to ask for an elective ceseran even though theres no reason i cant have a normal delivery?

[ditsydoll]

There's absolutely no medical reason that I couldn't give birth. I have a wonderful almost 4yo DD and had a pretty good delivery with her.

However, this time round I'm terrified, not of the pain but of something happening to be during labour or birth.

I keep having nightmares about dying and leave my beautiful DD without a mum. It's really starting to get to me and its just making me miserable. I keep trying to forget about it and enjoy my pregnancy and DD but it's starting to consume me.

Tried talking to Dp and he thinks I'm being silly.

Help

[choceyes]

*i personally believe those who never experience natural birth as it should be are missing out big time.

Oh really? well I personally don't feel like I missed out one bit! I'm not bothered at all that I didn't have a natural birth. As long as DCs are fine, that is all that matters. In the list of regrets re DCs, it doesn't even feature on the list.
I feel strongly about breastfeeding as I feel that it makes a difference to the health of my DCs but the method of birth whether it is a VB or a CS is immaterial, it doesn't make the slighest difference to them.
Infact my ELCS was probably safer for my DD than my highly medicalised 2 day labour followed by EMCS for DS, pumped full of pethidine to calm me down, he was born sleepy and no interest in feeding and BF failed miserably. HOrrible horrible experience. My DD's ELCS was wonderful, the most peaceful, life affirming experience I've ever had. She was born perky and eager to feed. I even enjoyed my hospital stay. It was difficult getting up in the first 24hrs but after that I was walking as normal. And my insides are lovely and intact . One of my NCT mates and to have reconstructive surgery after her VB. My mum had all sorts of problems after her VB. Even my MIL who's a midwife and also my constultant said a ELCS would be a far better option for DD.
I'd choose a ELCS over a VB anyday...but that's just me!

[RedToothBrush]

God there is some UTTER crap on this thread.

squeakytoy Tue 12-Feb-13 20:37:31
I am sure a cesarean is more dangerous than a natural birth in hospital?

This is why NICE covered this in their update on CS. Cos that ^ there isn't necessarily true.

The problem is that most of the time statistics on CS are all lumped together - ELCS and EMCS and all the figures for VBs are separate.

Except this is HUGELY flawed. You don't plan to have an EMCS. An EMCS is the consequence of planning a VB. In order for statistics to be properly comparable you need to separate EMCS from ELCS. Ideally the best way to do this is to compare Planned VB versus Planned ELCS as this is how things happen in the real world.

When you do this, a planned VB, which includes operative VBs and EMCS and the associated risks comes out only marginally better than a planned ELCS for first time mothers.

And this is one of the reasons that NICE said that it was perfectly acceptable to grant an ELCS on maternal request as the health risks were not significantly different.

NICE's guidance IS slightly misleading and open to criticism however, since it only looked at first time mothers and didn't look at subsequent risks for future pregnancies. So its perhaps not a suitable route to go down if you want a larger family and the risks of a VB are slightly reduced for women who have already had a VB and this isn't reflected in the guidance.

NICE's guidance also looked at one of the main reasons why women request CS. For mental health reasons such as anxiety. This was done because it has been an issue for several years that hadn't been tackled and was leading to widespread differences in treatment and the fact that anxiety wasn't being taken seriously enough. And indeed that previous traumatic experiences of birth were being ignored.

The update recognised this was a problem and had a long term psychological impact on some women. It was serious enough that denying access to an ELCS has been shown in studies to be reason enough for women to have terminations despite desperately wanting a child. This is a massive step forward.

The update suggested that various ways of dealing with the problem needed to be looked at and counselling offered as this benefitted some women who then felt able to have a VB rather than be 'forced' to have a VB. Essentially it is advocating better support all round for particularly anxious women not just allowing everyone to have a CS. (Theres a lot of people on MN who would suggest a homebirth as just one alternative to relieve anxieties but really depends on what your individual fears are about).

And finally cost. NICE assessed the cost of planned ELCS. Initially the short term cost looks cheaper than a planned VB (because you have to include the costs of EMCS under a planned VB too). BUT and this is a big but, they decided that this difference didn't give the whole picture.

The cost of complications - such as psychological issues or incontinence - meant they decided that the difference, over the medium and long term, was so small it wasn't enough grounds to refuse a request for an ELCS on.

