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.

So if I couldn't drive for 6wks, I guess I couldn't take them to school etc. as it's too far to walk. That's just one more reason why I could never choose to have a CS. But I guess everyone is in different circumstances.

I guess to me it just seems that there are so many reasons not to have a CS (unless necessary) and I'm not factoring in cost at all.

But then maybe that's coming from the perspective of having had 3 VBs with minimal intervension. (not smug, just musing)

but its not just the being covered bit.

Its the fact you are not fully healed - no matter what operation you have had, major abdominal surgery being one of them, it takes weeks to heal fully internally.

People look at their nice scar on their tummy thinking its looks lovely, almost disappeared, yet inside things are still healing.

I think its the culture of being so car dependant in this country too that adds to this

I had a EMCS with my first due to severe PET at 34weeks. This time, I'm 29weeks pregnant, I'd like to go for a VBAC. However, on talking with the midwife and consultant, they seemed to give the impression that I have the choice of having another caesarean if I want. Perhaps my previous history was interpreted as being traumatic, which it was but I'm over it now, so they think I'm allowed a bit more choice over how I give birth this time (though defo not allowed home, water or midwife centre birth).

If I had to have a repeat caesarean, I'd be happy to have one, it doesn't take as long as they say to recover and at least I don't have to worry as much about the state of my pelvic floor and faff afterwards!

I agree Alimat1 - that's what my MW/Consultant/Mum said - it's not the outside you have to worry about.

Normal, safe driving is fine - no problems. Like it said earlier, it's the breaking (proper pedal to the floor,instant reaction stuff) and then the impending impact that could do untold damage to a partially healed wound.

I think if you don't have to drive, don't. This is obviously not a 'choice' for some though who need a car to get around.

lol - the MW/Consultant/Mum NOT THE SAME PERSON as my slashes would infer

ladyofthemanor - I find your attitude smug in the extreme - just because you had a successful "natural" birth, its very easy and lazy for you to take this position - obviously not everyone is as lucky as you.

I had 2 fairly standard long painful and exhausting induced labours with my first 2 boys so had no reason to suspect labour no3 would be any different, induced at 38 weeks due to concerns about the babies size. Cue failed induction, baby stuck somewhere in my pelvis and a very EMCS, scarey stuff indeed. Including my panic attack on the table when I literally couldnt get a breath and thought I was going to die - lying flat on my back. DH said I said at this point that I had had enough, didnt want to do it anymore and was going home. Later he also told me he was in tears because he could see how white I was, how low my BP was and how DS3 wasnt moving.

DS3 eventually born with an apgar score of 2 via forceps - I had never thought that a possibility - he was so stuck in my pelvis they had to use the forceps during the c section! And then he had to be resusitated to.

And yes Im currently ttc - if Im lucky enough to get pregnant again Im going for an ELCS - because the idea of labour all going wrong again and experiencing what I did takes me straight back to lying on that table having a panic attack. Would that be defined as a "medical necessity" - dont know and dont care!

As it was DS3 was 10lbs born at exactly 38 weeks so god knows what size he would have been at full term.

Imo opinion if a woman is requesting a CS then there will always be a valid reason - even if it is to avoid pain. the aim of labour is a healthy baby, no-one gets a medal for doing it without drugs, I hate all the smug attitudes to this, which only serve to contribute to some women feeling guilty if they need a CS - that they couldnt "manage" to give birth the "proper" way.

Rev084 what age is your older child going to be when you have this one? Recovering from a 2nd section can be a different matter than recovering from a 1st.

Just as an aside a lot of damage to the pelvic floor is done during pregnancy itself so a section is no excuse not to do those pelvic floor exercises!

So you can you just ask for it on NHS or will they refuse .

I tell you something if I get up the duff again and they so no to a C-Section I'll probably miscarry out of fear after the god awful time I had with DS.

I told em for a month something was wrong and asked for another scan and got told no, then they moaned when he was over due and gave me a sweep and then the trouble started, pain, bleeding mixed with baby shit, poo pooed by the hospital every time I called em, ambulance, emergency C-section.

not doing that again.

My DD is 2.5, I've said I'd go for a VBAC but it all depends on what the consultant advises in the last few weeks. I currently have clinic and scan every 2 weeks, so who knows? I put my fate in the hands of the professionals.

rev084 why the frequent scans? Is it just because of your history?

Stop and think about why you are putting your fate in the hands of the professional. It's your responsibility to ask questions about the risks and benefits. In my experience, a direct question to a senior obstetrician usually elicits an honest answer. What happens when you buy a house? Or a car? Or go on holiday? Yes, at some point you will probably take a professional's word for it, but it won't be a passive choice on your part. I only say this because I get the impression you are unsure of yourself, I apologise if I'm wrong.

