my wound and this time the infection spread into my womb. Feeling shit with two wee ones and barely being able to lift them isn't nice. I often wonder how things would have turned out if I'd tried for a natural birth with DD.
Good luck with whatever you decide.
I will never be jealous of women who do child birth naturally. For me a VB was horrendous so I had a subsequent elective CS. That's what was best for me because my first birth led me to be terrified of child birth.
People will always debate what's worse but you'll never get your answer because its so different for every one. My CS was a walk in the park compared to my VB. you should see your consultant and ask the question only he can tell you if it's possible. Good luck.
Yanbu. C/s are safer for babies but normal delieries are safer for mums. (Marginally). I wanted an el c/s for personal reasons with dc1 but went into labour at 37w and ended up with an emergency c/s anyway. Ha an elective c/s with dc2. It was a wonderful stress free experience. I loved it.
abbycat that is such bollocks.what a stupid thing to say.
i personally believe those who never experience natural birth as it should be are missing out big time.
You can ask, but you might not get one. I asked for an ELCS but was refused, I ended up having an EMCS - I was delighted - absolutely no complications - but it must have cost the NHS a lot more than an agreeing to an ELCS in the first place.
And no, Amber, I absolutely do not feel I am missing out big time by not having experienced a 'natural' birth. Why do people get so evangelical about vaginal births?
Pmsl errr several people I know don't say that,I won't list the reasons why in consideration of the op.
I've got 3 children and never even had a labour pain-ignorance is bliss!
Ps if you decide to go for vb or are refused elcs then maybe try the hypnobirth techniques - not in order to do hypnobirth but as the relaxation techniques use positive visualisation etc they kept me calm during a back to back labour with a larger baby.
Hope you have a lovely birth whichever way you go - once you're cuddling your newborn it won't matter how it happened.
I had the opposite problem to you, I wanted a homebirth but I was high risk and it wouldn't have been a good idea. I'd previously had a very traumatic miscarriage, then a homebirth, then an attempted homebirth with emergency transfer which was medically straightforward but emotionally traumatic). My midwife arranged for me to have an appointment with the supervisor of midwives. We went through my birth plan together and talked about my various fears. It made a huge difference and I had a lovely VB with DS3. Would you find something like that helpful?
My feeling is YANBU - I think hospitals should do what the patient requests, and if you are happy having a c-section, then I see no reason why you shouldn't ask for one (though not so sure they will let you have one without a strong medical reason).
However, I would also suggest seeing if you could get treatment for your anxiety. I am very similar to you in that I worry hugely about everything and see danger everywhere. When my DD was 4 I had to go on a long plane journey for work and was terrified of the plane crashing and me leaving her behind. It's not great to live your life like that, so something like CBT might help.
Entirely your decision
Iirc you can't chose on the NHS, they don't let you unless there is a really sound medical reason unless I have that completely wrong. You can of course go privately.
Treatment for anxiety sounds more sensible an option than major surgery.
Best of luck x
Yanbu to think you might want an elcs. However having had 1straight forward birth you are about as low risk as it gets for a second. I believe (and am ready to be corrected) that you have the lowest rate of complications if you have a vaginal 2nd birth.
FWIW I was in and out in 6 hours with my second. Cannot believe a section could be more relaxed than that.
I was in for not much longer and yes the section was more relaxed because I felt safe.
Sorry amber that's hilarious... What bit about vaginal birth did I miss out on.
Amber how ridiculous, I Would rather be missing out big time than ever go through that horrendous experience that was a VB. Some people just don't do natural labour.
Yanbu OP, but a CS isn't an easy option either. No such thing when it comes to giving birth I'm afraid!
DoubleCake I've read that when you factor in treatments for picking up the pieces after bad VBs, it works out about the same. Don't have any stats to hand for that though, but certainly one needs to consider more than simply the cost of the procedure in isolation. I think if you're going to say that women shouldn't be able to choose inessential CS due to the expense, you need to cost it properly in order to be taken seriously. And your comment about most VB mums not needing follow up is missing the point. If those who do need it are expensive enough, it's perfectly possible for them to push up the average cost of a VB beyond a CS. I should add that I had a relatively complex VB but healed well and have needed no follow up, so I'm not biased here.
