ELCS purely due to preference - what would you do?(48 Posts)
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.
Thanks guys. WillowB - how scary, am so glad your baby got out ok in the end. I am completely with you on the continuous monitoring - I do believe it will be necessary in my case if I go for a VB and will not dispute this, as I know how quickly things can change.
Quite a bit has been mentioned up thread about foetal monitoring. I think it's important not to lose sight of why its sometimes needed. I know CM can be uncomfortable & a PITA but I'm absolutely certain it saved my baby's life.
I'd prepared myself for a 'natural' VB. tens machine, pool, breathing techniques etc.
I lost some blood when my waters went (had also bled all the way through my pg. due to placental probs) so they hooked me up to a machine for about 1hr. Started to get very cross at went point as my NCT teacher had said no more than 30mins at a time was necessary. Was all set to ask them to unhook me when baby's heartrate dropped through the floor. Will never ever forget that sound. Just a thud followed by an agonisingly long wait for another. They got baby out quickly but he needed Resuscitating and the oxygen levels in his cord were low but was fine after the initial first few minutes. I've since often wondered what would have happened if they'd not monitored me.
In hindsight i should have perhaps pushed for an ELCs due to the bleeding (they found out during CS that I have a prob with my uterus that prob caused the bleeding & caused baby to get stuck) but I was naive & the docs/midwives were fairly dismissive. I will choose an ELCs next time & if I was to labour before my CS then I would def want the monitoring (not that I'd have a choice). However I realise that this is purely down to my own experience.
I would consider how many children you think you want,and how old you are.ELCS heads you towards the section route for subsequent pregnancies..and I'm not really looking forward to my 3rd one in a few weeks!Nice calm way to have a baby but didn't appreciate the impact recovery time has on everything especially when you have at least 1 other child to look after.My fault though..I decided to have 3 children and chose ELCS for my first..also a Dr,had seen too much,was "old"(36) and had family Hx of stillbirth at term that terrified me so wanted baby out at 39/40.Good luck!
Sorry not to come back to the thread earlier. To be honest, I went privately for the first and my choice wasn't questioned. With the next, I went to book in for a private delivery and was told, "no need to pay, you've already had a section, you don't need to go privately, I'll do it on NHS for you. When would you like me to put it in my diary?"
It's a gamble no matter what you choose. You are taking chances no matter which you choose. You may prefer one risk profile over another, but have no doubt there are risks either way.
I have a friend who had 3 EmCS that went fine followed by an ElCS that was Hell. She didn't expect that, either.
Thanks to everyone else who has replied and shared stories - I really appreciate it and it's been incredibly helpful. I'll take the next couple of weeks to have a hard think about things before I see the consultant at 36 weeks and try to come to a decision.
I'm in a similar place to you. I have birth (induced + forceps) with major problems afterwards - severe SPD lasting 2 years and faecal incontinence (only once but it felt pretty dangerously close many times after, and even now I don't dare hold on too long).
As I result I feel that I am balancing the scales - on the one hand risking VB with all it's potential 2 year recovery problems, vs 6 weeks surgical recovery. Hmmmm... 2 years or 6 weeks?!!!!!
I know just because I had a tough birth the first time it doesn't mean it will happen again, but I am not prepared to take any chances thank you very much!
If I had my time again, knowing that I know now, I'd have asked for a c section. The beauty of hindsight!
Like you, I found it hard not to take on board other people's criticism. I had an obstetric registrar frown on me for asking for a C-section, which felt unpleasant but hasn't deterred me from asking to see the consultant about it. I don't want any regrets this time!
for me it was a question of where i would rather be hurt...and what sort of injuries i would be able to cope with.
i was in alot of pain down below from VB - that was straightforward - one small tear - my back hurt for years after, and the mental strain and pain of VB was too much for ME to cope with. I had a fab labour in the sense i was not monitered except for short periods - i moved round when i could - got on balls - my DH massaged me throughout - the two MW were wonderful.
The section was obvisouly so much calmer on the run up to it - the going to theatre was scary but you have expereinced that - it was a shock for me - the section it self was fine - I was nervous - the most nervous they had had for a long time apparently - but it was all over so quickly.
My recovery was a good six weeks - 8 weeks but inspite of having major surgery I feel more intact and well - than after an no complications or interventions VB.
For me - it was a case of =- can i cope if something goes wrong in labour - no - can i cope in surgery if something goes wrong - probably not but deifnalty much better.
Both my DC were ELCS. By maternal choice. No other reason. Tbey were botb wonxerful pain free experiences with quick pain free recoveries. Was driving within 8 days and running by 5 weeks.
But even those who have a birth with instruments don't all end up with horror stories - I had a forceps VBAC with my second and would still chose that over the CS I had with my first.
No complications at all after the birth - straight back to normal taking care of 2 little ones.
I just get a bit fed up of the "ooooo VB = complications after the birth, tearing, bladder weakness etc", when we get very little of the "CS = complications after birth, bladder cut , infection of wound and increased risk of future pregnancy placental problems" as well as the recovery period.
And there are just as many problems for older overweight women having a CS as having a VB.
