To ask for an maternal choice elective C-section?

[Miphy]

I am 20 weeks with first baby- name changed for this thread.

Prior to pregnancy I was already leaning towards requesting a section. I am a doctor, not working in anything related to it now but obviously spent time in obs & gynae placements.
In my obstetric placement we had to spend a week with the midwifery team so that we had a chance to see ‘normal’ birth. Without exception every single birth I attended went ‘wrong’ and either ended with assisted delivery- forceps, episiotomy, in one case horrendous tearing, or emergency section and massive postpartum haemorrhage.
In contrast elective section list was lovely- but wham bam baby out, happy well rested mums.
Then later in gynaecology saw clinic lists full of women with birth injuries and PTSD.
This massively influenced my perception of birth.

I had thought more more about water births, hypo birthing etc and thought I may as well give it a go vaginally.

However the more reading I do now about birth the more I read about horrendous birth injuries, and of my friends the ones who had sections all fully recommend it whereas some of my friends who have had a vaginal birth have told me some pretty horrendous stories. One still can’t have sex two years later. I know there’s a recovery after section but somehow surgical recovery seems more straightforward and I’m not short of hands on help and support- both our mums are retired, husband works from home, all very keen to provide hands on help.

It feels to me like an elective section involves known small risks, I know what I’m getting. Whereas with a vaginal birth I can have some lovely water birth, minimal tearing, quick recovery, or I can end up exhausted from a prolonged labour maybe with a wrecked undercarriage, maybe a distressed baby and then even potentially a high chance of needing an emergency section with even higher risks. And it seems I won’t know which way it will go until it literally happens. It really feels like the injuries by women after vaginal birth are minimised and you’re just supposed to deal- so they aren’t treated as ‘risks’ in the same way.

I find myself hoping the baby is breech so my decision is made for me. I’m thinking Of asking about maternal choice section at my antenatal clinic appointment. I wondered if anyone had any experiences or any advice?

My c section scars are just thin smooth lines with with a slightly thicker smooth bit where the 2 lines cross in the middle. There is a slight dimple in the area at each end, assuming this is where the muscle has been stitched back together a little more tightly but it's only noticeable if you are looking hard for it and doesn't show in a bikini, even a hipster one.

My scar is very neat but if I'm naked there is a dimple at one end & obviously a faint line of scar tissue. It does annoy me but what can I do. Having said that I saw something about showing of CS scars & one women had laser on it so maybe that 😆

I'm really fond of my scars, it's like a little reminder of my babies that will be with me even when they are grown adults

I am a doctor and had 2 x elcs, first was maternal request, second was technically due to previous section but it was my choice not to attempt vbac. The sections and the recovery were pretty straightforward and I’m happy it was the right decision for me. I was also under consultant care for preexisting health problems.
The only negative part of the experience was having to have an appointment with the unit’s birth choices midwife which was a poorly disguised attempt to bully me into going for vaginal delivery. First time round I was really hoping for a sensible, helpful discussion to help me make a decision but her views were very biased - she only gave me negative statistics for section and positive ones for vaginal delivery when the NHS’s own patient information literature is much more balanced. She also lied in my clinic letter. I came away feeling I couldn’t trust her and it made me much more sure I wanted a more predictable controlled delivery, done by doctors, if she was representing midwife care.

I did have issues with hypotension from the spinal both times, which made me feel sick and lightheaded, but it was controlled with fluids and vasopressors and wore off quickly afterwards.
It was a bit weird having ex-colleagues in theatre but both times they checked I was happy for them to be present - ODP first time and o&g sho second time.

@rantymcrantface66

I'm really fond of my scars, it's like a little reminder of my babies that will be with me even when they are grown adults

On a superficial level I’d absolutely have loved to have had a caesarean scar. I’m so, so envious of those who do.

@FartnissEverbeans

Actually I'd say the OP, as a clinician, is in an excellent position to avoid unnecessary interventions because she has a lot of knowledge and a good understanding of what clinical need is vs clinical convenience. If she chooses she can ask the right questions when an intervention is suggested to establish what if any actual risk for her in particular it is being recommended to avoid, ask for alternatives, what will most likely happen if they wait or choose not to intervene etc. Most ftms frankly get treated like morons by maternity care professionals a lot of the time,and accept what they are advised to do because they presume this is a recommendation based on their and their baby's best interest rather than trust policy being applied in a blanket way to avoid tiny risks. So she can "live in utopia", as can all women who are informed and empowered to access evidence and understand the basis of recommendations regarding their care, and most importantly to understand they don't have to do what they're told to do (I honestly thought it was "not allowed" to go past 42 weeks with my first baby. No idea what I thought would happen if I did; just totally believed it Was Not Done. If I'd known it in fact is done and is in the cast majority of cases perfectly safe, I could have saved myself a nasty induction).