AmberSocks those are simply your VBs. Those of others can be and sometimes are very different. You must surely know that. It's very unhelpful to extrapolate your experience to everyone. As for Ina May, I'm glad she helped you but yes, she does spout a fair amount of rubbish! For a start, your body wasn't made for anything. It's a product of evolution. And evolution has made birth difficult for us, because of the trade off between the benefits of a big brain and the benefits of a narrower pelvis allowing us to be more mobile. This is why it's intrinsically risky and inevitably goes wrong for some people. You were lucky, that's all. And I'm glad you found your VB to be an experience, but not all of us feel that way.
Ariel makes a good point about there not being legions of women wanting an elective CS. There are plenty of women who'd never in a million years have one that wasn't medically necessary, myself included and no doubt a few others on this thread judging from responses.
The suggestion about seeing the supervisor of midwives is a good one too.
*i personally believe those who never experience natural birth as it should be are missing out big time.
Oh really? well I personally don't feel like I missed out one bit! I'm not bothered at all that I didn't have a natural birth. As long as DCs are fine, that is all that matters. In the list of regrets re DCs, it doesn't even feature on the list.
I feel strongly about breastfeeding as I feel that it makes a difference to the health of my DCs but the method of birth whether it is a VB or a CS is immaterial, it doesn't make the slighest difference to them.
Infact my ELCS was probably safer for my DD than my highly medicalised 2 day labour followed by EMCS for DS, pumped full of pethidine to calm me down, he was born sleepy and no interest in feeding and BF failed miserably. HOrrible horrible experience. My DD's ELCS was wonderful, the most peaceful, life affirming experience I've ever had. She was born perky and eager to feed. I even enjoyed my hospital stay. It was difficult getting up in the first 24hrs but after that I was walking as normal. And my insides are lovely and intact . One of my NCT mates and to have reconstructive surgery after her VB. My mum had all sorts of problems after her VB. Even my MIL who's a midwife and also my constultant said a ELCS would be a far better option for DD.
I'd choose a ELCS over a VB anyday...but that's just me!
God there is some UTTER crap on this thread.
squeakytoy Tue 12-Feb-13 20:37:31
I am sure a cesarean is more dangerous than a natural birth in hospital?
This is why NICE covered this in their update on CS. Cos that ^ there isn't necessarily true.
The problem is that most of the time statistics on CS are all lumped together - ELCS and EMCS and all the figures for VBs are separate.
Except this is HUGELY flawed. You don't plan to have an EMCS. An EMCS is the consequence of planning a VB. In order for statistics to be properly comparable you need to separate EMCS from ELCS. Ideally the best way to do this is to compare Planned VB versus Planned ELCS as this is how things happen in the real world.
When you do this, a planned VB, which includes operative VBs and EMCS and the associated risks comes out only marginally better than a planned ELCS for first time mothers.
And this is one of the reasons that NICE said that it was perfectly acceptable to grant an ELCS on maternal request as the health risks were not significantly different.
NICE's guidance IS slightly misleading and open to criticism however, since it only looked at first time mothers and didn't look at subsequent risks for future pregnancies. So its perhaps not a suitable route to go down if you want a larger family and the risks of a VB are slightly reduced for women who have already had a VB and this isn't reflected in the guidance.
NICE's guidance also looked at one of the main reasons why women request CS. For mental health reasons such as anxiety. This was done because it has been an issue for several years that hadn't been tackled and was leading to widespread differences in treatment and the fact that anxiety wasn't being taken seriously enough. And indeed that previous traumatic experiences of birth were being ignored.
The update recognised this was a problem and had a long term psychological impact on some women. It was serious enough that denying access to an ELCS has been shown in studies to be reason enough for women to have terminations despite desperately wanting a child. This is a massive step forward.
The update suggested that various ways of dealing with the problem needed to be looked at and counselling offered as this benefitted some women who then felt able to have a VB rather than be 'forced' to have a VB. Essentially it is advocating better support all round for particularly anxious women not just allowing everyone to have a CS. (Theres a lot of people on MN who would suggest a homebirth as just one alternative to relieve anxieties but really depends on what your individual fears are about).
And finally cost. NICE assessed the cost of planned ELCS. Initially the short term cost looks cheaper than a planned VB (because you have to include the costs of EMCS under a planned VB too). BUT and this is a big but, they decided that this difference didn't give the whole picture.
The cost of complications - such as psychological issues or incontinence - meant they decided that the difference, over the medium and long term, was so small it wasn't enough grounds to refuse a request for an ELCS on.
UNFORTUNATELY the whole debate has been poorly reported, is highly political and is full of a shit load of myths. Too many people in power and too many member of the public think that ELCS on maternal request are lifestyle choices and do not think that psychological reasons are a good enough reason for an ELCS despite scientific evidence to the contrary. So hospitals are ignoring NICE in many places.
