To ask what the truth is about elective C Sections?

[Moomin8]

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?

I've just been on another thread re CS vs VB.

I have had both and, for me, the VB was better.

The actual CS was a breeze, but i did not enjoy the recovery. I was very lucky with my VB that my recovery was easy.

Re painful sex, I had sex within a few weeks after VB and everything felt exactly as it did before, but I had a lot of discomfort during sex for months after the CS. I used to have to stop and then ran to the shower to soothe my bits. It was horrendous. Also, I felt weird and out of it after my CS and on a lot of painkillers as everyone seems to be after CS. After VB I didn't even need paracetamol.

I definitely accept that generally it is safer for mother and baby to have a CS, but I think the risk of serious complications in either case is low enough that it is really just personal choice. I would definitely choose the VB as I think the pain, painkillers is guaranteed, whereas with VB there is a chance you will be lucky as I was.

But it's much of a muchness tbh. Both my birth experiences were fine. Not a total breeze from beginning to the end of my recovery or anything, but it would be frankly insane to expect that from childbirth. But both were fine.

I 'chose' ELCS with dc2, but there wasn't much of a choice as there was a clinical need for it. But I found my consultant very pro CS and the MWs slightly less so.

I think too much is put on emergency sections versus electives as well. There seems to be a definite assumption that the former is harder than the latter but from speaking to my consultant, my own experiences and that of friends I think it's so individual. Both of mine were emergencies (dc1 stuck at full dilation, waters gone for 81 hours, couldn't be pushed or pulled out with forceps and I was passing out on the operating table and dc2 was strangling herself with her cord) but I had the easiest and fastest recoveries of anyone I know. I literally bounced back for some reason. Didn't need any drugs post theatre and was back walking 3 miles a day with the pram by week 2 with dc2. I was out for lunch when she was 2 days old being told how lucky I was to have had such an easy birth as various people regailed me with their horror stories. No infections, I had a bit of numbness with dc1 but I was advised to massage the area once it was healed and I got feeling back and didn't lose it with dc2.

Yes dc1's arrival was traumatic but dc2's was amazing.

At my age with dc2 (almost 41), anal tears were mostly definitely a huge factor in my decision to opt for an elective combined with the fact that they couldn't explain why dc1 in an optimal position couldn't get out. My eldest SiL has incontinence issues and her youngest is 8. They have improved over the years, it's mostly urine now but it's had a huge effect on her.

Doctors should give individual risk profiles and let women make their own minds up I feel. Everyone will have their own red lines. I think if I wanted 5 children, I might have gone for a vbac with dc2 (which wouldn't have worked because I went into labour with her any way) but I don't. At 42 I'm probably done with having babies so the risks of placenta issues with future pregnancies are nothing to me compared with the risk of severe tearing for example.

It's the usual NHS short-sightedness. Vaginal deliveries are cheaper.

But if there are complications, it isn't cheaper (and not great for the woman concerned, either).

So let women choose.

But that;'s not allowed because when we're pregnant we're stupid and only fit to be incubators.

Not sure I'd want a consultant to do one who didn't really want to though.

I definitely agree there should be choice for women. But I also think that had I had been offered the choice with dc1, I would have bitten their hand off for a CS. In the end I had a difficult VB, but with the best, easiest recovery. I'd never have tried the VB if there was the offer of a CS.

Having now had an easy peasy ELCS, with a good recovery, I would still pick the VB. Because as good as my CS recovery was, the VB was in a different league. I was genuinely myself again immediately afterwards, although very tired after a long labour. After the CS I felt really odd (oramorph) and the recovery was definitely longer. But if you'd told me this before I had dc1, I'd have scoffed and thought "yeah right, having someone perform surgery on you vs pushing something out of my vagina? Obviously I'm picking the surgery"!

Also, I know a woman who had a phobia about childbirth who went on to have her baby at home in the bath and loved it.

So, it's a tricky one. Yes, I think women should be allowed to choose, but having been on MN before having DC1, I genuinely thought CS was the far more desirable choice, without really knowing what I was talking about. So I think more, unbiased education and then women can make educated choices.

There is also the whole "ugh my bits will stretch and I won't be able to have enjoyable sex" thing which good old fashioned, misogynistic school boy humour has out about. I couldn't believe it when I was back to normal so soon after dc2 VB.

CS was worse for my sex life due to the discomfort I've already mentioned and I also now have a CS gut which I'm struggling to shift. I really needed to have a CS, but if I'd chosen it, for what in my case would have been the wrong reasons, and had this gut? How annoying.

Doccc I see your point and I understand why a doctor would be more concerned about a harm she had caused during CS as opposed to harm that happened during VB, but from the women’s point of view the harm still occurs either way and birthing decisions are meaningless if not fully informed.

