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ELCS purely due to preference - what would you do?

(48 Posts)
TwitchyTail Tue 29-Jan-13 18:10:50

I'm almost 33 weeks with my first baby. For months I've had problems with the placenta which meant that an ELCS was expected. But now the problem has unexpectedly resolved itself, and I was told that there would be no problem with me going for a vaginal delivery. The only caveat is that I will need continuous monitoring of the fetus and it will need to be in the obstetric unit (not MLU).

This has thrown my brain into complete disarray, as I was all geared up for ELCS and secretly was really happy with this plan. I'm not tokophobic, I haven't had any traumatic experiences, there is now no medical reason for me to have one... basically I have no excuse, but I just feel that I prefer to take the risks of an ELCS than the more unpredictable risks of a VB. I know C-sections aren't the easy option (I'm a doctor and assisted in both types of birth during my medical training - admittedly a long time ago), but virtually everyone who has had an ELCS has a positive story to tell and I've heard so many first-baby VB horror stories.

Consultant will still let me have it but her advice would be for VB because there's no reason not to and I can tell she thinks I'm a giant fussy pfb wuss .

I'd really appreciate some honest opinions as to whether I'm being daft/unwise to consider having an ELCS just because I would prefer one.

bonzo77 Tue 29-Jan-13 18:41:43

I would have a CS every time. Yes, there are significant risks. But same with a VB. Like you I have some medical training and although i had no other option but CS both times, it
was what i would have opted for. I think we tend to be more confident in the face of known risks of surgery than the relative unknown of trying to let nature take its course. For some reason more of my friends have had CSs than VBs. no complications with any of the CSs group, lots with the VB ones. My own procedures and recoveries were uneventful. Yes, post surgery you should rest up, but I think all mothers of new borns should! And my vag etc are unscathed!

My second baby developed respiratory distress soon after birth which was a foreseeable complication due mostly to the CS and partly to prematurity (4weeks early). It resolved in 12 hours, so whilst worrying for me was bread and butter for the NiCU staff.

Floralnomad Tue 29-Jan-13 18:44:41

I'd have a section , I had a VB with my first and an ELCS with my second and if I could do it all again I would have two sections!

ilikesweetpeas Tue 29-Jan-13 18:50:28

I had an elective CS for various reasons (not medical) which I discussed with my consultant. He backed me up completely with my choice and I was very happy with the birth. I didn't feel that I missed out on anything, I found it a really positive experience. Also, the recovery was nowhere near as difficult as I anticipated. Obviously there was pain, but then you can have that following VB too. I had two minor wound infections which cleared quickly with antibiotics. If I was able to have another child I would make the same choice. I certainly don't think you are daft to have an ELCS. Good luck with whatever you decide

RedToothBrush Tue 29-Jan-13 19:40:33

TwitchyTail here's an article from 2008 which might be of interest to you.

Quote from the article:
One London study published in the Lancet in 1996 reported that 31% of female obstetricians would personally prefer a caesarean birth. In the US, the figure is almost 50%

If its so daft/unwise why are there such high figures within the profession? You definitely not alone in your preference for a ELCS.

Female doctors statistically tend to have small family and are far more likely than the general population to start a family after they are 35 because they spend so many years qualifying and practising first. Obviously the statistics for an uncomplicated delivery for first time mothers over 35 is a lot less favourable than in younger groups... and doctors are more likely to be aware of the downside of both EMCS, ELCS and VBs from their job.

There a lot of very logical, understandable and completely rational arguments to have an ELCS on the basis of pure preference. And the people making this decision overwhelmingly tend to actually be the best educated. Ironically the media seeks to label women who decide to do this - selfish, easily led, shallow, weak and very often stupid.

The reality and the myth simply do not match.

Do whats best for you and to hell with what anyone else thinks. Trust in your own judgment - other people do when you treat them.

TwitchyTail Tue 29-Jan-13 19:45:44

Wow, thank you so much for your prompt replies and sharing your stories. I was really expecting to get told to man up and deal with a "normal" birth if I had no proper reason for an ELCS. It's a huge help to get your views. I feel a bit more confident in requesting it when I go back at 36 weeks.

goodygumdrops Tue 29-Jan-13 20:40:38

I would take i to consideration how many children you would like to have.

TwitchyTail Tue 29-Jan-13 21:00:41

Good point goodygumdrops - we were planning on just this one, or at the very most two. If I wanted more than that I would avoid a C-section if possible.

RubyrooUK Tue 29-Jan-13 21:10:46

I have to have a CS for medical reasons.

Would much, much rather have a vaginal birth because despite having an "awful" vaginal birth with massive blood loss, tearing etc, my recovery was extremely quick, no restrictions on lifting or driving etc. I have a toddler and the idea of not lifting him or the baby at first seems impossible.

