Elective C-section: yes or no?

[Gennz]

So I have the option of choosing a ELCS. I'm only 8 weeks so I have a long time to decide! This is my first child. I would really liek to hear your experiences of ELCS vs natural birth.

As I see it, the options from best to worst are:

1. Straightforward natural delivery, no complications;
   
2. Elective C section;
   
3. Complicated natural birth resulting in emergency C section;
   
4. Complicated natural birth resulting in other intervention for delivery.
   
   (Numbers 3 & 4 may be interchangeable, this is a guess). The problem with weighing up the stats is that all we know is that 25% of births end in a C-section, and that a straightforward natural delivery is the preferable option.
   
   However, we don't know:
   (a) of the 25% of C sections, how many are emergencies and how many are elective. I think this is important because electives are vastly preferable to emergencies. With emergencies, my guess is that most of the damage and the recovery time results from the unsuccessful effort to push the baby out before the call is made to go for a EMCS, not the actual CS operation. Given elective C-sections are not widely available, my guess is that most of the 25% of birth resulting in CS are emergency CS.
   
   (b) of natural births, how many were really natural & straightforward (textbook labour, delivery with minimal damage & no interventions) vs how many were complicated i.e. required forceps or worse e.g. sustained damage leading to surgery. (I'm assuming by the time you require forceps, you have had a long and painful labour?)
   
   Because there are no stats available, I thought of all my friends who have given birth and collated their various stats. The outcomes from 18 births were:
   

• 6 straightforward, no complications
  
• 5 natural birth requiring interventions or surgery (meaning they were v long & painful and/or there was damage sustained)
  
• 7 c-sections (EMCS & ELCS)
  

The highly unscientific anecdotal evidence, then, suggests that chance of straightforward delivery with no intervention and not resulting in emergency C-section is 33%. Bear in mind that, even of the 6 births representing the 33% stat, I have no idea about the state of their bits after birth! They could be irretrievably altered or damaged for all I know.

Do I want to take my chances on 33% uncomplicated birth, or would it be better to go straight for the next-best option of elective C-section which presents more of a "known" risk. My biggest fear, even bigger than surgery (which I'm not really scared of, have had quite a few surgeries in my time so it holds no terrors for me) is lasting damage downstairs, resulting in problems with sex or with bladder. C-section would seem to remove this risk. I also like the idea that a CS "cleans you out" and reduces the lochia time.

However I would like 2 or maybe 3 kids so I know choosing a C section isn't ideal from this perspective.

(No doubt I am totally overthinking this. My job involves a lot of trying to mitigate risk (& controlling outcomes which I gather can be a bit futile when it comes to childbirth & parenting!!))

[EasterSundaySimmons]

Unless you have a medical condition then there is no need to have a Caesarian.

Women have been giving birth for thousands of years, many today still squat in the wild and have babies with no detriment to the baby or mothers wellbeing.

Having a natural birth with no pain relief meant I recovered very quickly each time from giving birth and was able to feed my baby immediately and attend to them, myself and visitors.

However, no one can predict what will happen when you give birth so it us wise to educate yourself on different scenarios in the event of any complications.

[bakingtins]

I think the NCT could probably help you out with more scientific stats, but to add to your anecdotes, in my group of 7 NCT buddies, now with 15 births under our belts there have been

2 unplanned CS first baby, both having ELCS for 2nd.
1 forceps delivery for first baby, natural delivery 2nd time.
Another 8 no intervention vaginal deliveries (using various things for pain relief)
One of the CS women has some sort of cervical abnormality preventing it dilating and was told she'd never deliver vaginally, the other thought long and hard about a VBAC 2nd time round but opted for ELCS in the end.

Prev C section puts you at higher risk of placenta percreta/ accreta, uterine rupture, adhesions etc in future pregnancies so get stats on future problems as well as taking unto account the initial recovery times, infection rates etc.

[Me23]

C section does not remove the risk of bladder injury at all. In fact there is a risk the bladder could be cut during the surgery. Plus all the other multiple risks that come with surgery.
Where prolapses are more common after vb, the pelvic floor is weakened by pregnancy itself regardless if delivery method.

[Gennz]

I realise women have been squatting in the wild/giving birth for thousands of years Easter. Given maternal mortality rates were also pretty high until quite recently I don't find this argument very persuasive! I'm not wedded to the idea of a natural birth, nor to a c-section - I'm just trying to figure out which presents the most acceptable risk.

Also - I don't know if it's different in the UK - but where I live no record is kept of perinatal birth injuries, so while you can look basic stats for C-section vs natural birth, there's no way of knowing whether that natural birth was in fact a preferable outcome.

Thanks bakingtins that is interesting - did all the natural births recover well? Part of the reason I am slightly about natural birth is that some of my friends have had terrible experiences - 4th degree tears, cervical ruptures etc - resulting in ongoing damage. I would rather C section surgery than ongoing damage from a natural birth.

[BlueMoonRoses]

Had three straightforward vaginal deliveries with gas and air. One ELCS for very complicated personal reason. SVD is by far the best option. CS was horrendous.

[ilovelattes]

I had natural delivery for my 1st with epidural for pain relief & cs for my 2nd due to placenta previa. Having had both experiences I would choose a natural birth. The cs for me was a scary medical procedure & not as positive an experience as the natural delivery.

[deepinthewoods]

C section also has risks for baby. A vaginal birth kick starts a baby's central nervous system and respiratory responses in a way that a C section can't. Babies born by C section have higher rates of breathing problems. It is more difficult to breastfeed after a C section.

[Xmasbaby11]

One horrendous vaginal birth ending in forceps and resulting in prolapsed uterus. One ELCS which was straightforward.

