If you chose an ELCS without medical reason, why?

[Sparksi]

I’m a FTM to be in my 20s, currently very low risk.

I am considering opting for a ELCS. There is no medical suggestion for me to have one but I have been reading up on local stats and month by month, it seems under 40% of women have an unassisted vaginal birth. This seems really low to me. Nearly as many people (circa 30%) had an EMCS.

I want to avoid an emergency situation where possible. I sway between wanting minimal intervention and birthing in the birth centre attached to the hospital, and just wanting a controlled, planned ELCS despite the longer recovery. We only plan for one, possibly two DC.

If I could guarantee a straightforward vaginal then that would be my first choice but it seems that the odds are actually against that, notwithstanding in the 40% who got it that will include women with birth injuries and tears. It just seems like a coin flip situation. I am risk averse and like to plan things, but I know childbirth is probably the most un-plan-able thing in the world!

If you picked a ELCS, why? Did you regret it?

My maternity unit has a facebook page and publishes their stats every month. I've just looked for last month:

15% planned c-section
85% spontaneous vaginal, of which:
> 11% had 3rd/4th degree tears
> 28% needed emergency section
> 13% needed forceps
> 4% needed vacuum / ventouse

Not great, eh....

We had to get baby out early due to IUGR but consultants tried to push me into an induction at 36 weeks

I went into the hospital and asked again for a c section which they thankfully agreed to.

It was a good thing I did, my placenta was in 4 parts and I had ragged membranes so either way I was going to be in theatre.

Don't regret the section, scar looks great, recovery wasn't amazing due to losing blood etc etc but also wasn't horrific and I've so many friends who laboured for days and ended up with one anyway

I requested one 4 years ago after reading NICE guidelines and although I made it very clear at 8 week booking in appointment this was what I wanted after 2 horrible births, they made it very difficult every step of the way. Insisting I didn't have the choice for non medical - yes I did. Trying to refuse it to the point I was in tears so I asked for a second opinion/ if another hospital could do it instead. They eventually booked a date a few days before the baby was due as she was huge, but I ended up going into labour earlier than the booked date so I had the section before then. It was a abit more of a difficult recovery for me vs natural birth but the experience itself was perfect, and I wish I'd known I could have done this when I had my other two. If you want a planned section, you may have to really stick to your guns and be firm, I certainly did!

Didn't fancy a vaginal birth.
My mum had lifelong injuries from giving birth to my elder sister.
The hospital I was due to give birth at had a 50% rate of c section for women my age so i thought it best to cut to the chase.

I was recommended an induction at 38 weeks for various reasons but I asked for a C-section instead as everyone I know who was induced early ended up with one anyway. It didn’t matter in the end as baby decided to stay breach so I was happy to already have my C-section booked in

Actually I had forgotten DD was breach throughout so would have ended up being a c-section anyway even if I hadn't requested it/ended up with emergency.

Caesareans cost the NHS considerably more.

I was terrified of needing a c section. The idea of it seems horrific to me. I am a little over 5 foot tall, and I gave birth to a 9 Ib 8oz baby with no intervention or pain relief. His older brother was only 8 Ib 11 oz and I had induction, epidural and forceps for him. I think it is all down to luck in the end. Just go with what feels right for you. Giving birth is a huge ordeal mentally and physically, whatever happens. If you and your baby are able to go home happy and healthy then it is a huge win.

Same reason as you. It’s a hedge your bets solution. Not the aiming for the best (good natural birth), but avoiding the worst (emergency c).

Two years on I’m happy. I was very lucky with my surgeon (although you are likely to get a more experienced surgeon with planned - mine was an absolute seamstress). A year on you couldn’t see my incision. Completely invisible.

But c sections aren’t risk free either. I have heard some horror stories. But if I was going to have one I would rather it be 9-5 with all the best surgeons and additional teams. Then in the middle of the night with knackered and flapped junior docs running around on a skeleton staff.

So it is what it is. There’s no way good way to give birth and whatever you choose it’s in the hand of the gods (or surgeons 🤣).

I opted for an ELCS for my second after failed induction and EMCS with my first. My recovery from the first c section was fine (other than being absolutely exhausted after not sleeping for almost 48 hours) so I wasn’t concerned about having another. Initially I decided just to go with the flow with the second - vaginal if everything in the pregnancy went smoothly and I went into labour naturally, c section at the slightest hint of complication or going overdue. High BP and concerns over slow growth meant that they wanted DC2 here at 38 weeks so it was planned c section. It was fabulous. Controlled, occurred at a civilised time of day following a full night’s sleep. I had slightly more pain the second time for a few days but the recovery wasn’t problematic in the slightest.

My experience isn’t what you asked as technically there were medical reasons for choosing the second c section, but I’m sharing because I feel I’m on the other side of not choosing an elective and having a difficult birth. I never even considered a c section throughout the easy pregnancy (and don’t regret that) but I wish I’d thought more about agreeing to the induction when things went pear shaped at the end. I had pre-eclampsia and a c section was not presented to me as an option at any point, just “we need to induce you”. Given what I now know of the high rate of EMCS in similar scenarios I do regret not asking more questions and not choosing a c section as I would have had a much easier start to motherhood. I have zero regrets about my ELCS.

I've had 2 for medical reasons and they were great. I felt planned and in control and they were both really straight forward. I was out after 24 hours both times.