The official NHS Maternity Statistics for 2010 - 2011 for the NW NHS strategic authority (as an example) show that the percentage of unassisted vaginal deliveries as follows:
Wirral University Teaching Hospital NHS Foundation Trust 46.3%
St Helens and Knowsley Hospitals NHS Trust 39.6%
Mid Cheshire Hospitals NHS Foundation Trust41.2%
Liverpool Women's NHS Foundation Trust 38.7%
East Cheshire NHS Trust 44.9%
Countess Of Chester Hospital NHS Foundation Trust 39.1%
University Hospital Of South Manchester NHS Foundation Trust 41.7%
Salford Royal NHS Foundation Trust 48.1%
Royal Bolton Hospital NHS Foundation Trust48.1%
Tameside Hospital NHS Foundation Trust47.6%
North Cumbria University Hospitals NHS Trust47.9%
Wrightington, Wigan And Leigh NHS Foundation Trust45.6%
University Hospitals Of Morecambe Bay NHS Foundation Trust 49.4%
Southport and Ormskirk Hospital NHS Trust41.3%
Central Manchester University Hospitals NHS Foundation Trust52.1%
Pennine Acute Hospitals NHS Trust49.6%
Stockport NHS Foundation Trust 46.8%
Warrington and Halton Hospitals NHS Foundation Trust 41.1%
Blackpool Teaching Hospitals NHS Foundation Trust45.8%
Lancashire Teaching Hospitals NHS Foundation Trust48.0%
East Lancashire Hospitals NHS Trust51.1%
NHS Information Centre maternity dataset definition for Normal Delivery:
Normal delivery is one defined as normal delivery as spontaneous vaginal birth. The following elements will constitute a normal delivery:
labour is not induced
oxytocin is not given to the mother
method of delivery is spontaneous vaginal (excludes caesarean, use of forceps, vacuum extraction)
no artificial rupture of membranes
medicated pain relief assistance (ie narcotics, regional anaesthesia, perineal infiltration) is not given to the mother
episiotomy is not carried out.
An assisted delivery therefore would be one where one or more of these factors are used to assist the mother to give birth and the baby to be born.
Therefore if you give birth in the NW you are statically more likely than not to NOT have a 'normal' unassisted delivery unless you are under the care of East Lancashire Hospitals NHS Trust or Central Manchester University Hospital NHS Foundation Trust.
Not to mention that those figures are for women as a whole group. As soon as you start to break down those figures into various groups, by whether you are a first/second time mother, by BMI or age some come out a lot better, but some come out much, much lower.
Women who are first time mothers, with a high BMI and are over 35 for example would rate worse than women who have already had a child, have a normal BMI and are in their mid twenties for example.
So its all about working out what risk factors are relevant and important to you, rather than going on some pie in the sky number that actually doesn't mean anything to anyone as is based on the mythical 'average woman'.
Bytheway in fairness to you I think what you are referring to is slightly different - you mean births that result in a VB that doesn't require a CS or instruments. The figures for this for the NW are (CS, Instrumental VB and VB:
Wirral University Teaching Hospital NHS Foundation Trust21.7%13.4%64.9%
St Helens and Knowsley Hospitals NHS Trust 22.3%9.0%68.7%
Mid Cheshire Hospitals NHS Foundation Trust22.4%13.4%64.0%
Liverpool Women's NHS Foundation Trust24.3%15.4%60.2%
East Cheshire NHS Trust23.4%12.1%64.5%
Countess Of Chester Hospital NHS Foundation Trust25.2%14.2%60.5%
University Hospital Of South Manchester NHS Foundation Trust25.6%14.5%59.8%
Salford Royal NHS Foundation Trust18.5%15.1%66.4%
Royal Bolton Hospital NHS Foundation Trust22.1%11.9%66.0%
Tameside Hospital NHS Foundation Trust21.0%9.3%69.7%
North Cumbria University Hospitals NHS Trust24.3%10.8%64.9%
Wrightington, Wigan And Leigh NHS Foundation Trust22.8%11.5%65.7%
University Hospitals Of Morecambe Bay NHS Foundation Trust22.9%12.3%64.8%
Southport and Ormskirk Hospital NHS Trust26.5%12.2%61.3%
Central Manchester University Hospitals NHS Foundation Trust17.9%15.0%67.1%
Pennine Acute Hospitals NHS Trust23.4%8.6%68.0%
Stockport NHS Foundation Trust23.8%14.4%61.8%
Warrington and Halton Hospitals NHS Foundation Trust24.6%13.0%62.4%
Blackpool Teaching Hospitals NHS Foundation Trust26.0%9.7%64.2%
Lancashire Teaching Hospitals NHS Foundation Trust22.4%9.2%68.4%
East Lancashire Hospitals NHS Trust23.8%10.8%65.4%
So women who get a VB without instruments ranges from 59.8% to 69.7% across the NW.
But I do think the first set of figures are actually more relevant (and these are the ones they are using on the NHS Choices website) so that women can be realistic about what to expect with their experience.