OP must decide what's right for her. Statistics will inform that. But so will an appreciation that a statistic of say 1 in 10 women does not mean 1 women selected at random from any 10 given women, and that clinical recommendations must be made per the particular patient's situation, not just a blanket stat. See for example the difference in outcomes for women who even just PLAN for a home birth, even if they transfer to hospital delivery AT ANY POINT in pregnancy or labour- far fewer interventions. Because these women have learned that they can ask questions and say no imo.

You are a doctor. You know that making a decision based on the very small number of births that you have personally witnessed/seen on lists is illogical and not evidence based. I suggest you go away and read some actual research on the potential risks and complications of both vaginal and caesarean birth and make an evidence-based decision.

On the births that you saw that went 'wrong' has it occurred to you that your presence might have been a factor in that? The birth environment has a massive impact on the intervention rates, and the birth environment absolutely includes the behaviour of those present. Having a stranger 'observing' the labouring woman certainly wouldn't have helped flow of oxytocin.

Homebirth! I’ve had two. The hospital birth was horrific. Issues of third degree tear I put down to the stress of not being in my home, having zero care as I was low risk.

The two home births after were wonderful
Full care of two midwives the whole time and in my own home so calm.

Ooh another top tip from me is to ask for antenatal care from home birth team. Same midwife every time, in your own home which makes a colossal difference in terms of how you relate to them - coming and presenting yourself in a clinic in a hospital or similar place you are automatically on the back foot, as if you're being assessed and evaluated, whereas when the midwife comes to your home it is a reminder to both of you each time they are providing a service to you, the service user. I absolutely loved my antenatal care, which I had not expected as was going for an HBAC AMA so was expecting a lot of scolding and pressure. I wouldn't go for s home birth if I were to have a third baby as clearly my body just doesn't like getting babies out of it 😆 but I would definitely request antenatal care from the home birth team.

rantymcrantface66

I had both of my caesarean sections before bikini cuts were invented.
One long line descending from just below my belly button . It is still there right in the middle of my tummy a big indent.My babies are 51 and 49 now, the younger one is a grandfather!.
I know what you mean about being proud of the scars.Without them I would not have my sons and five grandchildren and two great grandchildren now.

ELCS all the way, for all the reasons you say. Your choice, don’t be bullied or shamed. Don’t dwell on the horror stories from people who’ve had emergency CSs - completely different scenarios.

@Draineddraineddrained Please let me know if I’m reading your comment incorrectly.

OP is a dr with an understanding of potential risks and interventions that we can safely say is well above average. Based on her knowledge and experiences, her instinct is to go for ELCS.

You’re saying that because she is a dr, a vaginal delivery will be less of a risk and require potentially fewer interventions.

However, the dr in question has witnessed vaginal deliveries with intervention, the necessity or otherwise of which she would have been able to assess presumably in a similar way to possible interventions presented during the birth of her own child (if anything, I imagine it would be easier to be objective about the former than the latter).

This is a really bizarre line of reasoning. She’s not saying ‘I saw unnecessary interventions and want to avoid that for myself’ - there’s no indication that she saw anything unnecessary. Perhaps natural childbirth is just, for the most part, shit?

@jgjgjgjgjg

I suggest you go away and read some actual research on the potential risks and complications of both vaginal and caesarean birth and make an evidence-based decision

You’re telling the OP, who is a qualified dr, to do her research? I really hope you’re also a dr or else this comment is the most patronising one in the entire thread.

I went for my appointment today only to find out I’d only been put down for scan and not to see obstetrician.
I was surprised and pointed out one of the consultants I’m under for joint care because of my pre- existing conditions had asked for bloods to be done.
They did bloods once they realised and I asked if I could speak to someone about options- I got told they wouldn’t entertain a discussion about it until 31-34 weeks. I suppose at least by then I’ll know better what the situation is with babies growth and also as I’m at high risk of developing pre- eclampsia that would really impact on the management. I do understand why- the community midwives won’t discuss birth options with me either so I don’t have any option but to hang on and see.
For me because of my pre existing conditions Im at increased risk of having complications during a vaginal delivery and an emergency caesarean would be associated with an increase in morbidity and mortality compared to a planned caesarean.
It’s all well and good saying making an evidence based decision and trust me I’m trying! However if I go for VD I could end up with fewer risks and better recovery than an elective section all being well, or if things go wrong because I am high risk anyway I face being stacked with a plethora of risks to my life and my baby’s life that would dwarf the risks of an elective section. I need to personally decide what my risk tolerance is and there is no ‘right’ answer.