The guidance was supposed to stop the wide inconsistances in care. It hasn't. Some women are finding it easier to access ELCS but lots aren't.
Hospitals are still under pressure to reduce CS rates. And ELCS are an easy target as the reasons for ELCS are poorly understood and easy to reduce - at the expense of women. The irony is that despite the Department of Health and WHO saying we should not have a target rates for CS, hospitals are still aiming for 'optimal rates' and one of the things maternity units are rated on, is their CS rate! Like I say, its HUGELY political.
So is the OP being unreasonable.
HELL NO. A ELCS might not be suitable for everyone on similar grounds, as I've mentioned above, but it is a very valid, safe and cost effective request. And this is in the words of NICE, not just me.
And I bloody wish that people understood this issue properly, the research thats desperately needed was being done, what research is out there is actually of a decent standard, that medics get retrained on this issue and left their personal ideology and judgments at the door and just generally all the political crap and ignorance were removed.
Good luck OP, I hope that you get the birth that is right for you, without having to fight tooth and nail for it.
And I hope your DP gets the great big kick up the arse he deserves for being unsupportive. You are not being silly, whether you end up having an ELCS or whether you manage to face having a VB.
QUOTE Ambersocks 'abbycat that is such bollocks.what a stupid thing to say.
i personally believe those who never experience natural birth as it should be are missing out big time.'
Well I've done it both ways (vb and elcs) and say no one is missing out on anything, the important thing is the arrival of a healthy baby and an untraumatised Mother.
I had a friend who became depressed after a Section because of such claptrap about how she had been denied a 'proper birth experience'. Complete dangerous unhelpful NCT-induced tosh.
The strongest argument for CS is that medical staff invariably choose it for themselves and their nearest and dearest. It was several years ago but when I told my female consultant I wanted the safest way out for my second baby - she said well that's a section then. There's a slightly higher risk to you etc etc but better for your pelvic floor etc...so swings and roundabouts.
We pay our taxes - there is no real reason in 21st Century to deny women choice in such a matter. If men gave birth it would be GA all the way!
P.S. The reason NICE said that ELCS should be granted regardless of counselling, was because they have yet to prove that its helpful in all cases for everyone. There is debate over what works and what doesn't and this also needs to be in the context of a ticking clock of pregnancy.
Their assessment was that in the absence of knowing this crucial information and the fact that there were limitations in access to counselling - not least because of the timeframe, that allowing ELCS must be their recommendation.
I opted for CS. I was informed that it would be slightly more dangerous for me but safer for my twins. It went smoothly and I was up and about a day later. It's quite painful to cough, sneeze or laugh for a few days but apart from that, if I were to have more children, I'd definitely go for CS again! Saying that, there were women in the same ward who didn't recover so quickly. I think it all depends on fitness levels, how the procedure goes and of course the individual.
I don't think a conventional birth makes you a better woman and it certainly doesn't make you a better mother. Why suffer pain if you don't have to? I had four hours of labour before having my CS and for me, that was enough. You don't have to prove anything to anyone. Do what you think is best and ignore anyone who attempts judgement X
Well here are my thoughts, for what they are worth;
everybody is different everybody has wide and diverse opinions on this subject but I have had 3 elective, no medical reason, non emergency caesareans. I asked with DC1 and had a lovely consultant who was of the opinion that if a mother is happy with her birth it would deliver the best outcome. Had a number of midwives try to persuade me to try for a VB, I politely declined, all happy, 3 healthy DC.
Oh and recovery was a breeze, driving after less than 2 weeks with all 3 and back at a spinning class 2 weeks after DC2, no infections, no pain, no regrets and I don't feel less of a woman as an NCT mum tried to imply over coffee before I corrected her
I sooo feel after my horrific first birth experience - wonderfully and utterly empowered by the overwhelming glory of vaginal birth. Add in to the glory that I did it all almost to the end (when I was forced into a spinal and forceps - they actually reported me to social services for showing signs of resistance to this because I panicked at having someone wielding a set of forceps yelling at me) without pain relief because the hospital procrastinated, dithered, dodged the issue and generally dragged their feet in some kind of crusade to basically force mothers into doing it without anything at all to help - I've since found out they've got a dreadful reputation for doing this. I guess in the competitive birth stakes doing 8cm dilated without even the aid of paracetamol must earn me some iron woman points though.