Plus I am scared of the famous "CS overhang" as my stomach went back to normal after my vaginal birth. And clearly I have realised I'm a bit vain about it. blush

QTPie Tue 29-Jan-13 23:35:25

This thread is qiuite amusing because the OP is a doctor: to be completely honest, I have huge respect for doctors and think that they know everything (or at least most things!). So it is a surprise that you are uncertain...

I had an ELCS (breech): I would have had a VB (reluctantly really), but was relieved when DS was diagnosed breech and stayed breech.

An ELCS IS no walk in the park and there ARE risks, but I felt not comfortable with the risks than with a VB (I think that there is a lot more chance for "less serious" complications with a VB). A CS would be harder for a second birth (if you have a toddler to look after too), but I would still opt for an ELCS.

I drove after 4 weeks and was back in the gym/pool at 7 weeks. Not a huge hardship - since I basically sat and breastfed for much of the first 4 weeks... Did lots of walking from 3 weeks (well building up gently).

If you have the option ( sounds like you do), then weight up the risks for yourself and make your choice. Don't feel under pressure or guilty either way smile

QTPie Tue 29-Jan-13 23:38:37

That should read "felt more comfortable with the risks than with a VB". I felt that I has a better chance of "an ELCS without complications" than a "VB without complications"...

GingerJulep Tue 29-Jan-13 23:52:10

Erm, waste of NHS funds... go private?

TwitchyTail Wed 30-Jan-13 07:25:59

Haha QTPie, we like to think we know everything and maybe do when it comes to other people grin but when it's your own body it's a different matter! Thank you for sharing your ELCS experience. I feel the same way as you regarding being more comfortable with the risks of a CS rather than VB, which I think is a very personal decision.

Thanks Rubyroo, it's good to get another perspective. My sister (who also had an "awful" VB) feels the same - she would still have preferred it to a CS despite all the complications because her recovery was fast.

TwitchyTail Wed 30-Jan-13 07:49:07

RedToothBrush, thanks very much for linking that article (fascinating read), and for your helpful comments - I really appreciate it.

StarlightMcKenzie Wed 30-Jan-13 08:08:42

I'm a VB evangelical! But there is no way I would a)agree to continuous monitoring in a CLU in favour of a c/section.

If I have to be under the doctors, I believe their knowledge of natural VB makes the VB risky. They're better at c/s.

BUT, I would make absolutely certain that monitoring was essential and if not I'd have a homebirth or MLU in a stand alone unit.

Fairylea Wed 30-Jan-13 08:23:43

I chose to have a section with ds after a difficult birth with dd.

Personally I would choose a section over a vaginal birth anyday. The recovery was on a par to be honest but I liked the fact I didn't have the pain of contractions and also with dd I found I actually felt fed up with the whole thing by the time shed arrived and I wanted to sleep, whereas with ds I found the whole thing a lot more magical.

Ironically I would have needed a c section with ds anyway it turned out I had undiagnosed placenta previa... ! So not a straight forward section but still a good experience.

TwitchyTail Wed 30-Jan-13 08:41:44

Thanks StarlightMcKenzie - I actually agree with you there. If I had had a completely uncomplicated pregnancy I would likely have gone with the MLU option. I just feel that the continuous monitoring (and knock-on effects on my ability to be fully mobile in labour, use the pool etc) and complications so far mean the odds are already stacked against me having a successful VB. Unfortunately the monitoring is definitely necessary and for good reasons (no-one knows how the dodgy placental bloodflow is going to respond to labour). In the absence of (what I feel is) a decent shot at an uncomplicated VB, I would rather cut out the middleman and go straight to CS.

Thanks for sharing your experiences Fairylea - it's really helpful to hear from people who've had both.

maxbear Wed 30-Jan-13 09:37:07

Most elective sections are relatively uncomplicated, having said that a woman where I work recently ended up on life support in itu after an elective for maternal request. Thankfully she survived but she missed our on her Childs first four days and no doubt will have physical and emotional trauma to deal with. the other thing with sections is that women can have significant pain long term afterwards (some have this after VB too) some women have a lot of pain when they are having a period, some when they are having a bowel movement, it sounds a bit cliched but it is major surgery and you have to be prepared that it might not go to plan. Also doctors see horrible difficult births so they have a squewed idea of what VB is. For many women they give birth then go home without any problems. Doctors don't see these ones.

TwitchyTail Wed 30-Jan-13 09:50:00

Thanks maxbear. Gosh that poor woman - hope she is ok now. It's definitely important to be reminded that it's major surgery.

You are absolutely right about doctors seeing the worst births - one of the reasons I started this thread was to get some "normal people" opinions, rather than asking my doom-mongering medic friends who all have a special horror story to tell hmm

RedToothBrush Wed 30-Jan-13 09:55:40

Twitchy, here's the thing. Whilst you don't have a medical reason to have an ELCS you do have at least one medical reason to at least consider an ELCS by the sound of it. You have been having complications which by the sound of it are pretty serious and have potential to cause problems.

