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.

With ds1, my epidural wore off as they started to stitch up my fanjo, but didn't bother to top it up cos they "wouldn't take long". This was the most straumatic experience, and as a result ds2 arrived by planned c-section.

VB - labour etc fine, but being put back together with no pain relief meant I didn't mentally recover for years (not sure if I have yet tbh, 6 years later), had post-traumatic stress and postnatal repression. I was allowed home 4 days later but only because I begged them to let me out. Couldn't persevere with bfeeding as a result of physical and emotional pain. Couldn't sit for weeks.
ELCS - The recovery was easy. Not easIER. Just easy. Got home 2 days later, pain was manageable, was driving after 4 weeks.

It makes me LOL when my VBACing friend bangs on about her short labour and positive natural birth because she mentally 'chose' to be able to do it without any problems - how it was all about her positive mental attitude.

I mentally 'chose' to have a trouble free ELCS and recovery, and lo and behold was standing 5 hours after my ELCS, never had anything stronger than paracetamol and ibuprofen and was driving after a couple of weeks.

LUCK! It's a lottery.

Right.

Cost
Estimated cost for vaginal delivery is £1698, for caesarian section (planned or emergency) £3200. NICE estimates that if maternal requests for caesarean section were denied (this is for first deliveries not repeat sections incidentally) there is a potential cost saving of £10,990,017 per year. Overall trying for VBAC is also more cost effective.

Now, I don't think that this means that we should all have compulsory vaginal births - but cost is an issue.

Staffing / space.
Average stay post vaginal delivery 1-2 days, post section 3-4 days. This comes back to cost as well.
Doesn't mean we shouldn't offer elective section - but it does have resource implications.

d) and e)
Outcomes that are more common post section
Pain in the abdomen (tummy)
? Bladder injury
? Injury to the tube that connects
the kidney and bladder (ureter)
? Needing further surgery
? Hysterectomy (removal of the
womb)
? Admission to intensive care unit
? Developing a blood clot
? Longer hospital stay
? Returning to hospital afterwards
? Death of the mother
? Having no more children
? In a future pregnancy, the placenta
covers the entrance to the womb
(placenta praevia)
? Tearing of the womb in a future
pregnancy
? In a future pregnancy, death of the
baby before labour starts

Outcomes which are no more common after section or vaginal delivery
? Losing more than 1 litre of blood
(haemorrhage) before or after the
birth
? Infection of the wound or lining of
the womb
? Injuries to the womb or genital
organs, such as tearing around the
neck of the womb
? Bowel incontinence (no control of
bowel actions)
? Postnatal depression
? Back pain
? Pain during sexual intercourse

Outcomes which are less common after caesarian section
Pain in the area between the
vagina and anus (the perineum)
? Bladder incontinence 3 months
after the birth
? Sagging of the womb (prolapse)
through the vaginal wall

So overall, more negative outcomes after section - all other things being equal.

These are all reasons why people need to make very indidivual decisions carefully with appropriate information if requesting caesarian section without "medical" reason. I think it can be a valid choice - but not just because.

VBAC - different set of risks / benefits which I won't go on about now...

BetsyBoop - thanks v much for your links. I think that last site conflates emergency and elective c-section data at some points though. For example, there is no reason that the baby should be taken away from you at an elective c-section for any longer than it should at a vaginal birth.

"Average stay post vaginal delivery 1-2 days, post section 3-4 days."

Really???? My three local hospitals were all 24 hour stays for ELCS. Or are you including EMCS figures with ELCS figures?

Surely if you labour then have an emergency section that's going to be the cost of the vaginal delivery plus the cost of the c-section? Having a planned c-section has got to be cheaper than having an emergency one...

and was driving after a couple of weeks

I thought car insurance didn't cover you until 6 weeks after the op?

Agree that cost is an issue though - the only valid one IMO.

"Caesarean section is brilliant if you need it. Lifesaving even. If you don't it's just unnecessary surgery"

This makes me angry, it isn't unnecessary if the mother wants it.
Why does there need to be a justification other than maternal choice?
You here, in this phrase have decided that because YOU think that it may be unnecessary because of cost or no apparent medical need, but that doesn't de value the womans choice or opinion on how she wants to give birth.