Nope - I'm still having horrendous nightmares 10 months later, and the cost to the NHS in terms of follow up from the birth injuries and mental distress they caused is probably a fairly sizeable chunk of cost. And physically - I got off lightly really in terms of recovery from the structural stuff.
I cry myself to sleep probably 5/7 nights over various aspects of what I went through there... yet the "no section" mentality still pervading my area's NHS means I'm going to have to go through it all again (it's either that or let them take away our chance of having a sibling for DD1) - I have minimal choice in the matter - especially since the first birth took away any oomph I might have had to try to assert my rights within the system. I get to see the birth phobia/trauma midwife next week - but since I've spent most of this pregnancy having my concerns fobbed off so far - I'm not expecting a miracle at all.
But yep, it was such a glorious experience I feel my life would be emptier without having gone through vaginal birth... bollocks - I actually wish they'd gone for the section the second things looked mildly dicey - my life would be emptier then... emptier of the flashbacks and utter terror, and I'd feel so empty without crying in bed at night.
It's very easy to sit and glorify vaginal birth if you've had lovely ones that went straightforwardly, if you had staff who were on the ball with pain relief, a nice delivery suite, a cooperative baby and uterus... I'm sure then things are amazing - but stop burying your head in the sand about women who DIDN'T have all of that and who are still dealing with the fallout physically and mentally months and years down the line. And while I'm ranting about that - can we please stop this stupid obsession with "oooh didn't she do well" when things go conventionally - and the associated implication that you somehow did crap if you had a baby with shoulder distocia, or prematurity, or back-to-back or cord issues or whatever?!
You sound incredibly knowledgable on all of this. Its nice to read such an eloquent and backed up post.
To me - the best kind of birth is when the mother and the baby come through it in the least damanged way possible both phsycially and mentally and Alive.
Sorry to hear of your not-unusal NHS birth traumas.
Given the NICE guidelines and your on-going trauma. I really think even your NHS area will have to agree to an ELCS for your second. Your case is stronger when you have done VB once and it has gone horribly wrong.
Don't let midwives fob you off. Get you GP to refer you to discuss with a Consultant who is the ultimate decision maker.
If you see a SHO who tries to say no, simply say you want a higher opinion, usually 2 rungs up, they will accede since they need some ELCSs for doctors to practise on. It's not a good idea to be learning C-Sections in Emergency situations.
Of course you aren't less of a woman if you have a CS. Vaginal birth is not necessary to confer womanhood: I was a woman before DD came out of my fanny. I would like a second child, and would prefer a VB, but will not become even more of a woman if I'm successful in this undertaking. Ridiculous comment, but there are a few extremists who believe that. Unfortunately, they're permeating the discourse. Most women would see that stupidity for what it is, but the idea that women who have a CS are missing out seems to be taking hold for some. I have a friend who had an EMCS and feels she was deprived of the VB experience. So I offered to kick her in the fanny for 20 hours instead.
The evidence tells us that ELCS can be slightly safer for the baby, but is slightly more dangerous for the mother. However, we are so fortunate that in the UK today all ways of giving birth are very safe. I wouldn't go for an ELCS unless I had to though, but I know my view is skewed because the only woman I have ever looked after postnatally who almost died had an ELCS. And you can't make decisions based on anecdotes!
"So is the OP being unreasonable.
HELL NO. A ELCS might not be suitable for everyone on similar grounds, as I've mentioned above, but it is a very valid, safe and cost effective request. And this is in the words of NICE, not just me."
Less than 1% of low risk multiparous mothers giving birth in birth centres or at home have emergency c/s in the UK, compared to an overall national emergency c/s rate of 14%.
If we are talking cost effectiveness - there is no doubt that for healthy multiparous women as a group, on immediate cost grounds, v/b is massively cheaper for the NHS, as the intrapartum complications rate in this group is so very small.
There are many many areas where the NHS can look at cutting costs. I really dont think women and babys at the most vulnerable time of thier lives should be shaved first.
Luckily though- how the NHS finances things is not the concern of the op.
"The evidence tells us that ELCS can be slightly safer for the baby, but is slightly more dangerous for the mother."
Research into this area is conflicting.
A very recent study from Sweden:
Karlstrom A, Lindgren H, Hildingsson I.
Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study.
BJOG 2013;10.1111/1471-0528.12129 [doi].
