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.

I had an emergency CS with DD1 as I have narrow pelvis..and then with DD2 the pushed me to have a VBAC..I said no. They told me "Oh you'll be heavlily monitored and possibly induced...nothing can go wrong and we wont let you try for long before we have an emergency c section"

And then they were shocked when I said no! As if I would put up with a pressure filled birth like that when C Section (emergency) woud be waiting round the corner!

Bth DDs were well over 9 pounds and DD2 was even bigger than DD 1!

I'm definitely too posh to push

I actually had medical reasons which meant that pushing would have been impossible anyway, but I count that as a lucky accident. I'll just join iknowyouarebutwhatami in the smug corner :)

rinabean - The other lady in my antenatal group who had a planned section recovered quickly but don't know all the details. Other than that, don't know. I've had a lot of major surgery over the years (my latest being a total hip replacement last year) and I've always bounced back pretty rapidly so might not be the average example.

OP - I'm 99% sure that c-section is safest for my baby and probably for me. I also know that I only have about a 50% chance of delivering naturally if I try VBAC (because of age, weight and medical history) even before you take into account the size of my baby and I would like to avoid an emergency c-section at all costs. I certainly will never have an intervention free birth and I won't be allowed to have an active labour as I understand it, because of continuous fetal monitoring and other complications.

In most cases c-section is the safest way for the baby (generally research says this to my knowledge except for in one study that someone posted early).

I suppose I just don't really see why vaginal birth is the ambition and why women beat themselves or others up about mode of delivery. To me it's like focusing on the wedding rather than the marriage.

I want to focus on my baby, rather than the birth.

Rinabean To the question why shouldn't we?

a) Cost
b) Staffing levels are nowhere near high enough
c) Space, current maternity units are designed for the reasonably quick turnover that vaginal delivery generates.
d) Why would you give someone surgery that didn't need it, "First do no harm...."
e) The risk of post surgery infections/difficulty in mobility following section.
f) We already have a perfectly good way to get babies out (for most women).

(Same disclaimer applies as above)

Lol, crosspost. I'm not pro-CS or pro-anything really, but I think thinking of your baby is quite pointless and stress-inducing. Unless you have or the baby has a particular condition that would be best managed by one type of birth or another, there's no change to the risk to your baby that's worth worrying about (as long as you are not aiming your crotch towards a pit of lava and/or sharks).

iknowyouarebutwhatami - not quite sure what point you're trying to make, but I am well informed, I know the risks, and vb is safer for mother and baby ALL THINGS BEING EQUAL. As I said, each pregnancy is individual, and for my dc2, when a consultant recommended immediate CS at 32 weeks, I took the medical advice.

rinabean - I assume your comment is ironic, as I am sure you understand that a relationship with a father who doesn't kill its mother is preferable for an infant, than having a mother who leaves its father 'just in case'

Clytaemnestra, thanks again :)

DrMcDreamy

a) Irrelevant, really. It doesn't cost so much that it will cripple the NHS. Women pay in too, you know.
b) Hire more staff.
c) Yes, but elective sections can be booked in on empty days/turned away on busy days. So this is actually a plus to planned sections. All maternity units right now are understaffed and overcrowded. I don't think women and their birth choices can be blamed for this - it's a management problem.
d) Why would you make someone suffer unnecessarily?
e) This is also a risk with vaginal birth.
f) No we don't. It's totally flawed. It's not like it was designed to work properly - caesarean sections were!

Violethill, of course it was sarcastic! What I am saying is unless you are ingesting heavy metals as part of your birth plan, you are not significantly altering the risk to the baby, so it's not worth worrying about it (unless one of you has an underlying condition). :)

Agree with Mosschop in regards to NHS funds - if you demand a c section you should pay for it if it is not done to safeguard your health or that of your unborn baby.

But then I work in ther NHS and see what we can't provide because we don't have the money to - saving people with mental health problems and giving them decent care.

Dr Dreamy

So do you think that vasectomy's are a good use of NHS money? Are they really needed?

rinabean - the majority of pregnancies have the potential to result in a natural birth, so I don't know how you can possibly claim that your point f) is true!

Some pregnancies don't. Some pregnancies will never result in a natural, vaginal birth, because there are complications/abnormalities. Quite a lot more pregancies could result in a natural, vaginal birth, but the cascade of intervention such as induction/epidural results in forceps/ventouse/csection

But the fact remains that most births can, and do, occur vaginally.

Rinabean

a)You probably want to look into that.
b)The NHS can't afford the ones it's got.
c)Empty days? Snort.
d)By giving them unnecessary surgery?
e)Maybe. Bet it's not as hig a risk as with a section though.
f)Bollocks

Shewasashowgurl it's not comparable really. A vasectomy is a low risk, procedure done under local anaesthetic with a quick recovery time and is the only means we have to ensure relatively permanent sterility.

Ooooh, I am with you on this one. And I feel strongly about it. I had an emergency c-section last time, as I couldn't push DS out naturally. It was stressful for all, so I will elect. I understand every PCT is different, but most will offer a repeat caesarian if you request one.

I told my GP at first appointment I wanted one, and as a result now have an appointment with a consultant at hospital to discuss the options. I understand he will try and talk me out of it (so midwife says) because of a) cost b) manpower required c) it's not deemed natural. But they cannot downright refuse.