UNFORTUNATELY the whole debate has been poorly reported, is highly political and is full of a shit load of myths. Too many people in power and too many member of the public think that ELCS on maternal request are lifestyle choices and do not think that psychological reasons are a good enough reason for an ELCS despite scientific evidence to the contrary. So hospitals are ignoring NICE in many places.

The guidance was supposed to stop the wide inconsistances in care. It hasn't. Some women are finding it easier to access ELCS but lots aren't.

Hospitals are still under pressure to reduce CS rates. And ELCS are an easy target as the reasons for ELCS are poorly understood and easy to reduce - at the expense of women. The irony is that despite the Department of Health and WHO saying we should not have a target rates for CS, hospitals are still aiming for 'optimal rates' and one of the things maternity units are rated on, is their CS rate! Like I say, its HUGELY political.

So is the OP being unreasonable.

HELL NO. A ELCS might not be suitable for everyone on similar grounds, as I've mentioned above, but it is a very valid, safe and cost effective request. And this is in the words of NICE, not just me.

And I bloody wish that people understood this issue properly, the research thats desperately needed was being done, what research is out there is actually of a decent standard, that medics get retrained on this issue and left their personal ideology and judgments at the door and just generally all the political crap and ignorance were removed.

Good luck OP, I hope that you get the birth that is right for you, without having to fight tooth and nail for it.

And I hope your DP gets the great big kick up the arse he deserves for being unsupportive. You are not being silly, whether you end up having an ELCS or whether you manage to face having a VB.

[ukatlast]

QUOTE Ambersocks 'abbycat that is such bollocks.what a stupid thing to say.

i personally believe those who never experience natural birth as it should be are missing out big time.'

Well I've done it both ways (vb and elcs) and say no one is missing out on anything, the important thing is the arrival of a healthy baby and an untraumatised Mother.
I had a friend who became depressed after a Section because of such claptrap about how she had been denied a 'proper birth experience'. Complete dangerous unhelpful NCT-induced tosh.
The strongest argument for CS is that medical staff invariably choose it for themselves and their nearest and dearest. It was several years ago but when I told my female consultant I wanted the safest way out for my second baby - she said well that's a section then. There's a slightly higher risk to you etc etc but better for your pelvic floor etc...so swings and roundabouts.
We pay our taxes - there is no real reason in 21st Century to deny women choice in such a matter. If men gave birth it would be GA all the way!

[RedToothBrush]

P.S. The reason NICE said that ELCS should be granted regardless of counselling, was because they have yet to prove that its helpful in all cases for everyone. There is debate over what works and what doesn't and this also needs to be in the context of a ticking clock of pregnancy.

Their assessment was that in the absence of knowing this crucial information and the fact that there were limitations in access to counselling - not least because of the timeframe, that allowing ELCS must be their recommendation.

[Shelly32]

I opted for CS. I was informed that it would be slightly more dangerous for me but safer for my twins. It went smoothly and I was up and about a day later. It's quite painful to cough, sneeze or laugh for a few days but apart from that, if I were to have more children, I'd definitely go for CS again! Saying that, there were women in the same ward who didn't recover so quickly. I think it all depends on fitness levels, how the procedure goes and of course the individual.
I don't think a conventional birth makes you a better woman and it certainly doesn't make you a better mother. Why suffer pain if you don't have to? I had four hours of labour before having my CS and for me, that was enough. You don't have to prove anything to anyone. Do what you think is best and ignore anyone who attempts judgement X

[YellowFlyingPineapple]

Well here are my thoughts, for what they are worth;

everybody is different everybody has wide and diverse opinions on this subject but I have had 3 elective, no medical reason, non emergency caesareans. I asked with DC1 and had a lovely consultant who was of the opinion that if a mother is happy with her birth it would deliver the best outcome. Had a number of midwives try to persuade me to try for a VB, I politely declined, all happy, 3 healthy DC.

Oh and recovery was a breeze, driving after less than 2 weeks with all 3 and back at a spinning class 2 weeks after DC2, no infections, no pain, no regrets and I don't feel less of a woman as an NCT mum tried to imply over coffee before I corrected her

[MyDarlingClementine]

redtoothbrush

Hear Hear.

You sound incredibly knowledgable on all of this. Its nice to read such an eloquent and backed up post.

To me - the best kind of birth is when the mother and the baby come through it in the least damanged way possible both phsycially and mentally and Alive.

