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?

I’ve voted YANBU as your body, your choice. BUT I do think you’re being unreasonable to base it off the experiences you’ve had as a doctor, or other people’s stories. Much better to research the statistics for the hospital you will be giving birth at.

FWIW, I’ve had 2 vaginal births. DD1 was an induction ending in forceps. I recovered completely within 4 weeks, and had no lasting effects. DD2 was really easy, born 20 mins after I got to the hospital and with only a few pushes. Not downplaying how scary birth can be (although major surgery, also very scary) but people love to talk about their birth stories when they’re more traumatic. And for some reason, love telling pregnant women all the horror stories.

First birth - awful, injured, PTSD, counselling, ultimately a healthy baby but initially had sepsis. Thought couldn't face having another child.

Second birth - Elective section, such a positive experience, felt so much more in control and well cared for. Would happily have another, recovery included. Best decision ever.

Obviously everything you get on here will be anecdotal but chat with your midwives and go with your gut!

Sorry, going against the flow here.

Two vaginal births, first 34 hours, drugs (I think I screamed give me cocaine at one point!), forceps (which broke half way through) and ventouse and resultant episiotomy. Second, 2 1/2 hours beginning to end with no pain relief (which felt like a buzz saw cutting through me).
But, a month after each I was pretty much physically recovered and well enough to cope alone (husband worked away all week) and enjoy the babies.
Three ante-natal friends had caesareans, two emergency and one elective (also a doctor funnily enough) and they were still physically struggling 3 months later. One also developed psychological problems and found bonding with her baby very, very difficult (though of course that could equally have happened with vaginal birth).
Having experienced my/their recoveries, painful though mine were, I’d choose vaginal again every time (though at my age thankfully I don’t have to 🤣)

I'm having an elective caesarean this time.

My labour with my son was horrific, and the relief I feel knowing I don't have to go through it again is immense.

Oh and you get some lovely ‘hospital heroin’ pain relief 😏

I’m currently pregnant with second baby and unsure whether to choose VBAC or ELCS, first was elective due to breech presentation. Recovery was fine except for the frustration of not being able to carry baby in bassinet / pram etc for a few weeks. I totally get your reasons for choosing elective over vaginal. The one thing that is making me consider VBAC was the immediate few days following the section, we had skin to skin in the recovery ward but I think due to a mixture of coming down from a huge amount of anaesthetics and the lack of labour hormones it felt like my whole body was in shock and I missed out on that immediate bonding moment. I suffered major baby blues in hospital, totally out of character crying and feeling hopeless as breastfeeding took ages to establish.

Just wanted to add in terms of recovery and bonding.. I had skin to skin and felt something close to euphoria after csection because everything was exactly as I planned with no issues.
I couldn't lift anything heavier than a baby for recommended recovery time, however I was walking outside with my baby 3 days after. Pain was gone within 10 days. Not every C-Section recovery is doom and gloom

@bridgetreilly

The ones that go well aren’t the ones that need doctors. You can check the actual statistics, not just go by your own limited and biased experience.

I was shadowing midwives, not doctors.

I’m asking for advice for me so unsurprisingly my personal experiences of being stood in a room where things are going wrong resound more than statistics (1in 1000 risk vs 4 in 1000 risk etc)

My birthday at midwife unit was lovely. Massive pool, huge room and so quiet. Hypnobirthing worked really well. No injuries. Up in my feet the next day and at Tesco's the say after

@MrsSkylerWhite

Sorry, going against the flow here.

Two vaginal births, first 34 hours, drugs (I think I screamed give me cocaine at one point!), forceps (which broke half way through) and ventouse and resultant episiotomy. Second, 2 1/2 hours beginning to end with no pain relief (which felt like a buzz saw cutting through me).
But, a month after each I was pretty much physically recovered and well enough to cope alone (husband worked away all week) and enjoy the babies.
Three ante-natal friends had caesareans, two emergency and one elective (also a doctor funnily enough) and they were still physically struggling 3 months later. One also developed psychological problems and found bonding with her baby very, very difficult (though of course that could equally have happened with vaginal birth).
Having experienced my/their recoveries, painful though mine were, I’d choose vaginal again every time (though at my age thankfully I don’t have to 🤣)

It is genuinely helpful to hear someone who had interventions during a vaginal delivery and had a good recovery so thank you for that.

I'm amazed you're a doctor.

Surely you are aware of the statistics regarding SVD vs CS?

Of course sections have their place. I've had a CS for a breech delivery - although I went into labour early so it ended up being an emergency section at 10 cm. I actually think I'd have been fine delivering, especially having got to that point, but I wasn't given the choice. (It was my second labour). My first was was SVD, very straight forward and my 3rd also, also straightforward medically but a very fast & painful delivery.

My section recovery was fine. I'd heard many war stories about the pain etc, difficulty moving. I had no problems, very lucky.

So I've no skin in the game in terms of arguing for or against either.

What I'm amazed at is your generalising on such limited (in your medical training) and anecdotal (via friends / MN stories) evidence. That's where the stats come in!

Ultimately a CS is major surgery with all the attendant risks. Of course outcomes are very favourable but it shouldn't be seen as a simple process.

I personally favour VD and recognise how lucky I am to have had good experiences and recovery. I had an episiotomy with both SVDs, no problems at any point.

I don't say that my views are relevant to your choice of course but women's bodies are designed to deliver in this way, and accepting some people have difficult & problematic labours, the statistics will still point to positive outcomes for mother & baby.

Of course YANBU to have your own birth preferences but your descriptions of outcomes & after-effects are hyperbolic in the extreme. Surely, even if this is what you observed, you know that this isn't representative of most deliveries?

In my view, you should discuss your views & care with your medical team and make the best choice for you. But you should also engage with science & experience to dial down the drama on your horror stories.

