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AIBU?

To ask what the truth is about elective C Sections?

179 replies

Moomin8 · 04/12/2019 19:13

I'm not thinking of asking for one myself but I wondered what people's rights actually are because certainly it is not clear (perhaps intentionally)

My friend has a 6 month old ds and she had quite severe tokophobia. It's so bad for her that she can't even cope with smears or internal exams and needs medication to cope with these. So she had requested a section from quite early on, she told me. Apparently her midwives were in support of this but when she got to see the consultant at 36 weeks, her attitude was very unpleasant. She told my friend that tokophobia doesn't actually exist and got really shirty about my friend wanting a section.

My friend stood her ground and the section went ahead fine but she was upset about the consultant's approach. Her midwife told her that the doctor may have been trying to put her off because of cost of a section.

Does anyone know what the facts about this are?

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Monkeynuts18 · 04/12/2019 23:59

Stats on damage 2nd/3rd/4th degree tears, incontinence, prolapse, fistula, instrumental intervention etc need to be separated by 1st and subsequent VBs.

Absolutely agree, but would add that they should also be separated by the age bracket of the mother.

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Moomin8 · 05/12/2019 00:04

Another thing that bothers me is how keen they are not to let people have a physiological third stage! They try to give you that drug even if you don't need it. It caused me to be violently sick and I also had a haemorrhage.

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Teachermaths · 05/12/2019 04:05

@Fithles I agree with you re choice.

However c sections don't always run smoothly. I'll live with the impact of mine forever. I spent months with an open wound and a newborn to look after.

We are all speaking from personal experience here.

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Countryescape · 05/12/2019 04:16

It’s more expensive but funnily enough female obstetricians and obstetricians wives often opt for a c-section over natural delivery. Hmmm I wonder why? Because you don’t have incontinence, prolapse., reduced sexual satisfaction etc etc.

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EleanorShellstrop100 · 05/12/2019 04:57

It’s definitely a cost thing, combined with the fact that c-sections are major surgery and more risky for both mother and baby so choosing to have one when it’s not medically necessary seems like a bad idea for a lot of doctors. I say it’s definitely a cost thing because I’ve had my babies abroad where nothing is free and c-sections are given out without much protest from doctors - although they will make it clear that they think it’s not really necessary they won’t make much of a fuss about it or bring it up again if you’re certain - and they’re very often chosen.

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EleanorShellstrop100 · 05/12/2019 05:01

Having seen the difference in recovery between women with a (straightforward) natural birth and women with a (straightforward) c-section, id never in a million years choose the c-section. I’ll never understand how a c-section is seen as the ‘easy’ way. After my natural births I was up and about and feeling fine within 24 hours. Everyone I know who had a c-section has had weeks of suffering and often ongoing side effects of the c-section - some stuff suffer pain in the area of their scar years later. I really do think it’s the responsibility of the doctors to warn women about this.

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EleanorShellstrop100 · 05/12/2019 05:03

(Should add - I’m not saying doctors don’t warn women about this, I’m saying they do - and maybe that’s seen as negative or upsetting for women who have chosen a c-section and are maybe feeling guilty about it as society puts pressure on women to do everything ‘naturally’ at the moment. But really I think the doctors are just doing their jobs and are right to kind of stress the severity of a c-section.

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hazeyjane · 05/12/2019 05:26

I found my ELCS very traumatic and have long term and on going issues as a result of it.

I had a long labour followed by an episiotomy and 3rd degree tear requiring surgery, followed by a second degree tear which was badly repaired a year later for dd2. I had double incontinence after my births, and...Yes, I had the joy of shitting myself with 2 babies in tow...hence my decision to have an ELCS for ds, our 3rd.

My ELCS was a very traumatic experience (albeit, exacerbated by the fact that ds had to go to NICU at birth). I found it physically very frightening, I was in a lot of pain afterwards and was very ill. I was mentally overwhelmed by the feeling i must have got something very wrong, as I was not finding it a calm, healing experience with recovery that's a breeze that I had read about from many on here, I felt utter helplessness and a lack of control and like a woman sawn in half. I had read up, I had heard about traumatic experiences (but I guess we never think it will be us).

I had flashbacks afterwards, antidepressants helped. I had infections in my wound, I still get pain in it 9 years later. My bowels have never been the same since (which my GP says is associated with my section). My sex life has been affected. I am incredibly scared of ever needing surgery again, especially if it were something like a hysterectomy.

I have friends who have had similar issues after vaginal birth. Unfortunately any way of giving birth can be traumatic and have long lasting and devastating consequences.