Both my ELCS have been 'materal request' with no medical reason - I just didn't fancy the risk of damage to my pelvic floor whic seemed a good enough reason for my consultant to agree them. I thought they were great and had really quick recoveries each time plus my scar is hadly visible.

I'm all for natural birth for those that want it however not everyone does.

"privategodfrey Tue 01-Mar-11 22:20:07
and was driving after a couple of weeks

I thought car insurance didn't cover you until 6 weeks after the op?"

Nope - you're completely wrong. That's another myth peddled by the anti C-S brigade. My insurance company were happy for me to drive that soon.

Happy to have educated you

Happy to have educated you

I'm sure you are, and I'm happy to be "educated" :)

No need to be quite so snotty about it though.

LOL!

Off to bed now but thank you for all the supportive comments.

To those of you who think that if you want to have a c-section you should fund it yourself I would ask you a few question.......
Do you smoke or drink? Is your bmi outside the healthy range? Do you go skiing? Do you drive a car? Do you do anything that puts you at any risk whatsoever on a daily basis?
If you answered yes to any of the above then quite frankly you are being a complete bloody hypocrite!

Under the "you pay your money you make your choice" scenario, any woman who finds out that they are having a disabled baby during pregnancy should either have to abort or be forced to pay for all medical care for that child during it's lifetime as it is too much of a drain on the nhs!

Seriously, think things through before you make sweeping and condemnatory statements!

I'm having an elec c-sec tomorrow morning for what it's worth. Over here in germany it's a different system and you can actually choose the type of birth you want (chose to have elcs because vb last time was such a horrific experience with after effects that continue to this day!) If you disapprove I couldn't give a shit.

The nhs cannot possibly be sustained at it's current level and in any case it is not a valid argument - everybody makes choices on a daily basis about the life they live and the repercussions that will have on their future or immediate health.

We pay a lot more in medical insurance out here but the facilities are incomparable!

All facts and figures courtesy of NICE by the way, link here
www.nice.org.uk/nicemedia/live/10940/29333/29333.pdf

Agree luck has a lot to do with it either way!
Basically, I think women need to be given enough information to make their own decisions. Given the information above, I suspect there won't be vast numbers of people requesting elective sections "just because" - the risks are there. The benefits for an individual may, of course, outweigh the risks....

And, as I said, VBAC is a whole different kettle of fish (the bit that swings it for me is that risk of baby dying is 1/10000 for planned section, but 10/10000 for VBAC. And I only want one more baby so no probs w multiple sections).

you have to be able to perform an emergency stop to keep your physio and car insurance company happy.

I would not be happy performing an emergency stop a couple of weeks following major abdominal surgery.
Far too much healing on the 'inside' that you cant see.
you would be unaware of the damage you could be doing - scar tissue would not be fully healed by then

Tallpoppies, well said and I wish you the very best of luck for tomorrow x

Night all.

You need to talk to the insurance company then Alimat - like I say, they were happy, there was no "should wait til 6 weeks" about it.

I don't have a physio thought

What planet are you on country are you in?

but could you really perform an emergency stop?

And were you fully healed after 2 weeks? Internally?

"BetsyBoop - thanks v much for your links. I think that last site conflates emergency and elective c-section data at some points though. For example, there is no reason that the baby should be taken away from you at an elective c-section for any longer than it should at a vaginal birth."

Yes there are a few "americanisms" that you have to ignore temper with UK views :)

you have to be able to perform an emergency stop to keep your physio and car insurance company happy.

More mis information!! My insurance company (and DHs to) weren't even interested that I'd had a Csection and put this in writing to me to confirm) My GP just had a prod of my scar and said it would be fine - boh times I was driving within 2 weeks.

Could I perform an emergency stop?

Yes.

Were you fully healed after 2 weeks? Internally?

No idea.

FYI when I looked at private prices vaginal and c section prices were around £100 difference. I must admit I was surprised but perhaps because privately you get that one to one care through the whole labour? And c section is only an hour then after care is just done by nurses popping in.
I suppose if the NHS had the level of care people rightly say should be there for vaginal delivers but clearly isn't then those prices might be more comparable