Going back to anecdotes, in my wider circle of family, friends & acquaintances I only know of one person who had a highly problematic delivery, where she was poorly cared for, and did ultimately have traumatic birth injuries. Of course, my anecdotal evidence is not either to be relied on!

I worry about the trend in the UK & Ireland to move towards an over-medicalised, high intervention birth model - an overall rate of 32% of births being via CS & I suspect much higher in some cases if you filter by different demographics, including class / race / states.

In the UK - and in Ireland where I am - the rate is climbing too, at overall roughly 25%. However, in 2020, only 12% required instrumental assistance, which is why I refer you back to stats not hyperbole & limited experience.

Absolutely we've moved beyond forcing women to birth in a certain way, and denying them choice. But this narrative that 'CS is automatically better than VD' is doing nobody any favours.

If you are medical then there is a NICE guideline on it: NG192.

Looks quite detailed and nuanced - eg - they have to estimate the risk rather than giving actual numbers (due in part to the different study designs; difficulty in conducting RCTs). It’s not an easy decision as estimated risk of certain conditions is higher for c-section and certain conditions for vaginal birth. Different conditions will be viewed differently by different people; and also different people have different baseline risks (due to medical history) and situations (eg 1st child and wanting several more vs last/only child).

I’m currently pregnant with 3rd kid. We aren’t planning any more. I used to be quite clear I’d have a preference for vaginal birth - which I did have for previous 2. But now being more aware of complications of 3rd degree perineal tears, prolapse, I’d have a lower threshold for Elective C section. Basically I’m happy to aim for a vaginal birth, but any complications, eg over due date or breech or large baby or other problems - I’d want to consider elective C section (plus sterilisation).

Perhaps you could discuss this guideline with your midwife and ask for an appointment with obstetrician to talk about it further?

@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.

I’m here asking for advice based on my experience- of course it’s biased and totally anecdotal! It’s intended to illustrate why I feel how I do- not to frighten- but it’s true and has of course shaped how I see things .

I think you are underestimating the difficulty of caring for a newborn directly after a significant operation. I'm not sure a section is easier in the long run.

What advice are you actually asking though OP? This is what confuses me.

You’ve decided on a CS, fair enough. But your ‘experience’ seems skewed because ultimately I think you’re trying to drive a CS good, VD bad debate, and I’m not sure why it needs to be that black and white.

So again, what did you want advice on?

Do it.

I had an EMCS with DD after a long exhausting labour. Wish I'd gone straight for a section. If we have another, it will be ELCS without a doubt.

I had a c-section as my dd was breech. My dd had cows milk protein allergy (until 3) and really bad silent reflux (until 2). I do wonder sometimes if she wouldn't have had those if she'd been a vaginal birth - something to do with liquid being squeezed out of the lungs as being squeezed out and picking up good bacteria from the vagina. I really don't know though! I also have secondary infertility (been trying for 3 1/2 years including 5 failed ivfs and am paying for a specialist scan and potential surgery to see if it's my c-section niche causing implantation issues. But the actual operation was good and the recovery was fine. My point is it can also lead to long term issues.

I worry about the trend in the UK & Ireland to move towards an over-medicalised, high intervention birth model - an overall rate of 32% of births being via CS & I suspect much higher in some cases if you filter by different demographics, including class / race / states

Sorry, in the above para, I missed out the words as in the US after 'model'. I was saying UK & Ireland are moving in this direction.

(By the way, in the US, the high rate of sections in middle / higher income women, is linked to higher rates of pay for obstetricians for CS as well as fear of litigation.)

As you will know, planned C sections are, as is right, low priority.

I had a planned section. Arrived at hospital nil by mouth at 7am, daughter delivered at 3pm. Very nearly got sent home to come back next day. A different type of stress but those 8+ hours spent waiting to go to theatre were very hard.

I’m here asking for advice based on my experience- of course it’s biased and totally anecdotal!

I mean this genuinely, and not trying to be arsey, but why on earth would you just rely on such limited - and as you observe biased - information?

You can access reliable stats. You are a medical professional who can have a better understanding of relevant issues than many of us.

A previous posters reference to NICE guidelines is a thoughtful post and well-put.

Again, you are entitled to make the right choice for you of course. But the wildly exaggerated claims in your OP are disturbing. Your limited experience in training does not translate to reality.

Advocating major abdominal surgery because the NHS doesn't take birth injuries seriously is not the answer.

Each c-section increases your risk of adhesions and placenta previa. My 1st c-section (breech) resulted in an incubated baby in nicu for 2 weeks - babies lungs are designed to work after being squeezed through the birth canal. This doesn't happen in c-section births and some babies don't cope well. 2nd section was because of complete placenta previa due to adhesions after the 1st one. Massive blood loss and unable to have any more babies. C-sections are not the catch all answer

Vaginal delivery was long, painful and horrible with ventouse and tearing. Not enough pain relief which still makes me feel angry but I recovered very quickly and a lot faster than my friends who had c-sections. I don’t think there is an easy answer to this.

Yanbu. Had vaginal birth with dc1 and cesarean with dc2. Second was much better. Wasn't a planned section but no emergency or rush to it so expect it is more like a planned section.

Are you in physicians mums or pregnant doctor Uk groups? Lots of useful discussions on there. Good luck OP

Interestingly my DBro is a doctor (an obs/gynae consultant funnily enough!) and his wife is a doctor too. Neither share the views you've expressed but I have heard him say that many of his female colleagues like yourself favour a CS delivery.

It's not often based on negative experiences like you describe but often more of a control issue, they tend to be people who are high achieving & used to having the ability to control things to a significant extent, and this extends to birth.

(Of course now I'm wildly generalising as well as going on hearsay!)