[ukatlast]

Miaow
Sorry to hear of your not-unusal NHS birth traumas.
Given the NICE guidelines and your on-going trauma. I really think even your NHS area will have to agree to an ELCS for your second. Your case is stronger when you have done VB once and it has gone horribly wrong.
Don't let midwives fob you off. Get you GP to refer you to discuss with a Consultant who is the ultimate decision maker.
If you see a SHO who tries to say no, simply say you want a higher opinion, usually 2 rungs up, they will accede since they need some ELCSs for doctors to practise on. It's not a good idea to be learning C-Sections in Emergency situations.

[Bue]

The evidence tells us that ELCS can be slightly safer for the baby, but is slightly more dangerous for the mother. However, we are so fortunate that in the UK today all ways of giving birth are very safe. I wouldn't go for an ELCS unless I had to though, but I know my view is skewed because the only woman I have ever looked after postnatally who almost died had an ELCS. And you can't make decisions based on anecdotes!

[Shagmundfreud]

"So is the OP being unreasonable.

HELL NO. A ELCS might not be suitable for everyone on similar grounds, as I've mentioned above, but it is a very valid, safe and cost effective request. And this is in the words of NICE, not just me."


Less than 1% of low risk multiparous mothers giving birth in birth centres or at home have emergency c/s in the UK, compared to an overall national emergency c/s rate of 14%.

If we are talking cost effectiveness - there is no doubt that for healthy multiparous women as a group, on immediate cost grounds, v/b is massively cheaper for the NHS, as the intrapartum complications rate in this group is so very small.

[MyDarlingClementine]

There are many many areas where the NHS can look at cutting costs. I really dont think women and babys at the most vulnerable time of thier lives should be shaved first.


Luckily though- how the NHS finances things is not the concern of the op.

[Shagmundfreud]

"The evidence tells us that ELCS can be slightly safer for the baby, but is slightly more dangerous for the mother."

Research into this area is conflicting.

A very recent study from Sweden:

Karlstrom A, Lindgren H, Hildingsson I.
Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study.
BJOG 2013;10.1111/1471-0528.12129 [doi].
OBJECTIVE: To compare maternal complications and infant outcomes for women undergoing elective caesarean sections based on a maternal request and without recorded medical indication with those of women who underwent spontaneous onset of labour with the intention to have a vaginal birth. DESIGN: Retrospective register study. SETTING: Sweden; Medical Birth Register used for data collection. METHODS: A case-control study of 5877 birth records of women undergoing caesarean sections without medical indication and a control group of 13 774 women undergoing births through spontaneous onset of labour. The control group was further divided into women who actually had a vaginal birth and women who ended up with an emergency caesarean section. RESULTS: Maternal complications occurred more frequently among women undergoing caesarean section with odds ratios (OR) for bleeding complications of 2.5 (95% CI 2.1-3.0) in the elective caesarean group and 2.0 (95% CI 1.5-2.6) in the emergency caesarean group. The OR for infections was 2.6 in both groups. Breastfeeding complications were most common in women having an elective caesarean section: 6.8 (95% CI 3.2-14.5). Infant outcomes showed a higher incidence of respiratory distress with an OR of 2.7 (95% CI 1.8-3.9) in the elective caesarean section group compared with infants born by emergency caesarean section. The risk of hypoglycaemia was at least twice as high for infants in the caesarean group. CONCLUSIONS: Caesarean sections without medical indication as well as emergency caesarean sections were associated with higher risks for maternal and infant morbidity

[Psammead]

I've had two vbs. If I were to fall pregnant again (GOD FORBID!!!!) I would go for a c-section every time. DD2's birth has broken me. Go with your gut.

[VinegarDrinker]

It isn't true that the majority of obstetricians have elective CS.

[PolkadotCircus]

As you said "immediate cost" Shag,factor in the cost of reconstructive surgery and other treatments further down the line which can go on for years and which must be eye wateringly expensive and I doubt there is much in it.

Somebody needs to tot it all up.

Considering that the majority of NHS money is spent on the elderly(and a shed load on people who choose to destroy their health) I think begrudging women what they want at an extremely vulnerable time is shite tbf.

[MyDarlingClementine]

"factor in the cost of reconstructive surgery and other treatments further down the line which can go on for years and which must be eye wateringly expensive and I doubt there is much in it."


