to think elective repeat caesarian is a valid choice?

[schmee]

I'm currently pregnant with DC3 and would like to have a repeat c-section. I had a planned c-section last time as had twins, one of whom was breach. I haven't seen the consultant yet, so I don't know if I'll be allowed one on the NHS but I hope so.

I remember last time round people saying "oooh I don't blame you if you're having twins" when I said I was booked into for a section. I really don't understand what "blame" has to do with it, particularly as the decision was made to safeguard the health of my twins. This time round if I say my preference is for a repeat c-section the response is even worse, with people from frenemies to strangers feeling able to question my choice and try to get me to reconsider. WHY?

I wondered if people here think repeat c-section is a valid choice. And whether anyone's mind about planned sections had been changed by watching One Born last night which showed what a calm and baby-focussed scenario a scheduled section can be.

Iknowwhatyouarebutwhatami
DrMcDreamy - you must think natural birth with epidural is also an invalid choice then - that's a needle to the spine job too.

Um no. I'm not saying that epidurals/spinals are an invalid choice. I'm saying you can't compare that to a splash of lignocaine in terms of risk.

BetsyBoop - thanks v much for the RCOG guide link - super. I'd looked at that before but lost the link/forgotten the name of it.

Smiley
The reason I say this is because someone earlier said 'no where else in the NHS ask for surgery that isn't really necessary' I was just making the point that we have many procedures done that could be deemed unnecessary not just her view of c sections.
But your right there are a few obvious one that come to mind such a boob enlargement for teens!

Also NICE guidelines state (para 10.3)

"The risks and benefits of vaginal birth after CS compared with repeat CS are uncertain.
Therefore the decision about mode of birth after a previous CS should take into
consideration:
? maternal preferences and priorities
? a general discussion of the overall risks and benefits of CS
? risk of uterine rupture
? risk of perinatal mortality and morbidity

Bonzairob, I take it those are American stats?

I only ask because having been pg when we lived in the States, a hospital birth over there will be vastly more costly than a hospital birth here in the UK. For a start, there was almost continual monitoring. Also, almost always a Dr involved which is not the case here either. I don't think those costs acurately reflects the costs of a straighforward VB here compared to a CS here.

mercibucket - hope you're not in Surrey .

Seriously though - I think a lot of units are under pressure to reduce their c-section rate as they are judged on it (have I made this up?) But doesn't change the RCOG and NICE guidelines.

My midwife thinks that the consultant will suggest/offer one due to my age (which I think may be a euphemism for my weight).

I had a EMCS first time round and have been granted my request for ELRCS without much problems. The consultant suggested I might want to think about trying VBAC if I go into labour naturally and progress well before the date, however when I pointed out increased risk of rupture due to postnatal infection, he immediately agreed with my choice.

One big reason for me not to want to consider VBAC is the lack of ambulatory monitors at my trust - which obviously dampens the success rate. Really don't fancy putting myself through pain again just to get another EMCS.

I think either choice, if made informed, is valid. It's difficult though to find unbiased stats to help making up your mind though, as it's too political a topic.

Schmee
As I sign off just wanted to wish you all the best and hope you get your choice

Ballarat - I believe epidurals are administered far more in the U.S too- which is going to skew the statistics

It was me that said "Nowhere else in the NHS will they just give you surgery because you want it" and I stand by that.

A few examples:

A vasectomy - required outcome - permanent sterility, only way of acheiveing that? Vasectomy.

Boob job - Reason? Lopsided boobs causing huge mental distress. Only way of acheiving that? Breast augmentation.

Caesarean Section - Outcome - Baby - how to acheive that? Ah there is another way...

Do you get what I'm saying? It's surgery for surgery's sake. There is another way of achieving the desired outcome. This may not be suitable for mother and baby in which case surgery is the better option. But section just because? No you wouldn't get it elsewhere. It's unnecessary.

We came home to give birth because when I visited the labour wards over there, it seemed that almost every woman was expected to have an epidural and lie on the bed. They were actually quite shocked when I asked about standing up to give birth. I am sure they thought it was a rather primitive thing to do.

Thank you shewasashowgirl !

Violethill, yes, where we were, it was almost unheard of to birth without an epidural.

YANBU I had elective caesarean for my 2nd DC. First time I had emergency and the docs didn't want me to go too over my due date because of scar etc. I couldv'e waited to go into labour, but chose to have elective at 41 weeks. I didn't want to wait and end up having an emergency again. The elective scenario was so calm and relaxed. Completely different from emergency. I was talking the whole way through, there were so many people in the room it was like a tea party, but really it was a postive experience....but saying that, if I could have gone into labour I wouldv'e like to have tried to have natural but I don't labour
Anyway long way of saying YANBU go for it,

Caesarean Section - Outcome - Baby - how to acheive that? Ah there is another way...

But the point is, the "another way" is often not better than the ELCS!

It's not just because. If you don't want the baby to come out through your vagina it has to come out through the sunroof (thanks for that one, whoever posted it!). Boob job - that person could have therapy. The object is for the patient to be happy with her breasts, not necessarily for them to actually be even, right Vasectomy, I'll concede that there's no viable alternative.

"This may not be suitable for mother and baby in which case surgery is the better option. But section just because?"

But if the mother says it's not suitable then it's not, is it? You can't override her wishes like that. That's the problem I have with people saying women should be denied planned sections.

Violethill: I'm not disputing that what the article calls "spontaneous vaginal delivery" is better, but that's not always (or indeed, regularly) an option. I'd say most of the women in this thread saying that their birth was fine had that type. Anyone who mentioned tearing (sends me weak at the knees to think about it), anaesthetic/epidurals, foreceps etc. was in the higher-cost category. So far it's been two or three mums in the cheaper category.
However, I can try to find some stats on the incidence of unassisted vs assisted, too.

Ballarat: All of the stats are american, and if all births have constant monitoring and a doctor, then they will all be the same amount cheaper here. Even if there's some variance, the cost is still fairly close for assisted vaginal vs planned cesarean, so there's no reason to choose one over the other regarding cost to the NHS.

To the Google!

You are the one who doesn't have a clue if you thing cs is done under LOCAL anaesthetic! it is done under REGIONAL I.E Spinal or epidural which is totally different.

Depends how you define 'better' I suppose.

Yes, it does DrMcDreamy.

But you're proffering 'an alternative' as though it's the answer.

I'm sorry, but you need to consider those of us who've been physically damaged, and seen our children damaged by the 'alternative' that you seem to think we should accept over surgery.

Surgery was, by far and away, a better experience for me and my child than the 'alternative' you think we should all accept.

Go figure.

Oi Bonzairob

Are you calling me cheap

I had an episiotomy but they saved money by forgetting to give me a local before they cut me

Depends on the circumstance

OP,it is no-one's business but your own.

However, I had an ELCS 32 years ago because my first son was breech (and pretty big!)followed by two vaginal deliveries 25 and 22 years ago. I wouldn't have missed the experience of delivering my babies naturally for the world!