Sometimes people phrase having an ELCS as a 100% chance of needing less risky scheduled surgery versus an unknown % of having more high risk emergency surgery. I think this is a very good way of putting it. Of course you might end up with an uncomplicated VB but its ALWAYS a gamble.

In effect what you are doing is trying to 'beat the odds' and guess what your most likely outcome is going to be with the hand you are given if you take that gamble. If your medical judgment is that the odds are stacked against you then I do think that considering an ELCS is a very reasonable thing to do. You are making an educated weighing up your risks of having an assisted VB or EMCS in effect. You do need to factor in how many children you are likely to have as part of that risk too but you've already done that from what you've said. You are not making a decision on a flight of fancy or out of vanity. I think all this nonsense about that type of thing makes people question themselves even when they are very well informed and I do think its quite nice to see even a doctor doing the same thing.

I do not understand why this weighing up of risk is not considered legitimate though. Not everyone is a gambler in life and there are a lot of cases where, if you look at all the factors in combination, certain women have a very low chance of ever achieving a successful uncomplicated VB even if they have no medical indication for an ELCS. If they want to give it a go, then fair enough but I think being realistic about these things is fair so either way women can emotionally prepare themselves.

I also notice the ignorant and rude comment upthread about cost. Truth is, if you really want to compare bare costs at point of delivery only, an ELCS is considerably cheaper than an EMCS.

(Not to mention NICE actually state in their guidance that a) cost shouldn't be used as an argument against an ELCS and b) the true cost of both planned ELCS and planned VB which actually includes EMCS, could not be easily calculated due to long term complications such as incontinence. So that argument, is quite frankly a load of bollocks and shouldn't be used as a weapon to beat women into guilt with).

I don't believe there is ever a 'right' answer to this question. Only whats 'right' for each individual woman in her individual circumstances.

CaramelBobbi Wed 30-Jan-13 10:04:04

I had two sections by choice, no medical reason for them. Mine were both a walk in the park, so civilised and calm and I was driving within a week. Hugely recommend, both children perfectly healthy and normal.

I've known since childhood that I would never give birth 'naturally' - the uncertainty, pain and lack of dignity - just not for me.

I met a young femal urologist recently who told me that she too was having an elective section. She knew she was biased but so many of her patients had serious damage from vaginal deliveries.

In fact, one of my closest friends, a medic herself, tore from vagina to rectum. Is horrible what she has been through.

I wouldn't hesitate if I were you.

CaramelBobbi Wed 30-Jan-13 10:10:28

Should have added that sections were not just calm etc, but absolutely magical!!!!! The best, highest moments of my entire life. I cannot recommend enough.

I do appreciate that there is a world of difference between an emergency section and an elective. But not having any pain or contractions etc, fantastic.

ChunkyPickle Wed 30-Jan-13 10:12:31

The trouble is that humans are notoriously poor at estimating risk.

I had an EMCS, and now pregnant with my second I'm really not sure what I want to go for next time. I found the actual CS really unpleasant - uncontrollable shaking from the anaesthetic (so bad I didn't feel safe touching DS because I would have hit him), the feeling of them getting him out was extremely uncomfortable and made me repeatedly throw up what little I had in my stomach, waiting an hour in recovery before I could go down and spend time with my newborn, and even longer while the numbness wore off and I could move again etc.

I know that that extreme unpleasantness was very short-lived compared to a VB but on the other hand my longer (very straightforward) recovery meant that I spent most of a week with uncomfortably swollen legs, being careful moving, walking, even opening the fridge caused stabbing pains from the internal stitches and these things are guaranteed, vs. the good chance of being up and home and walking around just fine the next day with a similarly straightforward VB.

It's hard - I can take the devil I know. Assuming everything goes well it's a few minutes of horrible-ness followed by a few weeks of discomfort and healing, or the devil I don't know, and a few hours or days of horrible-ness, followed by days of discomfort and healing. If everything goes wrong, then TBH neither is going to be good.

Personally, looking at the odds I am leaning towards trying for a VB, but having a CS rather than being induced.

TwitchyTail Wed 30-Jan-13 10:12:58

Thank you so much RedToothBrush - your post has really helped to clarify my thoughts about this. You've hit the nail on the head about the basis for my request and put it much better than I could have done.

ByTheWay1 Wed 30-Jan-13 10:17:00

If you were driving within a week it cannot have been on the advice of your doctor! There is a real risk of rupture both internal and external due to the positioning of the seatbelt - and an emergency stop or an accident could kill you.

I had a CS for my first - breech baby - and would never, ever, ever do so by choice again. Had an epidural which only "took" down half of my body - the side they tested to see if I could feel anything.... excruciating! They got it right in the end, but I will never, ever, ever forget that. My second child was VBAC.

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