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 know a dural tap is rare, but do not underestimate how awful it is. It was the worst headache I’ve ever had by a long, long way. In fact, I’d say it was the worst pain I have ever had full stop. Trying to establish breastfeeding and trying to care for my newborn whilst being told to lay flat as much as possible is a nightmare with a banging headache, limited sleep, a bag of fluids going into the back of your hand and pain from the wound. I ended up back in theatre for a blood patch but not until three days later.

As a Dr, do you honestly think a CS carries 'small risk'!?
You are taking far more than small risks when having major surgery-which a CS is, for both mother and baby.

I would be exactly the same as you, OP.

I don’t have children, but if I decide to TTC one day, I think I would go so far as to see my GP first to discuss options for ELCS before even trying to get pregnant.

For me, it comes from a place of chronic pelvic pain and vaginal pain. Personally, I feel like I’ve “done my time” of unpredictable, out of control pain.

I would prefer an ELCS for the very fact that, to me, it seems like the more predictable and controlled experience, even if it does still involve pain and a long recovery. But at least you know (roughly) what’s coming, and there are experts in charge of it all!

The thing with vaginal birth is that you literally have no idea beforehand how it will go, and that would terrify me. I’m sure it’s all lovely if you’re the person who breezes through and is able to do their supermarket shopping the very next day. But there’s no way of guaranteeing that.

Had emergency section due to refusing induction, I always new I will not agree for it and always was more keen on section. Best thing ever, was out of hospital in less then 12 hours , used just paracetamol and ibuprofen, couldn't really feel pain but was advised to just keep taking it regularly. Would do it again if I ever decide to have 2nd child.

I desperately wish I'd had an elective.I had an awful labour resulting in ventouse delivery.

I’ve had 2 c sections and 2 vaginal births, all were a bit traumatic in some way. I would say overall I recovered better after the vaginal births, just did some pelvic floor exercises and everything went back into place. I hate my abdomen following the csections though, it’s the appearance and the numbness. However they were life saving for me so no regrets.

I had a ELCS (well it ended up being a very stressful experience trying to get it but only because my hospital provider was absolute dog shit) and the CS itself was amazing but the recovery was difficult due to mismanaged care afterwards. Again, if the midwives hadn’t been awful and damaged my bladder - long story - it would have been a breeze recovering.

One thing I would say is that it affected my milk coming in so breastfeeding was so so hard in the beginning and not being able to pick up the baby and do some caring duties immediately I found very hard emotionally. I think it did stop me from bonding with her immediately but 7 weeks down the line it’s absolutely fine.

If I’m ever blessed with another one I’d go ELCS again in a heartbeat. I knew that with 11 people in the room my DD and I would be safe if anything went wrong and that’s all I cared about.

@EarringsandLipstick

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.

I was going to reply to your previous post - but hypocritical calling me dramatic when you are reaching quite a lot in being critical of me!

I’ve made no wildly exaggerated claims? Only written my own experience. And I’m not saying CS is better than VD! I know for most people a VD will be more straightforward in terms of risk profile overall. However for some people it isn’t, I’ve seen with my own eyes the flip side and it has coloured my view of the potential risks. I’m trying to decide, whether me for as an individual and a mother to be, not as a clinician, whether I would feel more comfortable with the known risks of an elective section, compared to the unpredictably of going for a vaginal delivery.
When risks are put in numbers out of 100000 they just don’t feel that quantifiable to you- of course I’m aware of statistics but seeing bladder injury x vs perineal injury y isn’t really allaying my anxieties!

I’m a doctor. I had a beautiful labour in the pool but my son turned direct OP, so I ended up with forceps, PPH, 3rd degree tear and episiotomy. All healed well and I still came away feeling really positive about the whole experience. If I could go back in time I still wouldn’t have had an ELCS.

For me personally it was really important to have that experience of labour. Being a doctor helped because I had a good understanding of what was going on and therefore was able to be fully involved in the decision making, so it wasn’t scary like it might have been for someone who didn’t have that advantage. I didn’t like the idea of having surgery if I could avoid it so that also influenced my decision.

