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.

TBH - I think a couple of people are looking for an argument where there is none so maybe it's time to step away from the thread rather than going round in circles.

I haven't ever said that VB is a bad option and it's misleading to suggest that I have. I think we all work from the basis that a great VB is fantastic and I've been quite clear that's my opinion.

My post was about c-section in the shady area where VB is possible, but potentially more risky to the baby than a "straightforward birth" and about whether to elect for c-section is a valid choice in those circumstances. I'm also interested in why culturally we seem to think c-section is a "lesser" way of giving birth: a view which many other posters have encountered, and some, thankfully, have not.

From the posts it seems like the cultural bias against c-section is for a number of reasons:

• people having misinformation about c-section (thinking it's always worse for the baby/it's bad for the baby's development)
• people worried about the NHS money entailed (really fair point and one I actually strongly agree with, but there was an interesting debate about this one)
• people worried about the effect on the mother
• people who view c-section as something lazy people do to avoid pain: rather misguided as cs causes pain, but also worrying: do we think women have to go through pain?

Also a huge amount of support for c-section, both as a valid choice when there is a medical indication or higher risk, but also from some as a valid choice per se.

Thank you everyone who has wished me well, and everyone who has contributed and given me a clearer understanding of why prejudices might exist.

BTW The NICE guidelines bit is here: www.nice.org.uk/nicemedia/pdf/CG013NICEguideline.pdf
The quote is: "the risk of an intrapartum infant death is small for women who have a planned vaginal birth (about 10 per 10,000), but higher than for a planned repeat CS (about 1 per 10,000)" so both VBAC and repeat section are a completely valid choice with such low risks, but in repeat section the mother is taking more of the risk onto herself, in VBAC there is a slightly (but elevated 10 fold) risk for the infant.

larrygrylls one of the sanest posts I have read. Spot on.
schmee I have failed to actually answer your OP. No, YANBU, and all the best for your upcoming birth.

I'll hold my hands up and admit that I had missed the NICE tenfold increased mortality risk for the infant. But I think it's also relevant to point out that relative risks have to be seen in the perspective of absolute risk. The RCOG puts it well, I think: "The absolute risk of such birth-related perinatal loss is comparable to the risk for women having their first birth." So how come they don't just section every pregnant woman? Because the risk is so miniscule that the harms far outweigh the benefits.

YABU - a repeat c-section should not be a 'choice'. It should be done only as a last resort IMO due to valid medical reasons. A natural birth' (even a VBAC) is much better for baby in terms of 'switching on' their immune systems (exposure to mothers bacteria) for one thing.

I had a VBAC 7 months ago (wonderful experience) and it is made out to be much scarier than it is (c-section with previous twin birth as first one was breech and I was not happy about it). The risks are really minimal, same as the risks of anything going wrong in childbirth. Worrying about it does not achieve anything. My c-section was calm and relaxed but I would still not want another one. Don't want to be cut open unnecessarily for a one thing.

If you don't want to give birth naturally either get therapy or don't get pregnant.

If you don't want to give birth naturally either get therapy or don't get pregnant.

But YOU had a CS for a breech baby which some would argue could have been birthed naturally.......

Coming to this late and haven't read the entire thread but Fabbychic those are terrible things to say. Why would anyone have a CS? What an unbelievably stupid and insensitive remark. And by the way, all women who have CS choose it, because you can't cut someone open without their consent. I think you were suggesting women are choosing it without good reason, but if it's on the NHS then there must be good reason otherwise they wouldn't be offered it.

And to those who say CS is more dangerous for the baby, that's scaremongering nonsense that doesn't take into account individual circumstances. Schmee I totally support your last post. I can't believe we've ended up in a culture where being cut open is seen as some sort of easy option. All the best with the pregnancy and birth.

why do you want one ?