Perhaps mumsnetters can help me with this, I am in admiration of those who can deliver naturally, and think good for you. But I never felt jealous or envious, I just think physically we are all different some can and some can't. Or sometimes better for baby to have a C-section.

But why do people look down on those who have had a nasty experience before and elect, why is this seen as a lesser form of childbirth and perhaps even less "womanly" so to speak? I am not out to get at anybody, really I am not - but C-sections are major surgery requiring a great deal of guts (literally!) and bravery. Yet I have been on the receiving end of this kind of attitude on numerous occasions.

Good luck schmee - stick to your guns.

ELCS are more expensive than straightforward natural deliveries with no long term effects on mother and baby.

Not necessarily more expensive than a complicated delivery that sees the mother back in the system having her pelvic floor dealt with for months on end - it's not cut and dried.

Some ELCS cost the public purse more than natural deliveries. Same as the way some SAHM's giving up work and claiming tax credits costs the public purse. Yet plenty of people think that's ok as it's the 'right' thing for their children.

Violethill, I think we're on the same page. I am basically against the medicalisation of birth but pro-elcs when women don't want a "natural" birth. I think the ideal is: perfect/fairly good vaginal birth, then elcs, then any birth involving emergency intervention of any type (then any birth with a bad outcome, obviously...). If you don't think you'll have a good vaginal birth - so I think it's worth everyone trying at least once if they are just a bit unsure - then a planned section is best.

I think the damage done to women by vaginal birth is really underplayed because it's a cruel and non-perfect process. The whole thing where people say, yes, my birth experience was bad, I had a terrible tear - implying that there's such a thing as an ok tear and that's acceptable. I'm finding it hard to articulate my point fully, sorry! Basically saying most women don't die or become unable to walk after a vaginal birth doesn't mean it's acceptable. We need higher standards.

DrMcDreamy, you're working from these assumptions, yes?

1. We should fit the NHS rather than the NHS fitting us. (it's a practical assumption, I certainly grant you that)

2. It's better to use a flawed process for birth rather than one which is pretty much guaranteed in its outcomes because the second one involves surgery which should be avoided whenever possible. (Again, it's practical)

Right? I think I understand where you're coming from but I totally disagree!

I'm working from:

We need significant NHS and tax reforms. I don't care about what's practical today, I care about what's practical tomorrow. (I'm an idealist!)

Women should be able to give birth however they want (as long as it's possible, unfortunately they are still working on teleportation for me)

:)

DR Dreamy
Yet again why do people who haven't had a c section say such silly things.
Most elective c sections are also done under LOCAL anaesthetic and recovery times are comparable. C section is also a low risk procedure very much so when it's done as an elective rather than emergency. So are so misinformed as to the procedure. I really think you should find out more before debating about it.
As far as vasectomy goes there are plenty of other ways to ensure you don't pro-create so it's not really a good argument.

schmee YANBU. I had an emergency section with DS1 & then an elective with DS2 & had positive experiences with both. No one has ever questioned my decision regarding the elective because it was MY decision. If they did I wouldn't give a monkeys as I did what was best for us. This is your decision so do what you need to do & forget about what anyone says here or otherwise.

In fact rinabean here is a picture which demonstrates exactly how easy and pleasant my c-section was. I think they were in the midst of sewing up the 5th layer by then. (Don't worry, no wounds, blood or gore in the pic!)

Higher standards is a completely different issue rinabean - and I'd agree with you there. Personally, I would rather see far more well run MLUs, like the one where I delivered my first baby, where experienced and knowledgable midwives can support women through birth.

There is a wealth of evidence to show that how women feel about the birth they had is linked closely to the support they have during labour, the environment they are in etc rather than simply 'did they tear or not?' or 'was the labour 6 hours or 36?'

Interestingly, my first baby was my longest labour, the most painful labour, and my largest baby (the first two points are not surprising, as most first births tend to be harder, though I gather babies tend to get bigger with subsequent births, so I got that bit wrong!!) I was in second stage for nearly 3 hours, and tore quite badly. However, I would describe it as my best birth experience. I felt supported, and empowered throughout.

My Csection, on the other hand, was relatively painless, but it didn't make it 'better'. My VBAC was a natural birth, but took place in a large, impersonal hospital, with a lack of support from midwives (though plenty of doctors trying to hook me up on drips and get involved).

Let's have better resources, for sure, but 'better' doesn't (at least not for all women) mean more medicalisation, more drugs, more surgery.

Clytaemnestra, that's such a pretty picture! :) I never thought I could say something like that about a photo taken during an operation (I'm a big wimp). :o

Clytaemnestra no-one should look that good on an operating table

It's a lovely picture

shewasashowgirl not that I need to explain my credentials to you but I happen to know a little bit about caesarean sections as it goes.

There is a huge difference between a wee bit of lignocaine in your bollocks to a whacking great needle in your spine needed for a spinal anaesthesia. Vasectomies are typically an in and out job with little recovery time. Vasectomies are more and more often now being carried out in GP surgeries, thus cutting costs even further. You cannot compare them with EM/LSCS - in my opinion.

Oh and you also have no idea whether I've had a section or not.