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1300cakes · 05/12/2019 05:27

After my natural births I was up and about and feeling fine within 24 hours. Everyone I know who had a c-section has had weeks of suffering

See that's weird because after my cs I was up and about, feeling fine, within 24 hours. But most people I know who've had a vb have had weeks/months of suffering. Just goes to show you anecdotal evidence doesn't count for much.

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missyoumuch · 05/12/2019 05:41

@EleanorShellstrop100 Are you differentiating between your friends who had planned ELCS vs emergency CS after labour initiatied or induction?

I had two ELCS - DC1 was breech, DC2 I was hoping for VBAC and ended up with another ELCS as baby was making no effort to leave unassisted. I would absolutely have preferred a straightforward vaginal birth. But comparing with friends, I think ELCS was far better than a complicated vaginal birth or an emergency CS in terms of recovery and long-term impacts. Emergency CS seems to be the worst of both worlds if there's been a long labour beforehand.

It’s more expensive but funnily enough female obstetricians and obstetricians wives often opt for a c-section over natural delivery. Hmmm I wonder why?

This is true in my experience, it was female OBs (family member and close friend) who told me for DC1 don't bother with ECV to turn from breech and for DC2 don't stress about VBAC just have another ELCS.

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Booboostwo · 05/12/2019 05:58

Stephminx I don’t get your point, you can compare everything and still VB gone wrong is the most costly. So to repeat: a frequent argument says that women should not be allowed to choose CS because it costs more, this argument quotes very short term costs. However, when you compare long term costs of all birthing choices, e.g. short and long term costs of VBs ELCS and EMCS, for mother and baby, in cases where things go well and cases where risks actualize, VB is the most costly due to the risk of damaging the baby due to lack of oxygen. I am not comparing individual costs, but statistical ones.

It’s the same with smoking. On the face of it it looks like smokers cost more money because they need treatment for smoking related conditions. However, smokers also die younger because of this conditions and avoid all the old age costs they would have otherwise had, e.g. pensions, old age care and care for whatever they would have died from at an old age anyway. So smokers are cheaper on the NHS than non smokers.

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cukooboo · 05/12/2019 07:40

It’s more expensive but funnily enough female obstetricians and obstetricians wives often opt for a c-section over natural delivery. Hmmm I wonder why? Because you don’t have incontinence, prolapse., reduced sexual satisfaction etc etc.

I'm sure I've read in the past it was about 60% but midwives are more likely to have VB.
Obstetricians are obviously exposed to the problems a lot more so would take a more negative stance. I was never allowed to horse ride or ski as a child & had to cycle with a helmet (rarer in the 80s) due to experiences my parents had seen.

It's wrong to assume that CS only births will protect you from incontinence & prolapse though.

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Fithles · 05/12/2019 08:58

@cuckooboo you quoted me but missed an important word at the beginning:
I really struggle to understand the 'it probably won't happen to me' approach - though it's easy to see why.*

...meaning it's easy to see why I struggle to understand that approach - because it did happen to me. I was fit, healthy average weight in my early 30s, no GD, no poor family history. I read Juju Sundin, Ina May Gaskin, Marie Mongan. Did NCT and pregnancy fitness classes. Was fuck all use.

All VBs are not equal and when people talk about VB being easier to recover from, they mean straightforward VB. Women need to look at the stats for having a straightforward VB as a first time mother at their age etc.

Risk of faecal incontinence from pregnancy is vanishingly small and prolapse/urinary incontinence is minor. Risk of faecal incontinence/anal sphincter damage from instrumental delivery is significant - much more prevalent than permanent damage from CS - I think 30% chance.

It's quite easy to measure - how incontinent/prolapsed were you on the last day before you gave birth? And how much were you the day after?

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cukooboo · 05/12/2019 09:39

I thought I posted the "I", I didn't consciously leave it off. Pregnancy & childbirth carries risk. Risks that include miscarriage, stillbirth, delivery complications. I was aware of these risks & I didn't assume none of them would happen to me.

Women need to look at the stats for having a straightforward VB as a first time mother at their age etc.

I agree with this plus your general health can be an issue. However it's not possible to 100% predict the outcome of a VB, things can change in seconds. Obviously if I had another DC then there would be risks associated with VBAC & the fact I'm older.

My pelvic floor is definitely weaker now after DC2 than after DC1. Pelvic prolapse tends to become more of an issue as you age so who knows how I will fair on that front. They say risk can be caused by genetics as in how strong your muscles are. If that's true then potentially I may need surgery as my mum had it about 5 yrs ago.

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neonglow · 05/12/2019 09:42

And also women who would rather have a straightforward VB may be put off by the actual chance they will get that.