Chynah - it a twin birth with the first one being breech - read properly why dontcha? Pretty obvious what could go wrong with that so quite valid and despite my protests, I had to agree with my consultant with it being safer than trying to get them out naturally.

healthiswealth whoa there Nellie, with the unsubstantiated and anecdotal evidence. There is no strong evidence to suggest there exists any 'much better' choice between either option.
And last time I looked, previous c/s was a valid reason for a repeat c/s.

Erk I find myself in agreement with chynah. Must. Resist.

Chynah - it a twin birth with the first one being breech - read properly why dontcha?

healthis wealth I DID read properly- and if YOU read MINE properly you would see that I said SOME would argue that they could have been birthed naturally.

Yeah it would be high risk but they COULD - safer not to but that WAS'T what I said!

"If you don't want to give birth naturally either get therapy or don't get pregnant."

Quite possibly one of the dumbest things, I've ever read on Mumsnet, Whoa Nelly indeed.

So come on healthiswealth, what's your answer to chynah's point? In other words, why do you feel that other women are having CSs for less valid reasons than yours? And don't say you haven't said that, because that is the clear thrust of your post.

Schmee,

I can see your quote about 10/10,000 as opposed to 1/10,000 but, within it, there is no separation of those who follow the VBAC protocol and those who take the additional risk of a home birth, allow the labour to progress at a slow rate etc. However, fair point.

I'm surprised this "debate" is still going on!!

OP, in answer to your question - YANBU. It is pointless people saying that ELCS should or should not be a "choice." Their opinion does not remotely matter.
If the NHS thought that any given person did not have a valid reason to have one then they wouldn't have one. Full stop.

OP-YANBU, I will do the same thing if I get pregnant again.

22 years ago, I was induced 6 weeks early had DTS's vaginally-one was breech. I had 9 hours of back labour which was horrendous.

Fast forward to last December. I went into spontaneous labour 3.5 weeks early and was found to be a carrier of Strep B, the day before DD's birth. I spemt 5 hours in the most agonising pain, with contractions from the outset every 60-90 secs, but was still only 2cms dilated. DD's heartbeat was slowing, and I was advised by the Registrar there was no way the labour would progress positively and I'd need an EMCS. CS had been a "fear" of mine throughout the pregnancy and I wanted to avoid it at all costs.

However, If I had known 20+ years ago, what I know now, I would have soon let go of my stereotypical views about CS/"real women" and "natural birth". Even with the discomfort afterwards, my EMCS was a fucking walk in the park to the trauma of my first labour and the 5 hours I struggled with DD-before the Registrar said "enoughs enough". I am getting on a bit now, so if we want a sibling for 3 month old DD, we'll need to ideally make it happen this year, and I will definitely be requesting an ELCS if I am lucky enough to fall pregnant.

arsebiskits

Of course if people can give birth vaginally then that is the most obvious way but the point is that a surpising amount of people can not do this without damaging themselves and sometimes their babies.

Let us not forget that 1 in 4 women used to die in childbirth so as natural a process as people claim it to be, complications occur and women should not be denied/discouraged from having a c section because someone has a philosophy against them.

I really got the impression that the midwives I encountered before i left the UK were really anti c section " Oh dear you may end up having a c section if you go to the States."They really did put the fear in me as to what would await me in the US and it was fantastic in the end- i shudder at the thought of returning to the UK and having to give birth there as I know I will be up against people trying to push their "oh it's a natural process" ideology upon me. My baby was well over 10 pounds. His head was in the 99th percentile. My grandmother suffered a prolapsed womb for her entire life after birthing my father who was over 11 pounds.
You just have to read some threads on here to see some of the problems some women have after giving birth vaginally. BUT still there is this obstinate rejection of it as a good birth option for some women.

I have now seen what a more average sized baby looks like and can well imagine having been able to squeeze one of them out but some babies are bigger than others and some women's physiology is less suited to birthing vaginally/baby is bad position etc. It seems that some times the decision to go to a c section is not made soon enough.