As a generalisation I'd be very supportive of VBAC and I would hope that women who choose it do so actively. Overall, I'd be a much happier midwife if we were a long way closer to the WHO recommended levels of C/S - that way fewer women would need to consider VBAC.

YANBU. I had a natural, no drugs birth with number 1, with a 4th degree tear and serious bleeding that required an epidural afterwards to fix me up. I was a bit traumatised by it and decided to have an elective c-section with number 2 after birth counselling. I felt people made me feel like a failure for giving up on myself - and I think I gave myself those guilt feelings too, wondering how I had felt able to do it all myself the first time, but chickened out with my second.

For baby number 3 I requested a natural birth with drugs, and was told not to as it was likely to cause the same damage and be less repairable, but I think I might well have gone elective c section there anyhow. You should try to feel okay with whatever you decide and try not to mind what people say - but it is hard in a society that places such emphasis on natural childbirth.

I had 2 ELCS, the first for placenta previa the second one was my choice. I was out of hospital after 24hrs both times and recovery was pretty quick.

A Senior Midwife told me never to forget that it is your body, your baby, your birth and your choice.

Well there are health reasons to perform a repeat, namely possibility of uterine rupture during labour.

Who wants to be cut open seriously
Well no one, I imagine. But to me (having an elective after a crash) it was important that 1] I was awake for dd2's birth (GA for dd1) 2] that I didn't risk getting into that crash situation again 3] that I didn't risk uterine rupture & severely affect my child.

Whats wrong with giving birth naturally
Nothing at all. Just when you have already had a section, you are introducing new risk factors into any subsequent pregnancies. And you have to weigh these into the mix when you decide how to proceed.

Or is it can't be arsed with the labour pains
hahahahah fucking hahahaha! To think that women only have sections because they can't 'be arsed with labour pains' is spectacularly missing the point!

C sections are more dangerous for the baby than a vb so yabu and im quire frankly shocked that you didnt already know this

VBAC's can be more dangerous for mother & baby actually. And I am quite shocked if people don't know this!

Fluffymuff, sorry if I seemed as though I was on my high horse!

I suppose what I was trying to say was that where you say a 'proven medical need', when in fact the decision is down to a consultant, who in my case said there was no medical need, so the reason put on my notes was, 'maternal request'.

I'm burbling, sorry, I've had a shitty day.

Oh and the bit about how much I've cost the nhs, was supposed to be a joke - obviously not a very good one! I look forard to the spreadsheet though!

YANBU

I'll be having one too next time round and I am so glad I am somewhere where they will not risk me having VB after first emergency CS.I do not feel i missed out at all- i just don't get the whole.....ahhh it is life changing giving birth naturally. Actually I find that whole...my birth experience is so important self indulgent really- all that matters is the baby is born healthy and the mother is kept safe.

I spoke to someone whose daughter is a obstetrician and there are many obs who actually believe c sections are the healthiest way to give birth- for the baby of course.

Clearly if a baby can come naturally without damaging it or the mum that is a good thing but may times this is not poss.

I worked with so many kids with cerebral palsey - all a result of the birth process going wrong....thank god for c sections.

differentnameforthis "VBACS can be more dangerous for mother and baby actually"
More dangerous than what? I'm not being facetious. The risks of VBAC are different to the risks of repeated major abdominal surgery, and they differ again according to the obstetric history and the subsequent pregnancy. Current medical opinion holds that spontaneous, term VBAC is generally safer (note my use of the word "generally" - there are always exceptions). If this wasn't the case, VBAC wouldn't be encouraged.
There have been some good examples of why people have chosen repeat c/s in this thread. Indeed, there are certain situations where I would choose a c/s, and certain situations where I would choose a vaginal birth. What would matter to me was that I was fully informed and felt able to ask questions.

Lalamom, what if c/s doesn't lead to the baby being born healthy and the mother kept safe? Yes, some obstetricians believe c/sections are the healthiest way to give birth, but opinion is not the same as evidence. Obstetricians by the nature of their jobs only see the abnormal: of course they think that "many times it's not possible" for a baby to be born naturally - they're only called in when things go wrong. Childbirth is a normal, healthy event. Cerebral Palsy is definitively not always the result of birth 'going wrong' - sometimes it is the result of problems in the development of the brain during the pregnancy, prematurity, infection, brain haemorrhage, jaundice. And yes, hypoxia during birth. Sometimes that hypoxia occurs because normal birth was mismanaged. And yes, sometimes it could have been prevented by c/s. So, for the sake of the tiny number of cases of CP that we might prevent, let's just section every woman. Then come back to me in 3 year's time and we'll look at the morbidity and mortality.

arsebiskits - "The risks of VBAC are different to the risks of repeated major abdominal surgery, and they differ again according to the obstetric history and the subsequent pregnancy."