OBJECTIVE: To compare maternal complications and infant outcomes for women undergoing elective caesarean sections based on a maternal request and without recorded medical indication with those of women who underwent spontaneous onset of labour with the intention to have a vaginal birth. DESIGN: Retrospective register study. SETTING: Sweden; Medical Birth Register used for data collection. METHODS: A case-control study of 5877 birth records of women undergoing caesarean sections without medical indication and a control group of 13 774 women undergoing births through spontaneous onset of labour. The control group was further divided into women who actually had a vaginal birth and women who ended up with an emergency caesarean section. RESULTS: Maternal complications occurred more frequently among women undergoing caesarean section with odds ratios (OR) for bleeding complications of 2.5 (95% CI 2.1-3.0) in the elective caesarean group and 2.0 (95% CI 1.5-2.6) in the emergency caesarean group. The OR for infections was 2.6 in both groups. Breastfeeding complications were most common in women having an elective caesarean section: 6.8 (95% CI 3.2-14.5). Infant outcomes showed a higher incidence of respiratory distress with an OR of 2.7 (95% CI 1.8-3.9) in the elective caesarean section group compared with infants born by emergency caesarean section. The risk of hypoglycaemia was at least twice as high for infants in the caesarean group. CONCLUSIONS: Caesarean sections without medical indication as well as emergency caesarean sections were associated with higher risks for maternal and infant morbidity
I've had two vbs. If I were to fall pregnant again (GOD FORBID!!!!) I would go for a c-section every time. DD2's birth has broken me. Go with your gut.
It isn't true that the majority of obstetricians have elective CS.
As you said "immediate cost" Shag,factor in the cost of reconstructive surgery and other treatments further down the line which can go on for years and which must be eye wateringly expensive and I doubt there is much in it.
Somebody needs to tot it all up.
Considering that the majority of NHS money is spent on the elderly(and a shed load on people who choose to destroy their health) I think begrudging women what they want at an extremely vulnerable time is shite tbf.
"factor in the cost of reconstructive surgery and other treatments further down the line which can go on for years and which must be eye wateringly expensive and I doubt there is much in it."
Even then Polka, I have this week sat in a room of ladies who 70% are damaged in some way" below" saying they had been to the docs and were basically told ot get on with it - sewn up wrong, inverted/outverted bits (?!) flaps hanging down, bladder problems.
I reckon because of the culture towards women and child birth there are thousands of women out there who need further work but their doctors/ HP have been dismissve or ignorant and/or they are afraid to go for more help for a vairtiey of reason, not least of which - is that its a personal area of the body!!!
Shagmundfreud Wed 13-Feb-13 13:53:07
"The evidence tells us that ELCS can be slightly safer for the baby, but is slightly more dangerous for the mother."
Research into this area is conflicting.
Definitely. The stuff in the NICE guidance, tends to point to it being the other way round too - this is what is being recommended that women are told now. Babies are more likely to have problems breathing and need to be in SCBU after an ELCS. Which probably would put a lot of women off.
As you said "immediate cost" Shag,factor in the cost of reconstructive surgery and other treatments further down the line which can go on for years and which must be eye wateringly expensive and I doubt there is much in it.
Somebody needs to tot it all up.
NICE attempted to, and decided that it was impossible given all the variables.
VinegarDrinker Wed 13-Feb-13 14:00:52
It isn't true that the majority of obstetricians have elective CS.
No its not true.
There were figures published in a Guardian article a couple of years ago (here if anyone is interested) This was about what female obstetricians would personally prefer. The article said that the figure for the US was nearly 50%. For the UK there was a London study published in the Lancet in 1996. This reported 31%. (Note this was preference not what they actually were having too, so the figure is probably slightly less than this).
This is high, but it is not 'the majority'. The article does try and explain why this might be (potentially distorted view of child birth, more aware of the worst outcome and perhaps increased levels of anxiety as a result).
On top of all of this, I think its worth pointing out that the trouble with a lot of the stats is they are very generalised. So if you are a fit woman in your early twenties your chances of having a successful vb without complications is much, much higher than if you are over 35 and perhaps are having some complications already. So the data can be misleading if you don't take it with something of a pinch of salt. I do think its very much a case of finding out things as much as possible and then adding in your own personal considerations and I do think that anxieties need to be a very important consideration in that.
"On top of all of this, I think its worth pointing out that the trouble with a lot of the stats is they are very generalised."
95% of healthy mums having a subsequent baby in a birth centre or at home will have a completely straightforward delivery.
That's compared to less than 50% of women nationally over all.
As for obstetricians having planned c/s. Well yes, many do. But the other group of health professionals who are involved in a much wider spectrum of births - namely midwives - are much, much more likely to opt for a planned home birth, than the general population.