I wish I could have had a vaginal birth but ELCS were amazing and recovery was okay both times and my scar is so neat and tidy.

Not true. They cost a bit more.

I had one (only baby) for mental and physical health reasons. I had severe anxiety and was utterly terrified of going into labour. The anxiety was related to a gynaecological condition I'd suffered from for many years.

When I started to think about having a baby I realised natural birth was not something I could face doing. I researched, found the NICE guidelines regarding maternal requests, checked the hospital I was at allowed them (some didn't at the time) and then got pregnant. I told the midwife at my booking in appointment. I had fantastic support throughout my pregnancy from the maternal mental health services.

The reality for our antenatal group was that despite insisting that birth was all your choice etc etc, services are desperately stretched, and care was poor all around. At least half of us felt bullied and ignored by midwives during labour itself.

At the end of the day, they're trying to get all the babies out alive, and they don't seem to care much about the mums.

It's a vicious circle - the worse they perform, the more women opt for caesareans.

True. But heart surgery is hugely expensive too, and in a fair number of cases heart disease is lifestyle related. But we don’t query why men need heart surgery, and we certainly don’t offer less effective, more painful alternatives to them.

I am an obstetrician and I will be opting for an elective caesarean section for my twins in September. I think vaginal birth is wonderful and empowering but for me, who normally gets involved when things aren't going to plan there is too much uncertainty around delivering not just one but two babies vaginally. I'd be offered induction at 37 weeks (higher chance of caesarean section), plus twins (higher chance of caesarean section ) plus even after vaginal delivery of twin one still 10% risk of section for twin two. I wouldnt enjoy the labour at all, from the moment I came in I'd be worrying about who was on call, who was in charge (I'm delivering at the unit where I work) so I think from a MH POV a LSCS is the best thing for me. I'm undecided about what I'll do if I labour ahead of my booked section date especially if both twins head down. Knowing my luck I'll be wheeled across at 9cm on my last day of work with twin ones feet hanging out.
I fully support women's rights to birth however they choose and if anyone ever sees me in clinic they will not find me trying to talk them out of an elLSCS. As long as you understand the risks it's your birth and your choice as far as I'm concerned.

My maternity unit gave me an info sheet that had all the stats about different delivery methods on it, and the long and short of it is that ELCS carries the lowest risk to the baby. That made the decision easy for me.

Not as much as trying a vaginal delivery (particularly if induction is involved) and ending up with an emergency c-section though I'm guessing a

Thank you! The personal input is useful too considering what you do

I want to avoid an emergency situation where possible. I sway between wanting minimal intervention and birthing in the birth centre attached to the hospital, and just wanting a controlled, planned ELCS despite the longer recovery. We only plan for one, possibly two DC.

Those are (to me) by far the two best ways to have a baby, so I think you’re sensible to feel like that!

I had an ELCS. DD was breech (so there was a medical need) but I declined the ECV so it was partly my choice. I’m sure I had a worse recovery than a very straightforward vaginal birth on the birth centre, but probably a better one than a complicated vaginal birth with bad tearing, etc.

Wrong. The actual procedure costs around £700 more (which when you think a private/non uk resident brth is charged about £7000 isnt that significant - about 10% more) but when negligence claims for mishandled vaginal deliveries are taken into account overall they are cheaper for the NHS
https://www.itv.com/news/2019-04-18/caesareans-cheaper-than-natural-deliveries-once-negligence-claims-taken-into-account
And having worked for NHS complaints trusts will do ANYTHING to avoid getting to the settlement/payout stage so the fact there are so many successful claims is indicative that vaginal birth is far from the easy "natural" issue free option.

My relative is an obstetrician so when she had a baby she decided to try for a vaginal birth, see how it went and at the slightest hint of it not going well she planned (and did) change to section. So it was still classed as emergency section but I guess from your description you are more worried about the risks of vaginal than adverse to it if everything could be sure to be fine.
Good luck whatever you choose.

I lived someone similar to the UK with the NHS but maternal request was a valid reason.

I was high risk with various illnesses and would have needed to be induced and strapped up to heart rate monitors in bed. My research showed me that labouring in that way statistically would end in a c-section, and my OB agreed with me.

If I was healthy and no concerns I would have tried a water birth but given i was going to be very far away from that I felt a planned c section was best for me.

I just wanted the minimum of hassle. I told them I wanted a CS and they agreed to it possibly because I was over 40. They made one cursory attempt to dissuade me but that felt very much like box ticking to me.

The whole process from admission to going home with my DS was less than 36 hours. It was completely hassle free. No labour, no pain and the absolute minimum of fuss. I’ve had more demanding dental work!

Recovery was also nowhere near as bad as some make out. I was back to normal with just a little care with lifting anything heavy after a couple of days.

I had no medical need of a CS. I just took a cold headed look at the situation and decided the CS had the best chances. The first consultant was a dick about. I wonder if the midwife referred me to her on purpose to put me off? My partner stood up to the consultant, stood behind her to ensure she wrote the right thing on my notes. No exaggeration. But after that, all the staff were really supportive and the whole experience was just fab. The obstetrician and anesthetist in the theatre were a blast and both said they'd had all their children by planned CS. I have zero regrets. My tummy is a funny shape but down below is the same as before kids. I consider that a win.