The word 'normal' is something that is being thrown around a lot at the moment by strategic planners and isn't being used in the same way by everyone. Its a pretty important thing to understand what we are all actually talking about here. There's about 20% of women who are falling in between those definitions so obviously are needing an induction, episiotomy or pain relief.
Normal VB without complications is the MOST common type and outcome in England....
You need to check the figures at your actual hospital to see the risks as they stand for yourself. For instance in the US CS is much more common and consequently less risky than the UK - but most people quote the US statistics when talking about CS over here....
Trouble is very few people actually talk about the easy, non complicated births that don't actually have any future problems..
My first dd was a vg birth, no complications, I was induced but labour progressed well and after 22 hours in the hospital my dd was born and I went home.
Dd2 was a section due to her being breech. Give me a section any day!! Dd2 was undiagnosed as breech so she was classed as a "planned emergency" I didn't actually find out til I was In labour!
My consultant was amazing and my dh has said the midwives were brilliant with him too.
For my next baby, I'd like to try a vb but if I need another section I'd be happy!
I was in a similar(ish) position myself. DS1 was an ELCS as he was breech. This baby was breech the whole time and I was absolutely convinced he would remain like that as I have a heart shaped uterus so got the shock of my life last week when the scan confirmed he'd turned! I almost started crying because I was quite happy with having another ELCS and this suddenly meant I had to make the decision myself. Talked it over with the doctor (he was very good in that he made no attempt to convince me either way) and decided that on the basis of calculating the risk I have a lower chance of having a successful VBAC so am going to stay with an ELCS - Redtoothbrush has put it perfectly.
Anyway, now that it's decided and I have a date I feel like a huge weight is off my mind. I totally understand the feeling of pressure that you feel like you "should" have a natural birth but if you would feel better about having a CS then go for it. I mentioned this to my doctor and he said it was noone else's business at all and if it bothered me I should just tell everyone he was still breech cos noone would know! Some people will wear their judgy pants but just let them get on with it and do what's right for you - most important thing is that you and baby are fine.
I don't understand why UK hospitals would restrict movement when under fetal monitoring as it can only help the mother to move, and if I was told I would be strapped into a bed for a VB I would be thinking twice too - moving was all that kept me sane while I was being induced (pessary was OK, syntocin was very painful for me - probably because I wasn't progressing)
They monitored me, but they had wireless ones which I could even wear in the bath - perhaps that would be possible? Or persuade them to go intermittant?
Starlight - I totally agree that the mental aspect is what makes or breaks you in a lot of cases - telling you that you'll be stuck in a bed I think breaks you before you've even started. My care was absolutely brilliant, but I still regret letting them persuade me into an induction, and that will not be happening again.
I've had both and if you don't like the idea of monitoring during labour - if you are sure it's essential - id go for a elcs in your shoes. My recovery was the expected six weeks and sex was painful afterwards till dc2 arrived by vbac oddly; but the elcs was incredible and as others have said you are beyond knackered after a vb.
Worst part of elcs was spinal injection but this is v short lived compared to an uncomfortable labour hooked up to monitors. There are so many pros and cons to each, not an easy call.
The trouble is that humans are notoriously poor at estimating risk
Which is why you probably shouldn't ask people on the internet about their experiences anymore than you should ask friends who are medics tbh.
You'll generally attract polarised experiences and the people answering may not reflect your demographic or risk group either.
Best to stick with cold hard statistics on the subject where you can, whilst checking methodology carefully. Take the emotion out of it as much as possible.
Thanks for all the other replies - can't keep up and am cross-posting like mad
Chuncky VBs rock. They really really do. 2 of my 3 were the best experiences of my life and I am sad that I won't be doing it again. But not if you are scared, unsupported, interfered with or in my case, ever touched.
The psychological aspect of birth is overlooked hugely and imo so much about what goes wrong/right can be attributed to this. With my 3rd I didn't have any pain relief at all. I bossed everyone about and told them what I was doing, when I was doing it. I even did my own internals. I was the star of my show and in control. I was not a lamb to the slaughter and I was not manhandled, talked down to, spoken about in earshot as if I wasn't there or told what to do.
It was fecking EASY and 'almost' pain free. I pulled my baby out myself.
I would shout from the rooftops if it meant every (or at least most) woman could have that experience. However, I doubt it is possible in CLU with a monitor unless the woman is VERY good at hypnobirthing.
ChunkyPickle, thanks for sharing - totally agree that risk prediction is very difficult (even harder when doing it on yourself!) It's useful to hear the reality of CS experience and recovery.
Thanks CaramelBobbi - glad things went so well for you. Can I ask how your experience of requesting CS was? The consultant has actually been quite fair and reasonable about it, but I have seen two other members of the medical team who have really tried to dissuade me and made me feel bad for even asking, which has made me doubt my judgement.
I was driving within 10 days , my GP and insurance said if you could do an emergency stop that was ok . FWIW I have a very high pain threshold ( apparently ) and had no pain killers after the first day and made a super speedy recovery . On the other hand with my 'normal' first birth I ended up having blood transfusions and being unable to pick my rather large baby up for the first 3 days . Everyone's experience will obviously be different but my CS was a much more positive experience of giving birth than my VD.
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.
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.
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