These people should not be able to have access to a c section without it being as difficult as I understand it is in the UK. I met one woman who gave birth to an 11 pounder- she really had a bad time trying to give birth but they would neither let her have an epidural or a c section at the london hospital she was at-that is wrong and I am just so relieved i did not have to go through a london hospital if this is the state of play at this point in time.

Thank goodness there is not the same taboo here against them and when i needed one I got one without having to be up against people who seem to have a disproportionate aversion to them.

Great post lalamom

I had my DS1 in 1997, I went through a 36 hour labour, only reached 5cms. DS1 was what they called in that hospital 'star gazing', staring up out of the womb and I have a very high and far back cervix, so he wasn't positioned right. No one knew this until I had to have a c-section due to extremely low heart rate and critical oxygen level of DS1 (took a scrape from his head while he was still in me, not very nice at all). I was left in agony for hours and no one seemed to care at all.

Registrar eventually came in after he was shown the oxygen level result and he said I had to have an EMCS immediately.

It was a horrific experience and has been a source of great sadness to me always. That such a wonderful experience should be so awful.

I am now 26wks pg with my second (yes I'm a lot older now - 40) and I want to try for a vbac and it is what is encouraged. I have discussed this with my obstetrician as I am being monitored closely as I have no thyroid after two bouts of cancer and I suffer from bi-polar, my first psychosis coming after DS1 was born.

But I am terrified of experiencing the same again, absolutely terrified .

I have my next appt with Ob on 10 March at RHCH Winchester and I'm really nervous. I want to try for a vbac but also want to stipulate a cut off point so that I don't go through the same experience again. I also have to think of my mental health and although I am taking meds for the bi-polar etc the risk of an episode is very high.

If anyone has any advice for me on whether I should try or just go straight for an ELCS, I really would be very appreciative.

Sorry to hijack your thread OP but there seems to be lots of advice on here

How about induction, Libra? So that you go into labour during the day during the week/non-holiday when it seems to be there's often greater care coverage?

Something to discuss at your appointment, at any rate.

Hi expatinscotland MW has told me that they won't induce when you've had a previous EMCS or ELCS, so that doesn't appear to be an option, but I will ask the OB at my appointment, just to make sure.

Thanks for the input

induction might bring a whole load of new problems. I was induced twice and think that might have been the start of my problems (will never know for sure). First induction ended in emcs, 2nd induction ended in vbac but with forceps and venteuse delivery. Libra if the worry of trying for a vbac delivery is causing you to stress out maybe you would be better going for an elcs. Don't get to hung up on the 'natural' birth experience (i understand this need) - do what is best and easiest for you and your peace of mind. The baby will be fine either way but you need to think of yourself here.

I'm going to ask for a CS. 1st birth was VB, didn't find the pain too unbearable, but tore badly and don't want to risk further damage to PFs. Selfish maybe, but it's my body. Not that I need to explain my reasons and nor should you. A simple I have considered the options and this works the best for me should suffice.

" Don't get to hung up on the 'natural' birth experience" And why not. Why shouldn't it be something all women aim for? It should be something that is at least tried for if possible.
Giving birth naturally is the most fantastic thing.
It is not right that you have a section just because you don't want to give birth naturally.

Flippinpeedoff - your post does come across as incredibly judgmental.

'It should be something that is at least tried for if possible' - who says? why do you feel that you are best placed to determine how other women give birth?

'Giving birth naturally is the most fantastic thing' - for some women Perhaps for you. It was for me. But you only have to read many of the posts on this and other threads to realise that for other women VB can cause huge physical and mental trauma.

'It is not right that you have a section just because you don't want to give birth naturally' - why not? The difference is risk is marginal, the difference in cost is not significant, why shouldn't a woman make an informed decision based on her own personal circumstances?

flippingpeedoff - we are talking about Vbacs, not people choosing to have a CS just for the hell of it. I would have had a better experience if I had went for my planned elcs instead of the Vbac I choose in the end, and it would have been less traumatic and damaging for my child. For some people 'natural' just doesn't work and isn't a good experience.