At my local maternity a first-time mum being induced has something like a 50% chance of ending up with an emergency c-section. I think a lot of women, particularly if they knew it would be their only child, would just think ‘may as well have a planned c-section’ with crappy odds like that.

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hazeyjane · 05/12/2019 09:47

Obstetricians are obviously exposed to the problems a lot more so would take a more negative stance

I have heard this too @cukooboo, from my GP, when talking about the many issues after my ELCS with her. She also felt that there was a 'normalisation' of surgical procedures amongst many of the medical community.

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cukooboo · 05/12/2019 09:51

I was induced with my first (issue with blood flow which can be an indicator of higher risk of stillbirths) & I scoured the net looking for positive stories. I was the anomaly who had a pessary & was told they would be back to try again in 24 hrs, but didn't need it & ended up with a 1.5 hour active labour.

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cukooboo · 05/12/2019 10:00

The correlation between bacteria from the birth canal & general health is something that interests me as I was delivered by CS.

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Whattodoabout · 05/12/2019 10:06

The cost difference between a vaginal and c-section is actually negligible, there’s pennies in it. I’m not sure why consultants don’t like doing ELCS’s but they really try to push against it when you request one. If you have a traumatic vaginal birth it can cost more than a straight forward ELCS.

I requested one with my last DC because I had horrendous traumatic previous births. They did everything they could to stop me, I even had a consultant trying to talk me out of it when I was dressed in scrubs ready for theatre. Ridiculous. It went fine, I have no dramatic after effects and DS is fine too.

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neonglow · 05/12/2019 10:23

I think it really depends on the hospital. Some women have no issue requesting a c-section.

Even the criteria for what counts as a ‘medically needed’ c-section differs between hospital trusts.
Eg. One hospital won’t view a previous caesarean as a good enough reason to have an ELCS, whilst at other hospitals the same women would always be offered another section.

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UnderBellyLaughs · 05/12/2019 10:23

I had an elective c-section with my first. I was abused as a teenager and had huge fear, distres, and extreme anxiety around having a vaginal birth. This was before NICE guidelines changed.
My midwife understood completely and referred me to a sympathetic consultant, who was lovely and completely supportive of my choice. Referred to lots of professionals, and they stressed how important it was I understood the risks.
Every single medical professional I came into contact with was amazingly supportive - except for the surgeon on the day (alas not my consultant). He was a complete arse and said that he didn’t believe in elective c-sections.
His words caused me immense distress and completely ruined my birth experience. I was shaking so hard, it took ages to get the spinal block in. Thank god for a lovely anaesthetist and group of nurses who were visibly appalled at his words, and were amazing throughout.
If a fellow (and more senior) doctor approved the c-section, who the hell was he to say anything. It was all over my notes why I was having the c-section.
Thank god we never saw him again after the op.
He was on the receiving end of a formal complaint from us afterwards.

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strawbmilk · 05/12/2019 10:34

I was nervous asking for a CS for baby 2 as I'd heard it was difficult to get but the response was it's a woman's right to decide how she wants to give birth.
They did talk to me for an hour to understand the reasons why. They said 2nd births are much easier and can induce me so we can make childcare arrangements better but with 3 friends recently having a worse time birthing baby 2 I've opted for a CS. The only issue now I have is getting a date!

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Doccc · 05/12/2019 12:06

Obstetric anaesthetist in the NHS. It’s nothing to do with cost. CS has more blood loss, risk of damage to organs, anaesthetic risk etc etc. Obstetricians would be remiss if they didn’t mention these risks.

As many have pointed out, the risks of vaginal birth of genital tract trauma, incontinence are not insignificant. Brain damage or worse to the baby is rare but devastating when it does occur. However, these risks are part of the natural process of childbirth and rightly or wrongly not generally considered the fault of obstetric doctors if they occur, assuming care during labour is of a good standard.

Hence obstetricians can be guilty of overplaying the risks of caesareans whilst not respecting women’s concerns re the complications of vaginal birth.

I will say this though, the cumulative risk of placental invasion (accreta etc) is not to be underestimated. The risk isn’t that high with one or two scars but once you get three or more it starts to ramp up. And the blood loss from can be quite simply terrifying, and lethal. Some obstetricians are quite frank in their desire to reduce the rate of CS for this reason, and whilst that doesn’t justify resisting giving women the birth method they choose, you can understand where they’re coming from

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managedmis · 05/12/2019 12:12

I am in Switzerland and here they just ask - would you like a Caesarean section or a vaginal delivery?
And that’s that.

^^
Same in Canada. Two sections, please.

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managedmis · 05/12/2019 12:12

Obstetric anaesthetist in the NHS. It’s nothing to do with cost.

^

Really? No at all?

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