I've been medically qualified for over 30 years and a Consultant in the NHS for 20 of those. In my experience, individual clinicians give far less thought to cost than most people imagine. Managers do, and organisations in the broadest sense do, but the individual doctor, nurse or therapist who is looking after you is probably not considering the cost of your treatment a great deal. In fact most don't know very much about what things cost and in my experience it is actually extremely difficult to persuade frontline staff to change practice based on cost, even if it is fairly easy to demonstrate no difference in patient outcome. Plus NICE are not really in the habit of making recommendations that don't add up financially. In fact a lot of clinicians are a bit suspicious that NICE guidance is too financially driven, though my personal view is that most of it is fairly balanced these days.
If obstetricians are not following the guidance I think it is far more likely that their objections are clinical rather than financial. It isn't my field so I couldn't comment on what those concerns might be, but I will be very surprised if money is at the forefront of most, or even many of their minds.
Personally, I take a middling view. I do think women should be able to choose a section if it is what they want, but that it should not be the default position. Far better information needs to be given to inform decision making - particularly given the long term effects and the potential issues in future pregnancies which I have personally observed to be often woefully lacking. I'm all for choice, but properly informed choice and I think we areca long way from that unfortunately.

Thanks MAFIL. Whilst budget/finance may not be a primary factor, I'm almost certain that statistics are - hospitals very prominently publicise their CS rate and the man who butchered my nether regions was introduced by the MW as 'the guy who keep our CS rates down' the next day. justification for the horrendous damage - tick in the VB box. There was absolutely nothing natural about my VB but is it came out of my vagina it fell on the right side of the statistical fence.

I'd agree on far more information needing to be available, but about VB and instrumental VB more than CS. There's endless stats and information on risk and -ve aspects/outcomes of CS. Guidance is all set up to avoid a CS. I knew nothing about statistical changes of needing an instrumental delivery as a result of my induction, nor about types of instruments and the damage they can cause. Such damage is way-way more common than serious side effects of CS I heard multiple times from my first booking in appt when I suggested one and throughout my 2nd pg.

NICE unapologetically make national policy decisions based in large part on cost. They spend a lot of time trying to quantify everything in QALYs so that decisions are down to comparing numbers that always include costs.

I think more information in general is needed.

All I heard and read during dc1 pregnancy was the horrors of instrumental birth and how to avoid it (demanding a CS and fighting every HCP who disagreed). So much so, I was up to high do going into my induction, with my independent midwife who I hired because of the horrors of instrumental delivery and mean, awful doctors making me go through with something dangerous that I might not want. Also with my birth plan in hand which specifically stated I was to go straight to CS rather than forceps.

When the time came, it was ventouse or endangering my baby just so I could demand a CS and make her wait to come out, which would have been dangerous in the circumstances. Dc and I came out of it completely unscathed.

While birth injuries must be terrible to go through, the language and constant raging on MN about rights to a CS can actually get women more anxious than is necessary, in some cases.

A woman I know recently had an ELCS and ended up in a wheel chair because her spinal cord had been damaged in the operation. Yet if you come on MN it's all "ELCS - do it. Do yourself a favour. It's your right. Don't let them butcher you". As if CSs are a breeze and somehow the pinnacle of maternal health care.

I know probably hundreds of women who have given birth and the only one who came out of it with serious injuries was as the result of an ELCS.

There are risks to both, but I genuinely felt I was led to believe, when pregnant with dc1, that VB was the wrong choice and ELCS vastly superior. I think there is plenty of negative press about VB. I have only heard one person IRL be negative about CS and that is because she was genuinely phobic of surgery. She said she would never ever consent to a CS unless they put her under GA to go through with it and even then she would not be at all happy. Most women I know would be happy to take the ELCS if they were told it would be safer.

I agree with you @BeatriceTheBeast & one I the reasons I was so hard on myself after my CS was that I felt that I was wrong to find it so hard initially when so many say it's positive & that their recovery was a breeze.

I agree, Beatrice.

@Fithles I am genuinely sorry to hear about your awful experience and I do agree that "targets" of most kinds do little for patient care.
Our opinions are at least partially products of our own experience of course. I had a kind of planned section courtesy of an obstetrician with a very low threshold for intervention in my first pregnancy. I don't actually regret it now as I suspect given the circumstances I was in I would have been headed down the induction - epidural- emergency section route anyway, and skipping the first and middle bit seems like a better deal. But even though I was by then a fairly experienced doctor, I don't think I was well informed. Yes, I was told about DVT risk, wound infection rates and so on but nobody even mentioned things like potential impact on future pregnancies or my long term reproductive health and I didn't think to ask. It wasn't until I actually was pregnant again that I gave that any real thought. By that time I was in a job where I was anaesthetising regularly for a surgeon who did a lot of major pelvic surgery and had had quite a few very difficult experiences looking after women in theatre who had had multiple previous sections. I knew then that I didn't want to have another section unless it was clearly indicated and I felt quite angry, both with my original caregivers and myself that I had made my decision in my first pregnancy without any reference to the future. It might not have made a difference of course but at least I would have thought about it. I subsequently had two fairly straightforward vaginal births but my last pregnancy was complicated by a problem could have killed us both, directly related to my section nearly a decade earlier.
It isn't black and white of course, and decisions need to be made on what is best for the individual. But if we assume that the incidence of serious complications from sections remains static then an increasing number of sections will obviously lead to an increased number of affected women (though admittedly potentially a decrease in number of VB related problems). Specifically, the effect of a potential large increase in women having multiple sections remains to be seen but I suspect that it won't be great.
There are lots of shades of grey here.