I think I’ve made my decision that I will refuse induction if it is recommended, and request a section. However if I go into spontaneous labour then I may give it a crack….

an emergency caesarean would be associated with an increase in morbidity and mortality compared to a planned caesarean.

Why so?

What would happen in an emergency section that would differ from a planned one?

In your OP you didn't mention pre-existing conditions that might lead to complications in labour.

Obviously if this is the case it makes sense to consider a planned section and of course you'll have that conversation with your obstetrician in good time.

I did this course online and really found it helped my decision making with my birth and just made me feel more positive in general about the options and that I had some control over them thepositivebirthcompany.co.uk

@EarringsandLipstick

an emergency caesarean would be associated with an increase in morbidity and mortality compared to a planned caesarean.

Why so?

What would happen in an emergency section that would differ from a planned one?

Just a hunch but I’d suspect it’s because the cases where an emergency c section is needed mean the baby or mother are already in trouble, whereas a planned c section there hasn’t been that birth process for things to go wrong. Not that the c section in either case causes an increase in problems, but the nature of the patients presenting to each will be very different.

@EarringsandLipstick

As Monday says, EMCSs are usually performed where there’s already a concern about the baby or mother which obviously raises the risk of adverse outcomes. They’re also more likely to be performed by less experienced doctors because they’re more likely to be performed out of hours, and more likely to be conducted under time pressure. Also, the baby’s position is likely to be much lower (this is rare but I had a friend who had a failed forceps delivery - they pushed the baby back up the birth canal to perform the caesarean, so she was left with the worst of both worlds). Also I understand it’s more challenging to perform the surgery on a uterus that’s already contracting.

@SmidgenofaPigeon

Your birth, your choice.

For what it’s worth however, at 32 weeks pregnant and about to go for a natural birth (hopefully) myself, I do find some of the things you’ve said scaremongering- and coming from quite a biased perspective.

Same! I'm 36 weeks and wish I'd never opened this thread

YANBU

I think it's definitely based on the stories you hear. Based on my mum's experience with my brother and I (one emergency section, one elective section - both horrendous recoveries) and a friend who had an elective section and had infection after infection after infection meaning she couldn't hold or bond with her baby for months, I knew 100% that I did not want a c section.

I had a straightforward water birth with gas and air and no stitches. Recovery was a breeze and genuinely felt back to normal after a week. I did soooooo much research on how to avoid interventions and did all the spinning babies activities to increase the chances of my daughter being in the best position for labour.

It was such a positive experience. I know that things do go wrong (in both vaginal and c section births) but ultimately, a straightforward vaginal birth is undeniably the best option for your body than major abdominal surgery - and there's nothing at this stage to suggest you won't have a straightforward vaginal birth.

@Thehighlandcoo

I had a straightforward water birth with gas and air and no stitches. Recovery was a breeze and genuinely felt back to normal after a week. I did soooooo much research on how to avoid interventions and did all the spinning babies activities to increase the chances of my daughter being in the best position for labour.

I'm really pleased that you got the birth you wanted! But I do want to highlight that no amount of preparation of educating yourself on 'how to avoid interventions' is going to remove the need for those interventions if that's how it goes on the day. So much of birth is about luck: your body shape, your baby's positioning and size, your skin elasticity, none of which are things you have any control over.

It was such a positive experience. I know that things do go wrong (in both vaginal and c section births) but ultimately, a straightforward vaginal birth is undeniably the best option for your body than major abdominal surgery - and there's nothing at this stage to suggest you won't have a straightforward vaginal birth.

Unfortunately short of a fortune teller there's no way for any of us to know which type of birth is the best option for OP, it's an informed gamble either way. It's really time we stopped telling women one form of birth is 'undeniably better' than another, and instead gave information about the risks and benefits of both and let people decide for themselves.

I'm not trying to be critical of you personally so I'm sorry if it comes across that way, I just see birth stories shared very frequently where a mother has 'done all the preparation' and 'had a straightforward birth with good recovery' as if the latter is a direct consequence of the former.

They’re also more likely to be performed by less experienced doctors because they’re more likely to be performed out of hours, and more likely to be conducted under time pressure.

This is entirely untrue, certainly in Ireland, not sure why the UK would be different.
Plus the time pressure you describe is entirely contingent on the situation - an EMCS is simply one that wasn't planned, but there may not necessarily be any emergency.