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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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BeatriceTheBeast · 06/12/2019 08:36

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

Because she wanted to shout at me and put me back in my box, so tried to make out I was being offensive.

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BeatriceTheBeast · 06/12/2019 08:38

And it wasn't a great joke...perfecto fanjo. I was being silly and responding to the usual twattery pedalled on here about having a CS to stay honeymoon fresh (don't know whether to laugh or vomit at this notion, especially given my experience with both a tricky VB and an "easy" CS).

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1300cakes · 06/12/2019 08:54

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.

There are also women out there who were paralysed getting an epidural during a vaginal birth. So that's also a risk of a vb.

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1300cakes · 06/12/2019 08:55

It could also happen during an emcs, which is a complication of (you guessed it) vaginal birth.

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BeatriceTheBeast · 06/12/2019 09:01

Yes, I know that 1300, but nobody comes on to these threads making out that VBs are risk free, unlike ELCSs, which are touted on here as universally the best, easiest and safest way to give birth, when that simply isn't true.

Some people are unlucky or lucky in either type of birth, so it's really personal choice.

This is my main point^^. When people assert that definitely every woman should "do themselves a favour and go for the ELCS, so easy and you'll have a working fanny afterwards too wink wink" it irks me somewhat.

I had a tricky VB and was very lucky in terms of recovery and injuries. I was also quite lucky with my ELCS, but have more lasting effects as a result of the ELCS. But I know my good luck has nothing to do with my choices.

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neonglow · 06/12/2019 09:45

It could also happen during an emcs, which is a complication of (you guessed it) vaginal birth.

This is something that is often ignored. In fact, EMCS and ELCS statistics are often lumped together which is absolutely ridiculous as sometimes women requesting an ELCS are specifically wanting to AVOID the emergency section she may have a 50% chance of if she tries for a VB.

Also I do agree mumsnet is definitely a lot more ‘pro ELCS’ than a lot of other online parenting spaces. Many other fb groups or forums all of the replies would have been the standard misinformed ‘they’re way more dangerous to you and your baby! And so so expensive for the nhs. Why would you do it?!!’

I agree it’s about finding a middle ground. I was traumatised from an awful instrumental delivery with a dreadful recovery. I was requested a section the next time and was approved but ended up changing my mind. As it was I had a pretty straightforward VB with no stitches at all, left hospital the same day and there was no ‘recovery’ to be had. Perhaps I was lucky but statistically it being my second baby after a vaginal birth, a healthy pregnancy, me in my 20’s/low bmi and all the other factors I had very good odds of his type of outcome. And mentally I felt good because I was actually looked after and treated well unlike the first time.

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BeatriceTheBeast · 06/12/2019 09:57

Definitely agree, it is about finding a middle ground.

Anyone who makes a one size fits all, sweeping generalisation about how VB means you will never be the same again and ELCSs are a walk in the park, or vice versa, (but come on, who says VBs are a walk in the park?), has no credibility in my book.

I naively bought into the ELCS = easy, VB = damage spiel and only having gone through both do I now call bullshit.

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Booboostwo · 06/12/2019 10:00

BeatriceTheBeast it is not a competition to show off who has the worst injuries after birth or who was 'clever' enough to avoid them. It should be a concerted effort to strongly encourage medical professionals to give comprehensive information on risks and benefits on ALL birthing options, and details of particular circumstances so women can make a meaningful choice. Making a meaningful choice doesn't guarantee that one will avoid the risks, nothing and no one can guarantee a risk free birth, but it does guarantee that women remain the agents of their own destiny, making their own choices with respect to the risks that might affect them and their babies.

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BeatriceTheBeast · 06/12/2019 10:04

Yes, you are agreeing with me I think booboo? That is the exact point I have been making Smile.

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mumdom · 06/12/2019 10:13

The statistics on risk are prepared by insurance companies, with surprisingly little detailed input from doctors.

There is very little risk involved in a wholly elective c-section, as many of the potential risks have already been identified and appropriately prepared for.

However, the stats for these are muddled in with pre-booked caesareans which are called ELCS but in fact are not elective but medically necessary.

There are often underlying but not obviously clinical reasons for an ELCS, and tokophobia is definitely one, but you’re more likely to meet with a sympathetic reception for your request if you ‘prepare your case’ beforehand to show you fully understand the risks involved in both kinds of birth.

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Moomin8 · 06/12/2019 10:21

There are often underlying but not obviously clinical reasons for an ELCS, and tokophobia is definitely one, but you’re more likely to meet with a sympathetic reception for your request if you ‘prepare your case’ beforehand to show you fully understand the risks involved in both kinds of birth.