Even then Polka, I have this week sat in a room of ladies who 70% are damaged in some way" below" saying they had been to the docs and were basically told ot get on with it - sewn up wrong, inverted/outverted bits (?!) flaps hanging down, bladder problems.

I reckon because of the culture towards women and child birth there are thousands of women out there who need further work but their doctors/ HP have been dismissve or ignorant and/or they are afraid to go for more help for a vairtiey of reason, not least of which - is that its a personal area of the body!!!

[RedToothBrush]

Shagmundfreud Wed 13-Feb-13 13:53:07
"The evidence tells us that ELCS can be slightly safer for the baby, but is slightly more dangerous for the mother."
Research into this area is conflicting.

Definitely. The stuff in the NICE guidance, tends to point to it being the other way round too - this is what is being recommended that women are told now. Babies are more likely to have problems breathing and need to be in SCBU after an ELCS. Which probably would put a lot of women off.

As you said "immediate cost" Shag,factor in the cost of reconstructive surgery and other treatments further down the line which can go on for years and which must be eye wateringly expensive and I doubt there is much in it.

Somebody needs to tot it all up.

NICE attempted to, and decided that it was impossible given all the variables.

VinegarDrinker Wed 13-Feb-13 14:00:52
It isn't true that the majority of obstetricians have elective CS.

No its not true.
There were figures published in a Guardian article a couple of years ago (here if anyone is interested) This was about what female obstetricians would personally prefer. The article said that the figure for the US was nearly 50%. For the UK there was a London study published in the Lancet in 1996. This reported 31%. (Note this was preference not what they actually were having too, so the figure is probably slightly less than this).

This is high, but it is not 'the majority'. The article does try and explain why this might be (potentially distorted view of child birth, more aware of the worst outcome and perhaps increased levels of anxiety as a result).

On top of all of this, I think its worth pointing out that the trouble with a lot of the stats is they are very generalised. So if you are a fit woman in your early twenties your chances of having a successful vb without complications is much, much higher than if you are over 35 and perhaps are having some complications already. So the data can be misleading if you don't take it with something of a pinch of salt. I do think its very much a case of finding out things as much as possible and then adding in your own personal considerations and I do think that anxieties need to be a very important consideration in that.

[Shagmundfreud]

"On top of all of this, I think its worth pointing out that the trouble with a lot of the stats is they are very generalised."

Very true.

95% of healthy mums having a subsequent baby in a birth centre or at home will have a completely straightforward delivery.

That's compared to less than 50% of women nationally over all.

As for obstetricians having planned c/s. Well yes, many do. But the other group of health professionals who are involved in a much wider spectrum of births - namely midwives - are much, much more likely to opt for a planned home birth, than the general population.

[VinegarDrinker]

IME that figure has probably reduced since the Lancet survey, too.

[hazeyjane]

I know that elcs is often presented as the alternative to birth trauma and as if it is the trauma free option.

Personally the most traumatic of my 3 births was the elcs, horrendous op, felt dreadful afterwards, weeks to recover, couldn't cuddle ds for 2 days due to him being in scbu with respiratory distress and had pnd (thinking birth wasa contributory factor in this).

I know that neither method is guaranteed trauma free, but elcs can be just as awful as vb!

[MyDarlingClementine]

The OP has had a "pretty good " delivery.


Its not about the pain for her but the real fear of what may happen to her in labour.

It comes down to would you rather something went wrong in labour with a baby half stuck in you or on an operating table.

Would you rather being unable to sit down for weeks or be tender in your lower abdomen.

For alot of women its the totally un predictable nature of labour which is scary.

Its all very well saying " yes but this STAT says you are unlikely bla bla".

I have personally met too many people who were one of those small percentage problem stats.

[Shagmundfreud]

"If we had less stringent criteria for birth centres, they'd have lower rates of straightforward births."

Yes of course.

However, the complication rates for women opting for birth centres are still strikingly lower than for similar mums (ie, same parity, same social class, same obstetric risk criteria) going to an obstetric led unit.

Women birthing in obstetric led units in the UK appear to have nearly double the rate of emergency c/s compared to similar women who opt for birth centres.

"Also I don't think the relative preferences of midwives and obstetricians tells us anything other than both groups being influenced by the type of births they see more of"

Except that the vast majority of midwives are involved in high risk as well as uncomplicated births. ALL mothers in the UK have a midwife involved in their birth. Only a percentage will have a doctor present as well.