No contest .. for me the ELCS was a far better experience.

[IkeaFurnitureAssemblyChampions]

Based on my experiences vs my SIL's I would say that vaginal birth is the way to go. I have also met a woman who had an awful Caesarian scare story, and a friend of mind has had ongoing problems due to hers. My first birth experience was not great but I recovered quickly; second was great. Yes, it hurts - but honestly, based on seeing my SIL it is clear that a CS hurts too, and for a lot longer.

Sorry to be negative about anything to do with birth, but I did want to make clear that a CS is not always beer and skittles either from what I've heard. I recovered well - and quickly - from my vaginal births if that helps at all. And I am no 'earth mother' type :D

[OooOooTheMonkey]

I had a traumatic birth resulting in an EMCS. I will probably have ELCS next time. Having a section doesn't necessarily reduce lochia, I bled for about 9 weeks.
Recovery time is longer. I couldn't go out for about 3 weeks by which point I was getting cabin fever!
Congratulations on your pregnancy.

[deepinthewoods]

OP you may actually enjoy a vaginal delivery!! For me it was a very empowering experience. I wouldn't have wanted to miss that.

[VivaLeBeaver]

If you're thinking about 3 kids I'd recommend a vaginal birth. The risks go up with each section, more chance of uterine rupture in pregnancy, more chance of placenta accreta due to scar tissue.

And a Cs does not reduce the amount of time you have lochia for. It may be a bit lighter for the first few hours but it still builds up again. I had an emergency lscs and bled for weeks afterwards.

[Gennz]

Oh I totally get that not all CS stories will be good! The more info the better. Thank you all.

I discussed the respiratory risks with the ob & his view was that that was for CS before 39 weeks - he thought after 39 week that risk was much diminished if not eradicted. This seems to borne out by the research I've found online.

Bugger Ooo so much for that reason!

[Gennz]

Yes Viva that's the biggest pro-VB factor for me.

[Matildasmam22]

My personal experience was natural vb for first resulting in ventouse and two blood transfusions with a long recovery time.

Second emergency CS no complications up and about in 6 hours.

Everyone has different experience and advice but personally I'm expectingmy third and it's elective CS all the way.

[deepinthewoods]

It may be worth exploring active birth. Intervention during birth can result in a downward spiral necessitating yet more intervention.

I do realise that unexpected and unpreventable difficulties do happen during birth- VB or CS, but we can play a large part in trying to control situations ourselves.
Pethidine or diamorhine leads to lesser mobility, longer labours, women becoming tired, less able to cope with pain, increased epidural use, greater vontuse rates, higher incidence of episiotomy etc.

Avoiding heavy pain relief will usually make labours shorter and with fewer complications.
My first birth did have some intervention which I now believe was due to the doses of diamorphine I was given.
Second time I was keen to avoid, and only used gas and air, resulting in a very active labour, no intervention- over within 3 hours.
I was well enough to do a big weekely shop on my own at Tesco the next day with only my newborn and toddler for company.

Taking some control during a VB can make the process and outcome easier.

[Gennz]

I don't really care how many interventions I have as long as I emerge with a healthy baby and everything intact!

[PisforPeter]

I had an elective CS got much the same readings as you OP. If you are a healthy weight it is no more risky than a VB.
It was lovely and I felt in control all the way. Was up and about next morning and recovered really well. Drove after 3 weeks. DD is almost 2 & scar is barely visible. I've had friends who tried to have home births etc and ended up with very traumatic deliveries.
I wouldn't seek advice from NCT as they are very pro home birth etc..
Inbox me if you want.
Best of luck & enjoy your pregnancy X

[PisforPeter]

for much the same reasons

[Gennz]

Thanks PisforPeter! Was DD your first?

[deepinthewoods]

"I don't really care how many interventions I have as long as I emerge with a healthy baby and everything intact!"

But that's the point I am making. Interventions can leave you less than intact.

By having an epidural your risk of episiotemy increses dramatically for instance. I would rather endure some short lived pain in order not to have a stitched vulva for weeks.

[Only1scoop]

Gennz

I had an Elcs and it was an amazing experience....I felt reassured and happy and the whole procedure was very civilised and calm.

It was right for me and I'd have opted for the same again.

No problems....scar now invisible.

[Gennz]

But from where I'm sitting deep I could have the ELCS and avoid that risk as well.

[tak1ngchances]

This is all interesting discussion but it is biased and anecdotal. Only you can decide what is right for you, and I would do that in consultation with your healthcare professional(s).

[Armadale]

Here are the 2012/2013 stats for England.

Here you can look up the statistics for individual hospitals.

For me I think the most useful thing about thinking about this is that it has shown me that 'natural' births are the minority.

As in your anecdotal evidence, my hospital has a natural birth rate of 33% (although it is a big teaching hospital, so will have more difficult births to cover).

My SIL had a very traumatic birth last year which ended in an Em CS and an very poorly baby who had to go to SC for 8 days. She was desperately upset and how things had escalated, and it contributed significantly to her PND, in her opinion.

She really had been led to believe that a natural birth was likely to happen except in unusual cases, and the statistics just don't bear this out. It is almost as if some healthcare professionals are so keen on getting mothers a natural birth (which is obviously ideally the best option) that they do mislead on how likely this is and then women are shocked when it happens....

I now take the attitude that I am going to try to have a natural birth, and do what I can in this regard to help, such as staying active, but I have a 1 in 3 chance of it working out, and if things do go to intervention, then this is not me failing or things being dangerously out of control, but something that happens in 2 out of 3 cases.