I agree. But my friend isn't the most articulate person. She isn't really the kind of person who will research statistics etc (and I'm sure there are thousands like her). She just knew she couldn't cope with a vaginal delivery.

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BeatriceTheBeast · 06/12/2019 10:59

One more thing, at the risk of A) sounding like Columbo and B) advertising my own naivety Xmas Blush.

But, like the pp who said they felt bad after their CS because they felt they should be feeling fine and dandy, because that is all you seem to read about ELCS, I think my own foolishness at buying into this idea that ELCS is a walk in the park meant that after my own tricky, but fine VB, I was feeling all sorry for myself because "if I'd had an ELCS as is my right, god dammit, I'd be feeling great now", when actually, by most people's standards, I was incredibly lucky with that birth. Then, when I was told I probably should have a ELCS with dc2 and HCPs said x, y, or z could happen and what the recovery would be like, I smiled inwardly to myself and thought "ha! I've heard about your type on MN. Trying to scare me off eh"? What a shock for me when, what? The HCPs were right and a bunch of strangers on MN who said it was a cinch were not Xmas Shock? No way! So, not only was I wrong about my VB recovery, which in hindsight was great, but I lost trust in the HCPs looking after me with both DCs, because I "knew" better (I did not).

Just another point re the dangers of touting either type of birth as easy peasy and implying that HCPs would contradict everything they vowed to do, just to be mean and stop women having the births they want. Same goes for women being told a homebirth will solve all their woes GUARANTEED, regardless of circumstances.

I have to say that obviously this^^ was down to my own stupidity and fixation on things going wrong, but if you knew my history, I think you would understand. To a more calm, slightly less literal, person, they might be able to take some of the posts on here with the large pinch of salt, which they really need.

Anywho op, I hope your friend manages to find a sympathetic HCP to discuss this with and that she gets the right outcome.

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neonglow · 06/12/2019 11:34

There was the Montgomery v Lancashire case a few years back as well where the judge ruled in the woman’s favour and I’ve heard it’s opened up a lot of discussion about informed consent and stuff antenatally.

The woman was pregnant and because she had gestational diabetes (I think?) and was of a small stature she had a 10% chance of shoulder dystocia happening if she attempted a VB. The consultant knew this but purposely did not tell her when discussing birth mode because she didn’t want her to choose a section. As it was the woman did end up having this complication and a lifelong disabled child as a result.

I think it was ruled that purposely withholding information to sway towards a certain choice was going against a woman’s human rights to informed consent in that situation. Obviously it changed the way of thinking because it was about NOT having an intervention done rather than consenting to one.

One thing that struck me though was the consultant explained she didn’t tell women in that situation about those odds because then ‘everyone’ would want a c-section and that wouldn’t be in the best interests of women. I disagree that all women would choose one- we are all individuals, we all have our own needs and preferences and different risks are acceptable to us all. Maternity care needs to recognise this- we are actual thinking intelligent human beings.

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blackteasplease · 06/12/2019 11:38

I think we should stop calling it “elective” and atart called it “planned”. I know that it’s just in line with the general term “elective surgery”, but it makes people thing this is always a woman just saying shed prefer a CS.

Many if not most are performed because it’s thought likely to be necessary!

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2beautifulbabs · 06/12/2019 11:45

I had an elective c section with my second after a third degree tear and awful birth experience with my first and to be honest the section was by far the best experience I had I finally got to experience the birth I wanted as it was my last.

I think given I had a bad experience first time and was at risk of further damage if I had a natural birth again the consultant was all in favour of me having a c section I didn't have to put up a fight although I was dreading the meeting as had heard of some women being refused to have a c section so I think it depends on the circumstances whether they will allow one or not.

I think if my body would have allowed it I'd have gone for a natural birth because you heal quicker but I don't regret my section one bit and it wasn't all that bad the healing time either you just have to sit down op and weigh up the pros and cons of both and also worth making sure you have plenty of support afterwards because it is pretty tough for the first few days after a section you can still do things but just need a little help all the best Wink

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Dinosauratemydaffodils · 06/12/2019 12:05

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.

Most of the women I know take the opposite view, that c-sections are horrendous, a sign of failure and to be avoided at all costs. I still don't believe I gave birth to either of mine and whilst I accept that my sections probably saved both my life and that of dc1 and quite possibly dc2's life too (she was strangling herself with the cord which was only picked up because I'd already had an emcs), I still struggle massively with them. I chose an elective with dc2 because based on individual risk factors (age, the fact that my optimally positioned first child couldn't be pushed or pulled with forceps through my sub optimal pelvis, the fact that like all dh's family including dc1, dc2 had a massive head) I felt my chances of vaginal birth were slim to non existant. It was essentially the lesser of two evils for me. I would never advise anyone else to make the same choices though because it's so personal.