There is no right answer, you have to do what feels right for you and it sounds like you have pretty much decided and are just looking for affirmation. However, bear in mind that you will hear a lot of the worst case vaginal birth stories and not necessarily the good ones!

I have had one VB with spinal block forceps, quite a bit of blood loss, second deg tear & episiotomy. Then one planned (for medical reasons) c section, very straightforward.

There were pros and cons to both and I wouldn't say I preferred either.

I personally felt quite a sense of detachment about the c section, and it was definitely harder/slower to initiate bf after it. My incision healed well but I was less mobile after it (for about a week) than the v birth, despite having severe anaemia after the v birth as well as the internal tear & episiotomy. Not being able to drive for a month was a complete nightmare.

I do think we go about v birth all wrong. I was in a hospital for mine (for medical reasons, not what I wanted). I was made to lie on my back on a bed for ease of monitoring, this meant a slow & ineffective labour, thus the forceps!

I had some pelvic floor issues after the vb but these resolved themselves with the right exercise and weight loss.

I'm also a doctor and have worked a lot on labour ward. I know a lot of my colleagues have had maternal choice ELCS for exactly the reasons you described. It's not purely evidence-based or logical, and I do recommend looking into some real stats around the topic. But then most women don't make all their childbirth related decisions in an entirely logical way!

I have seen some awful things but never felt I wanted a CS unnecessarily. Others may feel very differently. As it was, I had two inductions, both resulting in vaginal births with not too much intervention and minimal long term damage despite BIG babies. So I'm glad I made the decision I did (I am pretty sure the obs reg I saw after DS2's final growth scan was about to offer me a CS but we went for induction instead) but nobody can guarantee that you would get the same results.

It's really interesting reading the replies here & the variety of experiences.

I'm really sorry for those who've had difficult or upsetting birth experiences and / or have suffered injuries or challenging recovery.

I appreciate how lucky I am - and it is just luck. I had two straightforward SVD, but my CS was also absolutely fine. I really really didn't want it. But my recovery was fine, mobile within 12 hours, no significant pain, in fact I was possibly more rested (as I'd longer in hospital) than with the SVDs and less pain as none of those vaginal tears that can be uncomfortable in the early days.

But reading the variety of experiences that to me is the point - we all have different experiences and basing your decision on how others have fared is really not useful.

@EarringsandLipstick

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!)

Lol, I think that’s fair tbh!

There is probably something about the medical side feeling quite reassuring to me and definitely about the feeling in control- I’ll take that.

you are reaching quite a lot in being critical of me!

That's unfair I think?

I'm critical of how you've presented your v limited experience as evidence when there is actual evidence you as a medic can access.

I'm not critical of you at all, and have made the point that of course you are entitled to choose the birth experience, where possible, that you are happiest with.

@Darkstar4855

I’m a doctor. I had a beautiful labour in the pool but my son turned direct OP, so I ended up with forceps, PPH, 3rd degree tear and episiotomy. All healed well and I still came away feeling really positive about the whole experience. If I could go back in time I still wouldn’t have had an ELCS.

For me personally it was really important to have that experience of labour. Being a doctor helped because I had a good understanding of what was going on and therefore was able to be fully involved in the decision making, so it wasn’t scary like it might have been for someone who didn’t have that advantage. I didn’t like the idea of having surgery if I could avoid it so that also influenced my decision.

There is no right answer, you have to do what feels right for you and it sounds like you have pretty much decided and are just looking for affirmation. However, bear in mind that you will hear a lot of the worst case vaginal birth stories and not necessarily the good ones!

Thank you that’s also really helpful and reassuring to me about considering VD! I think I’ve been seeing ELCS as preferable to VD + interventions but sounds from a few in here that it’s not necessarily the case ! Also if I do go for VD I am going to be an absolute nightmare for whichever poor midwife gets me checking the CTG

I ended up having an emergency c section and I don't think the recovery was that bad at all. I was kept in hospital for a few days afterwards and the thing that still haunts me is hearing another new mum in one of the other cubicles crying hysterically because she was so traumatised by her birthing experience, forceps delivery and third degree tears that required an hour of surgery afterwards. It still makes me feel upset thinking about her now and I never even met her or saw her face I hope she is ok.