@Fithles totally agree, I’d already request a CS when I did NCT but when we talked about instrumental delivery and I went away and googled it all (I was a bit naive pre that) I was like thank fk!!! I really still want a working vagina after this! I mentioned it to a couple of friends both who told me they were still in them midst of corrective surgery after botched instrumental delivery and subsequent stitches. I never knew and these are close friends whose babies are nearly 3.

My CS wasn’t a walk in the park I lost 4 pints of blood and the recovery was long but it was 4 weeks out of the rest of my life and to be honest I was on so much pain with breast feeding that took my mind off it. I was just pleased to have my baby here safely and my fanny still intact and the ability to go to toilet when I chose. Yeah I have some numbness round my scar but is that really a bit deal?!? Sorry if I’m minimising anyone’s issues around scar numbness but it’s not it’s in a part of the body you use (say like hands or feet) and that’s got to be preferable to your vagina being the wrong way out?!!

Well, I had a VB with perfecto fanjo afterwards and significant fanjo pain after CS. I heard all the gory details of many friends births and recoveries and not one has ended up with her fanny the wrong way out .

And I know two people whose VBs became complicated, the doctors waited too long and the babies were born with severe brain damage. It changed the lives of both families who are now lifelong carers to severely disabled young adults.

But then again who an individual knows is irrelevant because it is down to chance, even if you know a hundred people. What matters is statistics which give you an idea of overall risk as well as information on in ideal risk factors that place you in different statistical groups.

You are absolutely right booboo, but honestly, how else am I supposed to respond to

Sorry if I’m minimising anyone’s issues around scar numbness but it’s not it’s in a part of the body you use (say like hands or feet) and that’s got to be preferable to your vagina being the wrong way out?!!

This is the sort of nonsense people spout all.day on here. The smug ignorance of someone who has never had a VB asserting that they are universally terrible and damaging. Bollocks.

Yes...the way my vagina feels after an episiotomy, 3rd degree tear and 2nd degree tear a year later, is better (despite being fairly wrecked) than the way everything else feels many years after my ELCS. But that is my experience, and as I said earlier, any birth can have difficult or devestating consequences, minimising other people experiences does no one any favours.

Indeed hazeyjane. There is so much of this on here. People make light of CSs as if they're the desirable, easy option, when I know that not to be true from my own experience of both VB and ELCS.

And "my vag is in tact" comments have to be the one I find the most annoying as it's so ignorant and also because I experienced a lot of discomfort in that reason after CS and none after tricky VB. Selling women this idea that CS will keep you safe and totally damage free and doctors are all big meanies who don't want you to have them is so dangerous and frankly thick headed, yet I see otherwise sensible people on here dishing out these assertions as if they are fact.

In that region*

@BeatriceTheBeast grow up! I was responding to the person up thread maybe it was you, comparing scar numbness with life long debilitating injuries and need for ongoing surgery - it just doesn’t compare.

And don’t know hundreds of people’s birth stories do you! No one’s being smug apart from you talking about your ‘perfect fanjo’ that’s why women are shamed into thinking they can’t talk about things like vaginal prolapses and the fact they have to have a prosthesis to hold things in place! The statistics are 4 in every 100 women will suffer some form of birth injury but it’s thought to be higher because many women suffer in silence, probably because they’re shamed in to doing so because they’re told it’s bollocks by people like you with their perfect fanjos!

Jesus, perfecto fanjo was clearly a joke (admittedly, not a great one). And I was only responding to your smug assertion that you know all these POOR women who have been to hell and back because unlike clever old you, they stupidly agreed to a VB. Silly things .

It's the same crap people come on here and say every day when they have never even attempted a VB themselves and it is dangerous. So I'm not about to get back in my box because you go off on one calling me names and being generally unpleasant. Nice try though.

comparing scar numbness with life long debilitating injuries and need for ongoing surgery - it just doesn’t compare. - I must have missed this, did someone directly compare the 2?

Also wonder if you read my post about the woman I know who earlier this year had an ELCS and is now in a wheel chair, pushing her baby around town at the same time because her spinal cord was damaged.

Maybe you missed the memo, bit scar numbness is hardly the only potential problem with CSs.

Maybe, like I was with my births, (slightly less so with the CS), you were lucky and you could have the good grace to admit that instead of reassuring yourself and misinforming other women that it was a direct result of your clever choice to have an ELCS when luck always comes into it with childbirth.

Those were to wheel "grow up" ofbrie.

Not sure how "perfect fanjo" is more offensive than I really still want a working vagina after this!

About 3% of women suffer a serious tear which affects the muscles in the anus (back passage) and perineum (the area between the vagina and anus)

And this figure is affected by your age & overall health. Its higher than ideal but still lower than stillbirth figures which surprised me.