IME that figure has probably reduced since the Lancet survey, too.
Definitely agree that the stats are too generalised to tell us that much. Eg the high percentage of women having a straightforward delivery at home or in a birthing centre is no doubt related to others being risked out. It doesn't surprise me at all that a very self selecting group of women who are both low risk and motivated to have an NCB (as they surely are given their choice of provider) mostly succeed in their aims. Presumably low risk women who want an epidural wouldn't homebirth, and conversely a woman with placenta previa wouldn't be accepted onto an MLU. If we had less stringent criteria for birth centres, they'd have lower rates of straightforward births. Nor am I shocked that in a population where we have increasingly high percentages of higher risk mothers (first timers, obese, part of life spent in country with poor medical care etc) we have fewer straightforward births. If the population of birthing women were to change and be skewed more towards average weight, uncomplicated, multiparous 28 year olds, no doubt we would see a greater percentage of straightforward births. Although of course even those can be extremely risky, and sometimes obese 42 year old first timers have a really easy VB.
Also I don't think the relative preferences of midwives and obstetricians tells us anything other than both groups being influenced by the type of births they see more of. Which again makes total sense.
I know that elcs is often presented as the alternative to birth trauma and as if it is the trauma free option.
Personally the most traumatic of my 3 births was the elcs, horrendous op, felt dreadful afterwards, weeks to recover, couldn't cuddle ds for 2 days due to him being in scbu with respiratory distress and had pnd (thinking birth wasa contributory factor in this).
I know that neither method is guaranteed trauma free, but elcs can be just as awful as vb!
The OP has had a "pretty good " delivery.
Its not about the pain for her but the real fear of what may happen to her in labour.
It comes down to would you rather something went wrong in labour with a baby half stuck in you or on an operating table.
Would you rather being unable to sit down for weeks or be tender in your lower abdomen.
For alot of women its the totally un predictable nature of labour which is scary.
Its all very well saying " yes but this STAT says you are unlikely bla bla".
I have personally met too many people who were one of those small percentage problem stats.
"If we had less stringent criteria for birth centres, they'd have lower rates of straightforward births."
Yes of course.
However, the complication rates for women opting for birth centres are still strikingly lower than for similar mums (ie, same parity, same social class, same obstetric risk criteria) going to an obstetric led unit.
Women birthing in obstetric led units in the UK appear to have nearly double the rate of emergency c/s compared to similar women who opt for birth centres.
"Also I don't think the relative preferences of midwives and obstetricians tells us anything other than both groups being influenced by the type of births they see more of"
Except that the vast majority of midwives are involved in high risk as well as uncomplicated births. ALL mothers in the UK have a midwife involved in their birth. Only a percentage will have a doctor present as well.
I asked my community MW about home birth and she said
" When it goes well its truelly wonderful, but my god, when it goes wrong.....its horrendous".
I dont think she will be having a homebirth.
Would you rather being unable to sit down for weeks or be tender in your lower abdomen
God, I wish I had just been tender after my CS, it was agony as I am sure some vaginal births are - I really don't think you can predict how it is going to be for you.
I have also met one person, and I know this is really rare but she walked with a limp as a result of a side affect of an epidural/section - as I say, very rare but something to consider.
its just one step closer to life becoming like brave new world by aldous huxley,soon no one will bother giving birth and bringing kids up they will just grow them in a factory and let the government do ti for them.
However, the complication rates for women opting for birth centres are still strikingly lower than for similar mums (ie, same parity, same social class, same obstetric risk criteria) going to an obstetric led unit.
Does this measure anxiety?
This was one major problem with the place of birth study. Just how many of those women were making decisions based on anxieties? And how important is this? As mentioned upthread, is this self selection of some form? Is it necessarily the place of birth thats the entire problem or is it also the fact that women who choose a place of birth also have different levels of anxiety too?
I personally think anxiety needs to be considered a risk factor too. For a number of different reasons. There is evidence out there from both the pro-natural camp and the pro-ELCS camp that seems to suggest that anxiety is hugely important.
There is a theoretical case to be made here that those who have raised levels of anxiety from the word go would be more at risk even when they are in the same place of birth as women who don't have those similar anxieties.
Unless we have proper research done on this, we don't know if this is really the case, but I think its highly possible that this is what you would find.
Ooooo thanks for the reminder amber I must re read that book <looks for kindle...>
Yes that's what I'd always heard too, MyDarlingClementine. Home birth is usually fine, especially when risked out properly, and also all the data I've ever seen shows that women rate their experience as much better than hospital. That's very, very firmly established. So if you're lucky enough to get a straightforward birth, it's fantastic, but if the wrong sort of complication happens, you're screwed.