I’m trying to decide, whether me for as an individual and a mother to be, not as a clinician, whether I would feel more comfortable with the known risks of an elective section, compared to the unpredictably of going for a vaginal delivery.

That's entirely fair. 💐

I wish you luck with your decision. I guess your OP didn't capture this & I did feel it exaggerated VD outcomes, which as a medic you'd be aware of not being the case overall, despite what you observed.

But this is an absolutely valid point, of course.

@EarringsandLipstick

you are reaching quite a lot in being critical of me!

That's unfair I think?

I'm critical of how you've presented your v limited experience as evidence when there is actual evidence you as a medic can access.

I'm not critical of you at all, and have made the point that of course you are entitled to choose the birth experience, where possible, that you are happiest with.

Fair enough- I would emphasise though I am not presenting it as evidence - I know that 100% of births don’t end in intervention of course, just ones I try to observe.

However it has made me more nervous personally about VD.

I saw one baby die of herpes encephalitis and now absolutely don’t want anyone kissing my baby- I know statistically it makes absolutely zero sense but that’s a whole different thread!

@VonWeasel

I ended up having an emergency c section and I don't think the recovery was that bad at all. I was kept in hospital for a few days afterwards and the thing that still haunts me is hearing another new mum in one of the other cubicles crying hysterically because she was so traumatised by her birthing experience, forceps delivery and third degree tears that required an hour of surgery afterwards. It still makes me feel upset thinking about her now and I never even met her or saw her face I hope she is ok.

Gosh that's so upsetting to hear. The poor woman. 😞

You'll get a lot on here saying YABU but I'm with you here 100%.

@EarringsandLipstick

I’m trying to decide, whether me for as an individual and a mother to be, not as a clinician, whether I would feel more comfortable with the known risks of an elective section, compared to the unpredictably of going for a vaginal delivery.

That's entirely fair. 💐

I wish you luck with your decision. I guess your OP didn't capture this & I did feel it exaggerated VD outcomes, which as a medic you'd be aware of not being the case overall, despite what you observed.

But this is an absolutely valid point, of course.

Thank you! Oh yes I think this thread has emphasised that it’s turning into a heart not head decision at this point

Very tough decision especially when you have seen the worst. My first would have been on your list of 'going wrong' - ie ventouse and episiotomy. But I didn't have any long term issues and pretty much back to normal after about a month.

2nd baby was an emergency c section. Reasonably strait-forward but I didn't recover as quickly and was on painkillers for weeks. Couldn't drive for 4 weeks and dependant on other people for lifts.

But the hard part - my milk didn't come in after 6 days and I had to stop breastfeeding.

I have a scar and my stomach over hangs this. Having asked a few skinny friends - they admit there stomachs aren't the same. So scar I am ok with, the overhang not so.

But I have a healthy baby and that is the main thing.

I am surprised though as a doctor by your post - the majority of births will be straight forward

I’m loving all these ‘well you’re just saying that because you’re a doctor… your limited medical experience…’ responses. She’s a fucking doctor! How long did you lot spend shadowing midwives and studying human anatomy? How much more qualified does she have to be in order to have a valid opinion that disagrees with your own?

I’m seriously considering ELCS this time round after a horrible experience with DS1. My obstetrician had one too. I found this article, which is pretty old but interesting regardless: www.google.co.uk/amp/s/amp.theguardian.com/society/2008/jul/11/nhs.health1

This recent study is also interesting, especially for all the amateur statisticians in this thread: www.cmaj.ca/content/193/18/E634

“This analysis shows that planned CDMR is safe for low-risk pregnancies and may be associated with a lower risk of adverse delivery outcomes compared with planned vaginal deliveries.”

OP do talk to people who've had both, if you know any. I wasnt alone in feeling quite odd about the c section. Do bear in mind that hormonally there's a process and a point to the whole v birth, your body expects it and for some women a c section does really interrupt that natural process. If I'm honest while I know the c section was calm/fast etc, it was kind of a let down, none of the hormone rush of labouring to deliver. Don't underestimate the mental effect of that.

@welshladywhois40 “ the majority of births will be straight forward” - apparently not the case. Less than half of births do not require intervention.