That's partly why I'm a huge believer in individual risks being explained in a non biased way to women and then letting them decide. It's like the fact that they always mention babies being cut as a risk of a c-section, I still have a scar from them breaking my dm's waters and yet that's not mentioned in the literature.

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Booboostwo · 06/12/2019 12:08

I think we also underestimate the courage of women in getting pregnant in the first place and, by necessity, committing to one of these birth options all of which have risks.

It's part of the general underestimation and denigration of female tasks and I think it has multiple roots. When men invest in the stock market they are viewed as testosterone driven, goal oriented, risk takers that prop up society even if they end up loosing billions and tanking entire economies. When women get pregnant it's dismissed as the natural course of things. I suspect another underlying cause is the idea that one must not frighten pregnant women as they are delicate creatures who cannot be told the truth about what might happen to them. Men and women are complicit in this one, either because of paternalistic reasons to protect women or because of feelings of inevitability about pregnancy and birth.

The whole experience is about lack of control on the part of the women and this needs to change.

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BeatriceTheBeast · 06/12/2019 12:28

booboo, perfectly said! Women sign up for one of these options and they should be trusted to choose which one they want. But o definitely felt bombarded with horror stories of VBs on one hand and people doing the nudge, nudge, wink, wink, get a wee see section thing on the other, which I found extremely unhelpful. I wonder if there is a difference in age groups though, as I think in older groups of women, the opposite happens? Just an idea that's what the difference might be, but obviously I don't know.

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BeatriceTheBeast · 06/12/2019 12:41

*I definitely
*c section

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Booboostwo · 06/12/2019 13:21

My experience was the opposite. My mother nearly burst into tears and told me I would die during a CS, doctors at two hospitals refused to discuss birthing options and a doctor at a third told me that how I give birth is her choice (not UK), even a man who doesn't even have children told me that CS is very dangerous and I endangered my baby by choosing it.

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Dinosauratemydaffodils · 06/12/2019 14:03

I wonder if there is a difference in age groups though, as I think in older groups of women, the opposite happens? Just an idea that's what the difference might be, but obviously I don't know.

I'm 42 but my social circle ranges from late 20s to early 50s and I'd say their feelings on c-sections are fairly consistent (and negative). It's a relatively well off area, lots of stay at home mums and much higher than average breastfeeding statistics. Certainly I was upfront about booking an elective for dc2 and everyone was horrified because I was supposed to want another shot at "doing it properly".

I think parental attitudes towards birth play a part. Most of the women I know who struggled the most with their sections had mums like mine (very easy pain free natural birth) and didn't have the horror stories narrative. Mine was still doing the Times crossword half an hour before I was born. One of my closest friends who had a section for a breech baby was present for the homebirth of her 2 youngest siblings and she found comparing herself to her mum really hard. I hope with my own daughter I can keep it balanced.

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Phineyj · 06/12/2019 14:04

This is the kind of decision where AI could really help. Enter all available stats into a program and it gives you risk estimates based on your weight, age, previous deliveries etc. But given that due date is largely worked out by those little cardboard circles, I'm not holding my breath for a more evidence-based approach any time soon!

Flowers to all those who have had a bad experience. It is a sobering experience to realise you're not in control of decisions about your own body.

(I had an EMCS, no complications, to add to the anecdata).

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BeatriceTheBeast · 06/12/2019 14:11

I am 36 and not far from London, where there are not a lot of SAHMs... CSs are definitely not sniffed at here, but you definitely get some weird looks if you pull out a baby bottle of formula at some of the baby groups in South London Xmas Shock.

One of my mum friends lives in zone 1...or is it 2 and gave birth to all four of her dcs in her flat! She is now early 30s but had them all one after the other just after graduating uni, so was quite a young mum. So I suppose age isn't always the biggest factor.

I come from a very medical family, so I think surgery has never been painted as anything much to worry about. But my mum did have successful VBs with my siblings and me.

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reluctantlondoner · 06/12/2019 14:18

@Morgan12 why do you say go for ELCS having had both?

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Misty999 · 06/12/2019 14:22

I requested a elective they left it right till the last minute 36 weeks I think before they agreed and I think that was only because I had extreme swelling, itching, high bp and looked rather Ill. also an ivf pregnancy just keep asking if you want one if u persevere enough and get the right consultant you should get one.

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