Shagmund the average obstetrician is likely to see a higher percentage of births that go wrong than the average midwife, though. Or to flip it on its head, the average midwife will see more uncomplicated VBs than the average obstetrician. So of course that has an impact. I don't suggest that either group is incorrect, it's totally normal for humans to be more focused on what we've experienced ourselves than the bigger picture. Especially with issues like ELCS and homebirth where the data is, as you say yourself, unclear. Speaking of data, do you have any for the comparable women you mention to the MLU/HB group who gave birth in other settings?
What the fuck, Amber?
MyValiumRedhead makes a good point about complications from epidurals and CS too. I heard at my NCT class that the death rate for epidurals is 1 in 100,000- for me, that's safe enough, but if you're the 1 that won't be much consolation!
Really Valium, did you keep on top of your meds? I personally felt very little pain at all; but I did have lots of meds that I took regulary.
Again I have heard of people sent home on a paracetomol after a section.
I know of one lady who also had another op because of something that happened after her EM CS. Years after something cropped up.
ELC is most certainly not the easy option!
I dont know how many men would have an operation whilst being awake!
For people who fear child birth though, especially those who have had any sort of delivery that makes them feel scared and those who havant had a child but feel afraid - ELC is certianly another option.
Not the easy option, not a pain free option, not even a risk free option.
But another viable way of getting baby out .
Oh yes, and the pain was still horrific but apparently all within the realms of 'normal' after major surgery.
Unfortunalty they will say that in a hospital which makes it really hard to know if something else has gone wrong or if it is normal.
They can be dismissive of pain, because they must hear people moaning about it alot.
Post operative care is a whole other thread.
Ime people tend to be extremely dismissive of pain, shocking really.
Due two weeks today. First birth vaginal, straightforward although ventouse in the end.
I am now very concerned I will be required to have a c section as baby not in ideal position.
In my opinion, the excitement of not knowing when your baby is going to make his or her arrival is worth is worth a lot in itself and I would be sad to let that go.
Amber do you understand women are scared that they or their babies may die.
Thinking about it, I'm quite glad NICE decided it was impossible to properly quantify whether VB or CS is cheaper. You know that if they could, we'd all end up pressured to opt for the less expensive one. I much prefer a VB and wouldn't want a CS unless it were medically necessary, so I certainly wouldn't appreciate being pressured to have one if it turned out that on average it would cost £100 less or whatever.
"Yes that's what I'd always heard too, MyDarlingClementine. Home birth is usually fine, especially when risked out properly, and also all the data I've ever seen shows that women rate their experience as much better than hospital. That's very, very firmly established. So if you're lucky enough to get a straightforward birth, it's fantastic, but if the wrong sort of complication happens, you're screwed."
For mums expecting their second or third baby, home birth is no more risky for them or their babies. Even when you include those women whose births become complicated.
You are right that there are some births where the outcome will be worse because of a lack of immediate medical input (for example in the case of a cord prolapse or a severe shoulder dystocia). However, as the over all outcomes are similar for babies born at hospital and at home, I can only assume that someadditional baby injuries and deaths are caused by being in hospital in the first place.
It sounds like we agree on some points Shagmund. The most recent UK Birthplace study did show that there's a higher neonatal mortality rate for home birth amongst first timers, even with quite a high transfer rate, but I've never seen anything suggesting future deliveries are more risky.
It's not necessarily the case that some additional injuries and deaths are caused by being in hospital, though. Could be. But you'd also need to control for the fact that, even when only multiparous women are considered, generally those choosing homebirth would have a lower risk profile than those who don't. Also, obviously babies who are born very early sadly have a higher death rate than those who go to term, and generally if you go into labour at 27 weeks you're probably going to go to hospital even if you'd wanted a homebirth. That's not to say you're necessarily wrong, just that you'd need to consider other things too.
With any birth you worry about something going wrong.I had both of my children by crash ceasarian.The agony I went through during my second pregnancy was horrendous
That was the reason I had the tubal tie done as I never ever want to go through it again.
What I mean is- Shagmund you're saying that if death rates for multiparous are similar and some HB babies die or are injured due to lack of immediate medical attention, one would expect hospital morbidity and mortality rates to be lower to reflect that, and the fact that they aren't means there are deaths caused by being in hospital. But that might not be true. It's not the only possible explanation. The 'extra' deaths and injuries in hospital, the ones that match the percentage of babies who are injured or die at homebirth, could all be due to women who were previously low risk and then give birth very early (it happens). Or, that might only explain part of it. There are various possibilities.