Absolutely. Surely the point is, each women seeks advice about her pregnancy, each separate time she falls pregnant. There is no 'one size fits all'. I certainly know that from personal experience - I've had the works - natural MLU birth/csection/vbac.

For dc3 I spent loads of time talking to the consultant, who weighed up the risks for me, precisely because I by now had a complex obstetric history. The consultant said that, on balance, vbac would be less risky than an automatic elective cs, because the medical problems my dc2 had experienced weren't relevant to this baby. I would happily have had another CS if the consultant had said it would be safer- but he didn't.

IME the vast majority of women make decisions about their labours based on the lowest risk to the baby -that informs their choice about where to give birth, and how to give birth.

I can't speak for the celebrity culture whereby a lot of women do seem to have csections, certainly far more than the law of averages dictates, though having said that, you have to factor in where they are based and their cultural experiences. eg as has already been said, US culture is that it's 'normal' to anaesthetise the mother through epidural for labour, and their cs rate is far higher anyway.

Schmee,

Of course it is a valid choice. Vbacs carry risks, as do C sections and, these days the differences are marginal.

Having said that, a successful VBAC does give rise to a far shorter recovery time. Our first boy was an emergency C, 3 days in hospital and about 6 weeks until my wife was fully recovered (and she is an active and fit person). Our second son was born by VBAC. Even though it ended in a forceps delivery in theatre. I was able to collect my wife and baby the next day and she was fully recovered within about 2 weeks (due to stitches).

If you know the above and go for the C, it is absolutely a valid choice. I think good friends and family have a right to question any choice anyone makes, if they do it in a friendly and constructive manner. Anyone outside this circle should mind their own business.

DrMcDreamy - Yes, they give you a sheet to sign - they can't/don't need that for an unassisted vaginal birth, as that's not a procedure they do to you, if they had to list all the risks connected with vaginal birth for mother and baby, it would probably a similarly gruesome read.

As for cost, I've no doubt that a straightforward complication-free vaginal birth is cheaper than a ELCS. But what is the cost of a not-straightforward labour, ending in EMCS or instrumental delivery, with follow up surgery, possibly mental health treatment due to birth trauma etc etc?

I also don't get why previous CS doesn't count as a reason for ELCS in your book, when the risk of uterine rupture is proven to be elevated?

By no means should a woman be forced to have a CS if she really wants to have a go at VBAC after weighing up the risks.
But why the woman's choice for VBAC should be turned into a mandatory VBAC for those who don't want to take that risk I really really don't get.

I have so enjoyed reading this thread. I so desperately wanted a natural, drug free birth with my daughter, but after 72 hours of back-to-back labour, I had to accept that I just wasn't going to dilate and so had to have an emCS. I was absolutely gutted (haha), even though the surgery was not traumatic at all, and I was up and about 8 hours later. I felt like I'd missed out on a vital experience. It didn't help that several friends around the same time had pretty straightforward VBs. I even had a friend have a labour of 1 hour (!) And then go on about how it was because she had done pilates before and during her pregnancy. (The implication being that had I been more fit and healthy my birth would have been a dream)

Reading about others' experiences has really helped me, so thank you all for sharing.

Anyway, before I had this experience I was probably quite judgemental and smug about birth ("a woman's body is made to do this, it's natural, why would you choose a CS etc...) While I still think this is true in essence and would love to try for a VBAC next time, I now understand that some births just really won't happen naturally, it's nobody's fault, just the way it is. I also totally understand why someone would opt for an elCS after a traumatic earlier experience. It's so easy to judge if you've never been through a difficult labour or delivery yourself. And so insulting to assume that a bad birthing experience is just down to someone not having a positive enough mindset or not being fit enough, or that a CS is the easy or lazy option, or makes you less of a woman or mother somehow. IMHO. :)

widowadman I also don't get why previous CS doesn't count as a reason for ELCS in your book, when the risk of uterine rupture is proven to be elevated?

I have never said this. In fact I have categorically stated that I thought a previous section was in many cases a perfectly valid case for subsequent sections.

It is difficult. I am a midwife and it is surprising how many people think they can just choose to have major surgery on the NHS. (is different story if you have had a previous problem). But doctors should give advice for the next mode of delivery based on reading the previous notes and discussion with the women. For example they may advise a c/s for someone who had a massive baby, who laboured for days and pushed for hours and then had to have an emergency c/s and lost a lot of blood. Obviously they should take into account the women's choice but they don't have to dish out c/s because people want them. I always think you couldn't demand the NHS to remove a kidney because thats what you want!! You need to talk with your consultant and make an informed decision with their advice. Good luck! p.s if you had a VB the first time before the twins then your body has done it once so easy peesey!!!

If the hospital had offered me mobile monitoring for a VBAC I would have given it a shot. They insisted I would have to be strapped up and lying down during labour. They offered me no choice IMO.