Would you rather being unable to sit down for weeks or be tender in your lower abdomen.For alot of women its the totally un predictable nature of labour which is scary.
I had 3rd and 2nd degree tears with complications with dd1 and 2, honestly, they were nothing compared to how I felt after an elcs. Tender would be the understatement of the century! And that was with morphine.
I also could not in any way predict how I would feel after my cs, I couldn't predict that I would vomit and shake for hours afterwards, that my ds would be unable to feed and struggle to breathe, and that I wouldn't be able to hold him.
"The 'extra' deaths and injuries in hospital, the ones that match the percentage of babies who are injured or die at homebirth, could all be due to women who were previously low risk and then give birth very early (it happens)."
Well, the Place of Birth study 2011, which my figures come from, only uses data from women categorised as 'low risk' at the start of labour. So women who've gone into labour early would have been excluded from the study.
"But you'd also need to control for the fact that, even when only multiparous women are considered, generally those choosing homebirth would have a lower risk profile than those who don't."
The women in the Place of Birth study were matched for risk factors.
What I meant Hazy Jane is - I felt there was a more manageable range of problems that might occur with a section than being mid labour.
Op has been through labour - so she knows what that is like. If/when she looks at sections - its down to which set of risks and how she would rather take.
As said before - I would have rathered something went wrong mid section - than mid labour - personally so that was the risk I was prepared to take.
Some people have felt more pain than others after surgery, most people I have spoken too - have not felt pain too badly after a section.
I think the MW was just making a personal comment on how she felt obvisouly after witnessing home births that went wrong.
When she made the comment about HB being " horrendous" if it goes wrong, I dont think she was taking into account stats. Just her feelings at attending a lady in labour - when its going wrong.
Persoanlly I think a HB going well would be wonderful, I wish I had been brave enough to try it - as I am sure I would have been a good candiate for it - and been allowed to do it.
But that is how I feel. So its down to how OP feels, rather than going through stats etc...it doesnt make much difference when you are afraid.
"I had 3rd and 2nd degree tears with complications with dd1 and 2, honestly, they were nothing compared to how I felt after an elcs."
Again, its something that is so hard to quanitfy, the ladies who I know who had sections for various reasons 1st time, really wanted to experience birth second time round and both were severly dissapointed and upset with thier choices and they have major on going problems, they too couldnt hold thier babies.
Its so hard because you have to know yourself really really well and its not easy to sort of try it and then decide.
Like Gas and Air, you are always told its there etc - but you only know how it will make you feel when you try it! HOrrible being in labour then the G &A is making you sick - same as pethadine.
You ate right, unfortunately you can't know with birth until it actually happens!
But, I read a lot of threads on here before having ds, with lots of very positive experiences of electives, and that is great, but I just feel, after my experience, when I see a thread like this that I want to point out that there are unoredictable things that can happen. Seeing a surgeon with a look of panic on his face, whilst ou are lying there is not something I was prepared for!
When I say about not holding ds, I mean because of his breathing difficulties, meaning he was in nicu in an incubator. I aalso think it is important to point out that there is a higher incidence of respiratory distress in babies born by elcs.
When she made the comment about HB being " horrendous" if it goes wrong, I dont think she was taking into account stats. Just her feelings at attending a lady in labour - when its going wrong."
Oddly, I've never heard of a midwife tell a woman who's being induced how awful it is when it results in a 30 hour labour followed by a crash c/s under g/a, despite the fact that all midwives know that number of inductions will pan out like this.
I agree though that we tend to make decisions about these things based on gut feeling and fear. Shame really that the facts don't have more bearing on the decision making process when it comes to birth.
I agree with you Hazy, its important I think for as many stories to be shared as possible, so people can get the more realistic picture across the board.
I remember Amanda Holdens ELC experience when she nearly died and I read somewhere they were biking in blood for her.
Before my ELC I asked the consultant whether they had enough of my blood in the hospital should the same thing happen.
Yes one of the ladies I am talking about, her baby had to go into some sort of unit, he had a traumatic delivery.
Shag If I had been asking her about induction - she may have given an opinion on that too. I merely mentioned I was caught between a rock and a hard place, she gave me her feelings on HB and on ELC. She herself had hemoragged during labour.
Op has already had a baby by VB and feels afraid, its not the unkown to her, nor was it the un known to me.
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